Single Shot T1ρ Magnetic Resonance Imaging Of Metabolically Generated Water In Vivo

Management of degenerative disk disease and chronic low back pain

Degenerative disk disease is a strong etiologic risk factor of chronic low back pain (LBP). A multidisciplinary approach to treatment is often warranted. Patient education, medication, and cognitive behavioral therapies are essential in the treatment of chronic LBP sufferers. Surgical intervention with a rehabilitation regime is sometimes advocated. Prognostic factors related to the outcome of different treatments include maladaptive pain coping and genetics. The identification of pain genes may assist in determining individuals susceptible to pain and in patient selection for appropriate therapy. Biologic therapies show promise, but clinical trials are needed before advocating their use in humans.

Mapping of cerebral oxidative metabolism with MRI

Using a T(1rho) MRI based indirect detection method, we demonstrate the detection of cerebral oxidative metabolism and its modulation by administration of the mitochondrial uncoupling agent 2,4-dinitrophenol (DNP) in a large animal model with minimum utilization of gas. The study was performed by inhalation in swine during imaging on clinical MRI scanners. Metabolic changes in swine were determined by two methods. First, in a series of animals, increased metabolism caused by DNP injection was measured by exhaled gas analysis. The average whole-body metabolic increase in seven swine was 11.9% + or - 2.5% per mg/kg, stable over three hours. Secondly, hemispheric brain measurements of oxygen consumption stimulated by DNP injection were made in five swine using T(1rho) MRI following administration of gas. Metabolism was calculated from the change in the T(1rho) weighted MRI signal due to H(2)(17)O generated from inhalation before and after doubling of metabolism by DNP. These results were confirmed by direct oxygen-17 MR spectroscopy, a gold standard for in vivo H(2)(17)O measurement. Overall, this work underscores the ability of indirect oxygen-17 imaging to detect oxygen metabolism in an animal model with a lung capacity comparable to the human with minimal utilization of expensive gas. Given the demonstrated high efficiency in use of and the proven feasibility of performing such measurements on standard clinical MRI scanners, this work enables the adaption of this technique for human studies dealing with a broad array of metabolic derangements.

Estimation of the regional cerebral metabolic rate of oxygen consumption with proton detected 17O MRI during precision 17O2 inhalation in swine

Despite the importance of metabolic disturbances in many diseases, there are currently no clinically used methods for the detection of oxidative metabolism in vivo. To address this deficiency, (17)O MRI techniques are scaled from small animals to swine as a large animal model of human inhalation and circulation. The hemispheric cerebral metabolic rate of oxygen consumption (CMRO(2)) is estimated in swine by detection of metabolically produced H(2)(17)O by rapid T(1rho)-weighted proton magnetic resonance imaging on a 1.5T clinical scanner. The (17)O is delivered as oxygen gas by a custom, minimal-loss, precision delivery breathing circuit and converted to H(2)(17)O by oxidative metabolism. A model for gas arterial input is presented for the deeply breathing large animal. The arterial input function for recirculation of metabolic water is measured by arterial blood sampling and high field (17)O spectroscopy. It is found that minimal metabolic water "wash-in" occurs before 60s. A high temporal resolution pulse sequence is employed to measure CMRO(2) during those 60s after delivery begins. Only about one tidal volume of (17)O enriched oxygen gas is used per measurement. Proton measurements of signal change due to metabolically produced water are correlated with (17)O in vivo spectroscopy. Using these techniques, the hemispheric CMRO(2) in swine is estimated to be 1.23+/-.26 micromol/g/min, consistent with existing literature values. All of the technology used to perform these CMRO(2) estimates can easily be adapted to clinical MR scanners, and it is hoped that this work will lead to future studies of human disease.

Mechanical ventilator for delivery of ¹⁷O₂ in brief pulses

The ¹⁷O nucleus has been used recently by several groups for magnetic resonance (MR) imaging of cerebral metabolism. Inhalational delivery of ¹⁷O₂ in very brief pulses could, in theory, have significant advantages for determination of the cerebral metabolic rate for oxygen (CMRO₂) with MR imaging. Mechanical ventilators, however, are not typically capable of creating step changes in gas concentration at the airway. We designed a ventilator for large animal and human studies that provides mechanical ventilation to a subject inside an MR scanner through 25 feet of small-bore connecting tubing, and tested its capabilities using helium as a surrogate for ¹⁷O₂. After switching the source gas from oxygen to helium, the 0-90% response time for helium concentration changes at the airway was 2.4 seconds. The capability for creating rapid step changes in gas concentration at the airway in large animal and human studies should facilitate the experimental testing of the delivery ¹⁷O₂ in brief pulses, and its potential use in imaging CMRO₂.