Tissue sodium concentration in human brain tumors as measured with 23Na MR imaging

Quantitative sodium MRI of the mouse prostate

A method was developed for quantitative sodium MRI of the mouse prostate at 9.4 T. A small loop-gap radiofrequency coil was constructed and dual-tuned to both the proton and sodium frequencies. The location and boundary of the mouse prostate were localized using high-resolution T(2)-weighted proton images, and sodium images were acquired with 1mm isotropic resolution using a short echo time (0.6 ms) and a long pulse repetition time (300 ms) for sodium density weighting with minimal T(1) and T(2) contrast. Sodium concentration in the prostate was estimated by comparing pixel intensities within the prostate to the pixel intensities in a pair of reference vials with known sodium concentrations, and a radiofrequency field inhomogeneity correction was performed based on field maps of a homogeneous phantom. In a group of five healthy, 5-month-old BALB/c mice, the average sodium concentration within their prostates was measured to be 173 +/- 38 mM. Muscle tissue and bladder were also clearly visible in the sodium images, and their sodium concentrations were estimated to be 40 +/- 15 mM and 210 +/- 72 mM, respectively.

Molecular imaging of cancer: MR spectroscopy and beyond

Proton magnetic resonance spectroscopic imaging is a non-invasive diagnostic tool for the investigation of cancer metabolism. As an adjunct to morphologic and dynamic magnetic resonance imaging, it is routinely used for the staging, assessment of treatment response, and therapy monitoring in brain, breast, and prostate cancer. Recently, its application was extended to other cancerous diseases, such as malignant soft-tissue tumours, gastrointestinal and gynecological cancers, as well as nodal metastasis. In this review, we discuss the current and evolving clinical applications of proton magnetic resonance spectroscopic imaging. In addition, we will briefly discuss other evolving techniques, such as phosphorus magnetic resonance spectroscopic imaging, sodium imaging and diffusion-weighted imaging in cancer assessment.

Sodium MRI using a density-adapted 3D radial acquisition technique

A density-adapted three-dimensional radial projection reconstruction pulse sequence is presented which provides a more efficient k-space sampling than conventional three-dimensional projection reconstruction sequences. The gradients of the density-adapted three-dimensional radial projection reconstruction pulse sequence are designed such that the averaged sampling density in each spherical shell of k-space is constant. Due to hardware restrictions, an inner sphere of k-space is sampled without density adaption. This approach benefits from both the straightforward handling of conventional three-dimensional projection reconstruction sequence trajectories and an enhanced signal-to-noise ratio (SNR) efficiency akin to the commonly used three-dimensional twisted projection imaging trajectories. Benefits for low SNR applications, when compared to conventional three-dimensional projection reconstruction sequences, are demonstrated with the example of sodium imaging. In simulations of the point-spread function, the SNR of small objects is increased by a factor 1.66 for the density-adapted three-dimensional radial projection reconstruction pulse sequence sequence. Using analytical and experimental phantoms, it is shown that the density-adapted three-dimensional radial projection reconstruction pulse sequence allows higher resolutions and is more robust in the presence of field inhomogeneities. High-quality in vivo images of the healthy human leg muscle and the healthy human brain are acquired. For equivalent scan times, the SNR is up to a factor of 1.8 higher and anatomic details are better resolved using density-adapted three-dimensional radial projection reconstruction pulse sequence.

Astrocytes within multiple sclerosis lesions upregulate sodium channel Nav1.5

Astrocytes are prominent participants in the response of the central nervous system to injury, including neuroinflammatory insults. Rodent astrocytes in vitro have been shown to express voltage-gated sodium channels in a dynamic manner, with a switch in expression of tetrodotoxin-sensitive to tetrodotoxin-resistant channels in reactive astrocytes. However, the expression of sodium channels in human astrocytes has not been studied, and it is not known whether there are changes in the expression of sodium channels in reactive astrocytes of the human central nervous system. Here, we demonstrate a focal and robust upregulation of sodium channel Nav1.5 in reactive astrocytes at the borders of, and within, active and chronic multiple sclerosis lesions. Nav1.5 was only detectable at very low levels in astrocytes within multiple sclerosis macroscopically normal-appearing white matter or in normal control brain. Nav1.1, Nav1.2, Nav1.3 and Nav1.6 showed little or no expression in astrocytes within normal control tissue and limited upregulation in active multiple sclerosis lesions. Nav1.5 was also expressed at high levels in astrocytes in tissue surrounding new and old cerebrovascular accidents and brain tumours. These results demonstrate the expression of Nav1.5 in human astrocytes and show that Nav1.5 expression is dynamic in these cells. Our observations suggest that the upregulated expression of Nav1.5 in astrocytes may provide a compensatory mechanism, which supports sodium/potassium pump-dependent ionic homoeostasis in areas of central nervous system injury.

Reduction of B(0) inhomogeneity effects in triple-quantum-filtered sodium imaging

Triple-quantum (TQ) filtered sodium MR imaging has been proposed for separation of sodium signal arising from different physiological compartments. In a three-pulse sequence without refocussing pulse, the TQ signal is strongly sensitive to inhomogeneities of the B(0) field. We examine the dependence of the TQ signal intensity on the sequence parameters and propose a modified phase-cycling scheme to improve image quality. A new method for correction of B(0) inhomogeneity artefacts in TQ filtered sodium imaging is presented which requires only two acquisitions to obtain a correction as far as the B(0) inhomogeneity and the pulse widths are not too large. The method was verified in phantom experiments.

