Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study. The Rotterdam Scan Study

OBJECTIVE

White matter lesions are often seen on MR scans of elderly non-demented and demented people. They are attributed to degenerative changes of small vessels and are implicated in the pathogenesis of cognitive decline and dementia. There is evidence that especially periventricular white matter lesions are related to cognitive decline, whereas subcortical white matter lesions may be related to late onset depression. The frequency distribution of subcortical and periventricular white matter lesions according to age and sex reported.

METHODS

A total of 1077 subjects aged between 60-90 years were randomly sampled from the general population. All subjects underwent 1.5T MR scanning; white matter lesions were rated separately for the subcortical region and the periventricular region.

RESULTS

Of all subjects 8% were completely free of subcortical white matter lesions, 20% had no periventricular white matter lesions, and 5% had no white matter lesions in either of these locations. The proportion with white matter lesions increased with age, similarly for men and women. Women tended to have more subcortical white matter lesions than men (total volume 1.45 ml v 1. 29 ml; p=0.33), mainly caused by marked differences in the frontal white matter lesion volume (0.89 ml v 0.70 ml; p=0.08). Periventricular white matter lesions were also more frequent among women than men (mean grade 2.5 v 2.3; p=0.07). Also severe degrees of subcortical white matter lesions were more common in women than in men (OR 1.1; 95% confidence interval (95% CI) 0.8-1.5) and periventricular white matter lesions (OR 1.2; 95% CI 0.9-1.7), albeit that none of these findings were statistically significant.

CONCLUSIONS

The prevalence and the degree of cerebral white matter lesions increased with age. Women tended to have a higher degree of white matter lesions than men. This may underlie the finding of a higher incidence of dementia in women than in men, particularly at later age.

Noninvasive MRI thermometry with the proton resonance frequency (PRF) method: in vivo results in human muscle

The noninvasive thermometry method is based on the temperature dependence of the proton resonance frequency (PRF). High-quality temperature images can be obtained from phase information of standard gradient-echo sequences with an accuracy of 0.2 degrees C in phantoms. This work was focused on the in vivo capabilities of this method. An experimental setup was designed that allows a qualitative in vivo verification. The lower-leg muscles of a volunteer were cooled and afterwards reheated with an external water bolus. The temperature of the bolus water varied between 17 degrees C and 37 degrees C. The in vivo temperature images can be used to extract the temperature in muscle tissue. The data in the fat tissue are difficult to interpret because of the predominance of susceptibility effects. The results confirm the method's potential for hyperthermia control.

β-Alanine supplementation augments muscle carnosine content and attenuates fatigue during repeated isokinetic contraction bouts in trained sprinters

Carnosine (β-alanyl-l-histidine) is present in high concentrations in human skeletal muscle. The ingestion of β-alanine, the rate-limiting precursor of carnosine, has been shown to elevate the muscle carnosine content. We aimed to investigate, using proton magnetic resonance spectroscopy (proton MRS), whether oral supplementation with β-alanine during 4 wk would elevate the calf muscle carnosine content and affect exercise performance in 400-m sprint-trained competitive athletes. Fifteen male athletes participated in a placebo-controlled, double-blind study and were supplemented orally for 4 wk with either 4.8 g/day β-alanine or placebo. Muscle carnosine concentration was quantified in soleus and gastrocnemius by proton MRS. Performance was evaluated by isokinetic testing during five bouts of 30 maximal voluntary knee extensions, by endurance during isometric contraction at 45% maximal voluntary contraction, and by the indoor 400-m running time. β-Alanine supplementation significantly increased the carnosine content in both the soleus (+47%) and gastrocnemius (+37%). In placebo, carnosine remained stable in soleus, while a small and significant increase of +16% occurred in gastrocnemius. Dynamic knee extension torque during the fourth and fifth bout was significantly improved with β-alanine but not with placebo. Isometric endurance and 400-m race time were not affected by treatment. In conclusion, 1) proton MRS can be used to noninvasively quantify human muscle carnosine content; 2) muscle carnosine is increased by oral β-alanine supplementation in sprint-trained athletes; 3) carnosine loading slightly but significantly attenuated fatigue in repeated bouts of exhaustive dynamic contractions; and 4) the increase in muscle carnosine did not improve isometric endurance or 400-m race time.

