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Sakoda K, Baba S. Technical Note: Novel imaging method to obtain gray matter-attenuated inversion recovery image using low-field magnetic resonance imaging systems. Radiography (Lond) 2024; 30:231-236. [PMID: 38035438 DOI: 10.1016/j.radi.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/16/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The double inversion recovery (DIR) technique suppresses two types of tissue signals with different T1 values by applying two inversion recovery (IR) pulses with different inversion times (TI). In contrast, the double tissue suppression with multi-echo acquisition and single TI combining HIRE (DOMUST-HIRE) method, is a technique enabling the white-matter-attenuated inversion recovery (WAIR) images by setting one inversion time (TI) in a sequence based on the multi-echo method and subtracting the second echo image from the first echo image. Here, we propose a new sequence that can provide the gray-matter-attenuated inversion recovery image based on the DOMUST-HIRE method. METHODS In this small clinical study, we performed determination of optimal TI and physical evaluation by imaging a subject's head with T1WI and our proposed method for GAIR images. RESULTS Our proposed method could increase the contrast ratio and the contrast-to-noise ratio between white matter (WM) and gray matter (GM), whereas the signal-to-noise ratio WM and GM decreased than with T1WI method. CONCLUSIONS Our proposed method can be used to suppress GM and CSF signals. IMPLICATIONS FOR PRACTICE The use of our proposed method in low-field MRI systems could provide GAIR image.
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Affiliation(s)
- K Sakoda
- Department of Radiological Technology, Kagoshima Medical Technology College, Japan.
| | - S Baba
- Department of Radiological Technology, Kagoshima Medical Technology College, Japan
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Lespagnol M, Massire A, Megdiche I, Lespagnol F, Brugières P, Créange A, Stemmer A, Bapst B. Improved detection of juxtacortical lesions using highly accelerated double inversion-recovery MRI in patients with multiple sclerosis. Diagn Interv Imaging 2023; 104:401-409. [PMID: 37156721 DOI: 10.1016/j.diii.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE The purpose of this study was to compare a highly-accelerated double inversion recovery (fast-DIR) sequence using a recent parallel imaging technique (CAIPIRINHA) with a conventional DIR (conv-DIR) sequence for image quality and the detection of juxtacortical and infratentorial multiple sclerosis (MS) lesions. MATERIALS AND METHODS A total of 38 patients with MS who underwent brain MRI at 3 T between 2020 and 2021 were included. There were 27 women and 12 men with a mean age of 40 ± 12.8 (standard deviation) years (range: 20-59 years). All patients underwent conv-DIR sequence and fast-DIR sequence. Fast-DIR was obtained with a T2-preparation module to improve contrast and an iterative denoising algorithm to compensate noise enhancement. Two blinded readers reported the number of juxtacortical and infratentorial MS lesions for fast-DIR and conv-DIR, confirmed by further consensus reading that was used as the standard of reference. Image quality and contrast were evaluated for fast-DIR and conv-DIR sequences. Comparisons between fast-DIR and conv-DIR sequences were performed using Wilcoxon test and Lin concordance correlation coefficient. RESULTS Thirty-eight patients were analyzed. Fast-DIR imaging allowed detection of 289 juxtacortical lesions vs. 238 with conv-DIR, corresponding to a significant improved detection rate with fast-DIR (P < 0.001). Conversely, 117 infratentorial lesions were detected with conv-DIR sequence vs. 80 with fast-DIR sequence (P < 0.001). Inter-observer agreement for lesion detection with fast-DIR and conv-DIR was very high (Lin concordance correlation coefficient ranging between 0.86 and 0.96). CONCLUSION Fast-DIR improves the detection of juxtacortical MS lesions, but is limited for the detection of infratentorial MS lesions.
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Affiliation(s)
- Morgane Lespagnol
- Department of Neuroradiology, AP-HP, Henri Mondor University Hospital, 92010 Créteil, France
| | | | - Imen Megdiche
- Department of Neuroradiology, AP-HP, Henri Mondor University Hospital, 92010 Créteil, France
| | - Fabien Lespagnol
- MOX, Department of Mathematics, Politecnico di Milano, 20133 Milano, Italy; Research Center, INRIA, 75012 Paris, France
| | - Pierre Brugières
- Department of Neuroradiology, AP-HP, Henri Mondor University Hospital, 92010 Créteil, France
| | - Alain Créange
- Department of Neurology, AP-HP, Henri Mondor University Hospital, 92010 Créteil, France; Faculty of Medicine, Université Paris Est Créteil, 92010 Créteil, France
| | | | - Blanche Bapst
- Department of Neuroradiology, AP-HP, Henri Mondor University Hospital, 92010 Créteil, France; Faculty of Medicine, Université Paris Est Créteil, 92010 Créteil, France.
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Park CC, Brummer ME, Sadigh G, Saindane AM, Mullins ME, Allen JW, Hu R. Automated Registration and Color Labeling of Serial 3D Double Inversion Recovery MR Imaging for Detection of Lesion Progression in Multiple Sclerosis. J Digit Imaging 2023; 36:450-457. [PMID: 36352165 PMCID: PMC10039147 DOI: 10.1007/s10278-022-00737-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022] Open
Abstract
Automated co-registration and subtraction techniques have been shown to be useful in the assessment of longitudinal changes in multiple sclerosis (MS) lesion burden, but the majority depend on T2-fluid-attenuated inversion recovery sequences. We aimed to investigate the use of a novel automated temporal color complement imaging (CCI) map overlapped on 3D double inversion recovery (DIR), and to assess its diagnostic performance for detecting disease progression in patients with multiple sclerosis (MS) as compared to standard review of serial 3D DIR images. We developed a fully automated system that co-registers and compares baseline to follow-up 3D DIR images and outputs a pseudo-color RGB map in which red pixels indicate increased intensity values in the follow-up image (i.e., progression; new/enlarging lesion), blue-green pixels represent decreased intensity values (i.e., disappearing/shrinking lesion), and gray-scale pixels reflect unchanged intensity values. Three neuroradiologists blinded to clinical information independently reviewed each patient using standard DIR images alone and using CCI maps based on DIR images at two separate exams. Seventy-six follow-up examinations from 60 consecutive MS patients who underwent standard 3 T MR brain MS protocol that included 3D DIR were included. Median cohort age was 38.5 years, with 46 women, 59 relapsing-remitting type MS, and median follow-up interval of 250 days (interquartile range: 196-394 days). Lesion progression was detected in 67.1% of cases using CCI review versus 22.4% using standard review, with a total of 182 new or enlarged lesions using CCI review versus 28 using standard review. There was a statistically significant difference between the two methods in the rate of all progressive lesions (P < 0.001, McNemar's test) as well as cortical progressive lesions (P < 0.001). Automated CCI maps using co-registered serial 3D DIR, compared to standard review of 3D DIR alone, increased detection rate of MS lesion progression in patients undergoing clinical brain MRI exam.
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Affiliation(s)
- Charlie C Park
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Marijn E Brummer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Amit M Saindane
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Mark E Mullins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA.
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Tran D, DiGiacomo P, Born DE, Georgiadis M, Zeineh M. Iron and Alzheimer's Disease: From Pathology to Imaging. Front Hum Neurosci 2022; 16:838692. [PMID: 35911597 PMCID: PMC9327617 DOI: 10.3389/fnhum.2022.838692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/09/2022] [Indexed: 12/12/2022] Open
Abstract
Alzheimer's disease (AD) is a debilitating brain disorder that afflicts millions worldwide with no effective treatment. Currently, AD progression has primarily been characterized by abnormal accumulations of β-amyloid within plaques and phosphorylated tau within neurofibrillary tangles, giving rise to neurodegeneration due to synaptic and neuronal loss. While β-amyloid and tau deposition are required for clinical diagnosis of AD, presence of such abnormalities does not tell the complete story, and the actual mechanisms behind neurodegeneration in AD progression are still not well understood. Support for abnormal iron accumulation playing a role in AD pathogenesis includes its presence in the early stages of the disease, its interactions with β-amyloid and tau, and the important role it plays in AD related inflammation. In this review, we present the existing evidence of pathological iron accumulation in the human AD brain, as well as discuss the imaging tools and peripheral measures available to characterize iron accumulation and dysregulation in AD, which may help in developing iron-based biomarkers or therapeutic targets for the disease.
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Affiliation(s)
- Dean Tran
- Department of Radiology, Stanford School of Medicine, Stanford, CA, United States
| | - Phillip DiGiacomo
- Department of Radiology, Stanford School of Medicine, Stanford, CA, United States
| | - Donald E. Born
- Department of Pathology, Stanford School of Medicine, Stanford, CA, United States
| | - Marios Georgiadis
- Department of Radiology, Stanford School of Medicine, Stanford, CA, United States
| | - Michael Zeineh
- Department of Radiology, Stanford School of Medicine, Stanford, CA, United States
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Costagli M, Lapucci C, Zacà D, Bruschi N, Schiavi S, Castellan L, Stemmer A, Roccatagliata L, Inglese M. Improved detection of multiple sclerosis lesions with T2-prepared double inversion recovery at 3T. J Neuroimaging 2022; 32:902-909. [PMID: 35776654 PMCID: PMC9544719 DOI: 10.1111/jon.13021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Double inversion recovery (DIR) imaging is used in multiple sclerosis (MS) clinical protocols to improve the detection of cortical and juxtacortical gray matter lesions by nulling confounding signals originating from the cerebrospinal fluid and white matter. Achieving a high isotropic spatial resolution, to depict the neocortex and its typically small lesions, is challenged by the reduced signal-to-noise ratio (SNR) determined by multiple tissue signal nulling. Here, we evaluate both conventional and optimized DIR implementations to improve tissue contrast (TC), SNR, and MS lesion conspicuity. METHODS DIR images were obtained from MS patients and healthy controls using both conventional and prototype implementations featuring a T2-preparation module (T2P), to improve SNR and TC, as well as an image reconstruction routine with iterative denoising (ID). We obtained quantitative measures of SNR and TC, and evaluated the visibility of MS cortical, cervical cord, and optic nerve lesions in the different DIR images. RESULTS DIR implementations adopting T2P and ID enabled improving the SNR and TC of conventional DIR. In MS patients, 34% of cortical, optic nerve, and cervical cord lesions were visible only in DIR images acquired with T2P, and not in conventional DIR images. In the studied cases, image reconstruction with ID did not improve lesion conspicuity. CONCLUSIONS DIR with T2P should be preferred to conventional DIR imaging in protocols studying MS patients, as it improves SNR and TC and determines an improvement in cortical, optic nerve, and cervical cord lesion conspicuity.