Brain tissue sodium concentration in multiple sclerosis: a sodium imaging study at 3 tesla

Neuro-axonal degeneration occurs progressively from the onset of multiple sclerosis and is thought to be a significant cause of increasing clinical disability. Several histopathological studies of multiple sclerosis and experimental autoimmune encephalomyelitis have shown that the accumulation of sodium in axons can promote reverse action of the sodium/calcium exchanger that, in turn, leads to a lethal overload in intra-axonal calcium. We hypothesized that sodium magnetic resonance imaging would provide an indicator of cellular and metabolic integrity and ion homeostasis in patients with multiple sclerosis. Using a three-dimensional radial gradient-echo sequence with short echo time, we performed sodium magnetic resonance imaging at 3 T in 17 patients with relapsing-remitting multiple sclerosis and in 13 normal subjects. The absolute total tissue sodium concentration was measured in lesions and in several areas of normal-appearing white and grey matter in patients, and corresponding areas of white and grey matter in controls. A mixed model analysis of covariance was performed to compare regional tissue sodium concentration levels in patients and controls. Spearman correlations were used to determine the association of regional tissue sodium concentration levels in T(2)- and T(1)-weighted lesions with measures of normalized whole brain and grey and white matter volumes, and with expanded disability status scale scores. In patients, tissue sodium concentration levels were found to be elevated in acute and chronic lesions compared to areas of normal-appearing white matter (P < 0.0001). The tissue sodium concentration levels in areas of normal-appearing white matter were significantly higher than those in corresponding white matter regions in healthy controls (P < 0.0001). The tissue sodium concentration value averaged over lesions and over regions of normal-appearing white and grey matter was positively associated with T(2)-weighted (P < or = 0.001 for all) and T(1)-weighted (P < or = 0.006 for all) lesion volumes. In patients, only the tissue sodium concentration value averaged over regions of normal-appearing grey matter was negatively associated with the normalized grey matter volume (P = 0.0009). Finally, the expanded disability status scale score showed a mild, positive association with the mean tissue sodium concentration value in chronic lesions (P = 0.002), in regions of normal-appearing white matter (P = 0.004) and normal-appearing grey matter (P = 0.002). This study shows the feasibility of using in vivo sodium magnetic resonance imaging at 3 T in patients with multiple sclerosis. Our findings suggest that the abnormal values of the tissue sodium concentration in patients with relapsing-remitting multiple sclerosis might reflect changes in cellular composition of the lesions and/or changes in cellular and metabolic integrity. Sodium magnetic resonance imaging has the potential to provide insight into the pathophysiological mechanisms of tissue injury when correlation with histopathology becomes available.

In vivo(39)K, (23)Na and (1)H MR imaging using a triple resonant RF coil setup

The maintenance of a gradient of potassium and sodium ions across the cell membranes is essential for the physiological function of the mammal organism. The measurement of the spatial distribution of pathologically changing ion concentrations of (23)Na and (39)K with magnetic resonance imaging offers a promising approach in clinical diagnostics to measure tissue viability. Existing studies were focused mainly on (23)Na imaging as well as spectroscopy with only one post-mortem study for (39)K imaging. In this paper a triple resonant RF coil setup for the rat head at 9.4T is presented for imaging of both nuclei ((23)Na and (39)K) and the acquisition of anatomical proton images in the same experiment without moving the subject or the RF coil. In vivo MR images of (39)K and (23)Na in the rat brain were acquired as well as anatomical proton images in the same scanning session.

Parallel imaging with 3D TPI trajectory: SNR and acceleration benefits

Three-dimensional (3D) twisted projection imaging (TPI) trajectory has a unique advantage in sodium ((23)Na) imaging on clinical MRI scanners at 1.5 or 3 T, generating a high signal-to-noise ratio (SNR) with a short acquisition time (approximately 10 min). Parallel imaging with an array of coil elements transits SNR benefits from small coil elements to acquisition efficiency by sampling partial k-space. This study investigates the feasibility of parallel sodium imaging with emphases on SNR and acceleration benefits provided by the 3D TPI trajectory. Computer simulations were used to find available acceleration factors and noise amplification. Human head studies were performed on clinical 1.5/3-T scanners with four-element coil arrays to verify simulation outcomes. In in vivo studies, proton ((1)H) data, however, were acquired for concept-proof purpose. The sensitivity encoding (SENSE) method with the conjugate gradient algorithm was used to reconstruct images from accelerated TPI-SENSE data sets. Self-calibration was employed to estimate coil sensitivities. Noise amplification in TPI-SENSE was evaluated using multiple noise trials. It was found that the acceleration factor was as high as 5.53 (corresponding to acceleration number 2 x 3, ring-by-rotation), with a small image error of 6.9% when TPI projections were reduced in both polar (ring) and azimuthal (rotation) directions. The average noise amplification was as low as 98.7%, or 27% lower than Cartesian SENSE at that acceleration factor. The 3D nature of both TPI trajectory and coil sensitivities might be responsible for the high acceleration and low noise amplification. Consequently, TPI-SENSE may have potential advantages for parallel sodium imaging.