PET visualization of microglia in multiple sclerosis patients using [11C]PK11195

Activated microglia are involved in the immune response of multiple sclerosis (MS). The peripheral benzodiazepine receptor (PBR) is expressed on microglia and up-regulated after neuronal injury. [11C]PK11195 is a positron emission tomography (PET) radioligand for the PBR. The objective of the present study was to investigate [11C]PK11195 imaging in MS patients and its additional value over magnetic resonance imaging (MRI) concerning the immuno-pathophysiological process. Seven healthy and 22 MS subjects were included. Semiquantitative [11C]PK11195 uptake values were assessed with normalization on cortical grey matter. Uptake in Gadolinium-lesions was significantly increased compared with normal white matter. Uptake in T2-lesions was generally decreased, suggesting a PBR down-regulation. However, uptake values increased whenever a clinical or MR-relapse was present, suggestive for a dynamic process with a transient PBR up-regulation. During disease progression, an increase of normal-appearing white matter (NAWM) uptake was found, propagating NAWM as the possible real burden of disease. In conclusion, [11C]PK11195 and PET are able to demonstrate inflammatory processes with microglial involvement in MS.

Optimal experimental design for diffusion kurtosis imaging

Diffusion kurtosis imaging (DKI) is a new magnetic resonance imaging (MRI) model that describes the non-Gaussian diffusion behavior in tissues. It has recently been shown that DKI parameters, such as the radial or axial kurtosis, are more sensitive to brain physiology changes than the well-known diffusion tensor imaging (DTI) parameters in several white and gray matter structures. In order to estimate either DTI or DKI parameters with maximum precision, the diffusion weighting gradient settings that are applied during the acquisition need to be optimized. Indeed, it has been shown previously that optimizing the set of diffusion weighting gradient settings can have a significant effect on the precision with which DTI parameters can be estimated. In this paper, we focus on the optimization of DKI gradients settings. Commonly, DKI data are acquired using a standard set of diffusion weighting gradients with fixed directions and with regularly spaced gradient strengths. In this paper, we show that such gradient settings are suboptimal with respect to the precision with which DKI parameters can be estimated. Furthermore, the gradient directions and the strengths of the diffusion-weighted MR images are optimized by minimizing the Cramér-Rao lower bound of DKI parameters. The impact of the optimized gradient settings is evaluated, both on simulated as well as experimentally recorded datasets. It is shown that the precision with which the kurtosis parameters can be estimated, increases substantially by optimizing the gradient settings.

An investigation of the chemical stability of a monomer/polymer gel dosimeter

The aim of this work is to investigate the temporal stability of a polyacrylamide gelatin hydrogel used for 3D monomer/polymer gel dosimetry techniques involving different methods of analysis. Long-term instabilities for a similar gel have recently been reported, but differ markedly from those described in this work. Two kinds of long-term instabilities are described. One affects the slope of the dose-R2 plot and is related to post-irradiation polymerization of the comonomer/polymer aggregates. It is observed that post-irradiation polymerization only lasts 12 hours after irradiation. The other instability affects the intercept of the dose-R2 plot, lasts for up to 30 days and is related to the gelation process of gelatin. Further studies were performed on gelatin gels of varying compositions to obtain a better understanding of the molecular mechanism that causes the instability due to gelation. The studies included observations of the spin-spin and spin-lattice relaxation rates in combination with diffusion measurements and optical measurements. It is shown that the heating history during the manufacture of the gel affects the absolute R2 value of the gel but not its variation. The findings presented in this study may help in producing more stable and reproducible monomer/polymer gel dosimeters.

