Non-Fourier encoding with multiple spin echoes

The advantages and limitations of multiple spin-echo sequences for non-Fourier encoding are investigated. Complications caused by improper encoding of alternate magnetization pathways due to imperfect refocusing pulses are analyzed. It is shown that mirror image ghosts result if the encoding RF pulse matrix is real-valued. These ghosts can be avoided as long as the rows of the RF pulse matrix are conjugate symmetric, which implies that spatial profiles are real valued. Non-Fourier encoding using bases derived from wavelet, Hadamard, and other real-valued orthogonal functions does not result in a mirror ghost artifact. A RARE sequence for non-Fourier encoding has been implemented on a clinical imaging system and successfully applied for brain imaging.

Temperature monitoring of ultrasonically heated muscle with RARE chemical shift imaging

The ability to monitor tissue temperature in ultrasonically heated rabbit muscle is demonstrated using a chemical shift imaging approach based on the rapid acquisition with relaxation enhancement (RARE) fast imaging method [Hennig et al., Magn. Reson. Med. 3, 823-833 (1986)] applied in a line scan format. A three echo sequence with a 16 Hz spectral resolution with 64 ms echo readouts and 78 ms echo spacings is shown capable of measuring relevantly small water frequency shifts in phantoms. Applied to the in vivo model of ultrasonically heated rabbit muscle, water resonance frequencies at the ultrasonic focal point were found to be linearly related to temperature with a slope of -0.007 +/- 0.001 ppm/degree C (N = 6 studies). Measurements of the frequency shift in unheated tissue located away from the ultrasonically heated tissue varied by approximately 0.011 ppm over the course of the experiments, leading to an estimated temperature accuracy of +/- 1.6 degrees C in vivo.

Parcellation of the human prefrontal cortex using MRI

A methodology was developed for dividing prefrontal cortical gray matter into insular, orbital, inferior, middle, superior, cingulate, and frontal pole regions using anatomical criteria. This methodology was developed as a follow-up to one that measured whole prefrontal gray and white matter volumes in schizophrenic and control subjects. This study showed no overall volume differences in prefrontal cortex between schizophrenic and control subjects. The parcellation of prefrontal cortex was done to increase the probability of detecting abnormalities that were circumscribed to a particular portion of the region. A 1.5 Tesla magnet was used to acquire contiguous 1.5-mm coronal slices of the entire brain. Volumes were then measured in a group of right-handed male (n = 15) subjects. Gray matter was parcellated using criteria that were mainly based on gross anatomy, as visualized in 3-dimensional renderings of the brain. Reliability of the parcellation scheme was very high (r(i) = 0.80 and above). This methodology should be useful in the study of cortical pathology in a number of neurological disorders, including schizophrenia.

Temperature mapping using the water proton chemical shift: a chemical shift selective phase mapping method

A proton-chemical-shift-based temperature imaging method, called chemical shift selective phase mapping, is proposed. The technique uses frequency-selective suppression to provide frequency selectivity to the phase mapping method. Separate imaging of the phase distributions of the water and nonwater signals reduced the error due to the presence of a nonwater signal in measuring the water proton chemical shift change in two-component samples. Imaging of the phase difference between water and oil yielded an internally referenced water proton chemical shift measurement to visualize the temperature change distribution, which was unaffected by motion-induced susceptibility changes.

[Design, clinical suitability and future aspects of a 0.5 T MRI special system for interventional use]

PURPOSE

To develop a superconducting magnetic resonance (MR) imager that provides direct access to the patient and permits interactive MR-guided interventional procedures.

MATERIALS AND METHODS

A 0.5-T superconducting magnet that allows a region of vertical access to the patient was designed and constructed. This magnet was integrated with newly designed shielded gradient coils, flexible surface coils, nonmagnetic displays, position-monitoring probes and device-tracking instrumentation.

RESULTS

The magnet homogeneity was 12.3 ppm or better, and the gradient field was linear to within 1% over an imaging region of 30 cm in diameter. The signal-to-noise ratio was 10% higher than in a comparable 0.5-T superconducting imager. Images were obtained in several anatomic regions with use of routine pulse sequences. Interactive image plane selection and near real-time imaging, with use of fast gradient-recalled echo sequences were demonstrated at a rate of one image every 1.5 s. More than 240 procedures (including open brain surgery) have been successfully performed within this environment.