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Affiliation(s)
- Mauro Costagli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy.,Laboratory of Medical Physicsand Magnetic Resonance, IRCCS Stella Maris, Pisa, Italy
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Nicolò Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy
| | - Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy
| | | | | | - Luca Roccatagliata
- IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Okada T, Fujimoto K, Fushimi Y, Akasaka T, Thuy DHD, Shima A, Sawamoto N, Oishi N, Zhang Z, Funaki T, Nakamoto Y, Murai T, Miyamoto S, Takahashi R, Isa T. Neuroimaging at 7 Tesla: a pictorial narrative review. Quant Imaging Med Surg 2022; 12:3406-3435. [PMID: 35655840 PMCID: PMC9131333 DOI: 10.21037/qims-21-969] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/05/2022] [Indexed: 01/26/2024]
Abstract
Neuroimaging using the 7-Tesla (7T) human magnetic resonance (MR) system is rapidly gaining popularity after being approved for clinical use in the European Union and the USA. This trend is the same for functional MR imaging (MRI). The primary advantages of 7T over lower magnetic fields are its higher signal-to-noise and contrast-to-noise ratios, which provide high-resolution acquisitions and better contrast, making it easier to detect lesions and structural changes in brain disorders. Another advantage is the capability to measure a greater number of neurochemicals by virtue of the increased spectral resolution. Many structural and functional studies using 7T have been conducted to visualize details in the white matter and layers of the cortex and hippocampus, the subnucleus or regions of the putamen, the globus pallidus, thalamus and substantia nigra, and in small structures, such as the subthalamic nucleus, habenula, perforating arteries, and the perivascular space, that are difficult to observe at lower magnetic field strengths. The target disorders for 7T neuroimaging range from tumoral diseases to vascular, neurodegenerative, and psychiatric disorders, including Alzheimer's disease, Parkinson's disease, multiple sclerosis, epilepsy, major depressive disorder, and schizophrenia. MR spectroscopy has also been used for research because of its increased chemical shift that separates overlapping peaks and resolves neurochemicals more effectively at 7T than a lower magnetic field. This paper presents a narrative review of these topics and an illustrative presentation of images obtained at 7T. We expect 7T neuroimaging to provide a new imaging biomarker of various brain disorders.
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Affiliation(s)
- Tomohisa Okada
- Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Fujimoto
- Department of Real World Data Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Thai Akasaka
- Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Dinh H. D. Thuy
- Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Shima
- Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobukatsu Sawamoto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoya Oishi
- Medial Innovation Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Zhilin Zhang
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Funaki
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tadashi Isa
- Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Ineichen BV, Beck ES, Piccirelli M, Reich DS. New Prospects for Ultra-High-Field Magnetic Resonance Imaging in Multiple Sclerosis. Invest Radiol 2021; 56:773-784. [PMID: 34120128 PMCID: PMC8505164 DOI: 10.1097/rli.0000000000000804] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/09/2021] [Accepted: 05/09/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is growing interest in imaging multiple sclerosis (MS) through the ultra-high-field (UHF) lens, which currently means a static magnetic field strength of 7 T or higher. Because of higher signal-to-noise ratio and enhanced susceptibility effects, UHF magnetic resonance imaging improves conspicuity of MS pathological hallmarks, among them cortical demyelination and the central vein sign. This could, in turn, improve confidence in MS diagnosis and might also facilitate therapeutic monitoring of MS patients. Furthermore, UHF imaging offers unique insight into iron-related pathology, leptomeningeal inflammation, and spinal cord pathologies in neuroinflammation. Yet, limitations such as the longer scanning times to achieve improved resolution and incipient safety data on implanted medical devices need to be considered. In this review, we discuss applications of UHF imaging in MS, its advantages and limitations, and practical aspects of UHF in the clinical setting.
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Affiliation(s)
- Benjamin V. Ineichen
- From the Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Erin S. Beck
- From the Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Marco Piccirelli
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel S. Reich
- From the Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
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Madsen MAJ, Wiggermann V, Bramow S, Christensen JR, Sellebjerg F, Siebner HR. Imaging cortical multiple sclerosis lesions with ultra-high field MRI. NEUROIMAGE-CLINICAL 2021; 32:102847. [PMID: 34653837 PMCID: PMC8517925 DOI: 10.1016/j.nicl.2021.102847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cortical lesions are abundant in multiple sclerosis (MS), yet difficult to visualize in vivo. Ultra-high field (UHF) MRI at 7 T and above provides technological advances suited to optimize the detection of cortical lesions in MS. PURPOSE To provide a narrative and quantitative systematic review of the literature on UHF MRI of cortical lesions in MS. METHODS A systematic search of all literature on UHF MRI of cortical lesions in MS published before September 2020. Quantitative outcome measures included cortical lesion numbers reported using 3 T and 7 T MRI and between 7 T MRI sequences, along with sensitivity of UHF MRI towards cortical lesions verified by histopathology. RESULTS 7 T MRI detected on average 52 ± 26% (mean ± 95% confidence interval) more cortical lesions than the best performing image contrast at 3 T, with the largest increase in type II-IV intracortical lesion detection. Across all studies, the mean cortical lesion number was 17 ± 6 per patient. In progressive MS cohorts, approximately four times more cortical lesions were reported than in CIS/early RRMS, and RRMS. Yet, there was no difference in lesion type ratio between these MS subtypes. Furthermore, superiority of one MRI sequence over another could not be established from available data. Post-mortem lesion detection with UHF MRI agreed only modestly with pathological examinations. Mean pro- and retrospective sensitivity was 33 ± 6% and 71 ± 10%, respectively, with the highest sensitivity towards type I and type IV lesions. CONCLUSION UHF MRI improves cortical lesion detection in MS considerably compared to 3 T MRI, particularly for type II-IV lesions. Despite modest sensitivity, 7 T MRI is still capable of visualizing all aspects of cortical lesion pathology and could potentially aid clinicians in diagnosing and monitoring MS, and progressive MS in particular. However, standardization of acquisition and segmentation protocols is needed.
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Affiliation(s)
- Mads A J Madsen
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark.
| | - Vanessa Wiggermann
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark
| | - Stephan Bramow
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Jeppe Romme Christensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital - Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
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Abstract
After introduction of the first human 7 tesla (7T) system in 1999, 7T MR systems have been employed as one of the most advanced platforms for human MR research for more than 20 years. Currently, two 7T MR models are approved for clinical use in the U.S.A. The approval facilitated introduction of the 7T system, summing up to around 100 worldwide. The approval in Japan is much awaited. As a clinical MR scanner, the 7T MR system is drawing attention in terms of safety.Several large-sized studies on bioeffects have been reported for vertigo, dizziness, motion disturbances, nausea, and others. Such effects might also be found in MR workers and researchers. Frequency and severity of reported bioeffects will be presented and discussed, including their variances. The high resonance frequency and shorter RF wavelength of 7T increase the concern about the safety. Homogeneous RF pulse excitation is difficult even for the brain, and a multi-channel parallel transmit (pTx) system is considered mandatory. However, pTx may create a hot spot, which makes the estimation of specific absorption rate (SAR) to be difficult. The stronger magnetic field of 7T causes a large force of displacement and heating on metallic implants or devices, and the scan of patients with them should not be conducted at 7T. However, there are some opinions that such patients might be scanned even at 7T, if certain criteria are met. This article provides a brief review on the effect of the static magnetic field on humans (MR subjects, workers, and researchers) and neurons, in addition to scan sound, SAR, and metal implants and devices. Understanding and avoiding adverse effects will contribute to the reduction in safety risks and the prevention of incidents.
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Affiliation(s)
- Tomohisa Okada
- Human Brain Research Center, Graduate School of Medicine, Kyoto University
| | - Thai Akasaka
- Human Brain Research Center, Graduate School of Medicine, Kyoto University
| | - Dinh Hd Thuy
- Human Brain Research Center, Graduate School of Medicine, Kyoto University
| | - Tadashi Isa
- Human Brain Research Center, Graduate School of Medicine, Kyoto University
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Abstract
PURPOSE OF REVIEW Ultra-high field 7 T MRI has multiple applications for the in vivo characterization of the heterogeneous aspects underlying multiple sclerosis including the identification of cortical lesions, characterization of the different types of white matter plaques, evaluation of structures difficult to assess with conventional MRI (thalamus, cerebellum, spinal cord, meninges). RECENT FINDINGS The sensitivity of cortical lesion detection at 7 T is twice than at lower field MRI, especially for subpial lesions, the most common cortical lesion type in multiple sclerosis. Cortical lesion load accrual is independent of that in the white matter and predicts disability progression.Seven Tesla MRI provides details on tissue microstructure that can be used to improve white matter lesion characterization. These include the presence of a central vein, whose identification can be used to improve multiple sclerosis diagnosis, or the appearance of an iron-rich paramagnetic rim on susceptibility-weighted images, which corresponds to iron-rich microglia at the periphery of slow expanding lesions. Improvements in cerebellar and spinal cord tissue delineation and lesion characterization have also been demonstrated. SUMMARY Imaging at 7 T allows assessing more comprehensively the complementary pathophysiological aspects of multiple sclerosis, opening up novel perspectives for clinical and therapeutics evaluation.
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Spini M, Choi S, Harrison DM. 7T MPFLAIR versus MP2RAGE for Quantifying Lesion Volume in Multiple Sclerosis. J Neuroimaging 2020; 30:531-536. [PMID: 32569408 DOI: 10.1111/jon.12718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND PURPOSE Use of fluid-attenuated inversion recovery (FLAIR) scans to quantify multiple sclerosis (MS) lesion volume on 7 Tesla (7T) magnetic resonance imaging (MRI) has many downsides, including poor image homogeneity. There are little data about the relative benefit of alternative modalities. The purpose of this paper is to investigate if magnetization-prepared 2 rapid acquisition gradient echo (MP2RAGE) is a viable alternative to FLAIR for robust lesion volume measurement and disability correlations. METHODS Forty-seven participants with MS underwent annual brain 7T MRIs. Magnetization-prepared FLAIR (MPFLAIR) and MP2RAGE (both at .7 mm3 isotropic resolution) sequences from a total of 80 MRI scans from 47 subjects were reviewed. White matter lesion (WML) masks were manually constructed from MPFLAIR and T1 maps (from MP2RAGE). Lesion volumes (normalized to intracranial volume) were compared to clinical characteristics and disability scales scores by Pearson or Spearman correlation, as appropriate. Relative correlation strength was compared by Fisher r- to z-transformation. RESULTS Normalized lesion volume was greater in MPFLAIR masks (median .005 [range, .001-.030]) than from T1 maps (median .003 [range, .000-.015]). However, lesion volumes between MPFLAIR and T1 maps were highly correlated (rho = .87, P < .001). WML masks from both modalities correlated with most disability measures with no significant difference in the strength of correlation. CONCLUSIONS 7T MPFLAIR and MP2RAGE T1 map-based WML volumes are highly intercorrelated and both correlate with disability. Thus, MP2RAGE may be a viable alternative to FLAIR-based methods for WML measurement on 7T MRI in MS research.