Carnosine loading and washout in human skeletal muscles

Carnosine (β-alanyl-l-histidine) is present in high concentrations in human skeletal muscles. The oral ingestion of β-alanine, the rate-limiting precursor in carnosine synthesis, has been shown to elevate the muscle carnosine content both in trained and untrained humans. Little human data exist about the dynamics of the muscle carnosine content, its metabolic regulation, and its dependence on muscle fiber type. The present study aimed to investigate in three skeletal muscle types the supplementation-induced amplitude of carnosine synthesis and its subsequent elimination on cessation of supplementation (washout). Fifteen untrained males participated in a placebo-controlled double-blind study. They were supplemented for 5–6 wk with either 4.8 g/day β-alanine or placebo. Muscle carnosine was quantified in soleus, tibialis anterior, and medial head of the gastrocnemius by proton magnetic resonance spectroscopy (MRS), before and after supplementation and 3 and 9 wk into washout. The β-alanine supplementation significantly increased the carnosine content in soleus by 39%, in tibialis by 27%, and in gastrocnemius by 23% and declined postsupplementation at a rate of 2–4%/wk. Average muscle carnosine remained increased compared with baseline at 3 wk of washout (only one-third of the supplementation-induced increase had disappeared) and returned to baseline values within 9 wk at group level. Following subdivision into high responders (+55%) and low responders (+15%), washout period was 15 and 6 wk, respectively. In the placebo group, carnosine remained relatively constant with variation coefficients of 9–15% over a 3-mo period. It can be concluded that carnosine is a stable compound in human skeletal muscle, confirming the absence of carnosinase in myocytes. The present study shows that washout periods for crossover designs in supplementation studies for muscle metabolites may sometimes require months rather than weeks.

Overlapping neural systems represent cognitive effort and reward anticipation

Anticipating a potential benefit and how difficult it will be to obtain it are valuable skills in a constantly changing environment. In the human brain, the anticipation of reward is encoded by the Anterior Cingulate Cortex (ACC) and Striatum. Naturally, potential rewards have an incentive quality, resulting in a motivational effect improving performance. Recently it has been proposed that an upcoming task requiring effort induces a similar anticipation mechanism as reward, relying on the same cortico-limbic network. However, this overlapping anticipatory activity for reward and effort has only been investigated in a perceptual task. Whether this generalizes to high-level cognitive tasks remains to be investigated. To this end, an fMRI experiment was designed to investigate anticipation of reward and effort in cognitive tasks. A mental arithmetic task was implemented, manipulating effort (difficulty), reward, and delay in reward delivery to control for temporal confounds. The goal was to test for the motivational effect induced by the expectation of bigger reward and higher effort. The results showed that the activation elicited by an upcoming difficult task overlapped with higher reward prospect in the ACC and in the striatum, thus highlighting a pivotal role of this circuit in sustaining motivated behavior.

Assessment of neuroinflammation and microglial activation in Alzheimer's disease with radiolabelled PK11195 and single photon emission computed tomography. A pilot study

OBJECTIVES

Inflammation contributes to degeneration in Alzheimer's disease (AD), not simply as a secondary phenomenon, but primarily as a significant source of pathology. [(123)I]iodo-PK11195 is a single photon emission computed tomography (SPECT) ligand for the peripheral benzodiazepine receptor, the latter being expressed on microglia (brain resident macrophages) and upregulated under inflammatory circumstances. The objectives were to assess AD inflammation by detecting [(123)I]iodo-PK11195 uptake changes and investigate how uptake values relate with perfusion SPECT and neuropsychological findings.

METHODS

Ten AD and 9 control subjects were included. [(123)I]iodo-PK11195 SPECT images were realigned into stereotactic space where binding indices, normalized on cerebellar uptake, were calculated.

RESULTS

The mean [(123)I]iodo-PK11195 uptake was increased in AD patients compared with controls in nearly all neocortical regions; however, statistical significance was only reached in the frontal and right mesotemporal regions. Significant correlations were found between regional increased [(123)I]iodo-PK11195 uptake and cognitive deficits.

CONCLUSIONS

[(123)I]iodo-PK11195 is a cellular disease activity marker and allows in vivo assessment of microglial inflammation in AD.

Three-dimensional dosimetry using polymer gel and magnetic resonance imaging applied to the verification of conformal radiation therapy in head-and-neck cancer

BACKGROUND AND PURPOSE

It was our aim to investigate NMR-based BANG gel dosimetry as a three-dimensional dosimetry technique in conformal radiotherapy.