CONCLUSIONS

MR-guided interventional and surgical procedures can be performed with full patient access using an open-configuration, superconducting MR magnet with near real-time imaging and interactive image plane control.

Development and implementation of intraoperative magnetic resonance imaging and its neurosurgical applications

OBJECTIVE

We describe the development and implementation of a new open configuration magnetic resonance imaging (MRI) system, with which neurosurgical procedures can be performed using image guidance. Our initial neurosurgical experience consists of 140 cases, including 63 stereotactic biopsies, 16 cyst drainages, 55 craniotomies, 3 thermal ablations, and 3 laminectomies. The surgical advantages derived from this new modality are presented.

METHODS

The 0.5-T intraoperative MRI system (SIGNA SP, Boston, MA), developed by General Electric Medical Systems in collaboration with the Brigham and Women's Hospital, has a vertical gap within its magnet, providing the physical space for surgery. Images are viewed on monitors located within this gap and can also be acquired in conjunction with optical tracking of surgical instruments, establishing accurate intraoperative correlations between instrument position and anatomic structures.

RESULTS

A wide range of standard neurosurgical procedures can be performed using intraoperative MRI. The images obtained are clear and provide accurate and immediate information to use in the planning and assessment of the progress of the surgery.

CONCLUSION

Intraoperative MRI allows lesions to be precisely localized and targeted, and the progress of a procedure can be immediately evaluated. The constantly updated images help to eliminate errors that can arise during frame-based and frameless stereotactic surgery when anatomic structures alter their position because of shifting or displacement of brain parenchyma but are correlated with images obtained preoperatively. Intraoperative MRI is particularly helpful in determining tumor margins, optimizing surgical approaches, achieving complete resection of intracerebral lesions, and monitoring potential intraoperative complications.

Serial neuropsychological assessment and magnetic resonance imaging analysis in multiple sclerosis

OBJECTIVE

To assess the correlation between cognitive dysfunction and disease burden in multiple sclerosis (MS) during a 1-year period.

DESIGN

The Brief, Repeatable Battery of Neuropsychological Tests in Multiple Sclerosis was performed at entrance and 1 year. Patients underwent at least 20 proton density (range, 20-24) and T2-weighted axial magnetic resonance imaging (MRI) brain scans except for stable patients who were scanned monthly. Magnetic resonance imaging was evaluated using computer-automated, 3-dimensional volumetric analysis.

SETTING

A research clinic of a university hospital.

PATIENTS

Forty-four patients with MS of the following disease categories: relapsing-remitting (14), relapsing-remitting progressive (12), chronic progressive (13), and stable (5).

MAIN OUTCOME MEASURES

The relationships between scores on the Brief, Repeatable Battery of Neuropsychological Tests in Multiple Sclerosis and 2 MRI measures (total lesion volume and brain to intracranial cavity volume ratio) were assessed using linear regression. These MRI measures were also compared with cognitive status at 1 year using analysis of variance.

RESULTS

Overall, there was no decline in mean cognitive test performance during 1 year. Significant correlations were found between baseline neuropsychological test scores of nonverbal memory, information-processing speed, and attention and both MRI measures. Patients with chronic progressive MS demonstrated the strongest correlations. At 1 year, change in information-processing speed and attention correlated with change in total lesion volume. The mean increase in total lesion volume was 5.7 mL for 4 patients whose cognitive status worsened compared with 0.4 mL for 19 patients who improved and 0.5 mL for 21 patients who remained stable.

CONCLUSIONS

During a 1-year period mean cognitive performance did not worsen. Automated volumetric MRI measures of total lesion volume and brain to intracranial cavity volume ratio correlated with neuropsychological performance, especially in patients with chronic progressive MS. Worsening MRI lesion burden correlated with cognitive decline.

Computer-assisted surgical planning for cerebrovascular neurosurgery

OBJECTIVE

We used three-dimensional reconstructed magnetic resonance images for planning the operations of 16 patients with various cerebrovascular diseases. We studied the cases of these patients to determine the advantages and current limitations of our computer-assisted surgical planning system as it applies to the treatment of vascular lesions.