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Affiliation(s)
- Margaret Spini
- School of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Seongjin Choi
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Daniel M Harrison
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
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DiGiacomo P, Maclaren J, Aksoy M, Tong E, Carlson M, Lanzman B, Hashmi S, Watkins R, Rosenberg J, Burns B, Skloss TW, Rettmann D, Rutt B, Bammer R, Zeineh M. A within-coil optical prospective motion-correction system for brain imaging at 7T. Magn Reson Med 2020; 84:1661-1671. [PMID: 32077521 DOI: 10.1002/mrm.28211] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Motion artifact limits the clinical translation of high-field MR. We present an optical prospective motion correction system for 7 Tesla MRI using a custom-built, within-coil camera to track an optical marker mounted on a subject. METHODS The camera was constructed to fit between the transmit-receive coils with direct line of sight to a forehead-mounted marker, improving upon prior mouthpiece work at 7 Tesla MRI. We validated the system by acquiring a 3D-IR-FSPGR on a phantom with deliberate motion applied. The same 3D-IR-FSPGR and a 2D gradient echo were then acquired on 7 volunteers, with/without deliberate motion and with/without motion correction. Three neuroradiologists blindly assessed image quality. In 1 subject, an ultrahigh-resolution 2D gradient echo with 4 averages was acquired with motion correction. Four single-average acquisitions were then acquired serially, with the subject allowed to move between acquisitions. A fifth single-average 2D gradient echo was acquired following subject removal and reentry. RESULTS In both the phantom and human subjects, deliberate and involuntary motion were well corrected. Despite marked levels of motion, high-quality images were produced without spurious artifacts. The quantitative ratings confirmed significant improvements in image quality in the absence and presence of deliberate motion across both acquisitions (P < .001). The system enabled ultrahigh-resolution visualization of the hippocampus during a long scan and robust alignment of serially acquired scans with interspersed movement. CONCLUSION We demonstrate the use of a within-coil camera to perform optical prospective motion correction and ultrahigh-resolution imaging at 7 Tesla MRI. The setup does not require a mouthpiece, which could improve accessibility of motion correction during 7 Tesla MRI exams.
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Affiliation(s)
- Phillip DiGiacomo
- Department of Bioengineering, Stanford University, Stanford, California
| | - Julian Maclaren
- Department of Radiology, Stanford University, Stanford, California
| | - Murat Aksoy
- Department of Radiology, Stanford University, Stanford, California
| | - Elizabeth Tong
- Department of Radiology, Stanford University, Stanford, California
| | - Mackenzie Carlson
- Department of Bioengineering, Stanford University, Stanford, California
| | - Bryan Lanzman
- Department of Radiology, Stanford University, Stanford, California
| | - Syed Hashmi
- Department of Radiology, Stanford University, Stanford, California
| | - Ronald Watkins
- Department of Radiology, Stanford University, Stanford, California
| | | | - Brian Burns
- Applied Sciences Lab West, GE Healthcare, Menlo Park, California
| | | | - Dan Rettmann
- MR Applications and Workflow, GE Healthcare, Rochester, Minnesota
| | - Brian Rutt
- Department of Bioengineering, Stanford University, Stanford, California.,Department of Radiology, Stanford University, Stanford, California
| | - Roland Bammer
- Department of Radiology, University of Melbourne, Melbourne, Australia
| | - Michael Zeineh
- Department of Radiology, Stanford University, Stanford, California
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13
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Hayashi N, Sato Y, Maruyama T, Shimoyama Y, Motegi S, Ujita K, Kumasaka S, Ogura A, Ogura T, Tsushima Y. Development of a quantitative statistical analysis system for double inversion recovery (DIR) MRI: A preliminary clinical study. Technol Health Care 2019; 28:241-248. [PMID: 31594274 DOI: 10.3233/thc-195646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gray matter (GM) imaging is important in the investigation of many neurological diseases, including schizophrenia, multiple sclerosis, stroke, Alzheimer's disease, tuberous sclerosis, and epilepsy, which are all associated with changes in cortical GM. OBJECTIVE The aim of this study was to develop a quantitative statistical analysis system for double inversion recovery (DIR) MRI and to evaluate the new system using preliminary clinical data. METHODS The study population comprised of 10 healthy volunteers and six patients with or without brain degeneration. A quantitative statistical analysis system for DIR images was developed using the following steps: 1) brain spatial normalization, 2) mean and standard deviation (SD) map creation, and 3) Z-score map creation. To evaluate the new voxel-based morphometry system, Z-scores of lesions in patients with brain degeneration were measured and then compared with Z-scores of normal regions. RESULTS All DIR images were adequately spatially normalized to Montreal Neurological Institute MNI coordinate. Lesions in each patient were indicated by high Z-score values on a Z-score map, which were significantly higher than Z-scores of normal regions (p< 0.05). CONCLUSIONS In this study, we developed a quantitative statistical analysis system for DIR MRI. Using our system, clinicians might accurately diagnose early brain degeneration.
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Affiliation(s)
- Norio Hayashi
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Gunma, Japan
| | - Yusuke Sato
- Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Gunma, Japan.,Department of Radiology, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Tomoko Maruyama
- Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Gunma, Japan.,Department of Radiology, Shinshu University Hospital, Nagano, Japan
| | - Yuuya Shimoyama
- Department of Radiology, Shinozuka Hospital, Fujioka, Gumma, Japan
| | - Shunichi Motegi
- Department of Radiology, Josai Clinic, Maebashi, Gumma, Japan
| | - Kouichi Ujita
- Department of Radiology, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Soma Kumasaka
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akio Ogura
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Gunma, Japan
| | - Toshihiro Ogura
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Gunma, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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14
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Conrad BN, Barry RL, Rogers BP, Maki S, Mishra A, Thukral S, Sriram S, Bhatia A, Pawate S, Gore JC, Smith SA. Multiple sclerosis lesions affect intrinsic functional connectivity of the spinal cord. Brain 2019; 141:1650-1664. [PMID: 29648581 DOI: 10.1093/brain/awy083] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/04/2018] [Indexed: 11/13/2022] Open
Abstract
Patients with multiple sclerosis present with focal lesions throughout the spinal cord. There is a clinical need for non-invasive measurements of spinal cord activity and functional organization in multiple sclerosis, given the cord's critical role in the disease. Recent reports of spontaneous blood oxygenation level-dependent fluctuations in the spinal cord using functional MRI suggest that, like the brain, cord activity at rest is organized into distinct, synchronized functional networks among grey matter regions, likely related to motor and sensory systems. Previous studies looking at stimulus-evoked activity in the spinal cord of patients with multiple sclerosis have demonstrated increased levels of activation as well as a more bilateral distribution of activity compared to controls. Functional connectivity studies of brain networks in multiple sclerosis have revealed widespread alterations, which may take on a dynamic trajectory over the course of the disease, with compensatory increases in connectivity followed by decreases associated with structural damage. We build upon this literature by examining functional connectivity in the spinal cord of patients with multiple sclerosis. Using ultra-high field 7 T imaging along with processing strategies for robust spinal cord functional MRI and lesion identification, the present study assessed functional connectivity within cervical cord grey matter of patients with relapsing-remitting multiple sclerosis (n = 22) compared to a large sample of healthy controls (n = 56). Patient anatomical images were rated for lesions by three independent raters, with consensus ratings revealing 19 of 22 patients presented with lesions somewhere in the imaged volume. Linear mixed models were used to assess effects of lesion location on functional connectivity. Analysis in control subjects demonstrated a robust pattern of connectivity among ventral grey matter regions as well as a distinct network among dorsal regions. A gender effect was also observed in controls whereby females demonstrated higher ventral network connectivity. Wilcoxon rank-sum tests detected no differences in average connectivity or power of low frequency fluctuations in patients compared to controls. The presence of lesions was, however, associated with local alterations in connectivity with differential effects depending on columnar location. The patient results suggest that spinal cord functional networks are generally intact in relapsing-remitting multiple sclerosis but that lesions are associated with focal abnormalities in intrinsic connectivity. These findings are discussed in light of the current literature on spinal cord functional MRI and the potential neurological underpinnings.
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Affiliation(s)
- Benjamin N Conrad
- Neuroscience Graduate Program, Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert L Barry
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Baxter P Rogers
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Satoshi Maki
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arabinda Mishra
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Saakshi Thukral
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Subramaniam Sriram
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aashim Bhatia
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Siddharama Pawate
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John C Gore
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Seth A Smith
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
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15
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Advantages of fluid and white matter suppression (FLAWS) with MP2RAGE compared with double inversion recovery turbo spin echo (DIR-TSE) at 7T. Eur J Radiol 2019; 116:160-164. [PMID: 31153559 DOI: 10.1016/j.ejrad.2019.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/22/2019] [Accepted: 04/27/2019] [Indexed: 12/25/2022]
Abstract
Cerebrospinal fluid (CSF) and white matter (WM) signal suppression techniques allow better visualization of both WM and gray matter (GM) lesions in such disorders as multiple sclerosis and epilepsy. Recently, a technique, FLuid And White matter Suppression "FLAWS", has been proposed at 3 T based on the magnetization-prepared with two rapid gradient echoes (MP2RAGE) sequence. In this study, the FLAWS-MP2RAGE pulse sequence was compared with a double inversion recovery turbo spin echo (DIR-TSE) sequence at 7 T. Twenty-two healthy volunteers were examined. Isotropic spatial resolution of 1 mm and a scan time of approximately 6 min were chosen due to a restricted clinical schedule. Homogeneity of CSF and WM signal suppression was compared with GM signal as an intensity reference. Volumes of GM visualization and specific absorption rates (SARs) were compared using Wilcoxon-rank sum tests with Bonferroni-Holm correction for multiple comparisons. WM-to-GM signal ratios in FLAWS-MP2RAGE images were significantly lower than DIR-TSE (median: 24.5% vs 59.0%, P < 0.0001), whereas CSF-to-GM signal ratios in FLAWS-MP2RAGE were significantly higher than DIR-TSE (57.1% vs 38.3%, P = 0.0001). Ranges of the signal ratios between 20 and 80 percentiles were lower in FLAWS-MP2RAGE than DIR-TSE for WM (24.1% vs 37.2%, P < 0.0001) but were higher in FLAWS-MP2RAGE compared with DIR-TSE for CSF (80.8% vs 63.0%, P = 0.0001). Pixels of low GM signal (< 20% of the median) were mainly distributed at the skull base, and these low signal GM volume ratios were lower in FLAWS-MP2RAGE than DIR-TSE (2.27% vs 6.18%, P < 0.0001). Median SAR in sixteen subjects was 2.5 times higher in DIR-TSE than in FLAWS-MP2RAGE. FLAWS-MP2RAGE showed superior and more homogenous WM signal suppression, better GM visualization at the skull base and lower SAR compared with DIR-TSE, suggesting superiority of FLAWS-MP2RAGE at 7 T.
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16
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Gras V, Pracht ED, Mauconduit F, Le Bihan D, Stöcker T, Boulant N. Robust nonadiabatic T2
preparation using universal parallel-transmit kT
-point pulses for 3D FLAIR imaging at 7 T. Magn Reson Med 2019; 81:3202-3208. [DOI: 10.1002/mrm.27645] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Vincent Gras
- NeuroSpin, Commissariat à l’Energie Atomique, Université Paris-Saclay; Gif sur Yvette France
| | | | | | - Denis Le Bihan
- NeuroSpin, Commissariat à l’Energie Atomique, Université Paris-Saclay; Gif sur Yvette France
| | - Tony Stöcker
- German Center for Neurodegenerative Diseases; Bonn Germany
- Department of Physics and Astronomy; University of Bonn; Bonn Germany
| | - Nicolas Boulant
- NeuroSpin, Commissariat à l’Energie Atomique, Université Paris-Saclay; Gif sur Yvette France
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17
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Umino M, Maeda M, Ii Y, Tomimoto H, Sakuma H. 3D double inversion recovery MR imaging: Clinical applications and usefulness in a wide spectrum of central nervous system diseases. J Neuroradiol 2018; 46:107-116. [PMID: 30016704 DOI: 10.1016/j.neurad.2018.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/03/2018] [Accepted: 06/23/2018] [Indexed: 12/31/2022]
Abstract
Double inversion recovery (DIR) imaging provides two inversion pulses that attenuate signals from cerebrospinal fluid and normal white matter. This review was undertaken to describe the principle of the DIR sequence, the clinical applications of 3D DIR in various central nervous system diseases and the clinical benefits of the 3D DIR compared with those of other MR sequences. 3D DIR imaging provides better lesion conspicuity and topography than other MR techniques. It is particularly useful for diagnosing the following disease entities: cortical and subcortical abnormalities such as multiple sclerosis, cortical microinfarcts and cortical development anomalies; sulcal abnormalities such as meningitis and subacute/chronic subarachnoid hemorrhage; and optic neuritis caused by multiple sclerosis or neuromyelitis optica.
