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Fortier V, Mohamed A, McNabb E, Dana J, Zakarian R, Levesque IR, Reinhold C. R 2* Impact on Hepatic Fat Quantification With a Commercial Single Voxel Technique at 1.5 and 3.0 T. Can Assoc Radiol J 2024:8465371241255896. [PMID: 38832642 DOI: 10.1177/08465371241255896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
Rationale and Objectives: Fat quantification accuracy using a commercial single-voxel high speed T2-corrected multi-echo (HISTO) technique and its robustness to R2* variations at 3.0 T, such as those introduced by iron in liver, has not been fully established. This study evaluated HISTO at 3.0 T and sought to reproduce results at 1.5 T. Methods: Phantoms were prepared with a range of fat content and R2*. Data were acquired at 1.5 T and 3.0 T, using HISTO and a Dixon technique. Fat quantification accuracy was evaluated as a function of R2*. The patient study included 239 consecutive patients. Data were acquired at 1.5 T or 3.0 T, using HISTO and Dixon techniques. The techniques were compared using Bland-Altman plots. Bias significance was evaluated using a one-sample t-test. Results: In phantoms, HISTO was accurate within 10% up to a R2* of 100 s-1 at both field strengths, while Dixon was accurate within 10% where R2* was accurately quantified (up to 350 s-1 at 1.5 T, and 550 s-1 at 3.0 T). In patients, where R2* was <100 s-1, fat quantification from both techniques agreed at 1.5 T (P = .71), but not at 3.0 T (P = .007), with a bias <1%. Conclusion: Results suggest that HISTO is reliable when R2* is <100 s-1, corresponding to patients with at most mild liver iron overload, and that it should be used with caution when R2* is >100 s-1. Dixon should be preferred for hepatic fat quantification due to its robustness to R2* variations.
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Affiliation(s)
- Véronique Fortier
- Department of Medical Imaging, McGill University Health Centre, Montreal, QC, Canada
- Diagnostic Radiology, McGill University, Montreal, QC, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada
- Medical Physics Unit, McGill University, Montreal, QC, Canada
| | - Ahmed Mohamed
- Radiology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Evan McNabb
- Department of Medical Imaging, McGill University Health Centre, Montreal, QC, Canada
| | - Jérémy Dana
- Department of Medical Imaging, McGill University Health Centre, Montreal, QC, Canada
| | - Rita Zakarian
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Ives R Levesque
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada
- Medical Physics Unit, McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Caroline Reinhold
- Department of Medical Imaging, McGill University Health Centre, Montreal, QC, Canada
- Diagnostic Radiology, McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Montreal Imaging Experts Inc., Montreal, QC, Canada
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Jiang Z, Wang Y, Ding J, Yu S, Zhang J, Zhou H, Di J, Xing W. Susceptibility weighted imaging (SWI) for evaluating renal dysfunction in type 2 diabetes mellitus: a preliminary study using SWI parameters and SWI-based texture features. ANNALS OF TRANSLATIONAL MEDICINE 2021; 8:1673. [PMID: 33490185 PMCID: PMC7812222 DOI: 10.21037/atm-20-7121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Susceptibility weighted imaging (SWI) could reflect tissue blood oxygen levels, and then whether it could be used to evaluate renal injury remains to be further studied. This study aimed to examine the performance of SWI parameters and SWI-based texture features in evaluating renal dysfunction of type 2 diabetes mellitus (T2DM). Methods Forty-five patients with T2DM were included. With the estimated glomerular filtration rate (eGFR), the patients were divided into non-moderate-severe renal injured group (non-msRI, eGFR >60 mL/min/1.73 m2) and moderate-severe renal injured group (msRI, eGFR ≤60 mL/min/1.73 m2). The 3 SWI parameters and 16 SWI-based texture features between non-msRI and msRI were compared. The correlation between the parameters and BUN, Scr was analyzed. Results The signal intensity ratio of the medulla to psoas muscle (MPswi) was significantly lower than the signal intensity ratio of the cortex to psoas muscle (CPswi) in non-msRI and msRI group (t=8.619, 3.483, respectively, P<0.05). MPswi was higher, and the signal intensity ratio of the cortex to the medulla (CMswi), Skewness, Correlation were lower in msRI than in non-msRI (P<0.05). These parameters showed similar diagnostic efficacies for msRI (P>0.05), and AUCs were 0.703–0.854. CMswi was an independent protective factor for msRI (OR =0.026, P=0.003). MPswi and CMswi were correlated with BUN (r=0.416, −0.545, P<0.05). CMswi and Correlation were correlated with Scr (r=−0.645, −0.411, P<0.05). Conclusions SWI was valuable for assessing renal dysfunction, which may be helpful for the evaluation of moderate-severe renal injured patients with T2DM.