Proton, diffusion-weighted imaging, and sodium (23Na) MRI of uterine leiomyomata after MR-guided high-intensity focused ultrasound: a preliminary study

PURPOSE

To determine the feasibility of using combined proton (1H), diffusion-weighted imaging (DWI), and sodium (23Na) magnetic resonance imaging (MRI) to monitor the treatment of uterine leiomyomata (fibroids).

MATERIALS AND METHODS

Eight patients with uterine leiomyomata were enrolled and treated using MRI-guided high-intensity frequency ultrasound surgery (MRg-HIFUS). MRI scans collected at baseline and posttreatment consisted of T2-, T1-, and 1H DWI, as well as posttreatment 23Na MRI. The 23Na and 1H MRi were coregistered using a replacement phantom method. Regions of interest in treated and untreated uterine leiomyoma tissue were drawn on 1H MRI and DWI, wherein the tissue apparent diffusion coefficient of water (ADC) and absolute sodium concentrations were measured.

RESULTS

Regions of treated uterine tissue were clearly identified on both DWI and 23Na images. The sodium concentrations in normal myometrium tissue were 35.8+/-2.1 mmol (mM), in the fundus; 43.4+/-3.8 mM, and in the bladder; 65.3+/-0.8 mM with ADC in normal myometrium of 2.2+/-0.3x10(-3) mm2/sec. Sodium concentration in untreated leiomyomata were 28+/-5 mM, and were significantly elevated (41.6+/-7.6 mM, P<0.05) after treatment. Apparent diffusion coefficient values in the treated leiomyomata (1.30+/-0.38x10(-3) mm2/sec) were decreased compared to areas of untreated leiomyomata (1.75+/--4048micro-4050micro36x10(-3) mm2/sec; P=0.04).

CONCLUSION

Multiparametric imaging permits identification of uterine leiomyomata, revealing altered 23Na MRI and DWI levels following noninvasive treatment that provides a mechanism to explore the molecular and metabolic pathways after treatment.

Sodium MR imaging detection of mild Alzheimer disease: preliminary study

BACKGROUND AND PURPOSE

There is significant interest in the development of novel noninvasive techniques for the diagnosis of Alzheimer disease (AD) and tracking its progression. Because MR imaging has detected alterations in sodium levels that correlate with cell death in stroke, we hypothesized that there would be alterations of sodium levels in the brains of patients with AD, related to AD cell death.

MATERIALS AND METHODS

A total of 10 volunteers (5 with mild AD and 5 healthy control subjects) were scanned with a 20-minute sodium (23Na) MR imaging protocol on a 3T clinical scanner.

RESULTS

After normalizing the signal intensity from the medial temporal lobes corresponding to the hippocampus with the ventricular signal intensity, we were able to detect a 7.5% signal intensity increase in the brains of patients with AD (AD group, 68.25% +/- 3.4% vs control group, 60.75% +/- 2.9%; P < .01). This signal intensity enhancement inversely correlated with hippocampal volume (AD group, 3.22 +/- 0.50 cm3 vs control group, 3.91 +/- 0.45 cm3; r2 = 0.50).

CONCLUSIONS

This finding suggests that sodium imaging may be a clinically useful tool to detect the neuropathologic changes associated with AD.

Taxotere chemosensitivity evaluation in mice prostate tumor: validation and diagnostic accuracy of quantitative measurement of tumor characteristics by MRI, PET, and histology of mice tumor

Increased PET and MRI image intensities of mouse prostate tumors were correlated with histostaining tumor characteristics. The hypothesis was that increased intracellular sodium microMRI signal intensities and flouro-2-deoxy-glucose utilization by microPET in apoptosis rich regions in tumors were positively correlated as chemosensitivity assay of Taxotere. The PC-3 cancer cell line induced prostate tumor MRI and PET images and histology slices were digitally captured and compared in pre- and post-Taxotere treated tumors. The optimization of inversion recovery MRI parameters was done to generate sodium images of phantom. The (18)FDG biotransformation was optimized to measure PET image intensities. A criterion was developed to evaluate malignancy by histology. For correlation, regression analysis was done using imaging, histology, and immunostaining data from PC3 tumor after 24 and 48 hours post-Taxotere treatment. Apoptosis indices were calculated by histostaining and ss-DNA antibody assay. Sodium MRI and PET signal intensity distributions were comparable at specific locations relatively and measured in tumor tissue regions. In tumors, Taxotere induced an increase in intracellular sodium MRI signal 30% (p<0.001) with decreased tumor size (20%; p<0.001) and micro-PET showed FDG uptake increase 15% (p<0.001) with decreased tumor size (10%; p<0.001) than that of control tumors after 24 hours. Histological features indicated tumor risk (high 'intracellular/extracellular ratio', high mitotic index, and apoptotic index), decreased tumor viability (reduced mitotic figures, reduced diploidy or aneuploidy, and proliferation index) after Taxotere treatment. These features in co-registered intracellular sodium, microPET hypermetabolic, and monoclonal antibody (ss-DNA) sensitive regions showed (% difference > 6%). Apoptosis rich regions showed characteristic nuclei with S phase DNA histogram, appearing brighter on IC-Na images and mild active on PET images (sensitivity=65%; specificity=70%). In conclusion, MRI and PET multimodal imaging may be rapid non-invasive chemosensitivity assay to monitor the drug anticancer effect.

