Three-dimensional Dynamic Susceptibility-weighted Perfusion MR Imaging at 3.0 T: Feasibility and Contrast Agent Dose

A Novel Collateral Imaging Method Derived from Time-Resolved Dynamic Contrast-Enhanced MR Angiography in Acute Ischemic Stroke: A Pilot Study

BACKGROUND AND PURPOSE

Assessment of the collateral status has been emphasized for appropriate treatment decisions in patients with acute ischemic stroke. The purpose of this study was to introduce a multiphase MRA collateral imaging method (collateral map) derived from time-resolved dynamic contrast-enhanced MRA and to verify the value of the multiphase MRA collateral map in acute ischemic stroke by comparing it with the multiphase collateral imaging method (MRP collateral map) derived from dynamic susceptibility contrast-enhanced MR perfusion.

MATERIALS AND METHODS

From a prospectively maintained registry of acute ischemic stroke, MR imaging data of patients with acute ischemic stroke caused by steno-occlusive lesions of the unilateral ICA and/or the M1 segment of the MCA were analyzed. We generated collateral maps using dynamic signals from dynamic contrast-enhanced MRA and DSC-MRP using a Matlab-based in-house program and graded the collateral scores of the multiphase MRA collateral map and the MRP collateral map independently. Interobserver reliabilities and intermethod agreement between both collateral maps for collateral grading were tested.

RESULTS

Seventy-one paired multiphase MRA and MRP collateral maps from 67 patients were analyzed. The interobserver reliabilities for collateral grading using multiphase MRA or MRP collateral maps were excellent (weighted κ = 0.964 and 0.956, respectively). The agreement between both collateral maps was also excellent (weighted κ = 0.884; 95% confidence interval, 0.819-0.949).

CONCLUSIONS

We demonstrated that the dynamic signals of dynamic contrast-enhanced MRA could be used to generate multiphase collateral images and showed the possibility of the multiphase MRA collateral map as a useful collateral imaging method in acute ischemic stroke.

Comparison between dynamic susceptibility contrast magnetic resonance imaging and arterial spin labeling techniques in distinguishing malignant from benign brain tumors

OBJECTIVES

The purpose of this study was to preliminarily compare unenhanced arterial spin-labeled (ASL) imaging, dynamic susceptibility contrast-enhanced cerebral blood volume (DSCE-CBV) magnetic resonance imaging (MRI) for evaluation of tumor perfusion in patients with brain tumors.

MATERIALS AND METHODS

A total of 27 patients with brain tumors were examined in 1,5T MRI. Single phase and multiphase ASL, DSCE-CBV examinations were assessed by both qualitative and quantitative analysis for the detection of malignancy. Imaging results were correlated with a histopathology or follow-up.

RESULTS

Based on 31 studies in 27 patients with brain tumors, the visual inspection sensitivities for ASL and dynamic DSC perfusion imaging were 88% and 94%, respectively, with 100% specificity for both. On qualitative evaluation, sensitivities for ASL and DSC perfusion imaging perfusions were 88% and 94%, respectively, with 100% specificity for both. The highest sensitivity values for quantitative ASL imaging were obtained using a normalized cut-off ratio of 1.65, resulting in sensitivity of 94% for ASL imaging and cut-off ratio of 1.95 and sensitivity 94% for DSCE-CBV imaging.

CONCLUSION

The present study revealed similar sensitivity and specificity for both multhiphase ASL and DSC MRI. Thus, we suggest that ASL perfusion can be used in daily clinical practice.

Hyperintense acute reperfusion marker is associated with higher contrast agent dosage in acute ischaemic stroke

OBJECTIVE

The hyperintense acute reperfusion marker (HARM) on fluid-attenuated inversion recovery (FLAIR) images is associated with blood-brain barrier (BBB) permeability changes. The aim of this study was to examine the influence of contrast agent dosage on HARM incidence in acute ischaemic stroke patients.

METHODS

We prospectively included 529 acute ischaemic stroke patients (204 females, median age 71 years). Patients underwent a first stroke-MRI within 24 hours from symptom onset and had a follow-up on day 2. The contrast agent Gadobutrol was administered to the patients for perfusion imaging or MR angiography. The total dosage was calculated as ml/kg body weight and ranged between 0.04 and 0.31 mmol/kg on the first examination. The incidence of HARM was evaluated on day 2 FLAIR images.

RESULTS

HARM was detected in 97 patients (18.3%). HARM incidence increased significantly with increasing dosages of Gadobutrol. Also, HARM positive patients were significantly older. HARM was not an independent predictor of worse clinical outcome, and we did not find an association with increase risk of haemorrhagic transformation.

CONCLUSIONS

A higher dosage of Gadobutrol in acute stroke patients on initial MRI is associated with increased HARM incidence on follow-up. MRI studies on BBB should therefore standardize contrast agent dosages.

KEY POINTS

• Hyperintense acute reperfusion marker on MRI indicates blood-brain barrier disruption. • This observational study on stroke patients characterizes HARM. • Incidence depends on contrast agent dosage on the previous day. • HARM is also associated with older age and poor kidney function. • Interpretation of HARM must take dosage into consideration.

Bayesian estimation of cerebral perfusion using reduced-contrast-dose dynamic susceptibility contrast perfusion at 3T

BACKGROUND AND PURPOSE

DSC perfusion has been increasingly used in conjunction with other contrast-enhanced MR applications and therefore there is need for contrast-dose reduction when feasible. The purpose of this study was to establish the feasibility of reduced-contrast-dose brain DSC perfusion by using a probabilistic Bayesian method and to compare the results with the commonly used singular value decomposition technique.

MATERIALS AND METHODS

Half-dose (0.05-mmol/kg) and full-dose (0.1-mmol/kg) DSC perfusion studies were prospectively performed in 20 patients (12 men; 34-70 years of age) by using a 3T MR imaging scanner and a gradient-EPI sequence (TR/TE, 1450/22 ms; flip angle, 90°). All DSC scans were processed with block circulant singular value decomposition and Bayesian probabilistic methods. SNR analysis was performed in both half-dose and full-dose groups. The CBF, CBV, and MTT maps from both full-dose and half-dose scans were evaluated qualitatively and quantitatively in both WM and GM on coregistered perfusion maps. Statistical analysis was performed by using a t test, regression, and Bland-Altman analysis.

RESULTS

The SNR was significantly (P < .0001) lower in the half-dose group with 32% and 40% reduction in GM and WM, respectively. In the half-dose group, the image-quality scores were significantly higher in Bayesian-derived CBV (P = .02) and MTT (P = .004) maps in comparison with block circulant singular value decomposition. Quantitative values of CBF, CBV, and MTT in Bayesian-processed data were comparable and without a statistically significant difference between the half-dose and full-dose groups. The block circulant singular value decomposition-derived half-dose perfusion values were significantly different from those of the full-dose group both in GM (CBF, P < .001; CBV, P = .02; MTT, P = .02) and WM (CBF, P < .001; CBV, P = .003; MTT, P = .01).