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Affiliation(s)
- Zhenxing Jiang
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yu Wang
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jiule Ding
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Shengnan Yu
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jinggang Zhang
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Hua Zhou
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jia Di
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Wei Xing
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Using IVIM-MRI and R2⁎ Mapping to Differentiate Early Stage Liver Fibrosis in a Rat Model of Radiation-Induced Liver Fibrosis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4673814. [PMID: 30627558 PMCID: PMC6304485 DOI: 10.1155/2018/4673814] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/09/2018] [Accepted: 11/21/2018] [Indexed: 12/17/2022]
Abstract
Rationale and Objectives To investigate the utility of intravoxel incoherent motion MRI (IVIM-MRI) and R2⁎ mapping in diagnosing early stage liver fibrosis in a radiation-induced rat model. Materials and Methods Thirty rats were randomly divided into three groups with 10 rats in each group. Liver fibrosis was induced by exposure of right lobe of liver in each animal to 20 Gy of radiation. MRI examination was conducted at baseline, one month, two months, and three months after radiation using T1WI, T2WI, IVIM-DWI, and R2⁎ sequences. The pathological examination included hematoxylin eosin, masson trichrome, and prussian blue staining. D, D⁎, f, and R2⁎ values were measured in both left and right lobes for quantitative analysis. Results Regarding the surviving 23 rats, eight rats were diagnosed with stage F0, ten with stage F1, and five with stage F2 liver fibrosis using METAVIR Scores. The D values of right lobes decreased (P<0.05), and R2⁎ values increased (P<0.01) significantly as fibrosis levels increased. But there was no statistical difference in D⁎ (P=0.970) and f values (P=0.079). R2⁎ value showed a strong positive correlation (r=0.819, P<0.001), while D value showed a negative correlation with fibrosis stages (r=-0.424, P<0.001). D⁎ (r=0.029, P=0.744) and f values (r=-0.055, P=0.536) were poorly correlated with fibrosis levels. Conclusion IVIM-MRI and R2⁎ mapping are useful techniques for evaluating the severity of liver fibrosis in a radiation-induced rat model, and R2⁎ value is the most sensitive parameter in detecting early stage fibrosis.
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Performance of Magnetic Resonance Susceptibility-Weighted Imaging for Detection of Calcifications in Patients With Hepatic Echinococcosis. J Comput Assist Tomogr 2018; 42:211-215. [PMID: 29189399 DOI: 10.1097/rct.0000000000000687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We evaluated the performance of susceptibility-weighted imaging (SWI) for identification of hepatic calcifications in alveolar echinococcosis and cystic echinococcosis. METHODS The SWI images of 58 lesions in 40 patients (age, 49 ± 14 y) with alveolar echinococcosis (n = 22) or cystic echinococcosis (n = 18) were reviewed for calcifications. First, calcifications were suggested by visual assessment. Second, ratios of minimum intralesional intensity and mean lumbar muscle intensity were recorded. Computed tomography (CT) served as the criterion standard. RESULTS Thirty-seven lesions showed calcifications on CT. Susceptibility-weighted imaging provided a sensitivity of 89.2% (95% confidence interval [CI], 50.1-75.7) and a specificity of 57.1% (95% CI, 34.4-77.4) for calcifications detected by visual assessment. Receiver operating characteristic curves demonstrated a sensitivity of 67.6% and a specificity of 85.0% for an intensity ratio of 0.61. A specificity of 100% (95% CI, 80.8-100) and a sensitivity of 84.5% (95% CI, 67.3-93.2) were achieved by SWI for calcifications with a density greater than 184 HU in CT. CONCLUSIONS Identification of hepatic calcifications is possible with SWI. Susceptibility-weighted imaging offers the potential to reduce the need for of CT imaging for evaluation of echinococcosis.