Low-grade glioma: correlation of short echo time 1H-MR spectroscopy with 23Na MR imaging

BACKGROUND AND PURPOSE

There is considerable variability in the clinical behavior and treatment response of low-grade (WHO grade II) gliomas. The purpose of this work was to characterize the metabolic profile of low-grade gliomas by using short echo time (1)H-MR spectroscopy and to correlate metabolite levels with MR imaging-measured sodium ((23)Na) signal intensity. Based on previous studies, we hypothesized decreased N-acetylaspartate (NAA) and increased myo-inositol (mIns), choline (Cho), glutamate (Glu), and (23)Na signal intensity in glioma tissue.

MATERIALS AND METHODS

Institutional ethics committee approval and informed consent were obtained for all of the subjects. Proton ((1)H-MR) spectroscopy (TR/TE = 2200/46 ms) and sodium ((23)Na) MR imaging were performed at 4T in 13 subjects (6 women and 7 men; mean age, 44 years) with suspected low-grade glioma. Absolute metabolite levels were quantified, and relative (23)Na levels were measured in low-grade glioma and compared with the contralateral side in the same patients. Two-sided Student t tests were used to test for statistical significance.

RESULTS

Significant decreases were observed for NAA (P < .001) and Glu (P = .004), and increases were observed for mIns (P = .003), Cho (P = .025), and sodium signal intensity (P < .001) in low-grade glioma tissue. Significant correlations (r(2) > 0.25) were observed between NAA and Glu (P < .05) and between NAA and mIns (P < .01). Significant correlations were also observed between (23)Na signal intensity and NAA (P < .01) and between (23)Na signal intensity and Glu (P < .01). Ratios of NAA/mIns, NAA/(23)Na, and NAA/Cho were altered in glioma tissue (P < .001); however based on the t statistic, NAA/(23)Na (t = 9.6) was the most significant, followed by NAA/mIns (t = 6.1), and NAA/Cho (t = 5.0).

CONCLUSION

Although Glu concentration is reduced and mIns concentration is elevated in low-grade glioma tissue, the NAA/(23)Na ratio was the most sensitive indicator of pathologic tissue.

Molecular Neuroimaging: From Conventional to Emerging Techniques

The use of molecular imaging techniques in the central nervous system (CNS) has a rich history. Most of the important developments in imaging-such as computed tomography, magnetic resonance imaging, single photon emission computed tomography, and positron emission tomography-began with neuropsychiatric applications. These techniques and modalities were then found to be useful for imaging other organs involved with various disease processes. Molecular imaging of the CNS has enabled scientists and researchers to understand better the basic biology of brain function and the way in which various disease processes affect the brain. Unlike other organs, the brain is not easily accessible, and it has a highly selective barrier at the endothelial cell level known as the blood-brain barrier. Furthermore, the brain is the most complex cellular network known to exist. Various neurotransmitters act in either an excitatory or an inhibitory fashion on adjacent neurons through a multitude of mechanisms. The various neuronal systems and the myriad of neurotransmitter systems become altered in many diseases. Some of the most devastating diseases, including Alzheimer disease, Parkinson disease, brain tumors, psychiatric disease, and numerous degenerative neurologic diseases, affect only the brain. Molecular neuroimaging will be critical to the future understanding and treatment of these diseases. Molecular neuroimaging of the brain shows tremendous promise for clinical application. In this article, the current state and clinical applications of molecular neuroimaging will be reviewed.

MR Imaging: Brief Overview and Emerging Applications

Magnetic resonance (MR) imaging has become established as a diagnostic and research tool in many areas of medicine because of its ability to provide excellent soft-tissue delineation in different areas of interest. In addition to T1- and T2-weighted imaging, many specialized MR techniques have been designed to extract metabolic or biophysical information. Diffusion-weighted imaging gives insight into the movement of water molecules in tissue, and diffusion-tensor imaging can reveal fiber orientation in the white matter tracts. Metabolic information about the object of interest can be obtained with spectroscopy of protons, in addition to imaging of other nuclei, such as sodium. Dynamic contrast material-enhanced imaging and recently proton spectroscopy play an important role in oncologic imaging. When these techniques are combined, they can assist the physician in making a diagnosis or monitoring a treatment regimen. One of the major advantages of the different types of MR imaging is the ability of the operator to manipulate image contrast with a variety of selectable parameters that affect the kind and quality of the information provided. The elements used to obtain MR images and the factors that affect formation of an MR image include MR instrumentation, localization of the MR signal, gradients, k-space, and pulse sequences.

