Contrast agents and cerebral hemodynamics

Quantitative analysis of cerebral microvascular hemodynamics with T2-weighted dynamic MR imaging

The purpose of this study was to quantify cerebral microvascular hemodynamics with T2-weighted dynamic susceptibility contrast-enhanced magnetic resonance imaging (DSC-MRI) using a half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequence. We performed T2-weighted DSC-MRI with HASTE sequence in 19 normal subjects. After bolus injection of gadopentetate dimeglumine, HASTE images of two sections were acquired for the simultaneous creation of concentration-time curves in the internal carotid artery and in brain tissue. Absolute regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), and mean transit time (MTT) values of brain tissue were calculated on a base of the indicator dilution theory, and all values were corrected on the assumption that rCBF of white matter is constant in 22 mL/100 g tissue/min without age-dependent alteration. A decrease in rCBV and rCBF of gray matter was age dependent, while rCBV of white matter did not show significant change with aging. The mean rCBF value in gray matter was 37.3 +/- 8.4 mL/100 g tissue/min. The mean rCBV value was 4.1 +/- 0.8 mL/100 g tissue in gray matter and 2.9 + 0.4 mL/100 g tissue in white matter. The rCBV and rCBF values of gray and white matter obtained from T2-weighted DSC-MRI with HASTE sequence were slightly lower than the published data calculated by gradient-echo sequence. We were able to perform absolute quantifications of the capillary blood volume and flow, using a HASTE sequence, which would not have been possible with a gradient-echo sequence. This technique provides a new method for estimating cerebral microvascular hemodynamics.

Comparison of iron oxide particles (AMI 227) with a gadolinium complex (Gd-DOTA) in dynamic susceptibility contrast MR imagings (FLASH and EPI) for both phantom and rat brain at 1.5 Tesla

The goal of the study was to compare, in phantom and normally perfused rat brain tissue, a superparamagnetic iron oxide particle-based contrast agent (AMI 227) with a low-molecular-weight gadolinium chelate, gadolinium tetraazacyclododecanetetraacetic acid (Gd-DOTA), in two susceptibility contrast magnetic resonance imaging (MRI) modes [fast low-angle shot sequence (FLASH) and echoplanar imaging (EPI)]. A phantom consisting of dilution series of both contrast agents was manufactured. Dilutions were obtained with isotonic serum from the available agent solutions (0.5 mmol Gd/mL Gd-DOTA; 350 mumol Fe/mL AMI 227). Eighteen rats were studied. Contrast agent (0.1 mL) was bolus injected in each rat, and dynamic MRI was performed (first pass of the contrast agent) in rat brain. The doses of AMI 227 injected were extrapolated from the phantom experiment: 0.2 mmol/kg body weight of Gd-DOTA and 7, 14, and 28 mumol Fe/kg body weight of AMI 227 were injected. For both sequences, signal-to-noise ratios (S/N) were measured on each tube of the phantom and on rat brain from each image of the dynamic imaging. S/N was plotted versus contrast dilution (phantom) and versus time (rats). In the FLASH sequence, a well-shaped curve (S/N decrease, S/N peak decrease, S/N increase) of the first pass of the contrast agent was demonstrated for Gd-DOTA and for AMI 227 (7 mumol Fe/kg body weight). In the EPI sequence, a well-shaped curve was demonstrated for Gd-DOTA, and a plateau effect was noted for both concentrations of AMI 227. With the FLASH technique, dynamic susceptibility contrast imaging of rat brain can be performed with very low concentrations of AMI 227 compared with the Gd-DOTA concentration (0.2 mmol Gd/kg body weight) used in clinical practice. This could be of interest in perfusion imaging, because it may allow for first-pass susceptibility imaging after administration of a small volume in a narrow bolus.

Hyperacute stroke: simultaneous measurement of relative cerebral blood volume, relative cerebral blood flow, and mean tissue transit time

PURPOSE

To investigate additional information provided by maps of relative cerebral blood flow in functional magnetic resonance (MR) imaging of human hyperacute cerebral ischemic stroke.

MATERIALS AND METHODS

Diffusion-weighted and hemodynamic MR imaging were performed in 23 patients less than 12 hours after the onset of symptoms. Maps of relative cerebral blood flow and tracer mean tissue transit time were computed, as were maps of apparent diffusion and relative cerebral blood volume. Acute lesion volumes on the maps were compared with follow-up imaging findings.

RESULTS

In 15 of 23 subjects (65%), blood flow maps revealed hemodynamic abnormalities not visible on blood volume maps. A mismatch between initial blood flow and diffusion findings predicted growth of infarct more often (12 of 15 subjects with infarcts that grew) than did a mismatch between initial blood volume and diffusion findings (eight of 15). However, lesion volumes on blood volume and diffusion maps correlated better with eventual infarct volumes (r > 0.90) than did those on blood flow and tracer mean transit time maps (r approximately 0.6), likely as a result of threshold effects. In eight patients, blood volume was elevated around the diffusion abnormality, suggesting a compensatory hemodynamic response.

CONCLUSION

MR imaging can delineate areas of altered blood flow, blood volume, and water mobility in hyperacute human stroke. Predictive models of tissue outcome may benefit by including computation of both relative cerebral blood flow and blood volume.