CONCLUSIONS

Reduced-contrast-dose (0.05-mmol/kg) DSC perfusion of the brain is feasible at 3T by using the Bayesian probabilistic method with quantitative results comparable with those of the full-dose protocol.

Combined low-dose contrast-enhanced MR angiography and perfusion for acute ischemic stroke at 3T: A more efficient stroke protocol

BACKGROUND AND PURPOSE

There is need to improve image acquisition speed for MR imaging in evaluation of patients with acute ischemic stroke. The purpose of this study was to evaluate the feasibility of a 3T MR stroke protocol that combines low-dose contrast-enhanced MRA and dynamic susceptibility contrast perfusion, without additional contrast.

METHODS

Thirty patients with acute stroke who underwent 3T MR imaging followed by DSA were retrospectively enrolled. TOF-MRA of the neck and brain and 3D contrast-enhanced MRA of the craniocervical arteries were obtained. A total of 0.1 mmol/kg of gadolinium was used for both contrast-enhanced MRA (0.05 mmol/kg) and dynamic susceptibility contrast perfusion (0.05 mmol/kg) (referred to as half-dose). An age-matched control stroke population underwent TOF-MRA and full-dose (0.1 mmol/kg) dynamic susceptibility contrast perfusion. The cervicocranial arteries were divided into 25 segments. Degree of arterial stenosis on contrast-enhanced MRA and TOF-MRA was compared with DSA. Time-to-maximum maps (>6 seconds) were evaluated for image quality and hypoperfusion. Quantitative analysis of arterial input function curves, SNR, and maximum T2* effects were compared between half- and full-dose groups.

RESULTS

The intermodality agreements (k) for arterial stenosis were 0.89 for DSA/contrast-enhanced MRA and 0.63 for DSA/TOF-MRA. Detection specificity of >50% arterial stenosis was lower for TOF-MRA (89%) versus contrast-enhanced MRA (97%) as the result of overestimation of 10% (39/410) of segments by TOF-MRA. The DWI-perfusion mismatch was identified in both groups with high interobserver agreement (r = 1). There was no significant difference between full width at half maximum of the arterial input function curves (P = .14) or the SNR values (0.6) between the half-dose and full-dose groups.

CONCLUSIONS

In patients with acute stroke, combined low-dose contrast-enhanced MRA and dynamic susceptibility contrast perfusion at 3T is feasible and results in significant scan time and contrast dose reductions.

Arterial input function in perfusion MRI: a comprehensive review

Cerebral perfusion, also referred to as cerebral blood flow (CBF), is one of the most important parameters related to brain physiology and function. The technique of dynamic-susceptibility contrast (DSC) MRI is currently the most commonly used MRI method to measure perfusion. It relies on the intravenous injection of a contrast agent and the rapid measurement of the transient signal changes during the passage of the bolus through the brain. Central to quantification of CBF using this technique is the so-called arterial input function (AIF), which describes the contrast agent input to the tissue of interest. Due to its fundamental role, there has been a lot of progress in recent years regarding how and where to measure the AIF, how it influences DSC-MRI quantification, what artefacts one should avoid, and the design of automatic methods to measure the AIF. The AIF is also directly linked to most of the major sources of artefacts in CBF quantification, including partial volume effect, bolus delay and dispersion, peak truncation effects, contrast agent non-linearity, etc. While there have been a number of good review articles on DSC-MRI over the years, these are often comprehensive but, by necessity, with limited in-depth discussion of the various topics covered. This review article covers in greater depth the issues associated with the AIF and their implications for perfusion quantification using DSC-MRI.

Regional cerebral perfusion alterations in patients with mild cognitive impairment and Alzheimer disease using dynamic susceptibility contrast MRI

RATIONALE AND OBJECTIVES

The purpose of this study was to assess regional cerebral perfusion distribution in patients with Alzheimer disease (AD) or mild cognitive impairment (MCI) using dynamic susceptibility contrast magnetic resonance imaging.

MATERIALS AND METHODS

Regional changes of perfusion were evaluated in 34 patients with AD, 51 patients with MCI, and 23 healthy controls (HCs). Using region of interest analyses, regional cerebral blood flow (CBF), cerebral blood volume, and mean transit time were measured bilaterally in the hippocampus; the temporal, temporoparietal, frontal, and sensomotoric cortices; the anterior and posterior cingulate gyri; the lentiform nucleus; and the cerebellum.

RESULTS

A significant reduction of CBF in patients with AD compared to HCs was shown in the frontal and temporoparietal cortices bilaterally, the lentiform nuclei bilaterally, the left posterior cingulate gyrus, and the cerebellum. Compared with patients with MCI, patients with AD presented a reduction of CBF in the frontal cortices bilaterally, the left temporoparietal cortex, and the left anterior and posterior cingulate gyrus. In both hippocampi and the posterior cingulate gyrus, a trend to a slight increase of CBF in patients with MCI was noticed with a decrease in patients with AD.

CONCLUSIONS

Using dynamic susceptibility contrast magnetic resonance imaging, pathologic alterations of regional brain perfusion can be demonstrated in patients with AD compared to patients with MCI or HCs.

Imaging of the spine at 3 tesla

Magnetic resonance (MR) imaging at 3 T has proved superior to 1.5 T in the brain for detecting numerous pathologic entities including hemosiderin, tiny metastases, subtle demyelinating plaques, active demyelinating plaques, and some epileptogenic foci, as well as small aneurysms with MR angiography. 3 T is superior to most advanced imaging techniques including diffusion, diffusion tensor imaging, perfusion, spectroscopy and functional MR imaging. The increased signal/noise ratio at 3 T permits higher spatial resolution. Initially spine imaging at 3 T proved more difficult with less successful results. During the past 7 years, technological advances in magnet and surface coil design as well as improved radio frequency transmitters and pulse sequence design in combination with the large body of knowledge accrued by radiologists and physicists during a nine year experience with clinical imaging of the spine with the doubled B0, has resulted in 3 T MRI of the spine achieving a reputation similar to that for brain imaging.

Stroke: high-field magnetic resonance imaging

Diagnostic modalities for the diagnosis of acute stroke have increased in number and quality. Magnetic resonance imaging has increasingly become a central tool for the management of patients with stroke. New sequences, such as diffusion and perfusion, provide insight into the infarcted core and the hypoperfused brain. The use of higher magnetic fields allows us to gain in signal strength, which can be used to improve imaging speed and/or resolution. Recent additional sequences allow perfusion without contrast and susceptibility-weighted imaging can help identify early bleeding. These new techniques should provide more information about the on going ischemic process.