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Affiliation(s)
- Maki Umino
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, 514-8507 Tsu, Mie, Japan.
| | - Masayuki Maeda
- Department of Advanced Diagnostic Imaging, Mie University School of Medicine, Tsu, Mie, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University School of Medicine, Tsu, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University School of Medicine, Tsu, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, 514-8507 Tsu, Mie, Japan
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18
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Comparing lesion detection of infratentorial multiple sclerosis lesions between T2-weighted spin-echo, 2D-FLAIR, and 3D-FLAIR sequences. Clin Imaging 2018; 51:229-234. [PMID: 29879598 DOI: 10.1016/j.clinimag.2018.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/14/2018] [Accepted: 05/24/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Infratentorial lesions in patients with multiple sclerosis are associated with long-term disability. Two-dimensional fluid-attenuated inversion recovery demonstrates poor infratentorial lesion detection when compared to T2-weighted spin echo. Evidence of improved detection with 3D fluid-attenuated inversion recovery has been conflicting. This study compares the infratentorial lesion detection performance, observer performance, and signal and contrast properties between T2-weighted spin echo, 2D, and 3D fluid-attenuated inversion recovery. METHODS Two board-certified radiologists independently reviewed and counted infratentorial lesions from 85 brain MRIs in patients with clinically definite multiple sclerosis and concurrent 3D, 2D fluid-attenuated inversion recovery, and T2-weighted spin echo sequences. Contrast-to-noise and signal-to-noise ratios were measured for 25 MRIs. Wilcoxon signed-rank test was used for pairwise comparisons of the combined average infratentorial lesion count, contrast-to-noise, and signal-to-noise ratios, and was adjusted for three pairwise comparisons using Bonferroni correction. A corrected p value < 0.05 was considered statistically significant. RESULTS The number of lesions on 3D fluid-attenuated inversion recovery was significantly higher than those on 2D (p < 0.001) and T2-weighted spin echo (p < 0.001). Results of contrast-to-noise and signal-to-noise ratios were overall mixed and predominantly not concordant with lesion count findings, with T2-weighted spin echo demonstrating the highest signal-to-noise ratios and contrast-to-noise ratio of lesion compared with white matter but the lowest contrast-to-noise ratio of lesion compared with gray matter. CONCLUSION The 3D fluid-attenuated inversion recovery sequence addresses the disadvantage of poor infratentorial lesion detection on 2D, while still maintaining the advantage over T2-weighted spin echo in the detection of lesions adjacent to the cerebrospinal fluid.
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19
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Abstract
Since its technical development in the early 1980s, magnetic resonance imaging (MRI) has quickly been adopted as an essential tool in supporting the diagnosis, longitudinal monitoring, evaluation of therapeutic response, and scientific investigations in multiple sclerosis (MS). The clinical usage of MRI has increased in parallel with technical innovations in the technique itself; the widespread adoption of clinically routine MRI at 1.5T has allowed sensitive qualitative and quantitative assessments of macroscopic central nervous system (CNS) inflammatory demyelinating lesions and tissue atrophy. However, conventional MRI lesion measures lack specificity for the underlying MS pathology and only weakly correlate with clinical status. Higher field strength units and newer, advanced MRI techniques offer increased sensitivity and specificity in the detection of disease activity and disease severity. This review summarizes the current status and future prospects regarding the role of MRI in the characterization of MS-related brain and spinal cord involvement.
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Affiliation(s)
- Christopher C Hemond
- Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Departments of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Rohit Bakshi
- Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Departments of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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20
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How to choose the right MR sequence for your research question at 7 T and above? Neuroimage 2018; 168:119-140. [DOI: 10.1016/j.neuroimage.2017.04.044] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/29/2022] Open
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21
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Trattnig S, Springer E, Bogner W, Hangel G, Strasser B, Dymerska B, Cardoso PL, Robinson SD. Key clinical benefits of neuroimaging at 7T. Neuroimage 2018; 168:477-489. [PMID: 27851995 PMCID: PMC5832016 DOI: 10.1016/j.neuroimage.2016.11.031] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/06/2016] [Accepted: 11/12/2016] [Indexed: 01/15/2023] Open
Abstract
The growing interest in ultra-high field MRI, with more than 35.000 MR examinations already performed at 7T, is related to improved clinical results with regard to morphological as well as functional and metabolic capabilities. Since the signal-to-noise ratio increases with the field strength of the MR scanner, the most evident application at 7T is to gain higher spatial resolution in the brain compared to 3T. Of specific clinical interest for neuro applications is the cerebral cortex at 7T, for the detection of changes in cortical structure, like the visualization of cortical microinfarcts and cortical plaques in Multiple Sclerosis. In imaging of the hippocampus, even subfields of the internal hippocampal anatomy and pathology may be visualized with excellent spatial resolution. Using Susceptibility Weighted Imaging, the plaque-vessel relationship and iron accumulations in Multiple Sclerosis can be visualized, which may provide a prognostic factor of disease. Vascular imaging is a highly promising field for 7T which is dealt with in a separate dedicated article in this special issue. The static and dynamic blood oxygenation level-dependent contrast also increases with the field strength, which significantly improves the accuracy of pre-surgical evaluation of vital brain areas before tumor removal. Improvement in acquisition and hardware technology have also resulted in an increasing number of MR spectroscopic imaging studies in patients at 7T. More recent parallel imaging and short-TR acquisition approaches have overcome the limitations of scan time and spatial resolution, thereby allowing imaging matrix sizes of up to 128×128. The benefits of these acquisition approaches for investigation of brain tumors and Multiple Sclerosis have been shown recently. Together, these possibilities demonstrate the feasibility and advantages of conducting routine diagnostic imaging and clinical research at 7T.
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Affiliation(s)
- Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria; Christian Doppler Laboratory for Clinical Molecular MRI, Vienna, Austria.
| | - Elisabeth Springer
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria; Christian Doppler Laboratory for Clinical Molecular MRI, Vienna, Austria.
| | - Wolfgang Bogner
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Gilbert Hangel
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Bernhard Strasser
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Barbara Dymerska
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Pedro Lima Cardoso
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Simon Daniel Robinson
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
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22
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Hagens MH, Burggraaff J, Kilsdonk ID, Ruggieri S, Collorone S, Cortese R, Cawley N, Sbardella E, Andelova M, Amann M, Lieb JM, Pantano P, Lissenberg-Witte BI, Killestein J, Oreja-Guevara C, Wuerfel J, Ciccarelli O, Gasperini C, Lukas C, Rovira A, Barkhof F, Wattjes MP. Impact of 3 Tesla MRI on interobserver agreement in clinically isolated syndrome: A MAGNIMS multicentre study. Mult Scler 2018; 25:352-360. [PMID: 29327668 PMCID: PMC6393953 DOI: 10.1177/1352458517751647] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Compared to 1.5 T, 3 T magnetic resonance imaging (MRI) increases
signal-to-noise ratio leading to improved image quality. However, its
clinical relevance in clinically isolated syndrome suggestive of multiple
sclerosis remains uncertain. Objectives: The purpose of this study was to investigate how 3 T MRI affects the
agreement between raters on lesion detection and diagnosis. Methods: We selected 30 patients and 10 healthy controls from our ongoing prospective
multicentre cohort. All subjects received baseline 1.5 and 3 T brain and
spinal cord MRI. Patients also received follow-up brain MRI at 3–6 months.
Four experienced neuroradiologists and four less-experienced raters scored
the number of lesions per anatomical region and determined dissemination in
space and time (McDonald 2010). Results: In controls, the mean number of lesions per rater was 0.16 at 1.5 T and 0.38
at 3 T (p = 0.005). For patients, this was 4.18 and 4.40,
respectively (p = 0.657). Inter-rater agreement on
involvement per anatomical region and dissemination in space and time was
moderate to good for both field strengths. 3 T slightly improved agreement
between experienced raters, but slightly decreased agreement between
less-experienced raters. Conclusion: Overall, the interobserver agreement was moderate to good. 3 T appears to
improve the reading for experienced readers, underlining the benefit of
additional training.
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Affiliation(s)
- Marloes Hj Hagens
- Department of Neurology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jessica Burggraaff
- Department of Neurology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Iris D Kilsdonk
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Radiology and Nuclear Medicine, Onze Lieve Vrouwen Gasthuis, Amsterdam, The Netherlands
| | - Serena Ruggieri
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy/Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Sara Collorone
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy/NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Rosa Cortese
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK; Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Niamh Cawley
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Emilia Sbardella
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Michaela Andelova
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Michael Amann
- Department of Neurology, University Hospital Basel, Basel, Switzerland/Medical Image Analysis Center (MIAC), Basel, Switzerland/Division of Neuroradiology, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Johanna M Lieb
- Division of Neuroradiology, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Patrizia Pantano
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy/Istituto Neurologico Mediterraneo, Neuromed, Pozzilli, Italy
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Jens Wuerfel
- Medical Image Analysis Center (MIAC), Basel, Switzerland/NeuroCure, Charité - Berlin University of Medicine, Berlin, Germany/Department of Biomedical Engineering, University Hospital Basel, Basel, Switzerland
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Carsten Lukas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Alex Rovira
- Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Institutes of Neurology and Healthcare Engineering, UCL Institute of Neurology, London, UK
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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23
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Springer E, Dymerska B, Cardoso PL, Robinson SD, Weisstanner C, Wiest R, Schmitt B, Trattnig S. Comparison of Routine Brain Imaging at 3 T and 7 T. Invest Radiol 2017; 51:469-82. [PMID: 26863580 DOI: 10.1097/rli.0000000000000256] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to compare quantitative and semiquantitative parameters (signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR], image quality, diagnostic confidence) from a standard brain magnetic resonance imaging examination encompassing common neurological disorders such as demyelinating disease, gliomas, cerebrovascular disease, and epilepsy, with comparable sequence protocols and acquisition times at 3 T and at 7 T. MATERIALS AND METHODS Ten healthy volunteers and 4 subgroups of 40 patients in total underwent comparable magnetic resonance protocols with standard diffusion-weighted imaging, 2D and 3D turbo spin echo, 2D and 3D gradient echo and susceptibility-weighted imaging of the brain (10 sequences) at 3 T and 7 T. The subgroups comprised patients with either lesional (n = 5) or nonlesional (n = 4) epilepsy, intracerebral tumors (n = 11), demyelinating disease (n = 11) (relapsing-remitting multiple sclerosis [MS, n = 9], secondary progressive MS [n = 1], demyelinating disease not further specified [n = 1]), or chronic cerebrovascular disorders [n = 9]). For quantitative analysis, SNR and CNR were determined. For a semiquantitative assessment of the diagnostic confidence, a 10-point scale diagnostic confidence score (DCS) was applied. Two experienced radiologists with additional qualification in neuroradiology independently assessed, blinded to the field strength, 3 pathology-specific imaging criteria in each of the 4 disease groups and rated their diagnostic confidence. The overall image quality was semiquantitatively assessed using a 4-point scale taking into account whether diagnostic decision making was hampered by artifacts or not. RESULTS Without correction for spatial resolution, SNR was higher at 3 T except in the T2 SPACE 3D, DWI single shot, and DIR SPACE 3D sequences. The SNR corrected by the ratio of 3 T/7 T voxel sizes was higher at 7 T than at 3 T in 10 of 11 sequences (all except for T1 MP2RAGE 3D).In CNR, there was a wide variation between sequences and patient cohorts, but average CNR values were broadly similar at 3 T and 7 T.DCS values for all 4 pathologic entities were higher at 7 T than at 3 T. The DCS was significantly higher at 7 T for diagnosis and exclusion of cortical lesions in vascular disease. A tendency to higher DCS at 7 T for cortical lesions in MS was observed, and for the depiction of a central vein and iron deposits within MS lesions. Despite motion artifacts, DCS values were higher at 7 T for the diagnosis and exclusion of hippocampal sclerosis in mesial temporal lobe epilepsy (improved detection of the hippocampal subunits). Interrater agreement was 69.7% at 3 T and 93.3% at 7 T. There was no significant difference in the overall image quality score between 3 T and 7 T taking into account whether diagnostic decision making was hampered by artifacts or not. CONCLUSIONS Ultra-high-field magnetic resonance imaging at 7 T compared with 3 T yielded an improved diagnostic confidence in the most frequently encountered neurologic disorders. Higher spatial resolution and contrast were identified as the main contributory factors.
