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Sui B, Sannananja B, Zhu C, Balu N, Eisenmenger L, Baradaran H, Edjlali M, Romero JM, Rajiah PS, Li R, Mossa-Basha M. Report from the society of magnetic resonance angiography: clinical applications of 7T neurovascular MR in the assessment of intracranial vascular disease. J Neurointerv Surg 2024; 16:846-851. [PMID: 37652689 PMCID: PMC10902184 DOI: 10.1136/jnis-2023-020668] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023]
Abstract
In recent years, ultra-high-field magnetic resonance imaging (MRI) applications have been rapidly increasing in both clinical research and practice. Indeed, 7-Tesla (7T) MRI allows improved depiction of smaller structures with high signal-to-noise ratio, and, therefore, may improve lesion visualization, diagnostic capabilities, and thus potentially affect treatment decision-making. Incremental evidence emerging from research over the past two decades has provided a promising prospect of 7T magnetic resonance angiography (MRA) in the evaluation of intracranial vasculature. The ultra-high resolution and excellent image quality of 7T MRA allow us to explore detailed morphological and hemodynamic information, detect subtle pathological changes in early stages, and provide new insights allowing for deeper understanding of pathological mechanisms of various cerebrovascular diseases. However, along with the benefits of ultra-high field strength, some challenges and concerns exist. Despite these, ongoing technical developments and clinical oriented research will facilitate the widespread clinical application of 7T MRA in the near future. In this review article, we summarize technical aspects, clinical applications, and recent advances of 7T MRA in the evaluation of intracranial vascular disease. The aim of this review is to provide a clinical perspective for the potential application of 7T MRA for the assessment of intracranial vascular disease, and to explore possible future research directions implementing this technique.
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Affiliation(s)
- Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Bhagya Sannananja
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Vascular Imaging Lab, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Hediyeh Baradaran
- Department of Radiology & Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Javier M Romero
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Rui Li
- Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Vascular Imaging Lab, University of Washington School of Medicine, Seattle, Washington, USA
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2
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van Lanen RHGJ, Wiggins CJ, Colon AJ, Backes WH, Jansen JFA, Uher D, Drenthen GS, Roebroeck A, Ivanov D, Poser BA, Hoeberigs MC, van Kuijk SMJ, Hoogland G, Rijkers K, Wagner GL, Beckervordersandforth J, Delev D, Clusmann H, Wolking S, Klinkenberg S, Rouhl RPW, Hofman PAM, Schijns OEMG. Value of ultra-high field MRI in patients with suspected focal epilepsy and negative 3 T MRI (EpiUltraStudy): protocol for a prospective, longitudinal therapeutic study. Neuroradiology 2022; 64:753-764. [PMID: 34984522 PMCID: PMC8907090 DOI: 10.1007/s00234-021-02884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/09/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE Resective epilepsy surgery is a well-established, evidence-based treatment option in patients with drug-resistant focal epilepsy. A major predictive factor of good surgical outcome is visualization and delineation of a potential epileptogenic lesion by MRI. However, frequently, these lesions are subtle and may escape detection by conventional MRI (≤ 3 T). METHODS We present the EpiUltraStudy protocol to address the hypothesis that application of ultra-high field (UHF) MRI increases the rate of detection of structural lesions and functional brain aberrances in patients with drug-resistant focal epilepsy who are candidates for resective epilepsy surgery. Additionally, therapeutic gain will be addressed, testing whether increased lesion detection and tailored resections result in higher rates of seizure freedom 1 year after epilepsy surgery. Sixty patients enroll the study according to the following inclusion criteria: aged ≥ 12 years, diagnosed with drug-resistant focal epilepsy with a suspected epileptogenic focus, negative conventional 3 T MRI during pre-surgical work-up. RESULTS All patients will be evaluated by 7 T MRI; ten patients will undergo an additional 9.4 T MRI exam. Images will be evaluated independently by two neuroradiologists and a neurologist or neurosurgeon. Clinical and UHF MRI will be discussed in the multidisciplinary epilepsy surgery conference. Demographic and epilepsy characteristics, along with postoperative seizure outcome and histopathological evaluation, will be recorded. CONCLUSION This protocol was reviewed and approved by the local Institutional Review Board and complies with the Declaration of Helsinki and principles of Good Clinical Practice. Results will be submitted to international peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER www.trialregister.nl : NTR7536.
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Affiliation(s)
- R H G J van Lanen
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands. .,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.
| | - C J Wiggins
- Scannexus, Ultra-High Field MRI Research Center, Maastricht, the Netherlands
| | - A J Colon
- Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | - W H Backes
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J F A Jansen
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - D Uher
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - G S Drenthen
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A Roebroeck
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - D Ivanov
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - B A Poser
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - M C Hoeberigs
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - G Hoogland
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | - K Rijkers
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | - G L Wagner
- Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | | | - D Delev
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - H Clusmann
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - S Wolking
- Department of Epileptology and Neurology, RWTH Aachen University Hospital, Aachen, Germany
| | - S Klinkenberg
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - R P W Rouhl
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P A M Hofman
- Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - O E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
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3
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Morrison MA, Lupo JM. 7-T Magnetic Resonance Imaging in the Management of Brain Tumors. Magn Reson Imaging Clin N Am 2021; 29:83-102. [PMID: 33237018 DOI: 10.1016/j.mric.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article provides an overview of the current status of ultrahigh-field 7-T magnetic resonance (MR) imaging in neuro-oncology, specifically for the management of patients with brain tumors. It includes a discussion of areas across the pretherapeutic, peritherapeutic, and posttherapeutic stages of patient care where 7-T MR imaging is currently being exploited and holds promise. This discussion includes existing technical challenges, barriers to clinical integration, as well as our impression of the future role of 7-T MR imaging as a clinical tool in neuro-oncology.
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Affiliation(s)
- Melanie A Morrison
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Janine M Lupo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
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4
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Vachha B, Huang SY. MRI with ultrahigh field strength and high-performance gradients: challenges and opportunities for clinical neuroimaging at 7 T and beyond. Eur Radiol Exp 2021; 5:35. [PMID: 34435246 PMCID: PMC8387544 DOI: 10.1186/s41747-021-00216-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
Research in ultrahigh magnetic field strength combined with ultrahigh and ultrafast gradient technology has provided enormous gains in sensitivity, resolution, and contrast for neuroimaging. This article provides an overview of the technical advantages and challenges of performing clinical neuroimaging studies at ultrahigh magnetic field strength combined with ultrahigh and ultrafast gradient technology. Emerging clinical applications of 7-T MRI and state-of-the-art gradient systems equipped with up to 300 mT/m gradient strength are reviewed, and the impact and benefits of such advances to anatomical, structural and functional MRI are discussed in a variety of neurological conditions. Finally, an outlook and future directions for ultrahigh field MRI combined with ultrahigh and ultrafast gradient technology in neuroimaging are examined.
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Affiliation(s)
- Behroze Vachha
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Susie Y Huang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, 149 13th Street, Room 2301, Charlestown, MA, 02129, USA.