The PRESTO technique for fMRI

In the early days of BOLD fMRI, the acquisition of T(2)(*) weighted data was greatly facilitated by rapid scan techniques such as EPI. The latter, however, was only available on a few MRI systems that were equipped with specialized hardware that allowed rapid switching of the imaging gradients. For this reason, soon after the invention of fMRI, the scan technique PRESTO was developed to make rapid T(2)(*) weighted scanning available on standard clinical scanners. This method combined echo shifting, which allows for echo times longer than the sequence repetition time, with acquisition of multiple k-space lines per excitation. These two concepts were combined in order to achieve a method fast enough for fMRI, while maintaining a sufficiently long echo time for optimal contrast. PRESTO has been primarily used for 3D scanning, which minimized the contribution of large vessels due to inflow effects. Although PRESTO is still being used today, its appeal has lessened somewhat due to increased gradient performance of modern MRI scanners. Compared to 2D EPI, PRESTO may have somewhat reduced temporal stability, which is a disadvantage for fMRI that may not outweigh the advantage of reduced inflow effects provided by 3D scanning. In this overview, the history of the development of the PRESTO is presented, followed by a qualitative comparison with EPI.

Correlations between perfusion MR imaging cerebral blood volume, microvessel quantification, and clinical outcome using stereotactic analysis in recurrent high-grade glioma

BACKGROUND AND PURPOSE

Quantifying MVA rather than MVD provides better correlation with survival in HGG. This is attributed to a specific "glomeruloid" vascular pattern, which is better characterized by vessel area than number. Despite its prognostic value, MVA quantification is laborious and clinically impractical. The DSC-MR imaging measure of rCBV offers the advantages of speed and convenience to overcome these limitations; however, clinical use of this technique depends on establishing accurate correlations between rCBV, MVA, and MVD, particularly in the setting of heterogeneous vascular size inherent to human HGG.

MATERIALS AND METHODS

We obtained preoperative 3T DSC-MR imaging in patients with HGG before stereotactic surgery. We histologically quantified MVA, MVD, and vascular size heterogeneity from CD34-stained 10-μm sections of stereotactic biopsies, and we coregistered biopsy locations with localized rCBV measurements. We statistically correlated rCBV, MVA, and MVD under conditions of high and low vascular-size heterogeneity and among tumor grades. We correlated all parameters with OS by using Cox regression.

RESULTS

We analyzed 38 biopsies from 24 subjects. rCBV correlated strongly with MVA (r = 0.83, P < .0001) but weakly with MVD (r = 0.32, P = .05), due to microvessel size heterogeneity. Among samples with more homogeneous vessel size, rCBV correlation with MVD improved (r = 0.56, P = .01). OS correlated with both rCBV (P = .02) and MVA (P = .01) but not with MVD (P = .17).

CONCLUSIONS

rCBV provides a reliable estimation of tumor MVA as a biomarker of glioma outcome. rCBV poorly estimates MVD in the presence of vessel size heterogeneity inherent to human HGG.

Comparison of 3 Tesla proton MR spectroscopy, MR perfusion and MR diffusion for distinguishing glioma recurrence from posttreatment effects

PURPOSE

To compare 3 Tesla (3T) multi-voxel and single-voxel proton MR spectroscopy (MRS), dynamic susceptibility contrast perfusion MRI (DSC), and diffusion-weighted MRI (DWI) for distinguishing recurrent glioma from postradiation injury.

MATERIALS AND METHODS

We reviewed all 3T MRS, DSC and DWI studies performed for suspicion of malignant glioma recurrence between October 2006 and December 2008. Maximum Cho/NAA and Cho/Cr peak-area and peak-height ratios were recorded for both multi-voxel and single-voxel MRS. Maximum cerebral blood volume (CBV) and minimum apparent diffusion coefficient (ADC) were normalized to white matter. Histopathology and clinical-radiologic follow-up served as reference standards. Receiver operating characteristic curves for each parameter were compared.

RESULTS

Forty lesions were classified as glioma recurrence (n = 30) or posttreatment effect (n = 10). Diagnostic performance was similar for CBV ratio (AUC = 0.917, P < 0.001), multi-voxel Cho/Cr peak-area (AUC = 0.913, P = 0.002), and multi-voxel Cho/NAA peak-height (AUC = 0.913, P = 0.002), while ADC ratio (AUC = 0.726, P = 0.035) did not appear to perform as well. Single-voxel MRS parameters did not reliably distinguish tumor recurrence from posttreatment effects.

CONCLUSION

A 3T DSC and multi-voxel MRS Cho/Cr peak-area and Cho/NAA peak-height appear to outperform DWI for distinguishing glioma recurrence from posttreatment effects. Single-voxel MRS parameters do not appear to distinguish glioma recurrence from posttreatment effects reliably, and therefore should not be used in place of multi-voxel MRS.

Role of perfusion-weighted imaging at 3T in the histopathological differentiation between astrocytic and oligodendroglial tumors

OBJECTIVE

The differentiation of oligodendroglial tumors from astrocytic tumors is important clinically, because oligodendroglial tumors are more chemosensitive than astrocytic tumors. This study was designed to clarify the usefulness of 3T MR perfusion imaging (PWI) in the histopathological differentiation between astrocytic and oligodendroglial tumors. This is because there is a growing interest in the diagnostic performance of 3T MR imaging, which has the advantages of a higher signal-to-noise ratio (SNR) and greater spatial and temporal resolution.

MATERIALS AND METHODS

This study retrospectively included 24 consecutive patients with supratentorial, WHO grade II and III astrocytic and oligodendroglial tumors (7 astrocytic, 10 oligoastrocytic, and 7 oligodendroglial tumors) that were newly diagnosed and resected between November 2006 and December 2009 at Hiroshima University Hospital. These patients underwent dynamic susceptibility contrast-enhanced (DSC) PWI relative cerebral blood volume (rCBV) measurements before treatment. Astrocytic tumors were designated as the astrocytic group, and oligoastrocytic and oligodendroglial tumors as the oligodendroglial group. The regions of interest with the maximum rCBV values within the tumors were normalized relative to the contra-lateral white matter (rCBVmax).

RESULTS

The average rCBVmax of astrocytic tumors (2.01±0.68) was significantly lower than that of the oligoastrocytic (4.60±1.05) and oligodendroglial tumors (6.17±0.867) (P<0.0001). A cut-off value of 3.0 allowed to differentiate the oligodendroglial group from the astrocytic group at 100% sensitivity and 87.5% specificity.

CONCLUSION

The rCBVmax values obtained from 3T MR PWI may be useful as an adjunct to the postoperative histopathological diagnosis of glioma patients.

Effect of intravenous extracellular gadolinium based contrast medium on renal diffusion weighted images

RATIONALE AND OBJECTIVES

The aim of this study was to compare precontrast and postcontrast renal diffusion-weighted images for signal intensity (SI), apparent diffusion coefficient (ADC), and lesion conspicuity.