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Affiliation(s)
- Elisabeth Springer
- From the *High Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; †Support Center of Advanced Neuroimaging, University Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern and Inselspital, University of Bern, Bern, Switzerland; ‡Siemens Healthcare Pty Ltd Australia, Imaging and Therapy Systems, Magnetic Resonance, Macquarie Park, New South Wales, Australia; §Siemens Healthcare, Erlangen, Germany; and ∥CD Laboratory for Molecular Clinical MR Imaging, Vienna, Austria
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Chou IJ, Lim SY, Tanasescu R, Al-Radaideh A, Mougin OE, Tench CR, Whitehouse WP, Gowland PA, Constantinescu CS. Seven-Tesla Magnetization Transfer Imaging to Detect Multiple Sclerosis White Matter Lesions. J Neuroimaging 2017; 28:183-190. [DOI: 10.1111/jon.12474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 12/26/2022] Open
Affiliation(s)
- I-Jun Chou
- Division of Clinical Neuroscience; University of Nottingham; Nottingham UK
- Division of Academic Child Health; School of Medicine; University of Nottingham; Nottingham UK
- Division of Paediatric Neurology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Su-Yin Lim
- Division of Clinical Neuroscience; University of Nottingham; Nottingham UK
| | - Radu Tanasescu
- Division of Clinical Neuroscience; University of Nottingham; Nottingham UK
- Department of Neurology; Neurosurgery and Psychiatry; Carol Davila University of Medicine and Pharmacy; Colentina Hospital; Bucharest Romania
| | - Ali Al-Radaideh
- Sir Peter Mansfield Magnetic Resonance Centre; School of Physics and Astronomy; University of Nottingham; England UK
- Department of Medical Imaging; Faculty of Allied Health Sciences; Hashemite University; Zarqa Jordan
| | - Olivier E. Mougin
- Sir Peter Mansfield Magnetic Resonance Centre; School of Physics and Astronomy; University of Nottingham; England UK
| | | | - William P. Whitehouse
- Division of Academic Child Health; School of Medicine; University of Nottingham; Nottingham UK
| | - Penny A. Gowland
- Sir Peter Mansfield Magnetic Resonance Centre; School of Physics and Astronomy; University of Nottingham; England UK
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25
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Pracht ED, Feiweier T, Ehses P, Brenner D, Roebroeck A, Weber B, Stöcker T. SAR and scan-time optimized 3D whole-brain double inversion recovery imaging at 7T. Magn Reson Med 2017; 79:2620-2628. [PMID: 28905416 DOI: 10.1002/mrm.26913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/28/2017] [Accepted: 08/18/2017] [Indexed: 11/10/2022]
Abstract
PURPOSE The aim of this project was to implement an ultra-high field (UHF) optimized double inversion recovery (DIR) sequence for gray matter (GM) imaging, enabling whole brain coverage in short acquisition times ( ≈5 min, image resolution 1 mm3 ). METHODS A 3D variable flip angle DIR turbo spin echo (TSE) sequence was optimized for UHF application. We implemented an improved, fast, and specific absorption rate (SAR) efficient TSE imaging module, utilizing improved reordering. The DIR preparation was tailored to UHF application. Additionally, fat artifacts were minimized by employing water excitation instead of fat saturation. RESULTS GM images, covering the whole brain, were acquired in 7 min scan time at 1 mm isotropic resolution. SAR issues were overcome by using a dedicated flip angle calculation considering SAR and SNR efficiency. Furthermore, UHF related artifacts were minimized. CONCLUSION The suggested sequence is suitable to generate GM images with whole-brain coverage at UHF. Due to the short total acquisition times and overall robustness, this approach can potentially enable DIR application in a routine setting and enhance lesion detection in neurological diseases. Magn Reson Med 79:2620-2628, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
| | | | - Philipp Ehses
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Daniel Brenner
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Alard Roebroeck
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht, Maastricht University, The Netherlands
| | - Bernd Weber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Tony Stöcker
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Physics and Astronomy, University of Bonn, Bonn, Germany
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26
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Eichinger P, Wiestler H, Zhang H, Biberacher V, Kirschke JS, Zimmer C, Mühlau M, Wiestler B. A novel imaging technique for better detecting new lesions in multiple sclerosis. J Neurol 2017; 264:1909-1918. [PMID: 28756606 DOI: 10.1007/s00415-017-8576-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 12/24/2022]
Abstract
We developed a tool that performs longitudinal subtraction of 3D double inversion recovery (DIR) images in follow-up magnetic resonance (MR) examinations of patients with multiple sclerosis. As DIR sequences show a high lesion-to-parenchyma contrast, we hypothesized that such a tool might lead to increased sensitivity for new lesions as well as to speeding up the routine clinical work-up of follow-up MR imaging in multiple sclerosis by directly visualizing new lesions. DIR subtraction images of serial MR examinations were calculated in 106 patients with multiple sclerosis. Existence of new lesions was assessed in three different ways: by standard visual comparison, by FLAIR, and by DIR subtraction maps. A reference standard, to which the single modalities were compared, was defined by combining all information from all readouts and all readers. The presence and number of new lesions were determined and the time needed for analysis measured. Accuracy of detecting overall existence of new lesions using DIR subtraction maps was significantly higher than using visual comparison (96 vs. 86%, p = 0.013) or FLAIR subtraction maps (p < 0.001), with increased sensitivity and higher negative predictive value. Significantly more new lesions were detected when using DIR subtraction maps (p < 0.001). Analyzing subtraction maps took less than a third of the time needed for the standard visual comparison (p = 0.007). Thus, DIR subtraction maps improve the detection of new lesions in a clinical setting both in terms of accuracy and in terms of speed.
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Affiliation(s)
- Paul Eichinger
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Hanni Wiestler
- Department of Psychiatry and Psychotherapy, Isar-Amper-Klinikum München-Ost, Vockestraße 72, 85540, Haar, Germany
| | - Haike Zhang
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Viola Biberacher
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.,TUM-NIC, NeuroImaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.,TUM-NIC, NeuroImaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
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Abidi Z, Faeghi F, Mardanshahi Z, Mortazavi H. Assessment of the diagnostic accuracy of double inversion recovery sequence compared with FLAIR and T2W_TSE in detection of cerebral multiple sclerosis lesions. Electron Physician 2017; 9:4162-4170. [PMID: 28607651 PMCID: PMC5459288 DOI: 10.19082/4162] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/17/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. MRI has an important role in early diagnosis of MS within diagnostic criteria. AIM To determine the diagnostic value of the double inversion recovery (DIR) sequence in detection of brain MS lesions. METHODS In this cross-sectional study, 55 patients were admitted to the MRI department in Vali-E-Asr Hospital in Qaemshahr, Iran, from May 2016 to February 2016. Imaging was performed on a 1.5T Philips MR system using DIR, fluid attenuated inversion recovery (FLAIR), and T2-weighted turbo spin echo (T2W_TSE) sequences with the same parameters, including field of view (FOV), matrix, slice thickness, voxel size, and number of signal averaging (NSA). The DIR sequence has two different time inversions (TI1=3400, TI2=325ms): suppressing cerebrospinal fluid (CSF) and white matter signal. Data analysis was performed using the SPSS version 20, and p-value was gained from the patient-wise analysis by Wilcoxon analysis and paired samples t-test for matched pairs. RESULTS More lesions in number and size were depicted on the DIR sequence compared with FLAIR (p=0.000 with a relative ratio of 6) and T2W_TSE (p=0.000 with a relative ratio of 10). DIR demonstrated significantly more intracortical lesions compared with FLAIR (p=0.000 with a relative ratio of 2.53) and T2W_TSE (p=0.000 and relative ratio of 8.87). There was significantly higher contrast ratio between the white matter lesions and the normal appearing white matter (NAWM) in all anatomical regions especially in deep white matter (p=0.001). CONCLUSION An increasing total number of MS lesions can be detected by DIR sequence; thus, we recommend adding DIR sequence in routine MR protocols for MS patients.
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Affiliation(s)
- Zahra Abidi
- M.Sc. Student of Medical Imaging Technology, Radiology Technology Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariborz Faeghi
- Ph.D. of Medical Physics, Radiology Technology Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Mardanshahi
- M.D., Radiologist, Assistant Professor, Radiology Department, Mazandaran University of Medical Sciences, Sari, Iran
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Kilsdonk ID, Schoonheim M, Wattjes MP. In-vivo imaging of meningeal inflammation in multiple sclerosis: Presence of evidence or evidence of presence? Mult Scler 2017; 23:1169-1171. [PMID: 28417656 PMCID: PMC5476185 DOI: 10.1177/1352458517704924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Iris D Kilsdonk
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Radiology and Nuclear Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Menno Schoonheim
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Saranathan M, Worters PW, Rettmann DW, Winegar B, Becker J. Physics for clinicians: Fluid-attenuated inversion recovery (FLAIR) and double inversion recovery (DIR) Imaging. J Magn Reson Imaging 2017; 46:1590-1600. [DOI: 10.1002/jmri.25737] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/30/2017] [Indexed: 01/05/2023] Open
Affiliation(s)
| | | | | | - Blair Winegar
- Department of Medical Imaging; University of Arizona; Tucson Arizona USA
| | - Jennifer Becker
- Department of Medical Imaging; University of Arizona; Tucson Arizona USA
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Massire A, Taso M, Besson P, Guye M, Ranjeva JP, Callot V. High-resolution multi-parametric quantitative magnetic resonance imaging of the human cervical spinal cord at 7T. Neuroimage 2016; 143:58-69. [DOI: 10.1016/j.neuroimage.2016.08.055] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 11/17/2022] Open
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Ganzetti M, Wenderoth N, Mantini D. Quantitative Evaluation of Intensity Inhomogeneity Correction Methods for Structural MR Brain Images. Neuroinformatics 2016; 14:5-21. [PMID: 26306865 PMCID: PMC4706843 DOI: 10.1007/s12021-015-9277-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The correction of intensity non-uniformity (INU) in magnetic resonance (MR) images is extremely important to ensure both within-subject and across-subject reliability. Here we tackled the problem of objectively comparing INU correction techniques for T1-weighted images, which are the most commonly used in structural brain imaging. We focused our investigations on the methods integrated in widely used software packages for MR data analysis: FreeSurfer, BrainVoyager, SPM and FSL. We used simulated data to assess the INU fields reconstructed by those methods for controlled inhomogeneity magnitudes and noise levels. For each method, we evaluated a wide range of input parameters and defined an enhanced configuration associated with best reconstruction performance. By comparing enhanced and default configurations, we found that the former often provide much more accurate results. Accordingly, we used enhanced configurations for a more objective comparison between methods. For different levels of INU magnitude and noise, SPM and FSL, which integrate INU correction with brain segmentation, generally outperformed FreeSurfer and BrainVoyager, whose methods are exclusively dedicated to INU correction. Nonetheless, accurate INU field reconstructions can be obtained with FreeSurfer on images with low noise and with BrainVoyager for slow and smooth inhomogeneity profiles. Our study may prove helpful for an accurate selection of the INU correction method to be used based on the characteristics of actual MR data.