Early changes measured by magnetic resonance imaging in cerebral blood flow, blood volume, and blood-brain barrier permeability following dexamethasone treatment in patients with brain tumors

OBJECT

In this study the authors assessed the early changes in brain tumor physiology associated with glucocorticoid administration. Glucocorticoids have a dramatic effect on symptoms in patients with brain tumors over a time scale ranging from minutes to a few hours. Previous studies have indicated that glucocorticoids may act either by decreasing cerebral blood volume (CBV) or blood-tumor barrier (BTB) permeability and thereby the degree of vasogenic edema.

METHODS

Using magnetic resonance (MR) imaging, the authors examined the acute changes in CBV, cerebral blood flow (CBF), and BTB permeability to gadolinium-diethylenetriamine pentaacetic acid after administration of dexamethasone in six patients with brain tumors. In patients with acute decreases in BTB permeability after dexamethasone administration, changes in the degree of edema were assessed using the apparent diffusion coefficient of water.

CONCLUSIONS

Dexamethasone was found to cause a dramatic decrease in BTB permeability and regional CBV but no significant changes in CBF or the degree of edema. The authors found that MR imaging provides a powerful tool for investigating the pathophysiological changes associated with the clinical effects of glucocorticoids.

Crossed cerebellar diaschisis: assessment with dynamic susceptibility contrast MR imaging

The authors investigated the feasibility of using T2-weighted, half-Fourier rapid acquisition with relaxation enhancement, or RARE, dynamic susceptibility contrast magnetic resonance (MR) imaging to depict crossed cerebellar diaschisis. In 10 patients after unilateral supratentorial stroke, crossed cerebellar diaschisis was demonstrated in the relative regional cerebellar blood volume maps obtained with MR imaging. Cerebellar blood volume values for the nonaffected cerebellar hemisphere were significantly larger than those for the affected side (P = .0003).

CBF and CBV measurements by USPIO bolus tracking: reproducibility and comparison with Gd-based values

The authors measured cerebral blood flow (CBF) and cerebral blood volume (CBV) by bolus tracking of a novel ultrasmall superparamagnetic iron oxide (USPIO) contrast agent (NC100150) and compared absolute and relative perfusion measurements with those obtained by a standard gadolinium-based contrast agent. They found a linear correlation between the two methods. A dose of 0.4 mg Fe/kg body weight was found to produce a signal drop similar to that of a standard 0.2 mmol/kg gadodiamide injection using spin-echo echoplanar imaging (SE-EPI) at 1.0 T. The measurements showed a high degree of reproducibility of repeated absolute as well as relative CBF and CBV values, lending further hope to the possibility of using magnetic resonance bolus tracking for routine CBF and CBV measurements. Finally, the authors present their initial experience with high-resolution, non-EPI CBV maps obtained from steady-state levels of an intravascular superparamagnetic contrast agent.

Regional distribution of cerebral blood volume and cerebral blood flow in newborn piglets--effect of hypoxia/hypercapnia

The relationship between regional parenchymal cerebral blood volume (CBV), regional cerebral blood flow (CBF) and the calculated mean transit time (MTT) was investigated in 14 newborn piglets. The effects of combined hypoxic hypoxia (PaO2 = 32 +/- 5 mm Hg) and hypercapnia (paCO2 = 68 +/- 5 mm Hg) were measured in seven animals. Remaining animals served as the control group. During baseline conditions the highest CBF and CVB values were found in the lower brainstem and cerebellum, whereas white matter exhibited the lowest values (p < 0.05). MTT was prolonged within the cerebral cortex (2.34 +/- 0.42 s-1) compared with the thalamic MTT (1.53 +/- 0.38 s-1) (p < 0.05). Under moderate hypoxia/hypercapnia, a CBF increase to the forebrain (p < 0.05) resulted in an elevated brain oxygen delivery (p < 0.05) and so CMRO2 remained unchanged. Moreover, a moderate increase of CBV and a marked shortening of MTT occurred (p < 0.05). The CBV increase was higher in structures with lowest baseline values, i.e., thalamus (66% increase) and white matter (62% increase) (p < 0.05). MTT was between 22% of baseline in the lower brainstem and 49% in white matter (p < 0.05). We conclude that under normoxic and normocapnic conditions the newborn piglets exhibit a comparatively enlarged intraparenchymal CBV. Moderate hypoxia and hypercapnia induced a marked increase in cerebral blood flow which appears to be caused by an increased perfusion velocity, expressed by a strongly reduced mean transit time and by a concomitant CBV increase.

Fast acquisition of quantitative T2 maps

A rapid new technique called T2 fast acquisition relaxation mapping (T2 FARM) was developed to allow T2 maps to be reconstructed directly from k-space data acquired in 3 sec. A single acquisition measured two sets of k-space data, the first with T1 and T2 weighting independent of phase encode position, and the second with T2 weighting varying with phase encode position. These data were processed using an iterative least squares algorithm to produce a quantitative T2 map from the k-space data. T2 values of phantoms and an egg were determined from T2 FARM maps and spectroscopic Carr-Purcell-Meiboom-Gill (CPMG) measurements, demonstrating the validity of the new technique.

Comparison of the diagnostic information in relative cerebral blood volume, maximum concentration, and subtraction signal intensity maps based on magnetic resonance imaging of gliomas

RATIONALE AND OBJECTIVES

The authors investigate the validity of regional relative cerebral blood volume (rCBV) versus maximum concentration and subtraction signal intensity (SI) maps using simple reconstruction modes in patients with gliomas.