MATERIALS AND METHODS

In 62 patients (mean age, 54 ± 29; 29 men, 33 women) precontrast and postcontrast (0.1 mmol/kg of extracellular gadolinium-based contrast medium; mean, 3.3 ± 0.9 minutes], diffusion-weighted images at b values of 50 and 400 s/mm² were compared (3 T). The SI, signal-to-noise ratio, and ADC of the renal cortex, medulla, and lesions were measured. Lesion contrast-to-noise ratios (against the medulla and cortex) were calculated.

RESULTS

Postcontrast medullary SI decreased by 50% and cortical SI decreased by 33% and 39% on images at b = 50 s/mm² and b = 400 s/mm², respectively (P < .0001). The SI and signal-to-noise ratio of lesions did not change significantly after contrast, but lesion-medullary contrast-to-noise ratio was increased by 50% at both b = 50 s/mm² and b = 400 s/mm² (P < .005 and P = .0005, respectively) following contrast. Qualitative postcontrast lesion conspicuity was improved, with average scores of 2.8 ± 0.9 for all lesions (κ = 0.7 ± 0.08) and 3.2 ± 0.9 for solid lesions (κ = 0.82 ± 0.1). The ADC of renal cortex decreased (P = .03), but the ADC of renal medulla or renal lesions did not significantly change.

CONCLUSION

Postcontrast diffusion-weighted imaging causes a significant decrease in renal parenchymal signal without a significant change in lesion signal, resulting in increased lesion conspicuity.

DTI and PWI analysis of peri-enhancing tumoral brain tissue in patients treated for glioblastoma

To analyse the role of MR diffusion-tensor imaging (DTI) and perfusion-weighted imaging (PWI) in characterising tumour boundaries in patients with glioblastoma multiforme. Seventeen patients with surgically treated WHO IV grade gliomas who were candidates for adjuvant chemo-radiotherapy were enrolled. Before (T0) and after radiation treatment (T1), they underwent DTI and PWI, and the apparent diffusion coefficient (ADC), fractional anisotropy (FA) and relative cerebral blood volume (rCBV) in the enhancing tumour, the hyperintense tissue adjacent to the enhancing tumour, and the normal-appearing white matter (NAWM) adjacent to the hyperintense areas were analysed. The enhancing tissue at T1 was retrospectively divided on the basis of whether or not it was also enhancing at T0. The controls were the corresponding contralateral areas, on which we normalized the rCBV values, calculating the rCBV ratio. In NAWM, we did not find any significant differences in FA, ADC or rCBV. In the hyperintense perilesional regions, FA was significantly lower and ADC significantly higher than in the unaffected contralateral tissue; there were no significant differences in the rCBV maps. The values of FA, ADC and rCBV in enhancing neoplastic tissue were all significantly different from those observed in the contralateral tissue. There was no significant difference in rCBV values between the areas enhancing at T0 and those not enhancing at T0 but enhancing at T1, which may indicate the neoplastic transformation of apparently normal brain tissue. DTI metrics identify ultrastructural changes in hyperintense perilesional areas, but these are not specific for neoplastic tissue. rCBV seemed to reflect an ultrastructural alteration that was not visible at T0, but became visible (as neoplastic progression) on conventional MR images at T1. These findings could help identify tissue at risk of tumour infiltration.

High-relaxivity contrast-enhanced magnetic resonance neuroimaging: a review

Evaluation of brain lesions using magnetic resonance imaging (MRI) provides information that is critical for accurate diagnosis, prognosis, therapeutic intervention and monitoring response. Conventional contrast-enhanced MR neuroimaging using gadolinium (Gd) contrast agents primarily depicts disruption of the blood-brain barrier, demonstrating location and extent of disease, and also the morphological details at the lesion site. However, conventional imaging results do not always accurately predict tumour aggressiveness. Advanced functional MRI techniques such as dynamic contrast-enhanced perfusion-weighted imaging utilise contrast agents to convey physiological information regarding the haemodynamics and neoangiogenic status of the lesion that is often complementary to anatomical information obtained through conventional imaging. Most of the Gd contrast agents available have similar T1 and T2 relaxivities, and thus their contrast-enhancing capabilities are comparable. Exceptions are gadobenate-dimeglumine, Gd-EOB-DTPA, Gadobutrol and gadofosveset, which, owing to their transient-protein-binding capability, possess almost twice (and more) the T1 and T2 relaxivities as other agents at all magnetic field strengths. Numerous comparative studies have demonstrated the advantages of the increased relaxivity in terms of enhanced image contrast, image quality and diagnostic confidence. Here we summarise the benefits of higher relaxivity for the most common neuroimaging applications including MRI, perfusion-weighted imaging and MRA for evaluation of brain tumours, cerebrovascular disease and other CNS lesions.

Vessel size imaging using dual contrast agent injections

PURPOSE

To investigate the feasibility of a vessel size imaging (VSI) technique with separate contrast agent injections for evaluation of the vessel caliber in normal tissues and in brain tumors.

MATERIALS AND METHODS

Computer simulation was first performed to assess the potential errors in the estimation of vessel caliber that could result from time shifts between the dual contrast agent injections. Eight patients (four female, four male, 37-77 years old) with brain tumors (three high-grade gliomas, two low-grade gliomas, and three meningiomas) were recruited for clinical study. Dynamic susceptibility contrast magnetic resonance imaging (MRI) using gradient echo (GE) and spin echo (SE) echo-planar imaging sequences were performed separately with a 10-minute interval on a 3.0T scanner. Vessel caliber maps were calculated and analyzed in regions of interest at cortical gray matter (GM), thalamus, white matter (WM), and tumors.

RESULTS

From the computer simulation, the error of vessel caliber measurement was less than 8% when the difference between the time-to-peak of the GE and the SE studies was 1.5 seconds, and reduced to within 5% when the difference was 1 second. From the patient datasets of a 64 x 64 matrix, the estimated vessel calibers were 37.4 +/- 12.9 microm for cortical gray matter, 20.7 +/- 8.8 microm for thalamus, and 15.0 +/- 5.1 microm for white matter, comparable to results in the literature. Two patients had a VSI with 128 x 128 matrix and showed similar results in vessel calibers of normal tissues. All the tumors had larger mean vessel diameter than normal-appearing tissues. The difference in vascular size between normal tissue and tumor was demonstrated clearly in both the VSIs of regular and high spatial resolution.

CONCLUSION

This study suggests that VSI with a dual injection method is a feasible technique for estimating microvascular calibers of normal tissues and brain tumors in clinical scanners.

Optimized preload leakage-correction methods to improve the diagnostic accuracy of dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging in posttreatment gliomas

BACKGROUND AND PURPOSE

Relative cerebral blood volume (rCBV) accuracy can vary substantially depending on the dynamic susceptibility-weighted contrast-enhanced (DSC) acquisition and postprocessing methods, due to blood-brain barrier disruption and resulting T1-weighted leakage and T2- and/or T2*-weighted imaging (T2/T2*WI) residual effects. We set out to determine optimal DSC conditions that address these errors and maximize rCBV accuracy in differentiating posttreatment radiation effect (PTRE) and tumor.