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Affiliation(s)
- Marco Ganzetti
- Neural Control of Movement Laboratory, ETH Zurich, 8057, Zurich, Switzerland.,Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK
| | - Nicole Wenderoth
- Neural Control of Movement Laboratory, ETH Zurich, 8057, Zurich, Switzerland.,Laboratory of Movement Control and Neuroplasticity, KU Leuven, 3001, Leuven, Belgium
| | - Dante Mantini
- Neural Control of Movement Laboratory, ETH Zurich, 8057, Zurich, Switzerland. .,Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK.
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32
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Paul F. Pathology and MRI: exploring cognitive impairment in MS. Acta Neurol Scand 2016; 134 Suppl 200:24-33. [PMID: 27580903 DOI: 10.1111/ane.12649] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 01/24/2023]
Abstract
Cognitive impairment is a frequent symptom in people with multiple sclerosis, affecting up to 70% of patients. This article reviews the published association of cognitive dysfunction with neuroimaging findings. Cognitive impairment has been related to focal T2 hyperintense lesions, diffuse white matter damage and corical and deep gray matter atrophy. Focal lesions cannot sufficiently explain cognitive dysfunction in MS; microstructural tissue damage detectable by diffusion tensor imaging and gray matter atrophy are probably at least as relevant. Resting state functional magnetic resonance imaging is increasingly used to investigate the contribution of functional connectivity changes to cognitive function in MS. The fact that at least one third of MS patients are not overtly cognitively impaired despite significant radiographic tissue damage argues for protective factors (brain reserve, cognitive reserve) that require further clarification. It is concluded that the reported correlations between imaging findings and cognitive function do not imply causality. Well conceived and sufficiently powered longitudinal studies are lacking. Such studies would help unravel protective mechanisms against cogniitve decline and identify suitable imaging techniques to monitor cognitive function in individual patients with MS.
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Affiliation(s)
- F. Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center; Department of Neurology; Charité - Universitaetsmedizin Berlin; Berlin Germany
- Experimental and Clinical Research Center; Max Delbrueck Center for Molecular Medicine and Charité - Universitaetsmedizin Berlin; Berlin Germany
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Granata F, Morabito R, Mormina E, Alafaci C, Marino S, Laganà A, Vinci SL, Briguglio M, Calamuneri A, Gaeta M, Salpietro V, Longo M. 3T Double Inversion Recovery Magnetic Resonance Imaging: diagnostic advantages in the evaluation of cortical development anomalies. Eur J Radiol 2016; 85:906-14. [PMID: 27130050 DOI: 10.1016/j.ejrad.2016.02.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this work was to investigate the diagnostic value of the DIR sequence at 3T MR imaging operating in the evaluation of cortical development anomalies. METHODS We studied 40 patients, with a previous diagnosis of cortical dysplasia, by FLAIR-3D, DIR, FSE T2 and MPR-GE T1 sequences at 3T MRI. Two independent observers evaluated, for each sequence and lesion, some semiological aspects (cortical thickness, cortical signal intensity, white-gray matter blurring, subcortical white matter intensity). We made also a quantitative evaluation of the cortical signal intensity in lesion site, drawing a ROI on each MRI sequences and comparing them to the correspondent normal contralateral cortical area. RESULTS We identified 44 cortical development anomalies. Qualitative analyses showed a high level of agreement between the observers concerning DIR potentialities in detecting and characterizing the cortical development disorders. Particularly DIR sequence was able to demonstrate the blurring and the subcortical white matter anomalies. The quantitative analyses didn't show a significant difference between DIR and traditional sequences in the evaluation of the cortical signal intensity. CONCLUSION 3T MRI-DIR sequence is a useful and better suitable sequence compared to the traditional sequences in the characterization of some semiological aspects of the cortical development disorders, particularly blurring and subcortical white matter hyperintensity.
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Affiliation(s)
- Francesca Granata
- Neuroradiology Unit-Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy.
| | - Rosa Morabito
- Neuroradiology Unit-Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy; Biomedical department of internal and specialistic medicine, University of Palermo, Italy.
| | - Enricomaria Mormina
- Neuroradiology Unit-Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy.
| | - Concetta Alafaci
- Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, Neurosurgery Unit, University of Messina, Italy.
| | - Silvia Marino
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy.
| | - Angela Laganà
- Department of Neurosciences, University of Messina, Italy.
| | - Sergio Lucio Vinci
- Neuroradiology Unit-Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy.
| | - Marilena Briguglio
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Italy.
| | | | - Michele Gaeta
- Neuroradiology Unit-Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy.
| | - Vincenzo Salpietro
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Italy.
| | - Marcello Longo
- Neuroradiology Unit-Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy.
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Futatsuya K, Kakeda S, Yoneda T, Ueda I, Watanabe K, Moriya J, Murakami Y, Ide S, Ogasawara A, Ohnari N, Okada K, Adachi H, Korogi Y. Juxtacortical Lesions in Multiple Sclerosis: Assessment of Gray Matter Involvement Using Phase Difference-enhanced Imaging (PADRE). Magn Reson Med Sci 2016; 15:349-354. [PMID: 26841855 PMCID: PMC5608108 DOI: 10.2463/mrms.mp.2015-0099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose: In multiple sclerosis (MS), a juxtacortical lesion at the border between the gray matter (GM) and subcortical white matter (WM) may often involve the GM. A recently developed, phase-weighted magnetic resonance imaging (MRI) technique “phase difference enhanced imaging (PADRE)” can delineate the GM and WM clearly due to the difference in myelin concentration. We evaluated whether PADRE is useful for the detection of GM involvement in the juxtacortical MS lesions. Methods: One neuroradiologist reviewed the conventional MRI in 13 MS patients and selected 48 juxtacortical lesions. At the first reading session with the conventional MRI alone (T2-weighted imaging, and two-dimensional and three-dimensional fluid-attenuated inversion recovery), two other neuroradiologists classified the lesions into three patterns according to their anatomical locations: (a) subcortical WM lesions involving the subcortical WM alone; (b) intracortical (IC) lesions involving the GM alone; (c) mixed GM/subcortical WM (mixed) lesions involving the both subcortical WM and GM. We defined the subcortical WM as a WM within a distance of 10 mm from inner edge of the GM. For the analyses, we excluded the white matter lesions further than 10 mm from inner edge of the GM. At the second reading session MRI and PADRE were available and the radiologists re-evaluated their prior classification. Results: At the first reading session, 27 lesions were classified as (a), 1 as (b), and 20 as (c). Therefore, a total of 21 lesions (44%) were judged to involve the GM. At the second reading session, the classification of 15 (31%) lesions changed; all 15 lesions were judged to involve the GM on the PADRE. Interobserver agreement (kappa value) was 0.84 for the first- and 0.95 for the second reading session. Conclusion: PADRE is useful for detecting GM involvement of the juxtacortical MS lesions.
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Affiliation(s)
- Koichiro Futatsuya
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine
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Abstract
Due to its sensitivity to the different multiple sclerosis (MS)-related abnormalities, magnetic resonance imaging (MRI) has become an established tool to diagnose MS and to monitor its evolution. MRI has been included in the diagnostic workup of patients with clinically isolated syndromes suggestive of MS, and ad hoc criteria have been proposed and are regularly updated. In patients with definite MS, the ability of conventional MRI techniques to explain patients' clinical status and progression of disability is still suboptimal. Several advanced MRI-based technologies have been applied to estimate overall MS burden in the different phases of the disease. Their use has allowed the heterogeneity of MS pathology in focal lesions, normal-appearing white matter and gray matter to be graded in vivo. Recently, additional features of MS pathology, including macrophage infiltration and abnormal iron deposition, have become quantifiable. All of this, combined with functional imaging techniques, is improving our understanding of the mechanisms associated with MS evolution. In the near future, the use of ultrahigh-field systems is likely to provide additional insight into disease pathophysiology. However, the utility of advanced MRI techniques in clinical trial monitoring and in assessing individual patients' response to treatment still needs to be assessed.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Harrison DM, Roy S, Oh J, Izbudak I, Pham D, Courtney S, Caffo B, Jones CK, van Zijl P, Calabresi PA. Association of Cortical Lesion Burden on 7-T Magnetic Resonance Imaging With Cognition and Disability in Multiple Sclerosis. JAMA Neurol 2015; 72:1004-12. [PMID: 26192316 PMCID: PMC4620027 DOI: 10.1001/jamaneurol.2015.1241] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Cortical lesions (CLs) contribute to physical and cognitive disability in multiple sclerosis (MS). Accurate methods for visualization of CLs are necessary for future clinical studies and therapeutic trials in MS. OBJECTIVE To evaluate the clinical relevance of measures of CL burden derived from high-field magnetic resonance imaging (MRI) in MS. DESIGN, SETTING, AND PARTICIPANTS An observational clinical imaging study was conducted at an academic MS center. Participants included 36 individuals with MS (30 relapsing-remitting, 6 secondary or primary progressive) and 15 healthy individuals serving as controls. The study was conducted from March 10, 2010, to November 23, 2012, and analysis was performed from June 1, 2011, to September 30, 2014. Seven-Tesla MRI of the brain was performed with 0.5-mm isotropic resolution magnetization-prepared rapid acquisition gradient echo (MPRAGE) and whole-brain, 3-dimensional, 1.0-mm isotropic resolution magnetization-prepared, fluid-attenuated inversion recovery (MPFLAIR). Cortical lesions, seen as hypointensities on MPRAGE, were manually segmented. Lesions were classified as leukocortical, intracortical, or subpial. Images were segmented using the Lesion-TOADS (Topology-Preserving Anatomical Segmentation) algorithm, and brain structure volumes and white matter (WM) lesion volume were reported. Volumes were normalized to intracranial volume. MAIN OUTCOMES AND MEASURES Physical disability was measured by the Expanded Disability Status Scale (EDSS). Cognitive disability was measured with the Minimal Assessment of Cognitive Function in MS battery. RESULTS Cortical lesions were noted in 35 of 36 participants (97%), with a median of 16 lesions per participant (range, 0-99). Leukocortical lesion volume correlated with WM lesion volume (ρ = 0.50; P = .003) but not with cortical volume; subpial lesion volume inversely correlated with cortical volume (ρ = -0.36; P = .04) but not with WM lesion volume. Total CL count and volume, measured as median (range), were significantly increased in participants with EDSS scores of 5.0 or more vs those with scores less than 5.0 (count: 29 [11-99] vs 13 [0-51]; volume: 2.81 × 10-4 [1.30 × 10-4 to 7.90 × 10-4] vs 1.50 × 10-4 [0 to 1.01 × 10-3]) and in cognitively impaired vs unimpaired individuals (count: 21 [0-99] vs 13 [1-54]; volume: 3.51 × 10-4 [0 to 1.01 × 10-4] vs 1.19 × 10-4 [0 to 7.17 × 10-4]). Cortical lesion volume correlated with EDSS scores more robustly than did WM lesion volume (ρ = 0.59 vs 0.36). Increasing log[CL volume] conferred a 3-fold increase in the odds of cognitive impairment (odds ratio [OR], 3.36; 95% CI, 1.07-10.59; P = .04) after adjustment for age and sex and a 14-fold increase in odds after adjustment for WM lesion volume and atrophy (OR, 14.26; 95% CI, 1.06-192.37; P = .045). Leukocortical lesions had the greatest effect on cognition (OR for log [leukocortical lesion volume], 9.65; 95% CI, 1.70-54.59, P = .01). CONCLUSIONS AND RELEVANCE This study provides in vivo evidence that CLs are associated with cognitive and physical disability in MS and that leukocortical and subpial lesion subtypes have differing clinical relevance. Quantitative assessments of CL burden on high-field MRI may further our understanding of the development of disability and progression in MS and lead to more effective treatments.