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Hasiloglu ZI, Asik M, Ure E, Ertem F, Apak H, Albayram S. The utility of susceptibility-weighted imaging to evaluate the extent of iron accumulation in the choroid plexus of patients with β-thalassaemia major. Clin Radiol 2017; 72:903.e1-903.e7. [PMID: 28502664 DOI: 10.1016/j.crad.2017.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 12/20/2016] [Accepted: 04/11/2017] [Indexed: 01/09/2023]
Abstract
AIM To assess iron accumulation in the choroid plexus of β-thalassaemia patients using fast spin echo (FSE) T2-weighted, gradient echo (GRE) T2*-weighted, susceptibility-weighted imaging (SWI) and compare the results. MATERIALS AND METHODS Eighteen patients with transfusion-dependent β-thalassaemia and the control group underwent magnetic resonance imaging (MRI) examinations. Signal intensities were separately evaluated using a "number of hypointensity in the choroid plexus" (NHICP) grading system on axial FSE T2-weighted, GRE T2*-weighted, and SWI images. The NHICP grading system scores were compared using the chi-squared test. Spearman's correlation analysis was used to explore relationships between the variables and NHICP grading system scores. RESULTS The sensitivity of each technique was calculated: FSE T2-weighted imaging=0.17, GRE T2*-weighted imaging=0.48, and SWI=0.81. Three-sample test for equality of proportions showed that chi-squared=74.85, df=2, p<0.0001. All of the FSE T2-weighted, GRE T2*-weighted, and SWI images differed significantly in terms of their capacity to reveal iron accumulation in the choroid plexus. Of the three methods, SWI was the most sensitive. CONCLUSIONS SWI is useful for revealing iron deposition in the brains of β-thalassaemia patients, especially those in the early stages of disease, and it can be used to predict disease prognosis. The present study contributes to an understanding of the important role played by the choroid plexus in brain iron metabolism.
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Affiliation(s)
- Z I Hasiloglu
- Department of Radiology, Istanbul University, Cerrahpasa Medical School, Kocamustafapasa, Fatih, Istanbul, Turkey.
| | - M Asik
- Department of Radiology, Istanbul University, Cerrahpasa Medical School, Kocamustafapasa, Fatih, Istanbul, Turkey
| | - E Ure
- Department of Radiology, Istanbul University, Cerrahpasa Medical School, Kocamustafapasa, Fatih, Istanbul, Turkey
| | - F Ertem
- Istanbul University, Istanbul Medical School, Fatih, Istanbul, Turkey
| | - H Apak
- Department of Pediatrics, Division of Haematology, Istanbul University, Cerrahpasa Medical School, Kocamustafapasa, Fatih, Istanbul, Turkey
| | - S Albayram
- Department of Radiology, Istanbul University, Cerrahpasa Medical School, Kocamustafapasa, Fatih, Istanbul, Turkey
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Improving Detection of Iron Deposition in Cirrhotic Liver Using Susceptibility-Weighted Imaging With Emphasis on Histopathological Correlation. J Comput Assist Tomogr 2017; 41:18-24. [PMID: 27893493 DOI: 10.1097/rct.0000000000000484] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the value of susceptibility-weighted imaging (SWI) for detection and quantification of iron deposition in cirrhotic liver. METHODS Fifty-five cirrhotic patients underwent hepatic magnetic resonance imaging examination including SWI and multiecho T2*-weighted imaging (T2*WI). Detection of iron deposition and number of siderotic nodules were compared between SWI and T2*WI. Correlation among SWI phase value, T2* value, and hepatic iron concentration were determined. RESULTS Susceptibility-weighted imaging significantly improved detection of iron deposition compared with T2*WI (90.7% vs 66.7%, P = 0.002), attributing to grade 1 (73.3% vs 26.7%, P = 0.027) and grade 2 (93.8% vs 56.3%, P = 0.037). Iron deposition of grade 3 and 4 could be detected by both SWI and T2*WI. The number of siderotic nodules visualized on SWI was significantly larger than that on T2*WI (107.5 ± 7.4 vs 62.7 ± 4.6, P = 0.002). There were significantly negative correlation between phase value and iron score (r = -0.803), and positive correlation between phase value and T2* value (r = 0.771). CONCLUSIONS Susceptibility-weighted imaging can improve detection of minimal and mild iron deposition in cirrhotic liver.