MATERIALS AND METHODS

We recruited patients with previously treated high-grade gliomas undergoing image-guided re-resection of recurrent contrast-enhancing MR imaging lesions. Thirty-six surgical tissue samples were collected from 11 subjects. Preoperative 3T DSC used 6 sequential evenly timed acquisitions, each by using a 0.05-mmol/kg gadodiamide bolus. Preload dosing (PLD) and baseline subtraction (BLS) techniques corrected T1-weighted leakage and T2/T2*WI residual effects, respectively. PLD amount and incubation time increased with each sequential acquisition. Corresponding tissue specimen stereotactic locations were coregistered to DSC to measure localized rCBV under varying PLD amounts, incubation times, and the presence of BLS. rCBV thresholds were determined to maximize test accuracy (average of sensitivity and specificity) in distinguishing tumor (n = 21) and PTRE (n = 15) samples under the varying conditions. Receiver operator characteristic (ROC) areas under the curve (AUCs) were statistically compared.

RESULTS

The protocol that combined PLD (0.1-mmol/kg amount, 6-minute incubation time) and BLS correction methods maximized test AUC (0.99) and accuracy (95.2%) compared with uncorrected rCBV AUC (0.85) and accuracy (81.0%) measured without PLD and BLS (P = .01).

CONCLUSIONS

Combining PLD and BLS correction methods for T1-weighted and T2/T2*WI errors, respectively, enables highly accurate differentiation of PTRE and tumor growth.

Distinction between glioma progression and post-radiation change by combined physiologic MR imaging

INTRODUCTION

Magnetic resonance (MR) diffusion-weighted imaging (DWI), dynamic susceptibility contrast-enhanced perfusion imaging (DSC), and MR spectroscopy (MRS) techniques provide specific physiologic information that may distinguish malignant glioma progression from post-radiation change, yet no single technique is completely reliable. We propose a simple, multiparametric scoring system to improve diagnostic accuracy beyond that of each technique alone.

METHODS

Fifteen subjects with lesions suspicious for glioma progression following radiation therapy who had also undergone 3-tesla DWI, DSC, and MRS studies of the lesion were retrospectively reviewed. Minimum apparent diffusion coefficient (ADC) ratio, maximum regional cerebral blood volume (rCBV) ratio, and maximum MRS choline/creatine (Cho/Cr) and choline/N-acetyl-aspartate (Cho/NAA) metabolic peak-height ratios were quantified within each lesion. Each parameter (ADC ratio, rCBV ratio, and combined Cho/Cr and Cho/NAA ratios) was scored as either glioma progression (one point) or radiation change (zero point) based upon thresholds derived from our own data. For each lesion, the combined parameters yielded a multiparametric score (0 to 3) for prediction of tumor progression or post-radiation change.

RESULTS

Optimum thresholds for ADC ratio (1.30), rCBV ratio (2.10), and either combined Cho/Cr (1.29) and Cho/NAA (1.06) yielded diagnostic accuracies of 86.7%, 86.7%, and 84.6%, respectively (p < 0.05). A combined multiparametric score threshold of 2 improved diagnostic accuracy to 93.3% (p < 0.05).

CONCLUSION

In this small series combining 3-T DWI, DSC, and MRS diagnostic results using a simple, multiparametric scoring system has potential to improve overall diagnostic accuracy in distinguishing glioma progression from post-radiation change beyond that of each technique alone.

Construction and assessment of a 3-T MRI brain template

New MR imaging protocols enable visualization of brain structures. However, for dedicated clinical applications such as targeting deep brain stimulation (DBS), a more accurate localization requires the use of atlases. We developed a three-dimensional digitized mono-subject anatomical template of the human brain based on 3-T magnetic resonance images (MRI). By averaging 15 registered T1 image acquisitions, we have shown that the final image corresponds to an optimal image, limited by the performance of the 3-T MR machine. We compared different preprocessing workflows for template construction. With the optimal strategy, along with validated existing processing methods, one T1 template and one T1-T2 mixing template were created in order to improve visualization of spatially complex deep structures. Reduction of voxel size to 0.25 mm(3) was also advantageous to observe fine structures and white matter/gray matter intensity crossings. Results demonstrated that such a template also improved inter-patient registration for population comparison in DBS. These MR templates are made freely available to our community (http://www.vmip.org/mritemplate) to serve as a reference for neuroimage processing methods.

Relative cerebral blood volume values to differentiate high-grade glioma recurrence from posttreatment radiation effect: direct correlation between image-guided tissue histopathology and localized dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging measurements

BACKGROUND AND PURPOSE

Differentiating tumor growth from posttreatment radiation effect (PTRE) remains a common problem in neuro-oncology practice. To our knowledge, useful threshold relative cerebral blood volume (rCBV) values that accurately distinguish the 2 entities do not exist. Our prospective study uses image-guided neuronavigation during surgical resection of MR imaging lesions to correlate directly specimen histopathology with localized dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging (DSC) measurements and to establish accurate rCBV threshold values, which differentiate PTRE from tumor recurrence.

MATERIALS AND METHODS

Preoperative 3T gradient-echo DSC and contrast-enhanced stereotactic T1-weighted images were obtained in patients with high-grade glioma (HGG) previously treated with multimodality therapy. Intraoperative neuronavigation documented the stereotactic location of multiple tissue specimens taken randomly from the periphery of enhancing MR imaging lesions. Coregistration of DSC and stereotactic images enabled calculation of localized rCBV within the previously recorded specimen locations. All tissue specimens were histopathologically categorized as tumor or PTRE and were correlated with corresponding rCBV values. All rCBV values were T1-weighted leakage-corrected with preload contrast-bolus administration and T2/T2*-weighted leakage-corrected with baseline subtraction integration.

RESULTS

Forty tissue specimens were collected from 13 subjects. The PTRE group (n = 16) rCBV values ranged from 0.21 to 0.71, tumor (n = 24) values ranged from 0.55 to 4.64, and 8.3% of tumor rCBV values fell within the PTRE group range. A threshold value of 0.71 optimized differentiation of the histopathologic groups with a sensitivity of 91.7% and a specificity of 100%.

CONCLUSIONS

rCBV measurements obtained by using DSC and the protocol we have described can differentiate HGG recurrence from PTRE with a high degree of accuracy.

Contrast agent dose effects in cerebral dynamic susceptibility contrast magnetic resonance perfusion imaging

PURPOSE

To study the contrast agent dose sensitivity of hemodynamic parameters derived from brain dynamic susceptibility contrast MRI (DSC-MRI).

MATERIALS AND METHODS

Sequential DSC-MRI (1.5T gradient-echo echo-planar imaging using an echo time of 61-64 msec) was performed using contrast agent doses of 0.1 and 0.2 mmol/kg delivered at a fixed rate of 5.0 mL/second in 12 normal subjects and 12 stroke patients.