MATERIALS AND METHODS

The BANG gel consisting of gelatin, water and co-monomers was first validated in a cylindrical glass flask for a single standard beam. Next, the gel contained in a human neck-shaped cast was used to verify a treatment plan for the conformal irradiation of a concave tumour in the lower neck. Magnetic resonance relaxation rate images were acquired and, based on an appropriate calibration of the gel, converted to absorbed dose distributions. The resulting maps were compared with dose distributions measured using radiographic film.

RESULTS

The gel-measured dose profiles of standard beams agreed within 3% (root mean square difference) with the profiles measured with high spatial resolution by a diamond detector. For the multi-beam conformal treatment, the difference map between gel-measured and film-measured dose distributions revealed a noise component and a more systematic deviation including structural or space-coherent patterns. The mean absolute value of the difference amounted to 8%. A number of possible causes for this deviation are designated.

CONCLUSIONS

Polymer gel dosimetry in combination with magnetic resonance imaging is a promising method for dosimetric verification of conformal radiotherapy.

Important role of muscle carnosine in rowing performance

The role of the presence of carnosine (β-alanyl-l-histidine) in millimolar concentrations in human skeletal muscle is poorly understood. Chronic oral β-alanine supplementation is shown to elevate muscle carnosine content and improve anaerobic exercise performance during some laboratory tests, mainly in the untrained. It remains to be determined whether carnosine loading can improve single competition-like events in elite athletes. The aims of the present study were to investigate if performance is related to the muscle carnosine content and if β-alanine supplementation improves performance in highly trained rowers. Eighteen Belgian elite rowers were supplemented for 7 wk with either placebo or β-alanine (5 g/day). Before and following supplementation, muscle carnosine content in soleus and gastrocnemius medialis was measured by proton magnetic resonance spectroscopy (1H-MRS) and the performance was evaluated in a 2,000-m ergometer test. At baseline, there was a strong positive correlation between 100-, 500-, 2,000-, and 6,000-m speed and muscle carnosine content. After β-alanine supplementation, the carnosine content increased by 45.3% in soleus and 28.2% in gastrocnemius. Following supplementation, the β-alanine group was 4.3 s faster than the placebo group, whereas before supplementation they were 0.3 s slower ( P = 0.07). Muscle carnosine elevation was positively correlated to 2,000-m performance enhancement ( P = 0.042 and r = 0.498). It can be concluded that the positive correlation between baseline muscle carnosine levels and rowing performance and the positive correlation between changes in muscle carnosine and performance improvement suggest that muscle carnosine is a new determinant of rowing performance.

Multilingualism: an fMRI study

To investigate the hypothesis that in multilingual speakers different languages are represented in distinct brain regions, 12 multilingual right-handed men performed a word fluency task, a picture naming task, a comprehension reading task, and their respective control tasks in three languages (Dutch, French, and English) while whole-head functional magnetic resonance imaging (fMRI) was applied. In general, all language tasks revealed predominantly overlapping regions of activation for the different languages. Cerebral activation during use of the foreign languages showed a tendency toward a more extensive recruitment of the areas activated in the native language and the activation of a greater number of regions. Word generation in the foreign languages elicited additional bilateral inferior frontal activation, including Broca's area and left middle temporal gyrus activation; in the native language, additional postcentral activation was found. Picture naming in the foreign languages recruited additional inferior-lateral and medial frontal regions predominantly on the left, and more posterior right hemispheric activation in the mother tongue. During comprehension reading there was more activation in medial posterior regions in the native language. Our results suggest that the performance of language tasks in different languages engages largely the same cerebral areas but that the brain, to perform at a comparable proficiency level, engages more neural substrates for later acquired languages. Our findings do not support the view that languages learned later in life entail more right hemispheric involvement. Finally, a consequent effect of language exposure was found for reading, where increased familiarity engages more occipital activation whereas decreased familiarity appears to be associated with increased left hemispheric inferior frontal activation.