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5
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Eckstein K, Bachrata B, Hangel G, Widhalm G, Enzinger C, Barth M, Trattnig S, Robinson SD. Improved susceptibility weighted imaging at ultra-high field using bipolar multi-echo acquisition and optimized image processing: CLEAR-SWI. Neuroimage 2021; 237:118175. [PMID: 34000407 PMCID: PMC7612087 DOI: 10.1016/j.neuroimage.2021.118175] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/28/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose Susceptibility Weighted Imaging (SWI) has become established in the clinical investigation of stroke, microbleeds, tumor vascularization, calcification and iron deposition, but suffers from a number of shortcomings and artefacts. The goal of this study was to reduce the sensitivity of SWI to strong B1 and B0 inhomogeneities at ultra-high field to generate homogeneous images with increased contrast and free of common artefacts. All steps in SWI processing have been addressed −coil combination, phase unwrapping, image combination over echoes, phase filtering and homogeneity correction −and applied to an efficient bipolar multi-echo acquisition to substantially improve the quality of SWI. Principal results Our findings regarding the optimal individual processing steps lead us to propose a Contrast-weighted, Laplace-unwrapped, bipolar multi-Echo, ASPIRE-combined, homogeneous, improved Resolution SWI, or CLEAR-SWI. CLEAR-SWI was compared to two other multi-echo SWI methods and standard, single-echo SWI with the same acquisition time at 7 T in 10 healthy volunteers and with single-echo SWI in 13 patients with brain tumors. CLEAR-SWI had improved contrast-to-noise and homogeneity, reduced signal dropout and was not compromised by the artefacts which affected standard SWI in 10 out of 13 cases close to tumors (as assessed by expert raters), as well as generating T2* maps and phase images which can be used for Quantitative Susceptibility Mapping. In a comparison with other multi-echo SWI methods, CLEAR-SWI had the fewest artefacts, highest SNR and generally higher contrast-to-noise. Major conclusions CLEAR-SWI eliminates the artefacts common in standard, single-echo SWI, reduces signal dropouts and improves image homogeneity and contrast-to-noise. Applied clinically, in a study of brain tumor patients, CLEAR-SWI was free of the artefacts which affected standard, single-echo SWI.
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Affiliation(s)
- Korbinian Eckstein
- High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Beata Bachrata
- High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute for Clinical Molecular MR in Musculoskeletal Imaging, Vienna, Austria
| | - Gilbert Hangel
- High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | | | - Markus Barth
- School of Information Technology and Electrical Engineering, Faculty of Engineering, Architecture and Information Technology, The University of Queensland, Brisbane, Australia
| | - Siegfried Trattnig
- High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute for Clinical Molecular MR in Musculoskeletal Imaging, Vienna, Austria
| | - Simon Daniel Robinson
- High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute for Clinical Molecular MR in Musculoskeletal Imaging, Vienna, Austria; Department of Neurology, Medical University of Graz, Graz, Austria; Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
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6
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Park JE, Cheong EN, Jung DE, Shim WH, Lee JS. Utility of 7 Tesla Magnetic Resonance Imaging in Patients With Epilepsy: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:621936. [PMID: 33815251 PMCID: PMC8017213 DOI: 10.3389/fneur.2021.621936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/26/2021] [Indexed: 02/01/2023] Open
Abstract
Objective: 7 Tesla magnetic resonance imaging (MRI) enables high resolution imaging and potentially improves the detection of morphologic abnormalities in patients with epilepsy. However, its added value compared with conventional 1.5T and 3.0T MRI is unclear. We reviewed the evidence for the use of 7 Tesla MRI in patients with epilepsy and compared the detection rate of focal lesions with clinical MRI. Methods: Clinical retrospective case studies were identified using the indexed text terms "epilepsy" AND "magnetic resonance imaging" OR "MR imaging" AND "7T" OR "7 Tesla" OR "7T" in Medline (2002-September 1, 2020) and Embase (1999-September 1, 2020). The study setting, MRI protocols, qualitative, and quantitative assessment were systematically reviewed. The detection rate of morphologic abnormalities on MRI was reported in each study in which surgery was used as the reference standard. Meta-analyses were performed using a univariate random-effects model in diagnostic performance studies with patients that underwent both 7T MRI and conventional MRI. Results: Twenty-five articles were included (467 patients and 167 healthy controls) consisting of 10 case studies, 10 case-control studies, 4 case series, and 1 cohort study. All studies included focal epilepsy; 12 studies (12/25, 48%) specified the disease etiology and 4 studies reported focal but non-lesional (MRI-negative on 1.5/3.0T) epilepsy. 7T MRI showed superior detection and delineation of morphologic abnormalities in all studies. In nine comparative studies, 7T MRI had a superior detection rate of 65% compared with the 22% detection rate of 1.5T or 3.0T. Significance: 7T MRI is useful for delineating morphologic abnormalities with a higher detection rate compared with conventional clinical MRI. Most studies were conducted using a case series or case study; therefore, a cohort study design with clinical outcomes is necessary. Classification of Evidence: Class IV Criteria for Rating Diagnostic Accuracy Studies.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - E-Nae Cheong
- Department of Medical Science and Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Da Eun Jung
- Department of Pediatrics, Ajou University School of Medicine, Suwon, South Korea
| | - Woo Hyun Shim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Department of Pediatrics, Ajou University School of Medicine, Suwon, South Korea
| | - Ji Sung Lee
- Department of Statistics, College of Medicine, Ulsan University, Asan Medical Center, Seoul, South Korea
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7
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Hütter BO, Altmeppen J, Kraff O, Maderwald S, Theysohn JM, Ringelstein A, Wrede KH, Dammann P, Quick HH, Schlamann M, Moenninghoff C. Higher sensitivity for traumatic cerebral microbleeds at 7 T ultra-high field MRI: is it clinically significant for the acute state of the patients and later quality of life? Ther Adv Neurol Disord 2020; 13:1756286420911295. [PMID: 32313555 PMCID: PMC7155239 DOI: 10.1177/1756286420911295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/03/2020] [Indexed: 01/14/2023] Open
Abstract
Background The present study evaluates the possible prognostic benefits of 7 T susceptibility weighted imaging (SWI) of traumatic cerebral microbleeds (TMBs) over 3 T SWI to predict the acute clinical state and subjective impairments, including health-related quality of life (HRQOL), after closed head injury (CHI). Methods The study group comprised 10 participants with known TMBs All subjects underwent 3 T magnetic resonance imaging (MRI) and 7 T MRI, respectively. Location and count of TMBs were independently evaluated by two neuroradiologists. The initial Glasgow Coma Scale (GCS), the duration of coma and further clinical data were taken from the patients records. HRQOL was assessed by means of a questionnaire. Memory complaints and neurological symptoms were inquired at the time of the MRI examinations. Results SWI revealed a total of 485 TMBs at 3 T, 584 TMBs at 7 T with similar spatial resolution, and 684 TMBs at 7 T with a factor of 10 higher spatial resolution. The TMBs depicted by 7 T high-resolution SWI were correlated with the duration of coma (Spearman's rho of 0.77). The corresponding association with TMBs in 3 T MRI SWI showed a Spearman's rho of 0.71. The initial GCS score and TMBs correlated with a Spearman's rho of -0.35 at 3 T SWI MRI and a rho of -0.33 at 7 T high-resolution SWI, respectively. The physical aspect of HRQOL correlated substantially with the count of TMBs (rho = 0.44 for 3 T SWI and rho = 0.35 for both 7 T SWI sequences, respectively). Conclusions The number of TMBs showed a substantial association with indicators of the acute clinical state and chronic neurobehavioral parameters after CHI, but there was no additional advantage of 7 T MRI. These preliminary findings warrant a larger prospective study for the future.