METHODS

Twenty-five patients were studied using a 1.5 T magnetic resonance imaging scanner. To calculate the rCBV map, the magnetic resonance susceptibility effect SI/time curves were first transformed into concentration/time curves; then a gamma-variate function was fitted and the area under the curve was integrated. From the concentration/time data, the maximum concentration (MAX) maps were calculated pixel per pixel as the maximum peak amplitude of the concentration/time curve. Subtraction (SUB) maps are a result of simple image subtraction of pixelwise baseline SI minus the highest peak of susceptibility change pixel per pixel. Region of interest means SI measurement of the different maps was compared using statistical t test correlation.

RESULTS

Normal gray to white matter contrast did not show a significant difference among the rCBV, MAX, and SUB maps. Based on statistical evaluation, the low-grade lesions did not differ significantly in the rCBV, MAX, and SUB maps. The group with high-grade lesions (12 patients) showed no significant difference in standardized rCBV, MAX, and SUB maps.

CONCLUSION

Compared to rCBV maps, the simple MAX and SUB maps demonstrated good correlation in both high-grade and low-grade gliomas. This simpler approach could establish first-pass reconstruction in clinical settings because it reduces the need for time-consuming postprocessing.

Cerebral blood flow measurements by magnetic resonance imaging bolus tracking: comparison with [(15)O]H2O positron emission tomography in humans

In six young, healthy volunteers, a novel method to determine cerebral blood flow (CBF) using magnetic resonance (MR) bolus tracking was compared with [(15)O]H2O positron emission tomography (PET). The method yielded parametric CBF images with tissue contrast in good agreement with parametric PET CBF images. Introducing a common conversion factor, MR CBF values could be converted into absolute flow rates, allowing comparison of CBF values among normal subjects.

Differentiation of gray matter and white matter perfusion in patients with unilateral internal carotid artery occlusion

In this study, we investigated differences between gray matter and white matter perfusion in patients with a unilateral occlusion of the internal carotid artery (ICA) with dynamic susceptibility contrast. Seventeen patients and 17 control subjects were studied, using T2*-weighted gradient echo acquisition. Gray and white matter regions were obtained by segmentation of inversion recovery MRI. Lesions were excluded by segmentation of T2-weighted MRI. In the symptomatic hemisphere, cerebral blood volume was increased in white matter (P < .05) but not in gray matter. No cerebral blood flow changes were found. All timing parameters (mean transit time [MTT], time of appearance, and time to peak) showed a significant delay for both white and gray matter (P < .05), but the MTT increase of white matter was significantly larger than for gray matter (P < .05). These findings indicate that differentiation between gray and white matter is essential to determine the hemodynamic effects of an ICA occlusion.

Magnetic resonance imaging of acute stroke

In the investigation of ischemic stroke, conventional structural magnetic resonance (MR) techniques (e.g., T1-weighted imaging, T2-weighted imaging, and proton density-weighted imaging) are valuable for the assessment of infarct extent and location beyond the first 12 to 24 hours after onset, and can be combined with MR angiography to noninvasively assess the intracranial and extracranial vasculature. However, during the critical first 6 to 12 hours, the probable period of greatest therapeutic opportunity, these methods do not adequately assess the extent and severity of ischemia. Recent developments in functional MR imaging are showing great promise for the detection of developing focal cerebral ischemic lesions within the first hours. These include (1) diffusion-weighted imaging, which provides physiologic information about the self-diffusion of water, thereby detecting one of the first elements in the pathophysiologic cascade leading to ischemic injury; and (2) perfusion imaging. The detection of acute intraparenchymal hemorrhagic stroke by susceptibility weighted MR has also been reported. In combination with MR angiography, these methods may allow the detection of the site, extent, mechanism, and tissue viability of acute stroke lesions in one imaging study. Imaging of cerebral metabolites with MR spectroscopy along with diffusion-weighted imaging and perfusion imaging may also provide new insights into ischemic stroke pathophysiology. In light of these advances in structural and functional MR, their potential uses in the study of the cerebral ischemic pathophysiology and in clinical practice are described, along with their advantages and limitations.

Absolute cerebral blood flow and blood volume measured by magnetic resonance imaging bolus tracking: comparison with positron emission tomography values

The authors determined cerebral blood flow (CBF) with magnetic resonance imaging (MRI) of contrast agent bolus passage and compared the results with those obtained by O-15 labeled water (H215O) and positron emission tomography (PET). Six pigs were examined by MRI and PET under normo- and hypercapnic conditions. After dose normalization and introduction of an empirical constant phi Gd, absolute regional CBF was calculated from MRI. The spatial resolution and the signal-to-noise ratio of CBF measurements by MRI were better than by the H215O-PET protocol. Magnetic resonance imaging cerebral blood volume (CBV) estimates obtained using this normalization constant correlated well with values obtained by O-15 labeled carbonmonooxide (C15O) PET. However, PET CBV values were approximately 2.5 times larger than absolute MRI CBV values, supporting the hypothesized sensitivity of MRI to small vessels.

Perfusion-weighted imaging defects during spontaneous migrainous aura

Perfusion- and diffusion-weighted magnetic resonance imaging was performed during spontaneous visual auras in four migraineurs. Alterations in relative cerebral blood flow (16-53% decrease), cerebral blood volume (6-33% decrease), and tissue mean transit time (10-54% increase) were observed in the gray matter of occipital cortex contralateral to the affected visual hemifield. No changes in the apparent diffusion coefficient were observed either while the patients were symptomatic or after resolution of the visual symptoms but before the onset of headache. Functional magnetic resonance imaging can be a useful noninvasive tool to study hemodynamic changes during spontaneous attacks of migraine with aura.