Noninvasive (1)H and (23)Na nuclear magnetic resonance imaging of ancient Egyptian human mummified tissue

Historic mummies are a unique example of the human desire for immortality. Therefore, it is not surprising that modern diagnostic imaging has been widely applied to study them. Yet, magnetic resonance imaging (MRI) of such old remains has never been successfully achieved in a noninvasive way without rehydration. Furthermore, the impact of artificial mummification as done in ancient Egypt by natron (a blend of NaCl, Na(2)CO(3), NaHCO(3) and NaP(2)SO(4)) on human tissue with a particular focus on the sodium spatial distribution has never been addressed. Here, we show for the very first time completely noninvasive (1)H and (23)Na imaging of an ancient Egyptian mummified finger by nuclear magnetic resonance (NMR). Protons could be visualized by NMR only in the tissue close to surface and sodium primarily in the bone, while computer tomography images both, soft tissue and bone but does not distinguish between different chemical elements. The selective enrichment of sodium in the bone may by due to postmortem incorporation of (23)Na into the tissue by natron-based mummification because our reference measurement of a historical finger not subjected to artificial mummification showed no sodium signal at all. Our results demonstrate not only the general feasibility of nonclinical MRI to visualize historic dry human tissues but also shows the specific (1)H and (23)Na spatial distributions in such mummy tissue, which is particularly interesting for archeology and may open up a new application for MRI.

3D radial projection technique with ultrashort echo times for sodium MRI: clinical applications in human brain and skeletal muscle

(23)Na MRI has the potential to noninvasively detect sodium (Na) content changes in vivo. The goal of this study was to implement (23)Na MRI in a clinical setting for neurooncological and muscular imaging. Due to the biexponential T(2) decay of the tissue Na signal with a short component, which ranges between 0.5-8 ms, the measurement of total Na content requires imaging techniques with echo times (TEs) below 0.5 ms. A 3D radial pulse sequence with a TE of 0.2 ms at a spatial resolution of 4 x 4 x 4 mm(3) was developed that allows the acquisition and presentation of Na images on the scanner. This sequence was evaluated in patients with low- and high-grade gliomas, and higher (23)Na MR signals corresponding to an increased Na content were found in the tumor regions. The contrast-to-noise ratio (CNR) between tumor and white matter increased from 0.8 +/- 0.2 to 1.3 +/- 0.3 with tumor grade. In patients with an identified muscular (23)Na channelopathy (Paramyotonia congenita (PC)), induced muscle weakness led to a signal increase of approximately 18% in the (23)Na MR images, which was attributed to intracellular Na(+) accumulation in this region.

Elevated tissue sodium concentration in malignant breast lesions detected with non-invasive 23Na MRI

BACKGROUND

The hypothesis that physiological and biochemical changes associated with proliferating malignant tumors may cause an increase in total tissue sodium concentration (TSC) was tested with non-invasive, quantitative sodium ((23)Na) magnetic resonance imaging (MRI) in patients with benign and malignant breast tumors.

METHODS

(23)Na and (1)H MRI of the breast was performed on 22 women with suspicious breast lesions (> or =1 cm) at 1.5 Tesla. A commercial proton ((1)H) phased array breast coil and custom solenoidal (23)Na coil were used to acquire (1)H and (23)Na images during the same MRI examination. Quantitative 3-dimensional (23)Na projection imaging was implemented with negligible signal loss from MRI relaxation, or from radio-frequency field inhomogeneity, in less than 15 min. Co-registered (1)H and (23)Na images permitted quantification of TSC in normal and suspicious tissues on the basis of (1)H MRI contrast enhancement and anatomy, with histology confirmed by biopsy.

RESULTS

Sodium concentrations were consistently elevated in (N = 19) histologically proven malignant breast lesions by an average of 63% compared to glandular tissue. The increase in sodium concentration in malignant tissue was highly significant compared to unaffected glandular tissue (P < 0.0001, paired t-test), adipose tissue, and TSC in three patients with benign lesions.

CONCLUSION

Elevated TSC in breast lesions measured by non-invasive (23)Na MRI appears to be a cellular-level indicator associated with malignancy. This method may have potential to improve the specificity of breast MRI with only a modest increase in scan time per patient.

Patterns of enhancement on breast MR images: interpretation and imaging pitfalls

The role of dynamic contrast material-enhanced magnetic resonance (MR) imaging of the breast as an adjunct to the conventional techniques of mammography and ultrasonography has been established in numerous research studies. MR imaging improves the detection and characterization of primary and recurrent breast cancers and allows evaluation of the response to therapy. The breast imaging lexicon published by the American College of Radiology allows a standardized and consistent description of the morphologic and kinetic characteristics of breast lesions; however, there are many challenges in the interpretation of breast enhancement patterns and kinetics, and many imaging and interpretation pitfalls must be considered. New breast MR imaging techniques that are based on the use of molecular markers of malignancy may help improve lesion characterization. The margin characteristics of a lesion and the intensity of its enhancement at MR imaging 2 minutes or less after contrast material injection are currently considered the most important features for breast lesion diagnosis.