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Affiliation(s)
- Bernd-Otto Hütter
- Department of Neurosurgery, University Hospital Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Jan Altmeppen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Oliver Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Stefan Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Jens M Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Adrian Ringelstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Harald H Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Marc Schlamann
- Department of Neuroradiology, University Hospital Giessen, Giessen, Germany
| | - Christoph Moenninghoff
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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8
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Rutland JW, Delman BN, Gill CM, Zhu C, Shrivastava RK, Balchandani P. Emerging Use of Ultra-High-Field 7T MRI in the Study of Intracranial Vascularity: State of the Field and Future Directions. AJNR Am J Neuroradiol 2020; 41:2-9. [PMID: 31879330 DOI: 10.3174/ajnr.a6344] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/15/2019] [Indexed: 12/23/2022]
Abstract
Cerebrovascular disease is a major source of mortality that commonly requires neurosurgical intervention. MR imaging is the preferred technique for imaging cerebrovascular structures, as well as regions of pathology that include microbleeds and ischemia. Advanced MR imaging sequences such as time-of-flight, susceptibility-weighted imaging, and 3D T2-weighted sequences have demonstrated excellent depiction of arterial and venous structures with and without contrast administration. While the advantages of 3T compared with 1.5T have been described, the role of ultra-high-field (7T) MR imaging in neurovascular imaging remains poorly understood. In the present review, we examine emerging neurosurgical applications of 7T MR imaging in vascular imaging of diverse conditions and discuss current limitations and future directions for this technique.
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Affiliation(s)
- J W Rutland
- From the Translational and Molecular Imaging Institute (J.W.R., B.N.D., P.B.)
- Departments of Neurosurgery (J.W.R., C.M.G., R.K.S.)
| | - B N Delman
- From the Translational and Molecular Imaging Institute (J.W.R., B.N.D., P.B.)
- Diagnostic, Molecular, and Interventional Radiology (B.N.D.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - C M Gill
- Departments of Neurosurgery (J.W.R., C.M.G., R.K.S.)
| | - C Zhu
- Department of Radiology and Biomedical Imaging (C.Z.), University of California San Francisco, San Francisco, California
| | | | - P Balchandani
- From the Translational and Molecular Imaging Institute (J.W.R., B.N.D., P.B.)
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9
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7T MRI in epilepsy patients with previously normal clinical MRI exams compared against healthy controls. PLoS One 2019; 14:e0213642. [PMID: 30889199 PMCID: PMC6424456 DOI: 10.1371/journal.pone.0213642] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/26/2019] [Indexed: 11/20/2022] Open
Abstract
Objective To compare by 7 Tesla (7T) magnetic resonance imaging (MRI) in patients with focal epilepsy who have non-lesional clinical MRI scans with healthy controls. Methods 37 patients with focal epilepsy, based on clinical and electroencephalogram (EEG) data, with non-lesional MRIs at clinical field strengths and 21 healthy controls were recruited for the 7T imaging study. The MRI protocol consisted of high resolution T1-weighted, T2-weighted and susceptibility weighted imaging sequences of the entire cortex. The images were read by two neuroradiologists, who were initially blind to clinical data, and then reviewed a second time with knowledge of the seizure onset zone. Results A total of 25 patients had findings with epileptogenic potential. In five patients these were definitely related to their epilepsy, confirmed through surgical intervention, in three they co-localized to the suspected seizure onset zone and likely caused the seizures. In seven patients the imaging findings co-localized to the suspected seizure onset zone but were not the definitive cause, and ten had cortical lesions with epileptogenic potential that did not localize to the suspected seizure onset zone. There were multiple other findings of uncertain significance found in both epilepsy patients and healthy controls. The susceptibility weighted imaging sequence was instrumental in guiding more targeted inspection of the other structural images and aiding in the identification of cortical lesions. Significance Information revealed by the improved resolution and enhanced contrast provided by 7T imaging is valuable in noninvasive identification of lesions in epilepsy patients who are non-lesional at clinical field strengths.
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10
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Barisano G, Sepehrband F, Ma S, Jann K, Cabeen R, Wang DJ, Toga AW, Law M. Clinical 7 T MRI: Are we there yet? A review about magnetic resonance imaging at ultra-high field. Br J Radiol 2018; 92:20180492. [PMID: 30359093 DOI: 10.1259/bjr.20180492] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In recent years, ultra-high field MRI (7 T and above) has received more interest for clinical imaging. Indeed, a number of studies have shown the benefits from the application of this powerful tool not only for research purposes, but also in realms of improved diagnostics and patient management. The increased signal-to-noise ratio and higher spatial resolution compared with conventional and high-field clinical scanners allow imaging of small anatomical detail and subtle pathological findings. Furthermore, greater spectral resolution achieved at ultra-high field allows the resolution of metabolites for MR spectroscopic imaging. All these advantages have a significant impact on many neurological diseases, including multiple sclerosis, cerebrovascular disease, brain tumors, epilepsy and neurodegenerative diseases, in part because the pathology can be subtle and lesions small in these diseases, therefore having higher signal and resolution will help lesion detection. In this review, we discuss the main clinical neurological applications and some technical challenges which remain with ultra-high field MRI.
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Affiliation(s)
- Giuseppe Barisano
- 1 Department of Radiology, Keck Medical Center of University of Southern California , Los Angeles, CA , USA.,2 Stevens Neuroimaging and Informatics Institute, University of Southern California , Los Angeles, CA , USA
| | - Farshid Sepehrband
- 2 Stevens Neuroimaging and Informatics Institute, University of Southern California , Los Angeles, CA , USA
| | - Samantha Ma
- 2 Stevens Neuroimaging and Informatics Institute, University of Southern California , Los Angeles, CA , USA
| | - Kay Jann
- 2 Stevens Neuroimaging and Informatics Institute, University of Southern California , Los Angeles, CA , USA
| | - Ryan Cabeen
- 2 Stevens Neuroimaging and Informatics Institute, University of Southern California , Los Angeles, CA , USA
| | - Danny J Wang
- 2 Stevens Neuroimaging and Informatics Institute, University of Southern California , Los Angeles, CA , USA
| | - Arthur W Toga
- 2 Stevens Neuroimaging and Informatics Institute, University of Southern California , Los Angeles, CA , USA
| | - Meng Law
- 1 Department of Radiology, Keck Medical Center of University of Southern California , Los Angeles, CA , USA.,2 Stevens Neuroimaging and Informatics Institute, University of Southern California , Los Angeles, CA , USA
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11
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De Cocker LJ, Lindenholz A, Zwanenburg JJ, van der Kolk AG, Zwartbol M, Luijten PR, Hendrikse J. Clinical vascular imaging in the brain at 7T. Neuroimage 2018; 168:452-458. [PMID: 27867089 PMCID: PMC5862656 DOI: 10.1016/j.neuroimage.2016.11.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/30/2016] [Accepted: 11/16/2016] [Indexed: 01/23/2023] Open
Abstract
Stroke and related cerebrovascular diseases are a major cause of mortality and disability. Even at standard-field-strengths (1.5T), MRI is by far the most sensitive imaging technique to detect acute brain infarctions and to characterize incidental cerebrovascular lesions, such as white matter hyperintensities, lacunes and microbleeds. Arterial time-of-flight (TOF) MR angiography (MRA) can depict luminal narrowing or occlusion of the major brain feeding arteries, and this without the need for contrast administration. Compared to 1.5T MRA, the use of high-field strength (3T) and even more so ultra-high-field strengths (7T), enables the visualization of the lumen of much smaller intracranial vessels, while adding a contrast agent to TOF MRA at 7T may enable the visualization of even more distal arteries in addition to veins and venules. Moreover, with 3T and 7T, the arterial vessel walls beyond the circle of Willis become visible with high-resolution vessel wall imaging. In addition, with 7T MRI, the brain parenchyma can now be visualized on a submillimeter scale. As a result, high-resolution imaging studies of the brain and its blood supply at 7T have generated new concepts of different cerebrovascular diseases. In the current article, we will discuss emerging clinical applications and future directions of vascular imaging in the brain at 7T MRI.