RESULTS

1) Arterial signal showed the expected doubling in relaxation response (DeltaR2*) to dose doubling. 2) The brain signal showed a less than doubled DeltaR2* response to dose doubling. 3) The 0.2 mmol/kg dose studies subtly underestimated cerebral blood volume (CBV) and cerebral blood flow (CBF) relative to the 0.1 mmol/kg studies. 4) In the range of low CBV and CBF, the 0.2 mmol/kg studies overestimated the CBV and CBF compared with the 0.1 mmol/kg studies. 5) The 0.1 mmol/kg studies reported larger ischemic volumes in stroke.

CONCLUSION

Subtle but statistically significant dose sensitivities were found. Therefore, it is advisable to carefully control the contrast agent dose when DSC-MRI is used in clinical trials. The study also suggests that a 0.1 mmol/kg dose is adequate for hemodynamic measurements.

Pittfalls of MRI measurement of white matter perfusion based on arterial spin labeling

Although arterial spin labeling (ASL) MRI has been successfully applied to measure gray matter (GM) perfusion in vivo, accurate detection of white matter (WM) perfusion has proven difficult. Reported literature values are not consistent with each other or with perfusion measured with other modalities. In this work, the cause of these inconsistencies is investigated. The results suggest that WM perfusion values are substantially affected by the limited image resolution and by signal losses caused by the long transit times in WM, which significantly affect the label. From gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) bolus-tracking experiments (N=6), it is estimated that the transit time can be several seconds long in deep WM. Furthermore, simulations show that even at a spatial resolution of 7 microl voxel size, contamination by the GM signals can exceed 40% of the actual WM signal. From 10-min long flow-sensitive alternating inversion recovery ASL (FAIR-ASL) measurements at 3T in normal subjects (N=7), using highly sensitive detectors, it is shown that single-voxel (7 mul) deep WM perfusion values have an signal-to-noise ratio (SNR) less than 1. The poor sensitivity and heterogeneous transit time limit the applicability of ASL for measurement of perfusion in WM.

Perfusion magnetic resonance imaging correlates of neuropsychological impairment in multiple sclerosis

Although cognitive impairment is common in multiple sclerosis (MS), its pathophysiology is still poorly understood. Abnormalities of cerebral blood flow (CBF) have long been acknowledged in MS and advances in perfusion magnetic resonance imaging (MRI) allow for their assessment in vivo. We investigated the relationship between regional perfusion changes and neuropsychological (NP) dysfunctions in patients with relapsing-remitting and primary-progressive MS. Absolute CBF, cerebral blood volume (CBV) and mean transit time were measured in 32 MS patients and 11 healthy controls using dynamic susceptibility contrast-enhanced T2(*)-weighted MRI. A comprehensive NP test battery was administered to all patients. A mixed model analysis of covariance was performed for group comparisons in terms of perfusion measures in normal-appearing white matter (NAWM) and deep gray matter (GM). Pearson's correlations were used to describe the association of perfusion metrics with NP Z-scores. CBF and CBV values were significantly decreased in both NAWM and deep GM in MS patients compared with controls (P=0.01). In all patients, deep GM CBF was significantly associated with Rey Complex Figure Test (RCFT)-Copy (r=0.5; P=0.001) and deep GM CBV and NAWM CBV were significantly associated with Color-Word Interference Inhibition Switching test (D-KEFSIS) (r=0.4; P=0.008 and r=0.4; P=0.02). However, the only associations that remained significant after Bonferroni correction were between deep GM CBF and RCFT-Copy (P=0.006), and deep GM CBV and D-KEFSIS (P=0.04). Our results suggest a role for tissue perfusion impairment in NP dysfunction in MS. Large-scale studies are needed to characterize better this association.

Clinical advantages of 3.0 T MRI over 1.5 T

Since approval by the FDA in 2000, human MR imaging (MRI) at 3.0 T has been increasingly used in clinical practice. In spite of the potential technical challenges, a number of clinical advantages of 3.0 T MRI over 1.5 T have been identified in the recent years. This article reviews the benefits and the current knowledge of 3.0 T whole-body MRI from an evidence-based perspective and summarizes its clinical applications.

Gray matter-white matter contrast on spin-echo T1-weighted images at 3 T and 1.5 T: a quantitative comparison study

Discrepancies exist in the literature regarding contrast between gray and white matter on spin-echo (SE) T1-weighted MR imaging at 3 T. The present study quantitatively assessed differences in gray matter-white matter contrast on both single- and multi-slice SE T1-weighted imaging between 3 and 1.5 T. SE T1-weighted sequences with the same parameters at both 3 and 1.5 T were used. Contrast-to-noise ratio (CNR) between gray and white matter (CNR(GM-WM)) was evaluated for both frontal lobes. To assess the effects of interslice gap, multi-slice images were obtained with both 0 and 25% interslice gap. Single-slice CNR(GM-WM) was higher at 3 T (17.66 +/- 2.68) than at 1.5 T (13.09 +/- 2.35; P < 0.001). No significant difference in CNR(GM-WM) of multi-slice images with 0% gap was noted between 3 and 1.5 T (3T, 8.61 +/- 2.55; 1.5T, 7.43 +/- 1.20; P > 0.05). Multi-slice CNR(GM-WM) with 25% gap was higher at 3T (12.47 +/- 3.31) than at 1.5 T (9.73 +/- 1.37; P < 0.001). CNR(GM-WM) reduction rate of multi-slice images with 0% gap compared with single-slice images was higher at 3T (0.47 +/- 0.13) than at 1.5 T (0.38 +/- 0.09; P = 0.02). CNR(GM-WM) on single-slice SE T1-weighted imaging and CNR(GM-WM) on multi-slice images with 25% interslice gap were better at 3 T than at 1.5 T. The influence of multi-slice imaging on CNR(GM-WM) was significantly larger at 3T than at 1.5 T.

High-field-strength magnetic resonance: potential and limits

OBJECTIVE

To expatiate on the possible advantages and disadvantages of high magnetic field strengths for magnetic resonance imaging and, in particular, for magnetic resonance angiography.

METHODS AND RESULTS

A review of the available literature is given, presenting many of the advantages and disadvantages of imaging at higher field strengths. Focus is put on imaging at 3 to 7 T. Early results at 7 T are presented; these results indicate that several of the angiographic techniques commonly used at lower field strengths show promise for improvement by taking advantage of the higher signal and susceptibility sensitivity at 7 T.

CONCLUSIONS

The drive toward higher field strengths, both for the purpose of fundamental research and for clinical diagnostic imaging, is likely to continue. New applications using the unique properties of high field strength will almost certainly emerge as researchers gain more experience. The ultimate limiting factor is likely to be the physiological effects at high field strengths. However, this limit seems to lie at field strengths higher than 7 T because early experience shows good tolerance of 7 T examinations.