METHODS

Magnetic resonance angiograms or thin slice gradient echo magnetic resonance images were processed for three-dimensional reconstruction. The segmentation, based on the signal intensities and voxel connectivity, separated each anatomic structure of interest, such as the brain, vessels, and skin. A three-dimensional model was then reconstructed by surface rendering. This three-dimensional model could be colored, made translucent, and interactively rotated by a mouse-controlled cursor on a workstation display. In addition, a three-dimensional blood flow analysis was performed, if necessary. The three-dimensional model was used to assist in three stages of surgical planning, as follows: 1) to choose the best method of intervention, 2) to evaluate surgical risk, 3) to select a surgical approach, and 4) to localize lesions.

RESULTS

The generation of three-dimensional models allows visualization of pathological anatomy and its relationship to adjacent normal structures, accurate lesion volume determination, and preoperative computer-assisted visualization of alternative surgical approaches.

CONCLUSION

Computer-assisted surgical planning is useful for patients with cerebrovascular disease at various stages of treatment. Lesion identification, therapeutic and surgical option planning, and intraoperative localization are all enhanced with these techniques.

An automated registration algorithm for measuring MRI subcortical brain structures

An automated registration algorithm was used to elastically match an anatomical magnetic resonance (MR) atlas onto individual brain MR images. Our goal was to evaluate the accuracy of this procedure for measuring the volume of MRI brain structures. We applied two successive algorithms to a series of 28 MR brain images, from 14 schizophrenia patients and 14 normal controls. First, we used an automated segmentation program to differentiate between white matter, cortical and subcortical gray matter, and cerebrospinal fluid. Next, we elastically deformed the atlas segmentation to fit the subject's brain, by matching the white matter and subcortical gray matter surfaces. To assess the accuracy of these measurements, we compared, on all 28 images, 11 brain structures, measured with elastic matching, with the same structures traced manually on MRI scans. The similarity between the measurements (the relative difference between the manual and the automated volume) was 97% for whole white matter, 92% for whole gray matter, and on average 89% for subcortical structures. The relative spatial overlap between the manual and the automated volumes was 97% for whole white matter, 92% for whole gray matter, and on average 75% for subcortical structures. For all pairs of structures rendered with the automated and the manual method, Pearson correlations were between r = 0.78 and r = 0.98 (P < 0.01, N = 28), except for globus pallidus, where r = 0.55 (left) and r = 0. 44 (right) (P < 0.01, N = 28). In the schizophrenia group, compared to the controls, we found a 16.7% increase in MRI volume for the basal ganglia (i.e., caudate nucleus, putamen, and globus pallidus), but no difference in total gray/white matter volume or in thalamic MR volume. This finding reproduces previously reported results, obtained in the same patient population with manually drawn structures, and suggests the utility/efficacy of our automated registration algorithm over more labor-intensive manual tracings.

Thermal effects of focused ultrasound on the brain: determination with MR imaging

PURPOSE

To determine the feasibility of the use of temperature-sensitive magnetic resonance (MR) imaging for the detection of local temperature elevations at the focus of a low-power ultrasound beam in the brain.

MATERIALS AND METHODS

The brains in 28 rabbits were sonicated at acoustic power levels of 3.5-17.5 W. Four to five different locations were sonicated at different acoustic power levels in each rabbit. MR images were obtained 2 hours, 48 hours, 10 days, and 23 days after the sonications, depending on when the animals were sacrificed. Histologic evaluation of whole brain was performed.

RESULTS

Forty of 43 (93%) of the lowest-power (3.5-W) sonications were visible on temperature-sensitive MR images and did not result in any short- or long-term histologic or MR imaging evidence of tissue damage. A contrast-to-noise ratio of approximately 6 and a temperature elevation of 7 degrees-8 degrees C were observed.

CONCLUSION

Temperature elevations induced by means of focused ultrasound exposures that do not cause damage in the in vivo rabbit brain can be detected at temperature-sensitive MR imaging.

Double line scan diffusion imaging

A new double line scan diffusion imaging sequence (DLSDI) is presented. In DLSDI, two lines from two separate slices are acquired in each shot. As its predecessor, LSDI, DLSDI is insensitive to motion artifacts and it can be used on conventional MR scanners. In addition, DLSDI is almost twice as fast as LSDI. Preliminary results from phantom and patient studies show excellent agreement between ADC trace maps obtained with DLSDI and LSDI. The technical and the theoretical aspects of DLSDI are studied, and it is shown how the conditional random walk model can be used as an analytical tool to derive the diffusion sensitivity in the DLSDI sequence.