Measurement of changes in cerebral blood volume in spontaneously hypertensive rats following L-arginine infusion using dynamic susceptibility contrast MRI

To understand whether the NO-dependent vasodilator L-arginine was effective upon a chronically hypertensive cerebral capillary endothelium, dynamic susceptibility contrast MRI was used to measure the relative cerebral blood volume (rCBV) changes in nonischemic spontaneously hypertensive rats (SHRs). rCBV was measured in 11 rats at 4.7 T using fast gradient echo imaging with intravenous injection of Gd-DTPA. Images were acquired before, immediately after, and up to 90 min after the infusion of 300 mg/kg L-arginine (n = 7) or of an equivalent volume of saline (n = 4). L-arginine increased rCBV in cortex beginning 10 min after infusion and reached significance after 30 min (P < 0.01), reached a peak of 1.24 +/- 0.06 (mean +/- SEM) times pre-injection level after 50 min, and was sustained throughout the 90 min observation period. In contrast, the rCBV in the deeper gray matter (striatum) showed no statistically significant change over the 90 min observation period. While this is consistent with previous studies showing that L-arginine infusion can directly modulate vascular tone and cerebral hemodynamics, it demonstrates that the effect is present only in cortex, and that it can occur also in the setting of a disturbed capillary endothelium.

Regional relative blood volume MR maps of meningiomas before and after partial embolization

PURPOSE

Our goal was to evaluate the role of relative blood volume (rBV) measurements in monitoring the embolization effect in meningiomas by using maps of susceptibility-weighted first pass MR data.

METHOD

Eighteen examinations of nine patients before and following partial embolization were performed on a 1.5 T scanner. Embolization was achieved by injection of particles (45-150 microns). During dynamic imaging a bolus (0.2 mmol/kg) of gadopentetate dimeglumine was injected.

RESULTS

The tumor rBV/gray matter rBV ratio was 3.11 +/- 1.40 for untreated tumors and 0.12 +/- 0.09 for successfully embolized tumors. The regional rBV in embolized meningiomas was significantly lower than that in untreated meningiomas (t test, p < 0.001). Vital tumor tissue showed positive enhancement in T1 and high rBV; nonvital tissue lacked T1 enhancement and bolus effect in the first pass, thus leading to low or missing rBV values. However, we also observed lack of bolus formation despite T1 enhancement (6/9 postembolization regions), possibly due to slow collateral flow. One of the patients treated with embolization bled during surgery.

CONCLUSION

Maps of relative regional cerebral BV provide hemodynamic information in meningiomas and monitor the treatment effect of embolization in meningiomas more precisely than T1-weighted contrast-enhanced imaging.

Evaluation of peri-infarcted hypoperfusion with T2*-weighted dynamic MRI

The purpose of this study was to evaluate cerebral perfusion with T2*-weighted dynamic MRI in the area around the infarcted core. We examined seven patients with subacute cerebral infarction. After bolus injection a gadopentetate dimeglumine, a series of gradient-echo images were recorded in a selected slice. From these images, concentration-time curves were created on a region-of-interest (ROI) basis around infarction for calculating relative regional cerebral blood volume (rrCBV). Brain perfusion single photon emission computed tomography (SPECT) study also was performed with intravenous injection of 123I-labeled N-isopropyl-p-iodoamphetamine (123I-IMP). All patients showed prolonged signal decrease in the area around the infarcted core. ROI analysis showed significantly increased rrCBV compared to the normal side (P < .01, paired t test). The 123I-IMP SPECT study showed that these areas had decreased cerebral blood flow. Theses findings suggest compensatory vascular dilatation due to decreased perfusion pressure. T2*-weighted dynamic MRI is a useful method for detecting compensatory vasodilatation of ischemic insult in the peri-infarcted area.

An efficient and robust PC program to calculate MR based regional cerebral blood volume maps

In addition to morphological and anatomical information, functional information is increasingly used in clinical routine to assess pathological alterations of the brain. In addition to nuclear-medical methods there is a growing interest in using magnetic resonance imaging (MRI) to investigate tissue perfusion of the brain. The method employed is based on the indicator-dilution method after bolus injection of a contrast agent. In this paper we present the implementation of an efficient algorithm to calculate quantitatively the regional cerebral blood volume (rCBV). Computation requires about 1 min on a Macintosh Quadra 660AV. The results are represented as parameter images that allow global overall visual inspection as well as quantitative local evaluation by means of user-defined regions of interest.

Contrast agents in functional MR imaging

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

Accuracy of gamma-variate fits to concentration-time curves from dynamic susceptibility-contrast enhanced MRI: influence of time resolution, maximal signal drop and signal-to-noise