Proton and sodium MRI assessment of emerging tumor chemotherapeutic resistance

The ultimate goal of any cancer therapy is to target the elimination of neoplastic cells. Although newer therapeutic strategies are in constant development, therapeutic assessment has been hampered by the inability to assess, rapidly and quantitatively, efficacy in vivo. Diffusion imaging and, more recently, sodium MRI have demonstrated their distinct abilities to detect therapy-induced alterations in tumor cellularity, which has been demonstrated to be indicative of therapeutic efficacy. More importantly, both imaging modalities detect tumor response much earlier than traditional methodologies that rely on macroscopic volumetric changes. In this study, the correlation between tumor sodium and diffusion was further tested to demonstrate the sensitivity of sodium imaging to gauge tumor response to therapy by using a 9L rat gliosarcoma treated with varying doses of BCNU [1,3-bis(2-chloroethyl)-1-nitrosourea]. This orthotopic model has been demonstrated to display variability in response to BCNU therapy where initial insult has been shown to lead to drug-resistance. In brief, a single 26.6 mg/kg BCNU dose yielded dramatic responses in both diffusion and sodium MRI. However, a second equivalent BCNU dose yielded a much smaller change in diffusion and sodium, suggesting a drop in tumor sensitivity to BCNU. The MRI responses of animals treated with 13.3 mg/kg BCNU were much lower and similar responses were observed after the initial and secondary applications of BCNU. Furthermore, these results were further validated using volumetric measurements of the tumor and also ex vivo determination of tumor sensitivity to BCNU. Overall, these experiments demonstrate the sensitivity and applicability of sodium and diffusion MRI as tools for dynamic assessment of tumor response to therapy.

Practical design of a 4 Tesla double-tuned RF surface coil for interleaved 1H and 23Na MRI of rat brain

MRI is proving to be a very useful tool for sodium quantification in animal models of stroke, ischemia, and cancer. In this work, we present the practical design of a dual-frequency RF surface coil that provides (1)H and (23)Na images of the rat head at 4 T. The dual-frequency RF surface coil comprised of a large loop tuned to the (1)H frequency and a smaller co-planar loop tuned to the (23)Na frequency. The mutual coupling between the two loops was eliminated by the use of a trap circuit inserted in the smaller coil. This independent-loop design was versatile since it enabled a separate optimisation of the sensitivity and RF field distributions of the two coils. To allow for an easy extension of this simple double-tuned coil design to other frequencies (nuclei) and dimensions, we describe in detail the practical aspects of the workbench design and MRI testing using a phantom that mimics in vivo conditions. A comparison between our independent-loop, double-tuned coil and a single-tuned (23)Na coil of equal size obtained with a phantom matching in vivo conditions, showed a reduction of the (23)Na sensitivity (about 28 %) because of signal losses in the trap inductance. Typical congruent (1)H and (23)Na rat brain images showing good SNR ((23)Na: brain 7, ventricular cerebrospinal fluid 11) and spatial resolution ((23)Na: 1.25 x 1.25 x 5mm(3)) are also reported. The in vivo SNR values obtained with this coil were comparable to, if not better than, other contemporary designs in the literature.

Evaluation of patients with paramyotonia at 23Na MR imaging during cold-induced weakness

PURPOSE

To prospectively examine whether sodium 23 (23Na) magnetic resonance (MR) imaging can be used to visualize acute intracellular Na+ accumulation and the effects of specific therapy in patients with paramyotonia congenita (PC).

MATERIALS AND METHODS

Ethics committee approval and informed consent were obtained. Sixteen patients (four women, 12 men; mean age, 46.7 years +/- 16.7 [standard deviation]) with confirmed PC and 10 healthy volunteers (three women, seven men; mean age, 26.6 years +/- 3) were examined by using a 1.5-T MR system with a 16.8-MHz surface coil. 23Na MR imaging was performed before and after local cooling of the nondominant lower leg and exercising, with experimentally induced weakness scored by a neurologist. The 23Na MR examination was repeated in 13 patients and all volunteers after 3 days and, additionally, in seven patients after 4 days of oral administration of mexiletine, which blocks Na+ channels. The 23Na MR protocol comprised two-dimensional (2D) fast low-angle shot (FLASH), 2D radial, and free induction decay (FID) sequences. The FID data were fitted to a biexponential decay curve to evaluate the slow and fast components of the T2 relaxation time. Fast and slow components were assigned to intra- and extracellular Na+ concentrations, respectively. Radial and FLASH MR images were evaluated by means of a region-of-interest analysis by using 0.3% saline solution for reference. T1- and T2-weighted MR imaging were also performed. Data were analyzed by using a parametric t test.

RESULTS

After exercising, all patients developed considerable weakness exclusively in the cooled lower leg; no weakness was observed in volunteers. In patients, all 23Na MR images showed a significant increase in 23Na signal intensity in the cooled lower leg (P < .001) in comparison with nonsignificant findings in volunteers. After treatment with mexiletine, cooling and exercise induced almost no muscle weakness and no changes in 23Na MR signal intensity in patients.

CONCLUSION

23Na MR imaging enables visualization of muscular Na+ accumulation associated with muscle weakness in patients with PC, and effects of specific therapy can be detected.

Sodium and proton diffusion MRI as biomarkers for early therapeutic response in subcutaneous tumors

The ability to quantitate early effects of tumor therapeutic response using noninvasive imaging would have a major impact in clinical oncology. One area of active research interest is the ability to use MR techniques to detect subtle changes in tumor cellular density. In this study, sodium and proton diffusion MRI were compared for their ability to detect early cellular changes in tumors treated with a cytotoxic chemotherapy. Subcutaneous 9L gliosarcomas were treated with a single dose of 1,3-bis(2-chloroethyl)-1-nitrosourea. Both sodium and diffusion imaging modalities were able to detect changes in tumor cellularity as early as 2 days after treatment, which continued to evolve as increased signal intensities reached a maximum approximately 8 days posttreatment. Early changes in tumor sodium and apparent diffusion coefficient values were predictive of subsequent tumor shrinkage, which occurred approximately 10 days later. Overall, therapeutical induced changes in sodium and diffusion values were found to have similar dynamic and spatial changes. These findings suggest that these imaging modalities detected similar early cellular changes after treatment. The results of this study support the continued clinical testing of diffusion MRI for evaluation of early tumor treatment response and demonstrate the complementary insights of sodium MRI for oncology applications.