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Affiliation(s)
- Laurens Jl De Cocker
- Department of Radiology, University Medical Center Utrecht, The Netherlands; Department of Radiology, Kliniek Sint-Jan, Brussels, Belgium.
| | - Arjen Lindenholz
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Jaco Jm Zwanenburg
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | | | - Maarten Zwartbol
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Peter R Luijten
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, The Netherlands
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12
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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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13
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Xie MG, Li D, Guo FZ, Zhang LW, Zhang JT, Wu Z, Meng GL, Xiao XR. Brainstem Cavernous Malformations: Surgical Indications Based on Natural History and Surgical Outcomes. World Neurosurg 2018; 110:55-63. [DOI: 10.1016/j.wneu.2017.10.121] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 11/17/2022]
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14
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15
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Trattnig S, Bogner W, Gruber S, Szomolanyi P, Juras V, Robinson S, Zbýň Š, Haneder S. Clinical applications at ultrahigh field (7 T). Where does it make the difference? NMR IN BIOMEDICINE 2016; 29:1316-34. [PMID: 25762432 DOI: 10.1002/nbm.3272] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/20/2015] [Accepted: 01/22/2015] [Indexed: 05/11/2023]
Abstract
Presently, three major MR vendors provide commercial 7-T units for clinical research under ethical permission, with the number of operating 7-T systems having increased to over 50. This rapid increase indicates the growing interest in ultrahigh-field MRI because of improved clinical results with regard to morphological as well as functional and metabolic capabilities. As the signal-to-noise ratio scales linearly with the field strength (B0 ) of the scanner, the most obvious application at 7 T is to obtain higher spatial resolution in the brain, musculoskeletal system and breast. Of specific clinical interest for neuro-applications is the cerebral cortex at 7 T, for the detection of changes in cortical structure as a sign of early dementia, as well as for the visualization of cortical microinfarcts and cortical plaques in multiple sclerosis. In the imaging of the hippocampus, even subfields of the internal hippocampal anatomy and pathology can be visualized with excellent resolution. The dynamic and static blood oxygenation level-dependent contrast increases linearly with the field strength, which significantly improves the pre-surgical evaluation of eloquent areas before tumor removal. Using susceptibility-weighted imaging, the plaque-vessel relationship and iron accumulation in multiple sclerosis can be visualized for the first time. Multi-nuclear clinical applications, such as sodium imaging for the evaluation of repair tissue quality after cartilage transplantation and (31) P spectroscopy for the differentiation between non-alcoholic benign liver disease and potentially progressive steatohepatitis, are only possible at ultrahigh fields. Although neuro- and musculoskeletal imaging have already demonstrated the clinical superiority of ultrahigh fields, whole-body clinical applications at 7 T are still limited, mainly because of the lack of suitable coils. The purpose of this article was therefore to review the clinical studies that have been performed thus far at 7 T, compared with 3 T, as well as those studies performed at 7 T that cannot be routinely performed at 3 T. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- CD Laboratory for Clinical Molecular MR Imaging
| | - Wolfgang Bogner
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Gruber
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Sciences, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Vladimir Juras
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Sciences, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Simon Robinson
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Štefan Zbýň
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Haneder
- Vascular and Abdominal Imaging, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
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16
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Deng X, Zhang Z, Zhang Y, Zhang D, Wang R, Ye X, Xu L, Wang B, Wang K, Zhao J. Comparison of 7.0- and 3.0-T MRI and MRA in ischemic-type moyamoya disease: preliminary experience. J Neurosurg 2016; 124:1716-25. [DOI: 10.3171/2015.5.jns15767] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The authors compared the image quality and diagnostic sensitivity and specificity of 7.0-T and 3.0-T MRI and time-of-flight (TOF) MR angiography (MRA) in patients with moyamoya disease (MMD).
METHODS
MR images of 15 patients with ischemic-type MMD (8 males, 7 females; age 13–48 years) and 13 healthy controls (7 males, 6 females; age 19–28 years) who underwent both 7.0-T and 3.0-T MRI and MRA were studied retrospectively. The main intracranial arteries were assessed by using the modified Houkin’s grading system (MRA score). Moyamoya vessels (MMVs) were evaluated by 2 grading systems: the MMV quality score and the MMV area score. Two diagnostic criteria for MMD were used: the T2 criteria, which used flow voids in the basal ganglion on T2-weighted images, and the TOF criteria, which used the high-intensity areas in the basal ganglion on source images from TOF MRA. All data were evaluated by 2 independent readers who were blinded to the strength field and presence or absence of MMD. Using conventional angiography as the gold standard, the sensitivity and specificity of 7.0-T and 3.0-T MRI/MRA in the diagnosis of MMD were calculated. The differences between 7.0-T and 3.0-T MRI and MRA were statistically compared.
RESULTS
No significant differences were observed between 7.0-T and 3.0-T MRA in MRA score (p = 0.317) or MRA grade (p = 0.317). There was a strong correlation between the Suzuki’s stage and MRA grade in both 3.0-T (rs = 0.930; p < 0.001) and 7.0-T (rs = 0.966; p < 0.001) MRA. However, MMVs were visualized significantly better on 7.0-T than on 3.0-T MRA, suggested by both the MMV quality score (p = 0.001) and the MMV area score (p = 0.001). The correlation between the Suzuki’s stage and the MMV area score was moderate in 3.0-T MRA (rs = 0.738; p = 0.002) and strong in 7.0-T MRA (rs = 0.908; p < 0.001). Moreover, 7.0-T MR images showed a greater capacity for detecting flow voids in the basal ganglion on both T2-weighted MR images (p < 0.001) and TOF source images (p < 0.001); 7.0-T MRA also revealed the subbranches of superficial temporal arteries much better. Receiver operating characteristic curve analysis showed that, according to the T2 criteria, 7.0-T MRI/MRA was more sensitive (sensitivity 1.000; specificity 0.933) than 3.0-T MRI/MRA (sensitivity 0.692; specificity 0.933) in diagnosing MMD; based on the TOF criteria, 7.0-T MRI/MRA was more sensitive (1.000 vs 0.733, respectively) and more specific (1.000 vs 0.923, respectively) than 3.0-T MRI/MRA.
CONCLUSIONS
Compared with 3.0-T MRI/MRA, 7.0-T MRI/MRA detected and delineated MMVs more clearly and provided higher diagnostic sensitivity and specificity, although it did not show significant improvement in depicting main intracranial arteries. The authors speculate that 7.0-T MRI/MRA is a promising technique in the diagnosis of MMD because it is noninvasive compared with conventional angiography and it is more sensitive than 3.0-T MRI/MRA.