Validation of MR-based polymer gel dosimetry as a preclinical three-dimensional verification tool in conformal radiotherapy

The aim of this work was to investigate MR-based polymer gel dosimetry as a three-dimensional (3D) dosimetry technique in conformal radiotherapy. A cylindrical container filled with polymer gel was placed in a water-filled torso phantom to verify a treatment plan for the conformal irradiation of a mediastinal tumor located near the esophagus. Magnetic resonance spin-spin relaxation rate images were acquired and, after calibration, converted to absorbed dose distributions. The dose maps were compared with dose distributions measured using radiographic film. The average root-mean-square structural deviation, for the complete dose distribution, amounted to less than 3% between gel and film dose maps. It may be expected that MR gel dosimetry will become a valuable tool in the verification of 3D dose distributions. The influence of imaging artifacts arising from eddy currents, temperature drift during scanning, and B1 field inhomogeneity on the dose maps was taken into account and minimized.

Microglial imaging with positron emission tomography and atrophy measurements with magnetic resonance imaging in multiple sclerosis: a correlative study

OBJECTIVE

The objectives of the present study were to assess brain atrophy in multiple sclerosis (MS) patients during different disease stages and to investigate by PET and [11C]PK11195, a marker of microglial activation, the relationship between inflammation, atrophy and clinically relevant measures.

METHODS

Eight healthy subjects and 22 MS patients were included. Semiquantitative [11C]PK11195 uptake values, with normalization on cortical grey matter, were measured for magnetic resonance imaging T2- and T1-lesions and normal appearing white matter (NAWM). As atrophy index we used the ratio of the amount of white and grey matter divided by the ventricular size, using an optimized a priori based segmentation algorithm (SPM99).

RESULTS

Atrophy was significantly greater in MS patients compared to age-matched controls. A significant correlation was found between brain atrophy and both disease duration and disability, as measured with the Expanded Disability Status Scale. For NAWM, [11C]PK11195 uptake increased with the amount of atrophy, while T2-lesional [11C]PK11195 uptake values decreased according to increasing brain atrophy.

CONCLUSIONS

The present study suggests that brain atrophy, correlating with disease duration and disability, is directly related to NAWM and T2-lesional inflammation as measured by microglial activation.

Cerebral lateralization of praxis in right- and left-handedness: same pattern, different strength

We aimed to investigate the effect of hand effector and handedness on the cerebral lateralization of pantomiming learned movements. Fourteen right-handed and 14 left-handed volunteers performed unimanual and bimanual tool-use pantomimes with their dominant or nondominant hand during fMRI. A left hemispheric lateralization was observed in the right- and left-handed group regardless of which hand(s) performed the task. Asymmetry was most marked in the dorsolateral prefrontal cortex (DLPFC), premotor cortex (PMC), and superior and inferior parietal lobules (SPL and IPL). Unimanual pantomimes did not reveal any significant differences in asymmetric cerebral activation patterns between left- and right-handers. Bimanual pantomimes showed increased left premotor and posterior parietal activation in left- and right-handers. Lateralization indices (LI) of the 10% most active voxels in DLPFC, PMC, SPL, and IPL were calculated for each individual in a contrast that compared all tool versus all control conditions. Left-handers showed a significantly reduced overall LI compared with right-handers. This was mainly due to diminished asymmetry in the IPL and SPL. We conclude that the recollection and pantomiming of learned gestures recruits a similar left lateralized activation pattern in right and left-handed individuals. Handedness only influences the strength (not the side) of the lateralization, with left-handers showing a reduced degree of asymmetry that is most readily observed over the posterior parietal region. Together with similar findings in language and visual processing, these results point to a lesser hemispheric specialization in left-handers that may be considered in the cost/benefit assessment to explain the disproportionate handedness polymorphism in humans.

Does egocentric mental rotation elicit sex differences?