A comparison of three SPRITE techniques for the quantitative 3D imaging of the 23Na spin density on a 4T whole-body machine

Sodium density maps acquired with three SPRITE-based methods have been compared in terms of the resulting quantitative information as well as image quality and acquisition times. Consideration of factors relevant for the clinical implementation of SPRITE shows that the Conical-SPRITE variant is preferred because of a 20-fold reduction in acquisition time, slightly improved image quality, and no loss of quantitative information. The acquisition of a 3D data set (32x32x16; FOV=256x256x160 mm) for the quantitative determination of sodium density is demonstrated. In vivo Conical-SPRITE 23Na images of the brain of a healthy volunteer were acquired in 30 min with a resolution of 7.5x7.5x7.5 mm and a signal-to-noise ratio of 23 in cerebrospinal fluid and 17 in brain tissue.

Frequency-selective quadrupolar MRI contrast

A method for the selective detection of quadrupolar nuclei located in anisotropic environments is presented. The image contrast can be tuned to the degree of anisotropy in the sample by using frequency-swept pulsed. These methods are particularly useful in the field of sodium-MRI, where sodium signals from locally-ordered environments provide diagnostic information. In solid-state MRI, these methods could be useful for probing structural defects within the sample. We demonstrate here one-dimensional images, in which the pixel contrast indicates the presence or absence of quadrupolar coupling within a certain frequency range.

In vivo sodium magnetic resonance imaging of the human brain using soft inversion recovery fluid attenuation

Sodium imaging with soft inversion recovery fluid attenuation, which may be advantageous for intracellular weighting, was demonstrated with cerebrospinal fluid (CSF) suppression in five healthy volunteers at 4.7 T. Long rectangular inversion pulses reduce the average power deposition in an inversion recovery sequence, allowing repetition time to be shortened and more averages acquired for a given scan length. Longer pulses also significantly reduce the "depth" of Mz inversion in environments with rapid T1 and T2 relaxation (i.e., brain relative to CSF). Phantom experiments and simulation show a marked SNR increase when using a 10-ms, rather than a 1-ms, rectangular inversion pulse. Images were acquired in 11.1 min with a voxel size of 0.25 cm3 and the SNR in CSF, which is typically approximately 3 times larger than in brain, was reduced to 23% of that in the brain tissue, which had an average SNR of 17.

Translational molecular imaging for cancer

Although most clinical diagnostic imaging studies employ anatomic techniques such as computed tomography (CT) and magnetic resonance (MR) imaging, much of radiology research currently focuses on adapting these conventional methods to physiologic imaging as well as on introducing new techniques and probes for studying processes at the cellular and molecular levels in vivo, i.e. molecular imaging. Molecular imaging promises to provide new methods for the early detection of cancer and support for personalized cancer therapy. Although molecular imaging has been practiced in various incarnations for over 20 years in the context of nuclear medicine, other imaging modalities have only recently been applied to the noninvasive assessment of physiology and molecular events. Nevertheless, there has been sufficient experience with specifically targeted contrast agents and high-resolution techniques for MR imaging and other modalities that we must begin moving these new technologies from the laboratory to the clinic. This brief review outlines several of the more promising areas of pursuit in molecular imaging for oncology with an emphasis on those that show the most immediate likelihood for clinical translation.

Selecting ordered environments in NMR of spin 3/2 nuclei via frequency-sweep pulses

We demonstrate that frequency-swept pulses can be used for the selective and enhanced detection of quadrupolar nuclei located in anisotropic environments. The primary driving force for this technique development is the field of sodium-MRI, where sodium signals from locally ordered environments are known to be diagnostic of cartilage defects. We demonstrate here simple one-dimensional images of model systems, in which the signals from free sodium ions are suppressed, while ordered sodium is detected via the narrow central transition signal.

Application of 23Na MRI to monitor chemotherapeutic response in RIF-1 tumors

Effects of an alkylating anticancer drug, cyclophosphamide (Cp), on 23Na signal intensity (23Na SI) and water apparent diffusion coefficient (ADC) were examined in subcutaneously-implanted radiation-induced fibrosarcoma (RIF-1) tumors by 23Na and 1H magnetic resonance imaging (MRI). MRI experiments were performed on untreated control (n = 5) and Cp-treated (n = 6) C3H mice, once before Cp injection (300 mg/kg) then daily for 3 days after treatment. Tumor volumes were significantly lower in treated animals 2 and 3 days posttreatment. At the same time points, in vivo MRI experiments showed an increase in both 23Na SI and water ADC in treated tumors, whereas control tumors did not show any significant changes. The correlation between 23Na SI and water ADC changes was dramatically increased in the Cp-treated group, suggesting that the observed increases in 23Na SI and water ADC were caused by the same mechanism. Histologic sections showed decreased cell density in the regions of increased 23Na and water ADC SI. Destructive chemical analysis showed that Cp treatment increased the relative extracellular space and tumor [Na+]. We conclude that the changes in water ADC and 23Na SI were largely due to an increase in extracellular space. 23Na MRI and 1H water ADC measurements may provide valuable noninvasive techniques for monitoring chemotherapeutic responses.