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Affiliation(s)
- Xiaofeng Deng
- Departments of 1Neurosurgery and
- 2China National Clinical Research Center for Neurological Diseases (NCRC-ND)
- 3Center of Stroke, Beijing Institute for Brain Disorders
- 4Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
| | - Zihao Zhang
- 5State Key Laboratory of Brain and Cognitive Science, Beijing MRI Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences; and
- 6Graduate School, University of Chinese Academy of Sciences, Beijing, China
| | - Yan Zhang
- Departments of 1Neurosurgery and
- 2China National Clinical Research Center for Neurological Diseases (NCRC-ND)
- 3Center of Stroke, Beijing Institute for Brain Disorders
- 4Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
| | - Dong Zhang
- Departments of 1Neurosurgery and
- 2China National Clinical Research Center for Neurological Diseases (NCRC-ND)
- 3Center of Stroke, Beijing Institute for Brain Disorders
- 4Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
| | - Rong Wang
- Departments of 1Neurosurgery and
- 2China National Clinical Research Center for Neurological Diseases (NCRC-ND)
- 3Center of Stroke, Beijing Institute for Brain Disorders
- 4Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
| | - Xun Ye
- Departments of 1Neurosurgery and
- 2China National Clinical Research Center for Neurological Diseases (NCRC-ND)
- 3Center of Stroke, Beijing Institute for Brain Disorders
- 4Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
| | - Long Xu
- Departments of 1Neurosurgery and
- 2China National Clinical Research Center for Neurological Diseases (NCRC-ND)
- 3Center of Stroke, Beijing Institute for Brain Disorders
- 4Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
| | - Bo Wang
- 5State Key Laboratory of Brain and Cognitive Science, Beijing MRI Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences; and
| | - Kai Wang
- 7Neuroradiology, Beijing Tiantan Hospital, Capital Medical University
| | - Jizong Zhao
- Departments of 1Neurosurgery and
- 2China National Clinical Research Center for Neurological Diseases (NCRC-ND)
- 3Center of Stroke, Beijing Institute for Brain Disorders
- 4Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
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17
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De Ciantis A, Barba C, Tassi L, Cosottini M, Tosetti M, Costagli M, Bramerio M, Bartolini E, Biagi L, Cossu M, Pelliccia V, Symms MR, Guerrini R. 7T MRI in focal epilepsy with unrevealing conventional field strength imaging. Epilepsia 2016; 57:445-54. [PMID: 26778405 DOI: 10.1111/epi.13313] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the diagnostic yield of 7T magnetic resonance imaging (MRI) in detecting and characterizing structural lesions in patients with intractable focal epilepsy and unrevealing conventional (1.5 or 3T) MRI. METHODS We conducted an observational clinical imaging study on 21 patients (17 adults and 4 children) with intractable focal epilepsy, exhibiting clinical and electroencephalographic features consistent with a single seizure-onset zone (SOZ) and unrevealing conventional MRI. Patients were enrolled at two tertiary epilepsy surgery centers and imaged at 7T, including whole brain (three-dimensional [3D] T1 -weighted [T1W] fast-spoiled gradient echo (FSPGR), 3D susceptibility-weighted angiography [SWAN], 3D fluid-attenuated inversion recovery [FLAIR]) and targeted imaging (2D T2*-weighted dual-echo gradient-recalled echo [GRE] and 2D gray-white matter tissue border enhancement [TBE] fast spin echo inversion recovery [FSE-IR]). MRI studies at 1.5 or 3T deemed unrevealing at the referral center were reviewed by three experts in epilepsy imaging. Reviewers were provided information regarding the suspected localization of the SOZ. The same team subsequently reviewed 7T images. Agreement in imaging interpretation was reached through consensus-based discussions based on visual identification of structural abnormalities and their likely correlation with clinical and electrographic data. RESULTS 7T MRI revealed structural lesions in 6 (29%) of 21 patients. The diagnostic gain in detection was obtained using GRE and FLAIR images. Four of the six patients with abnormal 7T underwent epilepsy surgery. Histopathology revealed focal cortical dysplasia (FCD) in all. In the remaining 15 patients (71%), 7T MRI remained unrevealing; 4 of the patients underwent epilepsy surgery and histopathologic evaluation revealed gliosis. SIGNIFICANCE 7T MRI improves detection of epileptogenic FCD that is not visible at conventional field strengths. A dedicated protocol including whole brain FLAIR and GRE images at 7T targeted at the suspected SOZ increases the diagnostic yield.
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Affiliation(s)
- Alessio De Ciantis
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | - Carmen Barba
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,IMAGO7 Foundation, Pisa, Italy
| | - Michela Tosetti
- IRCCS Stella Maris Foundation, Pisa, Italy.,IMAGO7 Foundation, Pisa, Italy
| | - Mauro Costagli
- IRCCS Stella Maris Foundation, Pisa, Italy.,IMAGO7 Foundation, Pisa, Italy
| | | | - Emanuele Bartolini
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | - Laura Biagi
- IRCCS Stella Maris Foundation, Pisa, Italy.,IMAGO7 Foundation, Pisa, Italy
| | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Mark R Symms
- General Electric MR Scientist, Imago7, Pisa, Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
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18
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Starke RM. Do brainstem cavernous malformations have a higher rate of hemorrhage? Expert Rev Neurother 2015; 15:1109-11. [DOI: 10.1586/14737175.2015.1071193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Gizewski ER, Mönninghoff C, Forsting M. Perspectives of Ultra-High-Field MRI in Neuroradiology. Clin Neuroradiol 2015; 25 Suppl 2:267-73. [PMID: 26184503 DOI: 10.1007/s00062-015-0437-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/06/2015] [Indexed: 01/22/2023]
Abstract
PURPOSE Magnetic resonance imaging (MRI) is one of the most important methods for the diagnosis and therapy monitoring of various diseases. Today, magnets up to 3 T are standard. This review will give an overview of the clinical perspectives of ultra-high field MRI, meaning mainly 7 T. METHODS Literature review with focus on clinical applications of 7 T imaging in neuroscience combined with examples of own studies and perspectives. RESULTS This high-resolution technique offers the potential to improve certain tissue contrasts and signal in functional (fMRI) and metabolic (MRS) imaging. This overview demonstrates already existing potentials and advantages of the ultra-high magnetic field for central nervous system (CNS) diseases. CONCLUSIONS Although there are still some technical challenges for brain and spine imaging at 7 T, the method has clear benefit in selected structural, functional, and metabolic imaging.
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Affiliation(s)
- E R Gizewski
- Dept. of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria. .,Universitätsklinik für Neuroradiologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - C Mönninghoff
- Dept. of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - M Forsting
- Dept. of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
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20
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Moenninghoff C, Kraff O, Maderwald S, Umutlu L, Theysohn JM, Ringelstein A, Wrede KH, Deuschl C, Altmeppen J, Ladd ME, Forsting M, Quick HH, Schlamann M. Diffuse axonal injury at ultra-high field MRI. PLoS One 2015; 10:e0122329. [PMID: 25793614 PMCID: PMC4368671 DOI: 10.1371/journal.pone.0122329] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/10/2015] [Indexed: 01/14/2023] Open
Abstract
Objective Diffuse axonal injury (DAI) is a specific type of traumatic brain injury caused by shearing forces leading to widespread tearing of axons and small vessels. Traumatic microbleeds (TMBs) are regarded as a radiological marker for DAI. This study aims to compare DAI-associated TMBs at 3 Tesla (T) and 7 T susceptibility weighted imaging (SWI) to evaluate possible diagnostic benefits of ultra-high field (UHF) MRI. Material and Methods 10 study participants (4 male, 6 female, age range 20-74 years) with known DAI were included. All MR exams were performed with a 3 T MR system (Magnetom Skyra) and a 7 T MR research system (Magnetom 7 T, Siemens AG, Healthcare Sector, Erlangen, Germany) each in combination with a 32-channel-receive coil. The average time interval between trauma and imaging was 22 months. Location and count of TMBs were independently evaluated by two neuroradiologists on 3 T and 7 T SWI images with similar and additionally increased spatial resolution at 7 T. Inter- and intraobserver reliability was assessed using the interclass correlation coefficient (ICC). Count and diameter of TMB were evaluated with Wilcoxon signed rank test. Results Susceptibility weighted imaging revealed a total of 485 TMBs (range 1-190, median 25) at 3 T, 584 TMBs (plus 20%, range 1-262, median 30.5) at 7 T with similar spatial resolution, and 684 TMBs (plus 41%, range 1-288, median 39.5) at 7 T with 10-times higher spatial resolution. Hemorrhagic DAI appeared significantly larger at 7 T compared to 3 T (p = 0.005). Inter- and intraobserver correlation regarding the counted TMB was high and almost equal 3 T and 7 T. Conclusion 7 T SWI improves the depiction of small hemorrhagic DAI compared to 3 T and may be supplementary to lower field strengths for diagnostic in inconclusive or medicolegal cases.