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Affiliation(s)
- Daniel M Harrison
- Department of Neurology, School of Medicine, University of Maryland, Baltimore2Department of Neurology, School of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Snehashis Roy
- Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Bethesda, Maryland
| | - Jiwon Oh
- Department of Neurology, School of Medicine, The Johns Hopkins University, Baltimore, Maryland4Department of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Izlem Izbudak
- Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Dzung Pham
- Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Bethesda, Maryland
| | - Susan Courtney
- Department of Psychological and Brain Sciences, The Johns Hopkins University, Baltimore, Maryland
| | - Brian Caffo
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Craig K Jones
- Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, Maryland8F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Peter van Zijl
- Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, Maryland8F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Peter A Calabresi
- Department of Neurology, School of Medicine, The Johns Hopkins University, Baltimore, Maryland
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Bozin I, Ge Y, Kuchling J, Dusek P, Chawla S, Harms L, Ruprecht K, Niendorf T, Paul F, Kister I, Sinnecker T, Wuerfel J. Magnetic Resonance Phase Alterations in Multiple Sclerosis Patients with Short and Long Disease Duration. PLoS One 2015; 10:e0128386. [PMID: 26186349 PMCID: PMC4506094 DOI: 10.1371/journal.pone.0128386] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/24/2015] [Indexed: 11/19/2022] Open
Abstract
Objective The analysis of the MR phase provides additional information on the tissue microstructure. In multiple sclerosis (MS) lesions phase alterations may reflect different stages of inflammatory activity. Here we investigated lesion morphology in MS patients with short and long disease duration on T2* weighted, phase, magnitude and susceptibility weighted imaging (SWI) at 7 Tesla (T). Methods 17 MS or clinically isolated syndrome patients with short (<60 months) and 11 with long (>60 months) disease duration underwent 7T MRI. Lesions were subsequently analyzed side-by-side with regard to morphology and visibility on T2* weighted, SWI, magnitude and SWI-filtered phase images. Results 126 of 192 T2* weighted lesions (65.6%) were characterized by a phase alteration pattern, and hence could be differentiated on phase images. In detail, a significantly reduced proportion of lesions showing phase alterations was detectable in patients with longer disease duration (mean±SD 51±37%, range 0–100%) compared to patients with short disease duration (mean±SD 90±19.5%, range 50–100%, p = 0.003). Conclusion This cross-sectional study identified different patterns of phase changes in lesions of MS patients with short and long standing disease. Longitudinal studies are warranted to prove that MR phase imaging is useful in determining the activity and the developmental stage of individual MS plaques.
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Affiliation(s)
- Ivan Bozin
- NeuroCure Clinical Research Center, Charité –Universitaetsmedizin Berlin, Berlin, Germany
| | - Yulin Ge
- Department of Radiology, NYU School of Medicine, New York, New York, United States of America
| | - Joseph Kuchling
- NeuroCure Clinical Research Center, Charité –Universitaetsmedizin Berlin, Berlin, Germany
| | - Petr Dusek
- Institute of Neuroradiology, Universitaetsmedizin Goettingen, Goettingen, Germany
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Sanjeev Chawla
- Department of Radiology, NYU School of Medicine, New York, New York, United States of America
| | - Lutz Harms
- Clinical and Experimental Multiple Sclerosis Research Center, Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité—Universitaetsmedizin Berlin, Berlin, Germany
| | - Klemens Ruprecht
- Clinical and Experimental Multiple Sclerosis Research Center, Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité—Universitaetsmedizin Berlin, Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility, Max Delbrueck Center for Molecular Medicine, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité –Universitaetsmedizin Berlin, Berlin, Germany
- Clinical and Experimental Multiple Sclerosis Research Center, Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité—Universitaetsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
- * E-mail:
| | - Ilya Kister
- Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, New York, United States of America
| | - Tim Sinnecker
- NeuroCure Clinical Research Center, Charité –Universitaetsmedizin Berlin, Berlin, Germany
- Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, Germany
| | - Jens Wuerfel
- NeuroCure Clinical Research Center, Charité –Universitaetsmedizin Berlin, Berlin, Germany
- Institute of Neuroradiology, Universitaetsmedizin Goettingen, Goettingen, Germany
- Berlin Ultrahigh Field Facility, Max Delbrueck Center for Molecular Medicine, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
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Hayashi N, Yarita K, Sakata K, Motegi S, Nagase H, Ujita K, Ogura A, Ogura T, Shimada T, Tsushima Y. [Development of an Optimizing Program of Scanning Parameters for Double Inversion Recovery MRI]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2015; 71:512-9. [PMID: 26155807 DOI: 10.6009/jjrt.2015_jsrt_71.6.512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to develop an optimizing program of scanning parameters for double inversion recovery (DIR) MRI. The optimization algorithm consists of the following steps: (1) obtaining the initial parameters (TR, TE, and T1 values of the two attenuated tissues); (2) iterative calculation for minimization of errors; and (3) determination of the optimized TI(1st) and TI(2nd). To evaluate the developed algorithm, we performed the phantom and simulation studies using the phantoms which were imitated T1 values of white and gray matters and cerebrospinal fluid. In addition, white matter attenuated inversion recovery (WAIR) and gray matter attenuated inversion recovery (GAIR) images were obtained by optimized scan parameters in one volunteer. The developed algorithm could calculate the optimized TI(1st) and TI(2nd) values at once. Results of summation of signal intensity (SI) of two attenuated tissues shows that the SI of the two tissues were well-attenuated using the theoretical values which were calculated using the developed algorithm. The correlation coefficient of the SI of the phantom of the gray matter between actual and simulation measurements was r=0.997. The SI obtained by actual measurements well correlated with the SI obtained by the simulation measurements. The WAIR and GAIR images in the volunteer were well enhanced gray or white matters. We thus conclude that it is possible to calculate the optimized parameters for the DIR-MRI using the developed algorithm.
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Affiliation(s)
- Norio Hayashi
- School of Radiological Technology, Gunma Prefectural College of Health Sciences
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Rovira À, Wattjes MP, Tintoré M, Tur C, Yousry TA, Sormani MP, De Stefano N, Filippi M, Auger C, Rocca MA, Barkhof F, Fazekas F, Kappos L, Polman C, Miller D, Montalban X. Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process. Nat Rev Neurol 2015; 11:471-82. [PMID: 26149978 DOI: 10.1038/nrneurol.2015.106] [Citation(s) in RCA: 302] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The clinical use of MRI in patients with multiple sclerosis (MS) has advanced markedly over the past few years. Technical improvements and continuously emerging data from clinical trials and observational studies have contributed to the enhanced performance of this tool for achieving a prompt diagnosis in patients with MS. The aim of this article is to provide guidelines for the implementation of MRI of the brain and spinal cord in the diagnosis of patients who are suspected of having MS. These guidelines are based on an extensive review of the recent literature, as well as on the personal experience of the members of the MAGNIMS (Magnetic Resonance Imaging in MS) network. We address the indications, timing, coverage, reporting and interpretation of MRI studies in patients with suspected MS. Our recommendations are intended to help radiologists and neurologists standardize and optimize the use of MRI in clinical practice for the diagnosis of MS.
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Affiliation(s)
- Àlex Rovira
- Magnetic Resonance Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Mike P Wattjes
- MS Centre Amsterdam, VU University Medical Centre, Netherlands
| | - Mar Tintoré
- Neurology/Neuroimmunology Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Carmen Tur
- Neurology/Neuroimmunology Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Tarek A Yousry
- Lysholm Department of Neuroradiology, UCLH National Hospital for Neurology and Neurosurgery, University College London Institute of Neurology, UK
| | - Maria P Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Italy
| | - Nicola De Stefano
- Department of Neurological and Behavioural Sciences, University of Siena, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy
| | - Cristina Auger
- Magnetic Resonance Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy
| | | | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Austria
| | - Ludwig Kappos
- Department of Neurology, University of Basel, Switzerland
| | - Chris Polman
- MS Centre Amsterdam, VU University Medical Centre, Netherlands
| | - David Miller
- NMR Research Unit, Queen Square MS Centre, University College London Institute of Neurology, UK
| | - Xavier Montalban
- Magnetic Resonance Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Bagnato F, Hametner S, Pennell D, Dortch R, Dula AN, Pawate S, Smith SA, Lassmann H, Gore JC, Welch EB. 7T MRI-Histologic Correlation Study of Low Specific Absorption Rate T2-Weighted GRASE Sequences in the Detection of White Matter Involvement in Multiple Sclerosis. J Neuroimaging 2015; 25:370-8. [PMID: 25898858 DOI: 10.1111/jon.12238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 02/12/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The high value of the specific absorption rate (SAR) of radio-frequency (RF) energy arising from the series of RF refocusing pulses in T2-weighted (T2-w) turbo spin echo (TSE) MRI hampers its clinical application at 7.0 Tesla (7T). T2-w gradient and spin echo (GRASE) uses the speed from gradient refocusing in combination with the chemical-shift/static magnetic field (B0) inhomogeneity insensitivity from spin-echo refocusing to acquire T2-w images with a limited number of refocusing RF pulses, thus reducing SAR. OBJECTIVES To investigate whether low SAR T2-w GRASE could replace T2-w TSE in detecting white matter (WM) disease in MS patients imaged at 7T. METHODS The .7 mm3 isotropic T2-w TSE and T2-w GRASE images with variable echo times (TEs) and echo planar imaging (EPI) factors were obtained on a 7T scanner from postmortem samples of MS brains. These samples were derived from brains of 3 female MS patients. WM lesions (WM-Ls) and normal-appearing WM (NAWM) signal intensity, WM-Ls/NAWM contrast-to-noise ratio (CNR) and MRI/myelin staining sections comparisons were obtained. RESULTS GRASE sequences with EPI factor/TE = 3/50 and 3/75 ms were comparable to the SE technique for measures of CNR in WM-Ls and NAWM and for detection of WM-Ls. In all sequences, however, identification of areas with remyelination, Wallerian degeneration, and gray matter demyelination, as depicted by myelin staining, was not possible. CONCLUSIONS T2-w GRASE images may replace T2-w TSE for clinical use. However, even at 7T, both sequences fail in detecting and characterizing MS disease beyond visible WM-Ls.