Concentration-time curves derived from dynamic susceptibility-contrast enhanced magnetic resonance imaging are widely used to calculate cerebrovascular parameters. To exclude effects of recirculation, a non-linear regression method is used to fit a gamma-variate function to the concentration-time course. In previous studies the errors arising from the fitting procedure have not been quantified. In a computer simulation we investigate the uncertainties of parameters calculated from the fitted gamma-variate function, exploring the dependencies on signal-to-noise (SNR), time resolution (delta t), and maximal signal drop (MSD). Our study was performed to give a framework on how to design MR-sequences and choose contrast media and their application in order to yield concentration-time curves which allow a reliable performance of the gamma-variate fitting procedure. We recorded 396 concentration-time curves from regions of interest of 40 patients. The gamma-variate fitting procedure was applied to these curves resulting in 396 parameter sets. Ideal concentration-time curves as gamma-variate functions were generated from these sets with a given delta t, MSD, and SNR. Recirculation effect was simulated. Then the gamma-variate fitting was performed again. From ideal and simulated gamma-variate function the area and the normalized first moment were calculated. The uncertainties of the values calculated from the simulated curve relating to the values of the original one were determined. Increase of SNR decreases the involved errors. With SNR values of 100 and more there is only minor influence of delta t and MSD and the fitted curve approximates the original data very well. Smaller values of SNR lead to a stronger influence of delta t and MSD and a higher number of fitting failures. With increasing delta t the uncertainties also increase. Intermediate values of MSD (30% to 70%) yield the smallest errors while increasing or decreasing MSD yields an increase of uncertainty. To achieve low uncertainties in the calculation of cerebrovascular parameters from gamma-variate fits, delta t of the imaging sequence and MSD must be considered. This is more important the lower SNR is. The shown dependencies should be taken into account when choosing MR sequence parameters and application of contrast media.

High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part II: Experimental comparison and preliminary results

This report evaluates several methods to map relative cerebral blood flow (rCBF) by applying both parametric and nonparametric techniques to deconvolve high resolution dynamic MRI measurements of paramagnetic bolus passages with noninvasively determined arterial inputs. We found a nonparametric (singular value decomposition (SVD)) deconvolution technique produced the most robust results, giving mean gray:white flow ratio of 2.7 +/- 0.5 (SEM) in six normal volunteers, in excellent agreement with recent PET literature values for age-matched subjects. Similar results were obtained by using a model-dependent approach that assumes an exponential residue function, but not for a Gaussian-shaped residue function or for either Fourier or regularization-based model-independent approaches. Pilot studies of our CBF mapping techniques in patients with tumor, stroke, and migraine aura demonstrated that these techniques can be readily used on data routinely acquired by using current echo planar imaging technology. By using these techniques, the authors visualized important regional hemodynamic changes not detectable with rCBV mapping algorithms.

High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part I: Mathematical approach and statistical analysis

The authors review the theoretical basis of determination of cerebral blood flow (CBF) using dynamic measurements of nondiffusible contrast agents, and demonstrate how parametric and nonparametric deconvolution techniques can be modified for the special requirements of CBF determination using dynamic MRI. Using Monte Carlo modeling, the use of simple, analytical residue models is shown to introduce large errors in flow estimates when actual, underlying vascular characteristics are not sufficiently described by the chosen function. The determination of the shape of the residue function on a regional basis is shown to be possible only at high signal-to-noise ratio. Comparison of several nonparametric deconvolution techniques showed that a nonparametric deconvolution technique (singular value decomposition) allows estimation of flow relatively independent of underlying vascular structure and volume even at low signal-to-noise ratio associated with pixel-by-pixel deconvolution.

Cerebrovascular changes in rats during ischemia and reperfusion: a comparison of BOLD and first pass bolus tracking techniques

Both first pass bolus tracking of a susceptibility contrast agent and blood oxygenation level dependent (BOLD) sequences provide information on the tissue perfusion and the cerebral blood volume, but each sequence has its own particular limitations. In this article, both techniques were used to assess the cerebrovascular changes occurring in a rat model of focal cerebral ischemia with reperfusion after 2 h of ischemia. The blood oxygenation level dependent studies were performed before, during, and after 60 s of anoxia to observe the response of the tissue to a respiratory challenge. Both techniques were able to detect ischemia and reperfusion; however, first pass bolus tracking provided better sensitivity and was easier to interpret. Because the blood oxygenation level dependent sequence did not provide any additional information, bolus tracking would appear to be the method of choice for studies of cerebral ischemia with reperfusion.

Comparison of MR perfusion imaging and microsphere measurements of regional cerebral blood flow in a rat model of middle cerebral artery occlusion

The purpose of this investigation was to correlate magnetic resonance (MR) perfusion measurements with absolute regional cerebral blood flow (rCBF) in a rat model of focal ischemia. The MR perfusion measurements were made using dynamic first-pass bolus tracking of a susceptibility contrast agent, whereas rCBF was measured using radioactive microspheres. Two simple MR perfusion parameters, the maximum change in R2* (m delta R2*) and time delay to m delta R2* (t delta R2*), were derived from the signal intensity versus time curves on a pixel-to-pixel basis, without applying curve-fitting procedures or tracer kinetic theory. In each hemisphere, m delta R2* and t delta R2* were compared with the rCBF measurements in four selected regions of interest. Sixteen MR bolus tracking series were performed in 12 rats with occlusion of the middle cerebral artery. In all of the individual series there was a significant correlation (.0001 < or = p < or = .02) between m delta R2* and the microsphere rCBF measurements, with correlation coefficients ranging from .784 to .983. Pooling the m delta R2* data resulted in a correlation coefficient of .809 (p = .0001). There was a nonlinear correlation between the t delta R2* and rCBF. For both parameters there was considerable variation between different measurements regarding both the slope of the regression line and its intercept with the y-axis. Our results justify the use of m delta R2* as a relative measure of perfusion during acute cerebral ischemia. Because of the interindividual variation, calibration of MR perfusion measurements for the estimation of absolute flow values must be considered unreliable. The t delta R2* may have physiological relevance as a marker of collateral flow.