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Affiliation(s)
- Christoph Moenninghoff
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
- * E-mail:
| | - Oliver Kraff
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Stefan Maderwald
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Jens M. Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Adrian Ringelstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Karsten H. Wrede
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Jan Altmeppen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Mark E. Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Harald H. Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
- High Field and Hybrid MR Imaging, University Hospital Essen, Essen, Germany
| | - Marc Schlamann
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
- Institute for Neuroradiology, University Hospital Giessen, Giessen, Germany
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21
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Management of cerebral cavernous malformations: from diagnosis to treatment. ScientificWorldJournal 2015; 2015:808314. [PMID: 25629087 PMCID: PMC4300037 DOI: 10.1155/2015/808314] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 08/16/2014] [Indexed: 01/01/2023] Open
Abstract
Cerebral cavernous malformations are the most common vascular malformations and can be found in many locations in the brain. If left untreated, cavernomas may lead to intracerebral hemorrhage, seizures, focal neurological deficits, or headaches. As they are angiographically occult, their diagnosis relies on various MR imaging techniques, which detect different characteristics of the lesions as well as aiding in planning the surgical treatment. The clinical presentation and the location of the lesion are the most important factors involved in determining the optimal course of treatment of cavernomas. We concisely review the literature and discuss the advantages and limitations of each of the three available methods of treatment—microsurgical resection, stereotactic radiosurgery, and conservative management—depending on the lesion characteristics.
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Abstract
At ultra-high magnetic fields, such as 7T, MR imaging can noninvasively visualize the brain in unprecedented detail and through enhanced contrast mechanisms. The increased SNR and enhanced contrast available at 7T enable higher resolution anatomic and vascular imaging. Greater spectral separation improves detection and characterization of metabolites in spectroscopic imaging. Enhanced blood oxygen level-dependent contrast affords higher resolution functional MR imaging. Ultra-high-field MR imaging also facilitates imaging of nonproton nuclei such as sodium and phosphorus. These improved imaging methods may be applied to detect subtle anatomic, functional, and metabolic abnormalities associated with a wide range of neurologic disorders, including epilepsy, brain tumors, multiple sclerosis, Alzheimer disease, and psychiatric conditions. At 7T, however, physical and hardware limitations cause conventional MR imaging pulse sequences to generate artifacts, requiring specialized pulse sequences and new hardware solutions to maximize the high-field gain in signal and contrast. Practical considerations for ultra-high-field MR imaging include cost, siting, and patient experience.
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Affiliation(s)
- P Balchandani
- From the Translational and Molecular Imaging Institute (P.B.) Department of Radiology (P.B., T.P.N.), Icahn School of Medicine at Mount Sinai, New York, New York.
| | - T P Naidich
- Department of Radiology (P.B., T.P.N.), Icahn School of Medicine at Mount Sinai, New York, New York
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Rosenow F, Alonso-Vanegas MA, Baumgartner C, Blümcke I, Carreño M, Gizewski ER, Hamer HM, Knake S, Kahane P, Lüders HO, Mathern GW, Menzler K, Miller J, Otsuki T, Özkara C, Pitkänen A, Roper SN, Sakamoto AC, Sure U, Walker MC, Steinhoff BJ. Cavernoma-related epilepsy: Review and recommendations for management-Report of the Surgical Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia 2013; 54:2025-35. [DOI: 10.1111/epi.12402] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Felix Rosenow
- Department of Neurology; Epilepsy Center Hessen; University Hospital and Philipps-University Marburg; Marburg Germany
| | - Mario A. Alonso-Vanegas
- ABC Neurological Center & National Institute of Neurology and Neurosurgery; México City Mexico
| | - Christoph Baumgartner
- Second Neurological Department; Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology; General Hospital Hietzing with Neurological Center Rosenhügel; Vienna Austria
| | - Ingmar Blümcke
- Department of Neuropathology; University Hospitals Erlangen; Friedrich-Alexander University Erlangen-Nuremberg; Erlangen Germany
| | - Maria Carreño
- Neurology Service; Epilepsy Unit; Hospital Clinic of Barcelona; Barcelona Spain
| | - Elke R. Gizewski
- Department of Radiology; University Clinic for Neuroradiology; Medical University Innsbruck; Innsbruck Austria
| | - Hajo M. Hamer
- Department of Neurology; Epilepsy Center Erlangen; University Hospitals Erlangen; Friedrich-Alexander University Erlangen-Nuremberg; Erlangen Germany
| | - Susanne Knake
- Department of Neurology; Epilepsy Center Hessen; University Hospital and Philipps-University Marburg; Marburg Germany
| | - Philippe Kahane
- Department of Neurology and GIN INSERM U836-UJF-CEA; University Hospital of Grenoble; Grenoble France
| | - Hans O. Lüders
- Department of Neurosurgery; Epilepsy Center; University Hospitals Case Medical Center/Case Western Reserve University; Cleveland Ohio U.S.A
| | - Gary W. Mathern
- Departments of Neurosurgery and Psychiatry & BioBehavioral Medicine; David Geffen School of Medicine; Mattel Children's Hospital; University of California; Los Angeles California U.S.A
| | - Katja Menzler
- Department of Neurology; Epilepsy Center Hessen; University Hospital and Philipps-University Marburg; Marburg Germany
| | - Jonathan Miller
- Department of Neurosurgery; University Hospitals Case Medical Center/Case Western Reserve University; Cleveland Ohio U.S.A
| | - Taisuke Otsuki
- Epilepsy Center; National Center of Neurology and Psychiatry; Tokyo Japan
| | - Cigdem Özkara
- Cerrahpasa Medical Faculty; Istanbul University; Istanbul Turkey
| | - Asla Pitkänen
- A. I. Virtanen Institute for Molecular Sciences; University of Eastern Finland (UEF); Kuopio Finland
- Department of Neurology; Kuopio University Hospital; Kuopio Finland
| | - Steven N. Roper
- Department of Neurosurgery; University of Florida; Gainesville Florida U.S.A
| | - Americo C. Sakamoto
- Department of Neurosciences and Behavioral Science; Ribeirão Preto School of Medicine; University of São Paulo; São Paulo Brazil
| | - Ulrich Sure
- Department of Neurosurgery; University Hospital Essen; University of Duisburg-Essen; Essen Germany
| | - Matthew C. Walker
- Department of Clinical and Experimental Epilepsy; UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery; London United Kingdom
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24
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Long-term seizure outcomes following resection of supratentorial cavernous malformations. Clin Neurol Neurosurg 2013; 115:2377-81. [PMID: 24075713 DOI: 10.1016/j.clineuro.2013.08.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 08/10/2013] [Accepted: 08/25/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Symptomatic supratentorial cavernous malformations may present with seizure, headache, neurological deficit, or a combination thereof. Factors that contribute to treatment algorithms commonly include patient age, lesion size and location, lesion multiplicity, hemorrhage history, and the ability to control seizure activity with medication. A better appreciation of the impact of patient and lesion characteristics on post-operative seizure control may provide insight into management strategies. To determine long-term seizure outcomes following surgical resection of supratentorial cavernous malformations, the predictive value of characteristics including seizure duration and number, presence of generalized seizures, and lesion multiplicity and size on seizure control rate was evaluated. METHODS We performed a single institution retrospective review of consecutive patients with supratentorial cavernous malformations presenting with at least one seizure between 1995 and 2008. Univariate and multivariate analyses were used to determine the influence of patient and lesion characteristics on postoperative seizure control. RESULTS Fifty-six patients met inclusion criteria. Mean follow-up duration was 87.9 months. At last follow-up there were 46 patients (82.1%) that were free from impairing seizures (Engel Class 1). Ten patients (17.9%) were classified as Engel Class 2-4. Univariate analysis demonstrated that only the presence of multiple cavernomas was associated with worse post-operative seizure outcome (p=0.006). Multivariate analysis demonstrated that multiple cavernomas remained a significant predictor for development of worse seizure outcome controlling for number and duration of seizures prior to operation, presence of generalized tonic-clonic seizures, and size (odds ratio, 0.17; 95% confidence interval, 0.03, 0.99). CONCLUSION Resection of supratentorial cavernomas is associated with a high rate of postoperative seizure freedom. The presence of multiple cavernomas is predictive of seizure persistence following surgery.