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Yang SH, Lin J, Lu F, Dai YY, Han ZH, Fu CX, Hu FL, Gu HC. Contrast-enhanced susceptibility weighted imaging with ultrasmall superparamagnetic iron oxide improves the detection of tumor vascularity in a hepatocellular carcinoma nude mouse model. J Magn Reson Imaging 2016; 44:288-95. [PMID: 26808392 DOI: 10.1002/jmri.25167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/11/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of contrast-enhanced susceptibility-weighted imaging with ultrasmall superparamagnetic iron oxide (USPIO-enhanced SWI) in the assessment of intratumoral vascularity in hepatocellular carcinoma (HCC). MATERIALS AND METHODS Orthotopic xenograft HCC nude mouse models were established first and magnetic resonance imaging (MRI) examinations were performed on a 1.5T MR scanner 28 days later. Three groups of mice, 10 in each, were imaged using unenhanced and USPIO-enhanced SWI at doses of 4, 8, and 12 mg Fe/kg. Intratumoral susceptibility signal intensity (ITSS) was scored. ITSS-to-tumor contrast-to-noise ratio (ITSST-CNR) was measured. These measurements were compared between unenhanced and USPIO-enhanced SWI at each dose and differences in the measurements between different dose groups were estimated. Correlation between ITSS and tumor microvessel density (MVD) was analyzed. RESULTS Compared with unenhanced SWI, significantly higher ITSS was identified on USPIO-enhanced SWI at doses of 8 mg Fe/kg (Z = -2.000, P = 0.046) and 12 mg Fe/kg (Z = -2.333, P = 0.020). Significantly higher ITSST-CNR was found on USPIO-enhanced SWI than that on unenhanced SWI (P < 0.05). Significantly higher ITSST-CNR at a dose of 8 mg Fe/kg was observed than that at 4 mg Fe/kg (Z = -3.326, P = 0.001). Positive correlation between ITSS on USPIO-enhanced SWI at a dose of 8 mg Fe/kg and tumor MVD was demonstrated (r = 0.817, P = 0.004). CONCLUSION USPIO-enhanced SWI at a dose of 8 mg Fe/kg greatly improves the detection of intratumoral vascularity in a xenograft HCC model. J. Magn. Reson. Imaging 2016;44:288-295.