Sequential dynamic susceptibility contrast MR experiments in human brain: residual contrast agent effect, steady state, and hemodynamic perturbation

The stability and reproducibility of the dynamic susceptibility contrast (DSC) MRI method for sequential relative cerebral blood volume (relCBV) measurements was evaluated to validate the method for use in quantitative studies of cerebral hemodynamics in humans. A spin echo echo planar imaging protocol was used in conjunction with multiple bolus injections of the susceptibility contrast agent gadoteridol (GD). The effects of variation in interbolus interval (10 min to 4 h), the number of injections (two to four), and the effect of the cerebral vasodilating agent acetazolamide (ACZ) were evaluated in 44 experiments performed with 22 normal subjects. Two fundamental observations were made. First, with multiple injections of GD, the change in MR signal over time was not consistent from first to subsequent boluses. A second bolus administered 10 min to 2 h after an initial bolus resulted in signal change of greater amplitude and duration, resulting in artifactually elevated estimates of relCBV, consistent with a residual effect of GD. Second, a relative steady state could be reached with serial injections of GD, such that the profile of subsequent boluses closely paralleled those of previous ones. This facilitates the reliable measurement of relCBV during activation, as demonstrated by use of ACZ.

Regional comparison of tumor vascularity and permeability parameters measured by albumin-Gd-DTPA and Gd-DTPA

Sequential albumin-Gd-DTPA and Gd-DTPA dynamic enhancement studies were performed in an animal tumor model for the comparison of regional vascularity and permeability parameters measured by these two different sizes of contrast agents. The early albumin-Gd-DTPA enhancement arises from the vascular compartment, and the averaged signal enhancement derived from the first 3 to first 6 images postinjection can be reliably used to assess vascularity. The signal intensity in the images during the period of 5-10 min post-albumin-Gd-DTPA injection shows a steady linear variation. The intercept of the linear relationship is another indicator of the vascularity and the slope represents the tumor permeability to albumin-Gd-DTPA. The Gd-DTPA enhancement study was analyzed by a two-compartmental pharmacokinetic model to calculate the regional vascularity and permeability. The permeability parameters measured from albumin-Gd-DTPA and Gd-DTPA show an excellent correlation. The vascularity parameters measured from albumin-Gd-DTPA show good linear correlation with the low vascularity groups measured by Gd-DTPA, but show saturation for the high vascularity groups. The enhancement mechanisms for both contrast agents are discussed to relate the imaging parameters to the physiological variables.

Perfusion and diffusion-weighted MR imaging for in vivo evaluation of treatment with U74389G in a rat stroke model

BACKGROUND AND PURPOSE

The present study was performed to examine the potential of diffusion-weighted (DW) imaging and dynamic first-passage bolus tracking of susceptibility contrast agents (perfusion imaging) for early in vivo evaluation of the effects of treatment with the free radical scavenger U74389G in a rat model of temporary focal ischemia.

METHODS

After 45 minutes of middle cerebral artery occlusion, the treatment group (n = 9) received an infusion of U74389G, and the control group (n = 9) received the identical volume of the vehicle. Reperfusion was instituted in both groups after 120 minutes of middle cerebral artery occlusion. The DW images were collected during middle cerebral artery occlusion and reperfusion and were compared with histologically assessed areas of tissue injury after 2 hours of reperfusion. The dynamic perfusion series were processed on a pixel-to-pixel basis to produce parametric maps reflecting the maximum reduction in the signal obtained during the first passage of the contrast agent and the time delay between the arrival of the bolus and the point of maximum contrast-agent effect.

RESULTS

The area of ischemic injury, as assessed from the DW imaging at 60 minutes of reperfusion, was significantly smaller in the treatment group: 9 +/- 8% of ipsilateral hemisphere compared with 19 +/- 8% in the control group. The histological examination after 2 hours of reperfusion demonstrated an area of ischemic injury of 10 +/- 8% for the treatment group compared to 25 +/- 10% in the control group. In the treatment group, the perfusion imaging showed a reduction in time delay to maximum effect of the contrast agent in the ischemic hemisphere compared with the control group.

CONCLUSIONS

The DW imaging during early reperfusion showed a protective effect of postocclusion treatment with the free radical scavenger U74389G. The improvement of time delay to maximum effect of the contrast agent observed in the perfusion imaging of the treatment group may reflect an improvement in the collateral flow to the ischemic tissue.

Magnetic resonance imaging using deoxyhemoglobin contrast versus positron emission tomography in the assessment of brain function

1. Function of the brain can be assessed through radiologic imaging to determine physiology of underlying tissue. 2. Until recently, positron emission tomography has been the standard tool with which to study function. 3. In the past few years, several investigators have attempted to use magnetic resonance imaging, which has better resolution and is less expensive, to provide functional information. 4. A noninvasive technique termed BOLD (blood oxygen level dependent) has become a popular area of research to determine physiologic change that occurs in the brain in resting as well as activated states. 5. This article reviews what information PET has given us with regard to function of the brain, followed by a discussion of the principle of functional MRI of the brain with emphasis on what has been done in this field as well as future application of the technique.

A single-step method for estimation of local cerebral blood volume from susceptibility contrast MRI images

A new single-step method is described for estimation of local cerebral blood volume (CBV) from multiple rapidly acquired T2- or T2*-weighted MRI images after bolus administration of a susceptibility contrast agent. This method improves on existing methods in three ways. First, the method includes the baseline scan intensity value as a fitted parameter. Second, the model is fitted directly to the original scan intensity values instead of to transformed concentration curves, avoiding the propagation of errors that occurs in the transformation. Third, the equations are reparameterized with CBV fitted directly as a model parameter. Parameter estimation methods are compared by Monte Carlo simulation. The direct method described here yields more precise parameter estimates, with smaller mean absolute deviations from the true parameter values, than the existing method when compared using simulated data. Implementation is discussed and numerical evaluation of the Digamma or Psi function is described.