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25
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Clinical applications of 7T MRI in the brain. Eur J Radiol 2013; 82:708-18. [PMID: 21937178 DOI: 10.1016/j.ejrad.2011.07.007] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 07/12/2011] [Indexed: 11/19/2022]
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26
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Frischer JM, Göd S, Gruber A, Saringer W, Grabner G, Gatterbauer B, Kitz K, Holzer S, Kronnerwetter C, Hainfellner JA, Knosp E, Trattnig S. Susceptibility-weighted imaging at 7 T: Improved diagnosis of cerebral cavernous malformations and associated developmental venous anomalies. NEUROIMAGE-CLINICAL 2012; 1:116-20. [PMID: 24179744 PMCID: PMC3757736 DOI: 10.1016/j.nicl.2012.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 09/03/2012] [Accepted: 09/05/2012] [Indexed: 11/12/2022]
Abstract
Background and aim In the diagnosis of cerebral cavernous malformations (CCMs) magnetic resonance imaging is established as the gold standard. Conventional MRI techniques have their drawbacks in the diagnosis of CCMs and associated venous malformations (DVAs). The aim of our study was to evaluate susceptibility weighted imaging SWI for the detection of CCM and associated DVAs at 7 T in comparison with 3 T. Patients and methods 24 patients (14 female, 10 male; median age: 38.3 y (21.1 y–69.1 y) were included in the study. Patients enrolled in the study received a 3 T and a 7 T MRI on the same day. The following sequences were applied on both field strengths: a T1 weighted 3D GRE sequence (MP-RAGE) and a SWI sequence. After obtaining the study MRIs, eleven patients underwent surgery and 13 patients were followed conservatively or were treated radio-surgically. Results Patients initially presented with haemorrhage (n = 4, 16.7%), seizures (n = 2, 8.3%) or other neurology (n = 18, 75.0%). For surgical resected lesions histopathological findings verified the diagnosis of CCMs. A significantly higher number of CCMs was diagnosed at 7 T SWI sequences compared with 3 T SWI (p < 0.05). Additionally diagnosed lesions on 7 T MRI were significantly smaller compared to the initial lesions on 3 T MRIs (p < 0.001). Further, more associated DVAs were diagnosed at 7 T MRI compared to 3 T MRI. Conclusion SWI sequences at ultra-high-field MRI improve the diagnosis of CCMs and associated DVAs and therefore add important pre-operative information.
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Affiliation(s)
- Josa M Frischer
- Medical University Vienna, Department of Neurosurgery, Vienna, Austria
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van der Kolk AG, Hendrikse J, Luijten PR. Ultrahigh-field magnetic resonance imaging: the clinical potential for anatomy, pathogenesis, diagnosis, and treatment planning in brain disease. Neuroimaging Clin N Am 2012; 22:343-62, xii. [PMID: 22548936 DOI: 10.1016/j.nic.2012.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In this review, current (clinical) applications and possible future directions of ultrahigh-field (≥7 T) magnetic resonance (MR) imaging in the brain are discussed. Ultrahigh-field MR imaging can provide contrast-rich images of diverse pathologies and can be used for early diagnosis and treatment monitoring of brain disease. These images may provide increased sensitivity and specificity. Several limitations need to be overcome before worldwide clinical implementation can be commenced. Current literature regarding clinically based ultrahigh-field MR imaging is reviewed, and limitations and promises of this technique are discussed, as well as some practical considerations for the implementation in clinical practice.
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Affiliation(s)
- Anja G van der Kolk
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Postbox 85500, 3508 GA Utrecht, The Netherlands.
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28
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Moser E, Stahlberg F, Ladd ME, Trattnig S. 7-T MR--from research to clinical applications? NMR IN BIOMEDICINE 2012; 25:695-716. [PMID: 22102481 DOI: 10.1002/nbm.1794] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 08/25/2011] [Accepted: 08/31/2011] [Indexed: 05/31/2023]
Abstract
Over 20,000 MR systems are currently installed worldwide and, although the majority operate at magnetic fields of 1.5 T and below (i.e. about 70%), experience with 3-T (in high-field clinical diagnostic imaging and research) and 7-T (research only) human MR scanners points to a future in functional and metabolic MR diagnostics. Complementary to previous studies, this review attempts to provide an overview of ultrahigh-field MR research with special emphasis on emerging clinical applications at 7 T. We provide a short summary of the technical development and the current status of installed MR systems. The advantages and challenges of ultrahigh-field MRI and MRS are discussed with special emphasis on radiofrequency inhomogeneity, relaxation times, signal-to-noise improvements, susceptibility effects, chemical shifts, specific absorption rate and other safety issues. In terms of applications, we focus on the topics most likely to gain significantly from 7-T MR, i.e. brain imaging and spectroscopy and musculoskeletal imaging, but also body imaging, which is particularly challenging. Examples are given to demonstrate the advantages of susceptibility-weighted imaging, time-of-flight MR angiography, high-resolution functional MRI, (1)H and (31)P MRSI in the human brain, sodium and functional imaging of cartilage and the first results (and artefacts) using an eight-channel body array, suggesting future areas of research that should be intensified in order to fully explore the potential of 7-T MR systems for use in clinical diagnosis.
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Affiliation(s)
- Ewald Moser
- Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
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29
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Advances in ultra-high field MRI for the clinical management of patients with brain tumors. Curr Opin Neurol 2012; 24:605-15. [PMID: 22045220 DOI: 10.1097/wco.0b013e32834cd495] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW The last 5 years have seen the number of ultra-high field (UHF; 7 T and beyond) MRI scanners nearly double. Benefits include improved specificity, better sensitivity for signal-starved compounds, and the ability to detect, quantify, and monitor tumor activity and treatment effects. This is especially important in the current climate in which new treatments alter established markers of tumor and the surrounding environment, confounding traditional response criteria. RECENT FINDINGS Intra-tumoral heterogeneity and dramatic improvement in spatial localization have been observed with 7 and 8 T high-resolution T2-weighted and T2*-weighted imaging. This depiction of lesions that were not readily detected at lower field improved the classification of glioma. Sub-millimeter visualization of microvasculature has facilitated the detection of microbleeds associated with long-term effects of radiation. New metabolic markers seen at UHF may also assist in distinguishing tumor progression from treatment effect. SUMMARY Although progress has been limited by technical challenges, initial experience has demonstrated the promise of 7-T MRI in advancing existing paradigms for diagnosing, monitoring, and managing patients with brain tumors. The success of these systems will depend upon what new information can be gained by UHF, rather than simply improving the quality of the current lower field standard.