Rapid in vivo Taxotere quantitative chemosensitivity response by 4.23 Tesla sodium MRI and histo-immunostaining features in N-Methyl-N-Nitrosourea induced breast tumors in rats

Background

Sodium weighted images can indicate sodium signal intensities from different features in the tumor before and 24 hours following administration of Taxotere.

Aim

To evaluate the association of in vivo intracellular sodium magnetic resonance image intensities with immuno-biomarkers and histopathological features to monitor the early tumor response to Taxotere chemotherapy in Methyl-Nitroso-Urea induced rat xenograft breast tumors.

Methods and Materials

Methyl-Nitroso-Urea (MNU) induced rat xenograft breast tumors were imaged for sodium MRI and compared with tumor histology, immunostaining after 24 hours chemotherapy.

Results

Sodium MRI signal intensities represented sodium concentrations. Excised tumor histological sections showed different in vitro histological end points i.e. single strand DNA content of cell nuclei during cell cycle (G1/S-G2/M), distinct S or M histograms (Feulgen labeling to nuclear DNA content by CAS 200), mitotic figures and apoptosis at different locations of breast tumors. Necrosis and cystic fluid appeared gray on intracellular (IC) sodium images while apoptosis rich regions appeared brighter on IC sodium images. After 24 hours Taxotere-treated tumors showed lower 'IC/EC ratio' of viable cells (65–76%) with higher mitotic index; apoptotic tumor cells at high risk due to cytotoxicity (>70% with high apoptotic index); reduced proliferation index (270 vs 120 per high power field) associated with enhanced IC sodium in vivo MR image intensities and decreased tumor size (3%; p < 0.001; n = 16) than that of pre-treated tumors. IC-Na MR signal intensities possibly indicated Taxotere chemosensitivity response in vivo associated with apoptosis and different pre-malignant features within 24 hours of exposure of cancer cells to anti-neoplastic Taxotere drug.

Conclusion

Sodium MRI imaging may be used as in vivo rapid drug monitoring method to evaluate Taxotere chemosensitivity response associated with neoplasia, apoptosis and tumor histology features.

Sodium magnetic resonance imaging of chemotherapeutic response in a rat glioma

This study investigates the comparative changes in the sodium MRI signal and proton diffusion following treatment using a 9L rat glioma model to develop markers of earliest response to cancer therapy. Sodium MRI and proton diffusion mapping were performed on untreated (n = 5) and chemotherapy 1,3-bis(2-chloroethyl)-1-nitrosourea-treated rats (n = 5). Animals were scanned serially at 2- to 3-day intervals for up to 30 days following therapy. The time course of Na concentration in a tumor showed a dramatic increase in the treated brain tumor compared to the untreated tumor, which correlates in time with an increase in tumor water diffusion. The largest posttreatment increase in sodium signal occurred 7-9 days following treatment and correlated to the period of the greatest chemotherapy-induced cellular necrosis based on diffusion and histopathology. Both Na MRI and proton ADC mapping revealed early changes in tumor sodium content and cellularity. This study demonstrates the possibility of Na MRI to function as a biomarker for monitoring early tumor treatment and validates the use of monitoring changes in diffusion MRI values for assessing tumor cellularity.

Multiparametric and multinuclear magnetic resonance imaging of human breast cancer: current applications

The exploration of novel imaging methods that have the potential to improve specificity for the identification of malignancy is still critically needed in breast imaging. Changes in physiologic alterations of soft tissue water associated with breast cancer can be visualized by magnetic resonance (MR) imaging. However, it is unlikely that a single MR parameter can characterize the complexity of breast tissue. Techniques such as multiparametric MR imaging, proton magnetic resonance spectroscopic (MRSI) imaging, and 23Na sodium MR imaging when used in combination provide a comprehensive data set with potentially more power to diagnose breast disease than any single measure alone. A combination of MR, MRSI, and 23Na sodium MR parameters may be examined in a single MR imaging examination, potentially resulting in improved specificity for radiologic evaluation of malignancy.

Magnetic Resonance: An Introduction to Ultrashort TE (UTE) Imaging

The background underpinning the clinical use of ultrashort echo-time (UTE) pulse sequences for imaging tissues or tissue components with short T2s is reviewed. Tissues properties are discussed, and tissues are divided into those with a majority of short T2 relaxation components and those with a minority. Features of the basic physics relevant to UTE imaging are described including the fact that when the radiofrequency pulse duration is of the order T2, rotation of tissue magnetization into the transverse plane is incomplete. Consequences of the broad line-width of short T2 components are also discussed including their partial saturation by off-resonance fat suppression pulses as well as multislice and multiecho imaging. The need for rapid data acquisition of the order T2 is explained. The basic UTE pulse sequence with its half excitation pulse and radial imaging from the center of k-space is described together with options that suppress fat and/or long T2 components. Image interpretation is discussed. Clinical features of the imaging of cortical bone, tendons, ligaments, menisci, and periosteum as well as brain, liver, and spine are illustrated. Short T2 components in all of these tissues may show high signals. Possible future developments are outlined as are technical limitations.