Quantification of regional blood volumes by rapid T1 mapping

A new method is presented for the quantitative determination of regional blood volumes in vivo. It is based on rapid quantitative T1 mapping by Snapshot FLASH MRI combined with the injection of an intravascular MR contrast agent. Regional blood volumes in four different tissues of the rat (skeletal muscle, heart, liver, kidney) were determined in an in vivo experiment.

Pitfalls in MR measurement of tissue blood flow with intravascular tracers: which mean transit time?

Measuring tissue blood flow with NMR imaging of intravascular tracers is more difficult than measurements of tissue blood volume. One major obstacle to the application of the Central Volume Principle is the direct measurement of the mean transit time. In this note, we demonstrate that mean transit time (MTT), which relates tissue blood volume to blood flow via the Central Volume Principle, is not the first moment of the concentration-time curve for MR or CT imaging of purely intravascular tracers. However, while first moment methods cannot be used by themselves to determine absolute flow, we show that transit curves may provide a useful relative measure of flow, for example, by considering ratios of the first moments.

Measurement of cerebrovascular changes in cats after transient ischemia using dynamic magnetic resonance imaging

BACKGROUND AND PURPOSE

Hemodynamic changes associated with acute ischemia cannot be measured with conventional nuclear magnetic resonance imaging. In this study, we used dynamic susceptibility-contrast magnetic resonance imaging to measure the changes in vascular transit time and relative cerebral blood volume in a feline occlusion-reperfusion model.

METHODS

Dynamic susceptibility-contrast measurements were obtained before and during 10 minutes of global cerebral ischemia and for up to 3 hours after the onset of reperfusion. A cerebral blood flow index was calculated from the vascular transit time and relative cerebral blood volume measurements. Functional maps were constructed to demonstrate the regional hemodynamic differences resulting from the induced ischemia.

RESULTS

During the early phase after reperfusion, both the relative cerebral blood volume and blood flow index rose sharply, followed by a fall to near-basal levels at 45 minutes (1 x control and 1.3 x control, respectively). Thereafter, the volume rose slowly, whereas the flow index continued to drop. At 3 hours, cerebral blood volume had reached 1.6 times its control value, whereas the flow index had returned to its base value.

CONCLUSIONS

The hemodynamic behavior we observed in our model reflects the independent responses of the cerebral blood volume and flow index to ischemic insult. Measurements acquired by our method were consistent with the temporal behavior reported in previous radionuclide studies. Susceptibility-contrast nuclear magnetic resonance tomographic imaging proved to be valuable in detecting and quantifying both immediate and subsequent changes in the hemodynamic state of the ischemic and hyperemic feline brain.

The sensitivity of magnetic resonance image signals of a rat brain to changes in the cerebral venous blood oxygenation

The sensitivity of magnetic resonance image signals of the brain to the change in the cerebral blood oxygenation was measured in gradient echo images of rat brains at a field strength of 7 T. The sensitivity depended on the blood vessel volume relative to the tissue volume within the image voxel, and signal intensities in the cortical area were well correlated with the change in the venous blood de-oxygenation level at the sagittal sinus. Tissue signals in the image (15 ms echo time) showed a sensitivity of 10-20% change for the full range of deoxygenation level from 0-100%. From these observations and image simulations, the extent of the signal response to some neuro-stimulation which induces an increase in regional cerebral blood flow has been estimated for 4 T field strength.

Aqueous shift reagents for high-resolution cation NMR. VI. Titration curves for in vivo 23Na and 1H2O MRS obtained from rat blood

Frequency shift/concentration calibration curves applicable to the use of shift reagents (SRs) for in vivo 23Na MRS studies can be obtained from experiments with whole blood. Here, they are reported for titrations of rat blood with the SRs DyTTHA3- and TmDOTP5-. There are a number of considerations that must be made in order to derive accurate calibration curves from the experimental data. These include the effects of bulk magnetic susceptibility (BMS, since the SRs are paramagnetic), the effects of water flux (since addition of the SR stock solution to blood renders the plasma hyperosmotic), and the consequences of restricted distribution of the SR anion in the erythrocyte suspension. We give in some detail the BMS shift theory that obtains in this case and show also how it applies to excised perfused organ as well as in vivo studies. Also, we report significant effects of adjuvant Ca2+ additions in the TmDOTP5- titrations. These are very important to the successful use of this SR in vivo. Finally, our considerations of BMS lead naturally to an understanding of its manifestations in the shifts of the 1H2O resonance frequencies of cell suspensions and tissues induced by SRs. Since these are being increasingly reported, and often misinterpreted, we devote an experiment and some discussion to this subject. We show that this phenomenon cannot be used to quantitatively discriminate intra- and extracellular 1H2O signals.