Mental rotation tests traditionally show a male performance advantage. Some neuroimaging studies have reported sex-specific cortical activation patterns during mental rotation. However, these experiments used abstract stimuli and some studies did not systematically exclude performance as a confounding variable. The mental rotation of hands and hand-related objects, compared to abstract objects, is known to evoke an egocentric motor strategy. In this study, we used fMRI to explore potential gender-specific cortical activation patterns for the mental rotation of hands and tools in a sample with an adequate and equal performance for men and women. We found a common neural substrate for men and women comprising superior parietal lobe, dorsolateral premotor cortex, and extrastriate occipital areas, compatible with an egocentric motor strategy for the mental rotation of hands and tools. Sex differences were modest and limited to the mental rotation of hands. Women recruited more left ventral premotor cortex, which could imply that women rely more on imitation or use more perceptual comparisons. Men, on the other hand, drafted more the lingual gyrus, possibly referring to more extensive semantic or early visual processing. We conclude that men and women use a very similar motor strategy during egocentric mental rotation with a potential gender-specific accent.

Simulation and experimental verification of the diffusion in an anisotropic fiber phantom

Diffusion weighted magnetic resonance imaging enables the visualization of fibrous tissues such as brain white matter. The validation of this non-invasive technique requires phantoms with a well-known structure and diffusion behavior. This paper presents anisotropic diffusion phantoms consisting of parallel fibers. The diffusion properties of the fiber phantoms are measured using diffusion weighted magnetic resonance imaging and bulk NMR measurements. To enable quantitative evaluation of the measurements, the diffusion in the interstitial space between fibers is modeled using Monte Carlo simulations of random walkers. The time-dependent apparent diffusion coefficient and kurtosis, quantifying the deviation from a Gaussian diffusion profile, are simulated in 3D geometries of parallel fibers with varying packing geometries and packing densities. The simulated diffusion coefficients are compared to the theory of diffusion in porous media, showing a good agreement. Based on the correspondence between simulations and experimental measurements, the fiber phantoms are shown to be useful for the quantitative validation of diffusion imaging on clinical MRI-scanners.

31P-MRS demonstrates a reduction in high-energy phosphates in the occipital lobe of migraine without aura patients

BACKGROUND

Differences in brain energy metabolism have been found between migraine patients and controls in previous phosphorus magnetic resonance spectroscopy ((31)P-MRS) studies, most of them emphasizing migraine with aura (MwA). The aim of this study was to verify potential changes in resting-state brain energy metabolism in patients with migraine without aura (MwoA) compared to control subjects by (31)P-MRS at 3 tesla.

METHODS

Quantification was performed using the phantom replacement technique. MRS measurements were performed interictally and in the medial occipital lobe of 19 MwoA patients and 26 age-matched controls.

RESULTS

A significantly decreased phosphocreatine concentration ([PCr]) was found as in previous studies. While adenosine triphosphate concentration ([ATP]) was considered to be constant in previously published work, this study found a significant decrease in the measured [ATP] in MwoA patients. The inorganic phosphate ([P(i)]) and magnesium ([Mg(2+)]) concentrations were not significantly different between MwoA patients and controls.

CONCLUSIONS

The altered metabolic concentrations indicate that the energy metabolism in MwoA patients is impaired, certainly in a subgroup of patients. The actual decrease in [ATP] adds further strength to the theory of the presence of a mitochondrial component in the pathophysiology of migraine.

Variability of physiological brain perfusion in healthy subjects - A systematic review of modifiers. Considerations for multi-center ASL studies

Quantitative measurements of brain perfusion are influenced by perfusion-modifiers. Standardization of measurement conditions and correction for important modifiers is essential to improve accuracy and to facilitate the interpretation of perfusion-derived parameters. An extensive literature search was carried out for factors influencing quantitative measurements of perfusion in the human brain unrelated to medication use. A total of 58 perfusion modifiers were categorized into four groups. Several factors (e.g., caffeine, aging, and blood gases) were found to induce a considerable effect on brain perfusion that was consistent across different studies; for other factors, the modifying effect was found to be debatable, due to contradictory results or lack of evidence. Using the results of this review, we propose a standard operating procedure, based on practices already implemented in several research centers. Also, a theory of 'deep MRI physiotyping' is inferred from the combined knowledge of factors influencing brain perfusion as a strategy to reduce variance by taking both personal information and the presence or absence of perfusion modifiers into account. We hypothesize that this will allow to personalize the concept of normality, as well as to reach more rigorous and earlier diagnoses of brain disorders.