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Lupo JM, Chuang CF, Chang SM, Barani IJ, Jimenez B, Hess CP, Nelson SJ. 7-Tesla susceptibility-weighted imaging to assess the effects of radiotherapy on normal-appearing brain in patients with glioma. Int J Radiat Oncol Biol Phys 2011; 82:e493-500. [PMID: 22000750 DOI: 10.1016/j.ijrobp.2011.05.046] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 05/19/2011] [Accepted: 05/20/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the intermediate- and long-term imaging manifestations of radiotherapy on normal-appearing brain tissue in patients with treated gliomas using 7T susceptibility-weighted imaging (SWI). METHODS AND MATERIALS SWI was performed on 25 patients with stable gliomas on a 7 Tesla magnet. Microbleeds were identified as discrete foci of susceptibility that did not correspond to vessels. The number of microbleeds was counted within and outside of the T2-hyperintense lesion. For 3 patients, radiation dosimetry maps were reconstructed and fused with the 7T SWI data. RESULTS Multiple foci of susceptibility consistent with microhemorrhages were observed in patients 2 years after chemoradiation. These lesions were not present in patients who were not irradiated. The prevalence of microhemorrhages increased with the time since completion of radiotherapy, and these lesions often extended outside the boundaries of the initial high-dose volume and into the contralateral hemisphere. CONCLUSIONS High-field SWI has potential for visualizing the appearance of microbleeds associated with long-term effects of radiotherapy on brain tissue. The ability to visualize these lesions in normal-appearing brain tissue may be important in further understanding the utility of this treatment in patients with longer survival.
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Affiliation(s)
- Janine M Lupo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, USA.
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31
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Kang CK, Wörz S, Liao W, Park CA, Kim YB, Park CW, Lee YB, Rohr K, Cho ZH. Three Dimensional Model-Based Analysis of the Lenticulostriate Arteries and Identification of the Vessels Correlated to the Infarct Area: Preliminary Results. Int J Stroke 2011; 7:558-63. [PMID: 21978076 DOI: 10.1111/j.1747-4949.2011.00611.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Small vessel diseases have been studied noninvasively with magnetic resonance imaging. Direct observation or visualization of the connected microvessel to the infarct, however, was not possible due to the limited resolution. Hence, one could not determine whether vessel occlusion or abnormal narrowing is the cause of an infarct. Methods In this report, we demonstrate that the small vessel related to the infarct can be detected using ultra-high-field (7 T) magnetic resonance imaging and a three dimensional image analysis and modeling technique for microvessels, which thereby enables us to quantify the vessel morphology directly, that is, visualize the vessel that is related to the infarct. We compared vessels of selected stroke patients, who had recovered from stroke, with vessels from typical stroke patients, who had after effects like motor weakness, and age-matched healthy subjects to demonstrate the potential of the technique. Results The experimental results show that typical stroke patients had overall degradation or loss of small vessels, compared with the selected patients as well as healthy subjects. The selected patients, however, had only minimal loss of vessels, except for one vessel located close to the infarct area. Conclusions These preliminary results demonstrated that 7 T magnetic resonance imaging together with a three dimensional image analysis and modeling technique could provide information for detection of the vessel related to the infarct. In addition, three dimensional image analysis and modeling of vessels could further provide quantitative information on the microvessel structures comprising diameter, length and tortuosity.
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Affiliation(s)
- Chang-Ki Kang
- Neuroscience Research Institute, Gachon University of Medicine and Science, Incheon, Korea
| | - Stefan Wörz
- Department of Bioinformatics and Functional Genomics, Biomedical Computer Vision Group, University of Heidelberg, BIOQUANT, IPMB, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wei Liao
- Neuroscience Research Institute, Gachon University of Medicine and Science, Incheon, Korea
| | - Chan-A Park
- Neuroscience Research Institute, Gachon University of Medicine and Science, Incheon, Korea
| | - Young-Bo Kim
- Neuroscience Research Institute, Gachon University of Medicine and Science, Incheon, Korea
| | - Cheol-Wan Park
- Neuroscience Research Institute, Gachon University of Medicine and Science, Incheon, Korea
| | - Young-Bae Lee
- Department of Neurology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Karl Rohr
- Department of Bioinformatics and Functional Genomics, Biomedical Computer Vision Group, University of Heidelberg, BIOQUANT, IPMB, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Zang-Hee Cho
- Neuroscience Research Institute, Gachon University of Medicine and Science, Incheon, Korea
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32
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Campbell PG, Jabbour P, Yadla S, Awad IA. Emerging clinical imaging techniques for cerebral cavernous malformations: a systematic review. Neurosurg Focus 2010; 29:E6. [PMID: 20809764 DOI: 10.3171/2010.5.focus10120] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebral cavernous malformations (CCMs) are divided into sporadic and familial forms. For clinical imaging, T2-weighted gradient-echo sequences have been shown to be more sensitive than conventional sequences. Recently more advanced imaging techniques such as high-field and susceptibility-weighted MR imaging have been employed for the evaluation of CCMs. Furthermore, diffusion tensor imaging and functional MR imaging have been applied to the preoperative and intraoperative management of these lesions. In this paper, the authors attempt to provide a concise review of the emerging imaging methods used in the clinical diagnosis and treatment of CCMs.
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Affiliation(s)
- Peter G Campbell
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
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33
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Dammann P, Barth M, Zhu Y, Maderwald S, Schlamann M, Ladd ME, Sure U. Susceptibility weighted magnetic resonance imaging of cerebral cavernous malformations: prospects, drawbacks, and first experience at ultra–high field strength (7-Tesla) magnetic resonance imaging. Neurosurg Focus 2010; 29:E5. [DOI: 10.3171/2010.6.focus10130] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
High-resolution susceptibility weighted MR imaging at high field strength provides excellent depiction of venous structures, blood products, and iron deposits, making it a promising complementary imaging modality for cerebral cavernous malformations (CCMs). Although already introduced in 1997 and being constantly improved, susceptibility weighted imaging is not yet routine in clinical neuroimaging protocols for CCMs. In this article, the authors review the recent literature dealing with clinical and scientific susceptibility weighted imaging of CCMs to summarize its prospects and drawbacks and provide their first experience with its use in ultra–high field (7-T) MR imaging.
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Affiliation(s)
- Philipp Dammann
- 1Erwin L. Hahn Institute for Magnetic Resonance Imaging; Departments of
- 2Neurosurgery and
| | - Markus Barth
- 1Erwin L. Hahn Institute for Magnetic Resonance Imaging; Departments of
- 3Radboud University Nijmegen, Donders Institute for Cognitive Neuroimaging, Nijmegen, The Netherlands
| | | | - Stefan Maderwald
- 1Erwin L. Hahn Institute for Magnetic Resonance Imaging; Departments of
- 4Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany; and
| | - Marc Schlamann
- 4Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany; and
| | - Mark E. Ladd
- 1Erwin L. Hahn Institute for Magnetic Resonance Imaging; Departments of
- 4Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany; and
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34
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7.0 Tesla MRI: the "field of dreams"? Acad Radiol 2010; 17:407-9. [PMID: 20207312 DOI: 10.1016/j.acra.2009.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 12/18/2009] [Accepted: 12/18/2009] [Indexed: 11/20/2022]
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