Superparamagnetic iron oxide particles and positive enhancement for myocardial perfusion studies assessed by subsecond T1-weighted MRI

Superparamagnetic iron oxide particles (SPIOs) are usually referred to as T2 MR contrast agents, reducing signal intensity (SI) on T2-weighted MR images (negative enhancement). This study reports the original use of SPIOs as T1-enhancing contrast agents, primarily assessed in vitro, and then applied to an in vivo investigation of a myocardial perfusion defect. Using a strongly T1-weighted subsecond MR sequence with SPIOs intravenous (IV) bolus injection, MR imaging of myocardial vascularization after reperfusion was performed, on a dog model of coronary occlusion followed by reperfusion. Immediately after the intravenous bolus injection of 20 mumol/kg of SPIOs, a positive signal intensity enhancement was observed respectively, in the right and left ventricular cavity and in the nonischemic left myocardium. Moreover, compared to normal myocardium, the remaining ischemic myocardial region (anterior wall of the left ventricle) appeared as a lower and delayed SI enhancing area (cold spot). Mean peak SIE in the nonischemic myocardium (posterior wall) was significantly higher than in the ischemic myocardium (anterior wall) (110 +/- 23% vs. 74 +/- 22%, Mann-Whitney test alpha < 1%, n1 = 6, n2-n1 = 0, U > 2). In conclusion, the T1 effect of SPIOs at low dose, during their first intravascular distribution, suggests their potential use as positive markers to investigate the regional myocardial blood flow and some perfusion defects such as the "no-reflow phenomenon."

A new frontier of blood imaging using susceptibility effect and tailored RF pulses

In MRI, image contrast can be controlled by use of the susceptibility effect if an object contains paramagnetic substances. The localized linear gradient dephases spins in the voxel, leading to phase cancellation and thus reduced signal. This signal void phenomenon, can be exploited if the intrinsic linear gradient is either enhanced or compensated by externally applied RF generated phase distributions. In this paper, a new concept which utilizes the susceptibility effect through the use of tailored RF pulses is proposed. As potential applications of the method, two different types of tailored RF pulses are introduced: one for the enhancement of the susceptibility effect and the other for the correction of the susceptibility artifact, respectively. The former, for example, can be applied to angiography utilizing the paramagnetic property of deoxygenated blood, suggesting a new avenue for the angiography which, for the first time, is not based on flow, although the method is currently limited to imaging of venous blood or venography. Both a theoretical study of the method and experimental results are reported.

Atraumatic quantitation of cerebral perfusion in cats by 19F magnetic resonance imaging

We have noninvasively produced low-resolution, quantitative nuclear magnetic resonance images of cerebral blood flow in 2-ml voxels in eight cats. Typical signal-to-noise of 4 to 1 was obtained in cerebral voxels in 16.5-s epochs. Mean flow during normocapnia (paCO2 = 39 +/- 4 mm Hg) and hypercapnia (paCO2 = 62 +/- 4 mm Hg) was 53 +/- 20 ml/100 g-min and 140 +/- 36 ml/100 g-min, respectively. Fast flows in normocapnia were 94 +/- 13 and 182 +/- 39 ml/100 g-min in hypercapnia. These results suggest that an atraumatic quantitative imaging assessment of cerebral perfusion may be possible in humans using these techniques.

Evaluation of experimental early acute cerebral ischemia before the development of edema: use of dynamic, contrast-enhanced and diffusion-weighted MR scanning

The ability of dynamic, contrast-enhanced, magnetic susceptibility-weighted scanning to delineate early experimental acute cerebral infarction was compared with that of heavily T2-weighted and diffusion-weighted spin echo scanning. Spontaneously hypertensive rats, which had undergone right middle cerebral artery occlusion, were studied from 15 min to 3 h post ligation on a 1.5-T clinical whole-body imager. In contrast to the diffusion- and T2-weighted spin echo scans, the dynamic, contrast-enhanced technique clearly and consistently delineated the nonperfused regions as early as 15 min post ligation.

Ultrafast MR imaging of water mobility: animal models of altered cerebral perfusion

"Single shot" magnetic resonance (MR) diffusion imaging was used to study the details of signal decay curves in experimental perturbations of cerebral perfusion induced by hypercapnia or death. Despite large perfusion increases observed with dynamic susceptibility-contrast MR imaging, no correlation with these changes was seen in either the diffusion coefficient or any other intravoxel incoherent motion (IVIM) model parameters in dog gray matter as arterial carbon dioxide pressure increased. Non-monoexponential signal decay in cat gray matter was seen both before and after death. In addition, cat gray matter demonstrated a steady decrease in the diffusion coefficient after death. These data are strong evidence that the fast component of the non-monoexponential diffusion-related signal decay is not due solely to perfusion. The authors believe that a second compartment of nonexchanging spins, most likely cerebrospinal fluid, accounts for the non-monoexponential decay.

Susceptibility contrast imaging of cerebral blood volume: human experience

Magnetic resonance (MR) can offer a unique window on the structure/function relationships in the brain, by utilizing the established link between tissue function, metabolism, and hemodynamics. This report focuses on recent applications of MR-based cerebral blood volume (CBV) imaging in humans. Our methodology uses high-speed "single-shot" or echo planar imaging techniques, which provide the necessary temporal resolution for mapping the rapid cerebral transit of contrast agents. These MR CBV mapping techniques have been used to study normal human brain task activation and in the clinical study of patients with brain tumors. In the latter, positron emission tomography imaging was used for functional metabolic and CBV correlation. Susceptibility contrast CBV imaging should allow us to improve our understanding of the relationship between the detailed physiology and morphology of the microvascular bed and functional attributes of the brain. These techniques can be applied to understanding fundamental questions of cognitive neuroscience and can aid in improving diagnostic sensitivity and specificity in various neuropathologies.