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Affiliation(s)
- Francesca Bagnato
- Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
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Segal BM. Stage-specific immune dysregulation in multiple sclerosis. J Interferon Cytokine Res 2015; 34:633-40. [PMID: 25084180 DOI: 10.1089/jir.2014.0025] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A large body of data indicates that multiple sclerosis (MS) is an autoimmune disease which is initiated by CD4(+) T-helper 1 (Th1) and Th17 cells that are reactive against proteins in the myelin sheath. MS typically begins with a relapsing-remitting course, punctuated by clinical exacerbations associated with the development of focal inflammatory lesions in central nervous system white matter, followed by a secondary progressive (SP) phase, characterized by a gradual accumulation of neurological disability associated with widespread microglial activation and axonal loss. The molecular and cellular basis for this transition is unclear, and the role of inflammation during the SP stage is a subject of active debate. As of now, no immunological biomarkers have been identified in MS that are predictive of the clinical course or therapeutic responsiveness to disease-modifying agents, or that correlate with new lesion development, cumulative lesion load, or degree of disability. The discovery of such biomarkers would greatly facilitate clinical management and provide power for smaller and shorter clinical trials. In this article, we discuss the literature on immunological biomarkers in MS with a focus on stage-specific differences and similarities.
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Affiliation(s)
- Benjamin M Segal
- Holtom-Garrett Program in Neuroimmunology and Multiple Sclerosis Center, Department of Neurology, University of Michigan , Ann Arbor, Michigan
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Optimization of magnetization-prepared 3-dimensional fluid attenuated inversion recovery imaging for lesion detection at 7 T. Invest Radiol 2014; 49:290-8. [PMID: 24566291 DOI: 10.1097/rli.0000000000000041] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to optimize the 3-dimensional (3D) fluid attenuated inversion recovery (FLAIR) pulse sequence for isotropic high-spatial-resolution imaging of white matter (WM) and cortical lesions at 7 T. MATERIALS AND METHODS We added a magnetization-prepared (MP) FLAIR module to a Cube 3D fast spin echo sequence and optimized the refocusing flip angle train using extended phase graph simulations, taking into account image contrast, specific absorption rate (SAR), and signal-to-noise ratio (SNR) as well as T1/T2 values of the different species of interest (WM, grey matter, lesions) at 7 T. We also effected improved preparation homogeneity at 7 T by redesigning the refocusing pulse used in the MP segments. Two sets of refocusing flip angle trains-(a) an SNR-optimal and (b) a contrast-optimal set-were derived and used to scan 7 patients with Alzheimer disease/cognitive impairment and 7 patients with multiple sclerosis. Conventional constant refocusing flip MP-FLAIR images were also acquired for comparison. Lesion SNR, contrast, and lesion count were compared between the 2 optimized and the standard FLAIR sequences. RESULTS Whole brain coverage with 0.8 mm isotropic spatial resolution in ∼5-minute scan times was achieved using the optimized 3D FLAIR sequences at clinically acceptable SAR levels. The SNR efficiency of the SNR-optimal sequence was significantly better than that of conventional constant refocusing flip MP-FLAIR sequence, whereas the scan time was reduced more than 2-fold (∼5 vs >10 minutes). The contrast efficiency of the contrast-optimal sequence was comparable with that of the constant refocusing flip sequence. Lesion load ascertained by lesion counting was not significantly different among the sequences. CONCLUSION Magnetization-prepared FLAIR-Cube with refocusing flip angle trains optimized for SNR and contrast can be used to characterize WM and cortical lesions at 7 T with 0.8 mm isotropic resolution in short scan times and without SAR penalty.
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Elnekeidy AM, Kamal MA, Elfatatry AM, Elskeikh ML. Added value of double inversion recovery magnetic resonance sequence in detection of cortical and white matter brain lesions in multiple sclerosis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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van Veluw SJ, Fracasso A, Visser F, Spliet WGM, Luijten PR, Biessels GJ, Zwanenburg JJM. FLAIR images at 7 Tesla MRI highlight the ependyma and the outer layers of the cerebral cortex. Neuroimage 2014; 104:100-9. [PMID: 25315783 DOI: 10.1016/j.neuroimage.2014.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/01/2014] [Accepted: 10/04/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Fluid-attenuated inversion recovery (FLAIR) imaging is an important clinical 'work horse' for brain MRI and has proven to facilitate imaging of both intracortical lesions as well as cortical layers at 7T MRI. A prominent observation on 7T FLAIR images is a hyperintense rim at the cortical surface and around the ventricles. We aimed to clarify the anatomical correlates and underlying contrast mechanisms of this hyperintense rim. MATERIALS AND METHODS Two experiments with post-mortem human brain tissue were performed. FLAIR and T2-weighted images were obtained at typical in vivo (0.8mm isotropic) and high resolution (0.25mm isotropic). At one location the cortical surface was partly removed, and scanned again. Imaging was followed by histological and immunohistochemical analysis. Additionally, several simulations were performed to evaluate the potential contribution from an artifact due to water diffusion. RESULTS The hyperintense rim corresponded to the outer - glia rich - layer of the cortex and disappeared upon removal of that layer. At the ventricles, the rim corresponded to the ependymal layer, and was not present at white matter/fluid borders at an artificial cut. The simulations supported the hypothesis that the hyperintense rim reflects the tissue properties in the outer cortical layers (or ependymal layer for the ventricles), and is not merely an artifact, although not all observations were explained by the simulated model of the contrast mechanism. CONCLUSIONS 7T FLAIR seems to amplify the signal from layers I-III of the cortex and the ependyma around the ventricles. Although diffusion of water from layer I into CSF does contribute to this effect, a long T2 relaxation time constant in layer I, and probably also layer II-III, is most likely the major contributor, since the rim disappears upon removal of that layer. This knowledge can help the interpretation of imaging results in cortical development and in patients with cortical pathology.
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Affiliation(s)
- Susanne J van Veluw
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Alessio Fracasso
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
| | - Fredy Visser
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands; Philips Healthcare, Best, the Netherlands
| | - Wim G M Spliet
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter R Luijten
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jaco J M Zwanenburg
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Comparison of 3D double inversion recovery and 2D STIR FLAIR MR sequences for the imaging of optic neuritis: pilot study. Eur Radiol 2014; 24:3069-75. [DOI: 10.1007/s00330-014-3342-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 07/03/2014] [Accepted: 07/11/2014] [Indexed: 10/24/2022]
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Massire A, Vignaud A, Robert B, Le Bihan D, Boulant N, Amadon A. Parallel-transmission-enabled three-dimensional T2-weighted imaging of the human brain at 7 Tesla. Magn Reson Med 2014; 73:2195-203. [DOI: 10.1002/mrm.25353] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/02/2014] [Accepted: 06/13/2014] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | - Alexis Amadon
- CEA, DSV, I2BM, NeuroSpin; UNIRS Gif-sur-Yvette France
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Derakhshan M, Caramanos Z, Narayanan S, Arnold DL, Louis Collins D. Surface-based analysis reveals regions of reduced cortical magnetization transfer ratio in patients with multiple sclerosis: a proposed method for imaging subpial demyelination. Hum Brain Mapp 2014; 35:3402-13. [PMID: 24356893 PMCID: PMC6869281 DOI: 10.1002/hbm.22410] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 05/13/2013] [Accepted: 09/16/2013] [Indexed: 12/25/2022] Open
Abstract
The in vivo detection of subpial cortical gray matter lesions in multiple sclerosis is challenging. We quantified the spatial extent of subpial decreases in the magnetization transfer ratio (MTR) of cortical gray matter in subjects with multiple sclerosis, as such reductions may indicate regions of cortical demyelination. We exploited the unique geometry of cortical lesions by using two-dimensional parametric surface models of the cortex instead of traditional three-dimensional voxel-wise analyses. MTR images were mapped onto intermediate surfaces between the pial and white matter surfaces and were used to compute differences between secondary-progressive MS (n = 12), relapsing-remitting MS (n = 12), and normal control (n = 12) groups as well as between each individual patient and the normal controls. We identified large regions of significantly reduced cortical MTR in secondary-progressive patients when compared with normal controls. We also identified large regions of reduced cortical MTR in 11 individual patients (8 secondary-progressive, 3 relapsing-remitting). The secondary-progressive patients showed larger areas of abnormally low MTR compared with relapsing-remitting patients both at the group level and on an individual basis. The spatial distributions of abnormal MTR preferentially involved cingulate cortex, insula, and the depths of sulci, in agreement with pathological descriptions of subpial gray matter lesion distribution. These findings suggest that our method is a plausible in vivo imaging technique for quantifying subpial cortical demyelinating lesions in patients with multiple sclerosis and, furthermore, can be applied at the typical clinical field strength of 1.5 T.
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Affiliation(s)
- Mishkin Derakhshan
- McConnell Brain Imaging CentreMontreal Neurological InstituteMontrealQuebecH3A 2B4Canada
| | - Zografos Caramanos
- McConnell Brain Imaging CentreMontreal Neurological InstituteMontrealQuebecH3A 2B4Canada
| | - Sridar Narayanan
- McConnell Brain Imaging CentreMontreal Neurological InstituteMontrealQuebecH3A 2B4Canada
| | - Douglas L. Arnold
- McConnell Brain Imaging CentreMontreal Neurological InstituteMontrealQuebecH3A 2B4Canada
- NeuroRx ResearchMontrealQuebecH2X 4B3Canada
| | - D. Louis Collins
- McConnell Brain Imaging CentreMontreal Neurological InstituteMontrealQuebecH3A 2B4Canada
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Morphological features of MS lesions on FLAIR* at 7 T and their relation to patient characteristics. J Neurol 2014; 261:1356-64. [DOI: 10.1007/s00415-014-7351-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 04/08/2014] [Accepted: 04/10/2014] [Indexed: 01/10/2023]
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Uwano I, Kudo K, Yamashita F, Goodwin J, Higuchi S, Ito K, Harada T, Ogawa A, Sasaki M. Intensity inhomogeneity correction for magnetic resonance imaging of human brain at 7T. Med Phys 2014; 41:022302. [DOI: 10.1118/1.4860954] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Mugler JP. Optimized three‐dimensional fast‐spin‐echo MRI. J Magn Reson Imaging 2014; 39:745-67. [PMID: 24399498 DOI: 10.1002/jmri.24542] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/31/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- John P. Mugler
- Department of Radiology and Medical ImagingUniversity of Virginia School of MedicineCharlottesville Virginia USA
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