ExploreASL: An image processing pipeline for multi-center ASL perfusion MRI studies

Arterial spin labeling (ASL) has undergone significant development since its inception, with a focus on improving standardization and reproducibility of its acquisition and quantification. In a community-wide effort towards robust and reproducible clinical ASL image processing, we developed the software package ExploreASL, allowing standardized analyses across centers and scanners. The procedures used in ExploreASL capitalize on published image processing advancements and address the challenges of multi-center datasets with scanner-specific processing and artifact reduction to limit patient exclusion. ExploreASL is self-contained, written in MATLAB and based on Statistical Parameter Mapping (SPM) and runs on multiple operating systems. To facilitate collaboration and data-exchange, the toolbox follows several standards and recommendations for data structure, provenance, and best analysis practice. ExploreASL was iteratively refined and tested in the analysis of >10,000 ASL scans using different pulse-sequences in a variety of clinical populations, resulting in four processing modules: Import, Structural, ASL, and Population that perform tasks, respectively, for data curation, structural and ASL image processing and quality control, and finally preparing the results for statistical analyses on both single-subject and group level. We illustrate ExploreASL processing results from three cohorts: perinatally HIV-infected children, healthy adults, and elderly at risk for neurodegenerative disease. We show the reproducibility for each cohort when processed at different centers with different operating systems and MATLAB versions, and its effects on the quantification of gray matter cerebral blood flow. ExploreASL facilitates the standardization of image processing and quality control, allowing the pooling of cohorts which may increase statistical power and discover between-group perfusion differences. Ultimately, this workflow may advance ASL for wider adoption in clinical studies, trials, and practice.

Validation and application of polymer gel dosimetry for the dose verification of an intensity-modulated arc therapy (IMAT) treatment

Polymer gel dosimetry was used to assess an intensity-modulated arc therapy (IMAT) treatment for whole abdominopelvic radiotherapy. Prior to the actual dosimetry experiment, a uniformity study on an unirradiated anthropomorphic phantom was carried out. A correction was performed to minimize deviations in the R2 maps due to radiofrequency non-uniformities. In addition, compensation strategies were implemented to limit R2 deviations caused by temperature drift during scanning. Inter- and intra-slice R2 deviations in the phantom were thereby significantly reduced. This was verified in an investigative study where the same phantom was irradiated with two rectangular superimposed beams: structural deviations between gel measurements and computational results remained below 3% outside high dose gradient regions; the spatial shift in those regions was within 2.5 mm. When comparing gel measurements with computational results for the IMAT treatment, dose deviations were noted in the liver and right kidney, but the dose-volume constraints were met. Root-mean-square differences between both dose distributions were within 5% with spatial deviations not more than 2.5 mm. Dose fluctuations due to gantry angle discretization in the dose computation algorithm were particularly noticeable in the low-dose region.

Current state and guidance on arterial spin labeling perfusion MRI in clinical neuroimaging

This article focuses on clinical applications of arterial spin labeling (ASL) and is part of a wider effort from the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group to update and expand on the recommendations provided in the 2015 ASL consensus paper. Although the 2015 consensus paper provided general guidelines for clinical applications of ASL MRI, there was a lack of guidance on disease-specific parameters. Since that time, the clinical availability and clinical demand for ASL MRI has increased. This position paper provides guidance on using ASL in specific clinical scenarios, including acute ischemic stroke and steno-occlusive disease, arteriovenous malformations and fistulas, brain tumors, neurodegenerative disease, seizures/epilepsy, and pediatric neuroradiology applications, focusing on disease-specific considerations for sequence optimization and interpretation. We present several neuroradiological applications in which ASL provides unique information essential for making the diagnosis. This guidance is intended for anyone interested in using ASL in a routine clinical setting (i.e., on a single-subject basis rather than in cohort studies) building on the previous ASL consensus review.