3.0 Tesla imaging of the musculoskeletal system

High-field MRI at 3.0T is rapidly gaining clinical acceptance and experiencing more widespread use. The superiority of high-field imaging has clearly been demonstrated for neurological imaging. The impact of 3.0T imaging of the musculoskeletal system has been less dramatic due to complex optimization issues. Areas under consideration include coil technology, protocol modification, artifact reduction, and patient safety. In this article we review these issues and describe our experience with 3.0T musculoskeletal MRI. Fundamentally, an increased signal-to-noise ratio (SNR) is responsible for improved imaging at higher field strength. Increased SNR allows more headroom to adjust parameters that affect image resolution and examination time. It has been established that T1 relaxation time increases at 3.0T, while T2 time decreases. Consequently, scanner parameters require adjustment for optimization of images. Chemical shift and magnetic susceptibility artifacts are more pronounced and require special techniques to minimize the effect on image quality. Spectral fat saturation techniques can take advantage of the increased chemical shift. The specific absorption rate (SAR) and acoustic noise thresholds must be kept in mind at these higher fields. We additionally present some of the clinical issues we have experienced at 3.0T. A decision must be made as to whether to trade higher resolution for reduced scanning time. In general, we believe that routine imaging at 3.0T increases diagnostic confidence, especially for evaluations of cartilaginous and ligamentous structures.

Feasibility of dynamic susceptibility contrast perfusion MR imaging at 3T using a standard quadrature head coil and eight-channel phased-array coil with and without SENSE reconstruction

PURPOSE

To investigate changes in image and dynamic signal-to-noise ratios (SNRs) of the DeltaR2* curve, as well as magnetic susceptibility-induced artifacts between a standard quadrature head coil and an eight-channel phased-array coil with and without sensitivity-encoding (SENSE) at 3T, compared to the current clinical standard head coil acquisition at 1.5T.

MATERIALS AND METHODS

Dynamic susceptibility contrast (DSC) perfusion MRI was performed on 80 brain tumor patients using a gradient-echo, echo-planar imaging (EPI) sequence. Image and dynamic SNR were compared between 1.5T and 3T field strengths, a quadrature and eight-channel phased-array coil, and a conventional vs. partially parallel EPI acquisition with SENSE reconstruction. The amount of geometric distortion and signal dropout was quantified and compared between conventional and SENSE EPI acquisitions within the same exam at 3T.

RESULTS

An initial 2.6-fold elevation in dynamic SNR was observed in normal-appearing white matter when doubling the field strength (P < 0.001), with an additional 1.7-fold increase found when employing an eight-channel phased-array coil (P < 0.002). Compared to the standard 3T eight-channel coil acquisition, the implementation of SENSE reduced the number of voxels experiencing large anterior shifts in the phase-encode direction, lowered the volume of signal dropout by 2.0-11.5%, and allowed a 1.4-fold increase in slice coverage, while only decreasing the dynamic SNR by 22%.

CONCLUSION

SENSE EPI at 3T yielded a significant improvement in dynamic SNR over the 1.5T acquisitions. A significant reduction in magnetic susceptibility-induced artifacts was achieved with SENSE EPI compared to the standard EPI eight-channel coil acquisition at 3T.

Pattern of hemodynamic impairment in multiple sclerosis: dynamic susceptibility contrast perfusion MR imaging at 3.0 T

This study aimed to determine regional pattern of tissue perfusion in the normal-appearing white matter (NAWM) of patients with primary-progressive (PP), relapsing-remitting (RR) multiple sclerosis (MS) and healthy controls, and to investigate the association between perfusion abnormalities and clinical disability. Using dynamic susceptibility contrast (DSC) perfusion MRI at 3 T, we studied 22 patients with clinically definite MS, 11 with PP-MS and 11 with RR-MS and 11 age- and gender-matched healthy volunteers. The MRI protocol included axial dual-echo, dynamic susceptibility contrast enhanced (DSC) T2*-weighted and post-contrast T1-weighted images. Absolute cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in the periventricular, frontal, occipital NAWM and in the splenium of the corpus callosum. Compared to controls, CBF and CBV were significantly lower in all NAWM regions in both PP-MS patients (p values from <0.0001 to 0.001) and RR-MS (p values from <0.0001 to 0.020). Compared to RR-MS, PP-MS patients showed significantly lower CBF in the periventricular NAWM (p=0.002) and lower CBV in the periventricular and frontal NAWM (p values: 0.0029 and 0.022). EDSS was significantly correlated with the periventricular CBF (r=-0.48, p=0.0016) and with the periventricular and frontal CBV (r=-0.42, p=0.015; r=-0.35, p=0.038, respectively). This study suggests that the hemodynamic abnormalities of NAWM have clinical relevance in patients with MS. DSC perfusion MRI might provide a relevant objective measure of disease activity and treatment efficacy.

High spatial resolution contrast-enhanced MR angiography of the supraaortic arteries using the quadrature body coil at 3.0T: A feasibility study

To examine whether the the increased signal-to-noise (S/N) available at 3.0T would permit the use of the quadrature body coil for high spatial resolution contrast-enhanced (CE) MR angiography (MRA), and whether the large FOV that was used in our routine 1.5T protocol would also be feasible at 3.0T. In a prospective study, 43 patients and five volunteers were examined on a clinical whole-body 3.0T MR unit (Intera, Philips Medical Systems, Best, The Netherlands) after institutional review board approval and informed consent. Three-dimensional CE MRA (T1 gradient echo-sequence with TR/TE = 5.7/1.93 msec.; acquisition time, 1:54 min.) using randomly segmented central k-space ordering (CENTRA) was acquired with the quadrature body coil, using over a FOV of 350 mm. A high-image matrix of 432x432 yielded a non-zero filled voxel size of 0.81 mm x 0.81 mm x 1.0 mm (0.66 mm(3)). For quantitative analysis, contrast ratios (CR) between vessels (S) and signal in surrounding tissue (ST) were calculated [(S-ST)/(S+ST)]. For qualitative analysis, image quality and presence of artifacts were rated by two radiologists in consensus on a five-point scale (1=excellent to 5=nondiagnostic). Digital subtraction angiography (DSA) served as the standard of reference in patients with vascular disease. In the five volunteers, 1.5T CE MRA using a phased array neurovascular coil was available for intraindividual comparison. 3.0T CE MRA was successfully performed in 48/48 subjects (100%). Mean CR+/- SD were 0.76 (139.30/182.42) and 0.87 (235.18/270.14) at 3.0T and 1.5T respectively . Mean image quality was 3.82+/-0.86. Intraindividual comparison between 1.5T and 3.0T CE MRA in the volunteers revealed no significant difference in image quality (4.2+/-0.74 vs 4.6+/-0.80; p>0.05). Vascular disease was correctly identified in 13/13 patients with DSA correlation. CE MRA of the supraaortic arteries is feasible at 3.0T using a large FOV of 350 mm. The signal gain at 3.0T enables high spatial resolution contrast-enhanced MR angiography by using the built-in quadrature body coil only.