Use of cortical surface vessel registration for image-guided neurosurgery

OBJECTIVE

We have treated patients with brain surface tumors by using video registration of a three-dimensional image to the surgical field, to identify eloquent cortices, localize the lesions, and define the tumor margins. "Skin-to-skin" registration using the skin surface to produce alignment was performed earlier but was difficult in areas with few prominent registration landmarks. For this reason, "vessel-to-vessel" registration using the cortical vessels as fiducials was applied to 17 cases, to improve accuracy. This article presents the advantages and limitations of vessel-to-vessel registration, as determined from the data for these cases. The accuracy is also estimated.

METHODS

A three-dimensional model was reconstructed from magnetic resonance imaging data, and a two-dimensional projection was superimposed on the video image of the actual surgical field. The tumor was resected with guidance from the registered video image. The two-dimensional projection accuracy of vessel-to-vessel registration was compared with that of skin-to-skin registration by using a phantom study.

RESULTS

All 17 tumors underwent gross total resection, and the patients experienced no major permanent neurological deficits. In the phantom study, the two-dimensional, projected, target registration error of a tumor with skin-to-skin registration was estimated as 8.9 +/- 5.3 mm and that with vessel-to-vessel registration was 1.3 +/- 1.4 mm (99th percentile confidence intervals, 24.8 and 5.5 mm, respectively).

CONCLUSION

Video registration using cortical surface vessels is practical and improves two-dimensional projection accuracy significantly, compared with skin registration.

NMR of laser-polarized 129Xe in blood foam

Laser-polarized 129Xe dissolved in a foam preparation of fresh human blood was investigated. The NMR signal of 129Xe dissolved in blood was enhanced by creating a foam in which the dissolved 129Xe exchanged with a large reservoir of gaseous laser-polarized 129Xe. The dissolved 129Xe T1 in this system was found to be significantly shorter in oxygenated blood than in deoxygenated blood. The T1 of 129Xe dissolved in oxygenated blood foam was found to be approximately 21 (+/-5) s, and in deoxygenated blood foam to be greater than 40 s. To understand the oxygenation trend, T1 measurements were also made on plasma and hemoglobin foam preparations. The measurement technique using a foam gas-liquid exchange interface may also be useful for studying foam coarsening and other liquid physical properties.

3D localization of surface 10-20 EEG electrodes on high resolution anatomical MR images

A method to visualize surface EEG electrodes on conventional high-resolution magnetic resonance (MR) images is presented. Because conventional silver or gold electrodes generate an insignificant artifactual signal signature in MR images, a plastic capsule filled with gadolinium-doped water was designed to mold onto each electrode, thereby outlining the electrode surfaces as a negative imprint on MR images. MR images of the head with capsules affixed clearly demonstrated the location and shape of the electrodes. Selected cranial tissues were identified by using semi-automatic image segmentation to determine their three-dimensional spatial relationship to the electrodes. Such representations could be used as a starting point for more precise EEG source localization modeling applicable to individual patients.

Implementation of a reduced field-of-view method for dynamic MR imaging using navigator echoes

A new technique was designed and implemented that increases imaging speed in dynamic imaging in which change is restricted to a fraction of the full field of view (FOV). The technique is an enhancement of a reduced FOV method first reported by Hu and Parrish. This enhancement extends the use of the Hu and Parrish method to cases in which there is cyclic motion throughout the entire FOV that normally would be aliased into the reduced FOV. This method requires the initial acquisition of a number of baseline k-space data sets to characterize the background physiological motion during imaging. Projection navigator echoes along both the phase- and the frequency-encoded directions are acquired and used to correct for motion outside the reduced FOV. Automatic placement or repositioning of the updated fraction of the FOV using navigators also is investigated. With this method, when using a 32-echo rapid acquisition with relaxation enhancement (RARE) sequence, single-shot updates of T2-weighted, 128 x 128 pixel images are obtained, yielding a fourfold increase in temporal resolution compared to full k-space update methods.