Developing a comprehensive presurgical functional MRI protocol for patients with intractable temporal lobe epilepsy: a pilot study

Our aim was to put together and test a comprehensive functional MRI (fMRI) protocol which could compete with the intracarotid amytal (IAT) or Wada test for the localisation of language and memory function in patients with intractable temporal lobe epilepsy. The protocol was designed to be performed in under 1 h on a standard 1.5 tesla imager. We used five paradigms to test nine healthy right-handed subjects: complex scene-encoding, picture-naming, reading, word-generation and semantic-decision tasks. The combination of these tasks generated two activation maps related to memory in the mesial temporal lobes, and three language-related maps of activation in a major part of the known language network. The functional maps from the encoding and naming tasks showed typical and symmetrical posterior mesial temporal lobe activation related to memory in all subjects. Only four of nine subjects also showed symmetrical anterior hippocampal activation. Language lateralisation was best with the word generation and reading paradigms and proved possible in all subjects. The reading paradigm enables localisation of language function in the left anterior temporal pole and middle temporal gyrus, areas typically resected during epilepsy surgery. The combined results of this comprehensive f MRI protocol are adequate for a comparative study with the IAT in patients with epilepsy being assessed for surgery.

99mTc-ECD brain perfusion SPET: variability, asymmetry and effects of age and gender in healthy adults

Reliable and high-resolution reference data for regional cerebral blood flow measured with single-photon emission tomography (SPET) are necessary for optimal clinical and research use. Therefore, a large dataset of normal technetium-99m labelled ethylene cysteine dimer (ECD) perfusion SPET in carefully screened healthy volunteers with an age range spanning six decades was created, with correction for non-uniform attenuation and scatter and based on an anatomically standardised analysis. Eighty-nine healthy volunteers, stratified for gender (46 females, 43 males; age 20-81 years), were included. Twelve volunteers underwent repeated 99mTc-ECD SPET after 2.5+/-2.3 weeks. An automated whole-brain volume of interest analysis with MANOVA as well as voxelwise analysis using SPM99 was conducted. Average intersubject variability was 4.8% while intrasubject reproducibility was 3.0%. An age-related decline in tracer uptake was found in the anterior cingulate gyrus, bilateral basal ganglia, left prefrontal, left lateral frontal and left superior temporal and insular cortex (all P=0.001-0.02). There was an overall increase in right/left asymmetry with age, which was most pronounced in the frontal and temporal neocortex. The most significant correlations between AI and age decade were found in the prefrontal (R=0.35, P=0.001) and superior temporal neocortex (R=0.43, P<0.001). Women had significantly higher uptake in the right parietal cortex (P<0.001), while men showed higher uptake in the cerebellum and the left anterior temporal and orbitofrontal cortex (all P<0.01). This normative dataset allows age- and gender-specific patient and group assessment of 99mTc-ECD perfusion SPET under a wide variety of clinical circumstances in relation to normal variations and highlights the importance of both age- and gender-specific normal datasets for optimal analysis sensitivity.

The use of functional MRI to evaluate cervical flexor activity during different cervical flexion exercises

The purpose of this study was to investigate the recruitment pattern of deep and superficial neck flexors evoked by three different cervical flexion exercises using muscle functional MRI. In 19 healthy participants, transverse relaxation time (T2) values were calculated for the longus colli (Lco), longus capitis (Lca), and sternocleidomastoid (SCM) at rest and following three exercises: conventional cervical flexion (CF), craniocervical flexion (CCF), and a combined craniocervical flexion and cervical flexion (CCF-CF). CCF-CF gave the highest T2 increase for all muscles. CCF displayed a significantly higher T2 increase for the Lca compared with the Lco and the SCM. When comparing the CCF and CF, no significant difference was found for the Lca, whereas the Lco and SCM displayed a higher T2 increase during CF compared with CCF. This study shows that muscle functional MRI can be used to characterize the specific activation levels and recruitment patterns of the superficial and deep neck flexors during different cervical flexion exercises. During CCF-CF, all synergists are maximally recruited, which makes this exercise useful for high-load training. CCF may provide a more specific method to assess and retrain Lca muscle performance compared with CF and CCF-CF. This study highlights the need to differentiate between the Lco and Lca when evaluating their function, since these results demonstrate a clear difference in activation of both muscles.