Multiparametric 3T MR approach to the assessment of cerebral gliomas: tumor extent and malignancy

INTRODUCTION

Contrast-enhanced MR imaging is the method of choice for routine assessment of brain tumors, but it has limited sensitivity and specificity. We verified if the addition of metabolic, diffusion and hemodynamic information improved the definition of glioma extent and grade.

METHODS

Thirty-one patients with cerebral gliomas (21 high- and 10 low-grade) underwent conventional MR imaging, proton MR spectroscopic imaging ((1)H-MRSI), diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) at 3 Tesla, before undergoing surgery and histological confirmation. Normalized metabolite signals, including choline (Cho), N-acetylaspartate (NAA), creatine and lactate/lipids, were obtained by (1)H-MRSI; apparent diffusion coefficient (ADC) by DWI; and relative cerebral blood volume (rCBV) by PWI.

RESULTS

Perienhancing areas with abnormal MR signal showed 3 multiparametric patterns: "tumor", with abnormal Cho/NAA ratio, lower ADC and higher rCBV; "edema", with normal Cho/NAA ratio, higher ADC and lower rCBV; and "tumor/edema", with abnormal Cho/NAA ratio and intermediate ADC and rCBV. Perienhancing areas with normal MR signal showed 2 multiparametric patterns: "infiltrated", with high Cho and/or abnormal Cho/NAA ratio; and "normal", with normal spectra. Stepwise discriminant analysis showed that the better classification accuracy of perienhancing areas was achieved when regarding all MR variables, while (1)H-MRSI variables and rCBV better differentiated high- from low-grade gliomas.

CONCLUSION

Multiparametric MR assessment of gliomas, based on (1)H-MRSI, PWI and DWI, discriminates infiltrating tumor from surrounding vasogenic edema or normal tissues, and high- from low-grade gliomas. This approach may provide useful information for guiding stereotactic biopsies, surgical resection and radiation treatment.

3.0 T Neuroimaging: Technical Considerations and Clinical Applications

Since approval by the US Food and Drug Administration (FDA) in 2000, human MR imaging at field strength up to 4.0 T in clinical practice and up to 8.0 T on research systems has become available. Although human MR imaging at field strengths greater than 1.5 T was performed even before 1999 on research systems, the FDA approval for clinical use and the advent of actively shielded magnets marked a new trend for MR vendors and users. Because of the potential technical benefits when moving from 1.5 T to 3.0 T, the number of 3.0 T installations is increasing continuously worldwide. This article reviews the benefits, challenges, and the current knowledge of 3.0 T whole body MR imaging and summarizes its clinical applications.

Contrast-enhanced MR imaging of the breast at 3.0 and 1.5 T in the same patients: initial experience

PURPOSE

To establish a pulse sequence for dynamic contrast material-enhanced magnetic resonance (MR) imaging of the breast at 3.0 T and to prospectively compare MR imaging at 3.0 T with MR imaging at 1.5 T in the same patients.

MATERIALS AND METHODS

A prospective intraindividual internal review board-approved study was performed in 37 women with 53 lesions (25 breast cancers, 28 benign focal lesions) who underwent contrast-enhanced dynamic bilateral subtraction MR imaging twice, once at 1.5 T with a standard technique (voxel size, 1.44 mm3) and once at 3.0 T (voxel size, 0.45-0.72 mm3) with variable repetition time and flip angle settings. Written informed consent was obtained. Sagittal single breast high-spatial-resolution MR imaging was performed with active fat suppression. Image quality, number and features of enhancing lesions, and Breast Imaging Reporting and Data System categories were compared by using the Wilcoxon matched-pairs signed rank test and Student t test for matched pairs. Diagnostic confidence was compared by using a receiver operating characteristic (ROC) analysis.

RESULTS

With repetition time prolonged to account for longer T1 relaxation times at 3.0 T and a flip angle of 60 degrees, enhancement rates at 3.0 T were substantially below those at 1.5 T. In two patients with benign lesions, enhancement was rated as insufficient to establish diagnosis. When parameter settings were kept equivalent, equivalent enhancement rates were observed with both systems. With these settings, 3.0-T MR imaging yielded homogeneous signal intensity over the entire field of view. No dielectric resonance effects were observed. Overall image quality scores for the dynamic series were slightly higher at 3.0 T (P<.01). A total of 49 lesions were prospectively identified with both systems. Owing to substantial patient motion at 1.5 T, two malignant lesions in one patient were visualized at 3.0 T only. At 3.0 T, differential diagnosis of enhancing lesions was possible with higher diagnostic confidence, as reflected by a larger area under the ROC curve (P<.05).

CONCLUSION

Initial experiences indicate that contrast-enhanced MR imaging at 3.0 T is nearing readiness for clinical use.

Intraindividual Comparison of Gadobenate Dimeglumine and Gadobutrol for Cerebral Magnetic Resonance Perfusion Imaging at 1.5 T

RATIONALE AND OBJECTIVE

The objective of this study was to compare 0.1 and 0.2 mmol/kg body weight (bw) doses gadobenate dimeglumine (Gd-BOPTA; MultiHance) and gadobutrol (Gd-BT-DO3A; Gadovist) for cerebral perfusion magnetic resonance (MR) imaging at 1.5 T.

METHODS

Twelve healthy male volunteers enrolled into a randomized intraindividual comparative study underwent 4 perfusion MR imaging examinations with 0.1 and 0.2 mmol/kg bw doses of each contrast agent. The imaging parameters, slice positioning, and contrast agent application were highly standardized. Quantitative determinations based on signal intensity/time (SI/T) curves at regions of interest (ROI) on the gray and white matter were made of the regional cerebral blood volume and flow (rCBV and rCBF, respectively), the percentage signal drop, and the full width half maximum (FWHM) of the SI/T curve. Qualitative evaluation of the quality of the rCBV and rCBF maps was assessed by an independent offsite blinded reader.

RESULTS

A single dose of both agents was sufficient to achieve high-quality, diagnostically valid perfusion maps at 1.5 T, and no significant benefit for one agent over the other was noted for quantitative or qualitative determinations. The susceptibility effect, described by percentage of signal loss (gadobutrol: 29.4% vs gadobenate dimeglumine: 28.3%) and the FWHM (gadobutrol: 6.4 seconds vs gadobenate dimeglumine: 7.0 seconds) were similar for 0.1 mmol/kg bw doses of the 2 agents. Double doses of the 2 agents produced better overall image quality but no clinical benefit over the single-dose examinations.

CONCLUSION

Both the 1 molar MR contrast agent gadobutrol and the weak protein-interacting agent gadobenate dimeglumine permit the acquisition of high-quality perfusion maps at doses of 0.1 mmol/kg bw. The susceptibility effect is comparable for both agents and stronger than for conventional MR contrast agents.