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Affiliation(s)
- Shuo-Hui Yang
- Department of Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, P.R. China.,Department of Radiology, Shuguang Hosipital, Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, P.R. China
| | - Fang Lu
- Department of Radiology, Shuguang Hosipital, Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Yuan-Yuan Dai
- Department of Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, P.R. China
| | - Zhi-Hong Han
- Department of Pathology, Shuguang Hosipital, Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Cai-Xia Fu
- Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, P.R. China
| | - Feng-Lin Hu
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Hong-Chen Gu
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, P.R. China
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Ding J, Xing W, Wu D, Chen J, Pan L, Sun J, Xing S, Dai Y. Evaluation of Renal Oxygenation Level Changes after Water Loading Using Susceptibility-Weighted Imaging and T2* Mapping. Korean J Radiol 2015; 16:827-34. [PMID: 26175582 PMCID: PMC4499547 DOI: 10.3348/kjr.2015.16.4.827] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 04/08/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess the feasibility of susceptibility-weighted imaging (SWI) while monitoring changes in renal oxygenation level after water loading. MATERIALS AND METHODS Thirty-two volunteers (age, 28.0 ± 2.2 years) were enrolled in this study. SWI and multi-echo gradient echo sequence-based T2(*) mapping were used to cover the kidney before and after water loading. Cortical and medullary parameters were measured using small regions of interest, and their relative changes due to water loading were calculated based on baseline and post-water loading data. An intraclass correlation coefficient analysis was used to assess inter-observer reliability of each parameter. A receiver operating characteristic curve analysis was conducted to compare the performance of the two methods for detecting renal oxygenation changes due to water loading. RESULTS Both medullary phase and medullary T2(*) values increased after water loading (p < 0.001), although poor correlations were found between the phase changes and the T2(*) changes (p > 0.05). Interobserver reliability was excellent for the T2(*) values, good for SWI cortical phase values, and moderate for the SWI medullary phase values. The area under receiver operating characteristic curve of the SWI medullary phase values was 0.85 and was not different from the medullary T2(*) value (0.84). CONCLUSION Susceptibility-weighted imaging enabled monitoring changes in the oxygenation level in the medulla after water loading, and may allow comparable feasibility to detect renal oxygenation level changes due to water loading compared with that of T2(*) mapping.
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Affiliation(s)
- Jiule Ding
- Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, Jiangsu 213003, China
| | - Wei Xing
- Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, Jiangsu 213003, China
| | - Dongmei Wu
- Shanghai Key Laboratory of Magnetic Resonance Imaging, East China Normal University, Shanghai 200241, China
| | - Jie Chen
- Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, Jiangsu 213003, China
| | - Liang Pan
- Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, Jiangsu 213003, China
| | - Jun Sun
- Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, Jiangsu 213003, China
| | - Shijun Xing
- Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, Jiangsu 213003, China
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Adachi Y, Sato N, Saito Y, Kimura Y, Nakata Y, Ito K, Kamiya K, Matsuda H, Tsukamoto T, Ogawa M. Usefulness of SWI for the Detection of Iron in the Motor Cortex in Amyotrophic Lateral Sclerosis. J Neuroimaging 2014; 25:443-51. [PMID: 24888543 DOI: 10.1111/jon.12127] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 01/07/2014] [Accepted: 03/02/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of the present retrospective study was to evaluate the sensitivity of susceptibility-weighted imaging (SWI) compared to conventional spin-echo T2-weighted and T2*-weighted images in detecting iron deposition in the motor cortex of amyotrophic lateral sclerosis (ALS) patients in comparison with age-matched normal controls. We also investigated the etiology of the low signal referring to the pathology of one autopsy case. METHODS This retrospective magnetic resonance (MR) study included 23 ALS patients and 28 age-matched normal controls. The signal intensity of the motor cortex was scored by SWI, conventional T2-weighted images and T2*-weighted images. A postmortem study of one patient was also performed. RESULTS On SWI, there was a significant difference between the precentral cortical signal intensity scores in the ALS patients and the controls (P < .0001). The total scores of signal intensities of the precentral cortex were positively correlated with age in the normal controls (r = .494), but no correlation was observed in the ALS patients. The postmortem study showed intensely stained microglias and macrophages after antiferritin antibody staining in the precentral cortices. CONCLUSIONS Decreased signal intensity of the motor cortex on SWI may serve a useful role in ALS diagnoses, particularly in young patients. MR images were also helpful for speculating on the etiology of ALS.
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Affiliation(s)
- Yuko Adachi
- National Center Hospital of Neurology and Psychiatry Radiology, Kodaira, Tokyo, Japan
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Comparison between multi-echo T2* with and without fat saturation pulse for quantification of liver iron overload. Magn Reson Imaging 2013; 31:1704-8. [DOI: 10.1016/j.mri.2013.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 07/02/2013] [Accepted: 07/21/2013] [Indexed: 01/08/2023]
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