MR appearance and spectral features of injected ethanol in the liver: implication for fast MR-guided percutaneous ethanol injection therapy

PURPOSE

Our goal was to evaluate several fast MR strategies for monitoring ethanol distributions so that percutaneous ethanol injection might be guided with MRI.

METHOD

Fast RF spoiled GRE sequences (SPGR) and T2-weighted rapid acquisition with relaxation enhancement (RARE) sequences with and without spectroscopic-quality water suppression techniques were assessed for their ability to depict the distribution of injected ethanol in ex vivo pig liver. A line scan Carr-Purcell-Meiboom-Gill spectroscopic imaging sequence was used to validate observations and measure spectral relaxation characteristics of the ethanol signal in liver. Injected deuterated ethanol was also tested as an alternative possibility to depict the distribution of ethanol.

RESULTS

The water-suppressed T2-weighted RARE sequence depicted the distribution of ethanol better than other sequences. Deuterated ethanol appeared as a signal void on all sequences.

CONCLUSION

Water-suppressed T2-weighted RARE sequences could be useful to rapidly monitor MR-guided PEI.

Magnetic resonance imaging study of hippocampal volume in chronic, combat-related posttraumatic stress disorder

This study used quantitative volumetric magnetic resonance imaging techniques to explore the neuroanatomic correlates of chronic, combat-related posttraumatic stress disorder (PTSD) in seven Vietnam veterans with PTSD compared with seven nonPTSD combat veterans and eight normal nonveterans. Both left and right hippocampi were significantly smaller in the PTSD subjects compared to the Combat Control and Normal subjects, even after adjusting for age, whole brain volume, and lifetime alcohol consumption. There were no statistically significant group differences in intracranial cavity, whole brain, ventricles, ventricle:brain ratio, or amygdala. Subarachnoidal cerebrospinal fluid was increased in both veteran groups. Our finding of decreased hippocampal volume in PTSD subjects is consistent with results of other investigations which utilized only trauma-unexposed control groups. Hippocampal volume was directly correlated with combat exposure, which suggests that traumatic stress may damage the hippocampus. Alternatively, smaller hippocampi volume may be a pre-existing risk factor for combat exposure and/or the development of PTSD upon combat exposure.

Image guidance with laser applications

Image-guided laser surgery is defined, and an outline of its development is provided. Recent advances in radiologic imaging provide added visualization of laser-induced tissue effects. Current research around the world illustrates the power and potential of this technique in both laser and nonlaser applications. Future studies will reveal the actual contribution to laser surgery in otolaryngology.

Optimization of spoiled gradient-echo phase imaging for in vivo localization of a focused ultrasound beam

The parameters of a spoiled gradient-echo (SPGR) pulse sequence have been optimized for in vivo localization of a focused ultrasound beam. Temperature elevation was measured by using the proton resonance frequency shift technique, and the phase difference signal-to-noise ratio (SNR delta phi) was estimated in skeletal muscle and kidney cortex in 10 rabbits. Optimized parameters included the echo time equivalent to T2* of the tissue, the longest repetition time possible with a 20-s sonication, and the flip angle equivalent to the Ernst angle. Optimal SPGR phase imaging can detect a sonication beam with a peak phase difference of 0.55 radian, which corresponds to a temperature elevation of 7.3 degrees C. The sonication beam can be localized within one voxel (0.6 x 0.6 x 5 mm3) at power levels that are below the threshold for thermal damage of the tissue.

MR imaging of the female pelvic floor in the supine and upright positions

The goal of this study was to determine whether a .5-T open configuration magnet system could be used to evaluate the female pelvic floor support structures and their functional changes in the upright and supine positions. We evaluated five normal volunteers with full bladders in the supine and sitting positions. Multiple measurements were obtained, including distance between symphysis and urethra, bladder neck to fixed pubococcygeal line, and posterior urethrovesical angle. The pelvic floor was evaluated for integrity of the urethra, vagina, and supporting ligaments. High quality, interpretable images were obtained for all five patients in both positions. Most of the pelvic floor structures were stable, with the exception of the posterior urethrovesical angle, which increased in the sitting position. We conclude that the vertically open configuration magnet system shows promise for evaluation of the female pelvic floor, including urinary stress incontinence and prolapse.