Intracranial Lesion Detection and Artifact Characterization: Comparative Study of Susceptibility and T2*-Weighted Imaging in Dogs and Cats

Effect of gadolinium contrast medium administration on susceptibility-weighted imaging of the canine brain

Susceptibility-weighted imaging (SWI) is a gradient echo (GE) MRI sequence. Intravenous administration of gadolinium (Gd) may affect GE images, but its effect on SWI has not been investigated in veterinary medicine. This cross-sectional prospective study evaluated the effects of Gd on SWI. Seventy-one dogs that underwent brain MRI were included and distributed in two groups. Susceptibility-weighted imaging was performed pre- and postcontrast, obtained immediately after Gd administration (Group A: n = 35) or delayed (Group B: n = 36; median delay 19.9 min). Pre- and post-Gd SWI were analyzed for signal intensity changes in the lentiform nuclei of gray matter (GM), in the centrum semiovale of white matter (WM), and in brain lesions. No difference in GM signal intensity was identified in either group between pre- and postcontrast images (Group A, P = .395; Group B, P = .895). In group A, WM signal intensity was lower in pre- than post-Gd sequences (P = .019). Brain lesions were identified in 30/71 (41%) cases; the signal intensity of intracranial lesions was significantly lower in pre- than post-Gd images in both groups (P < .001); the number of lesions influenced the difference in signal intensity in group B (P = .043). Susceptibility artifacts did not change in appearance between pre- and postcontrast images in either the normal brain or in parenchymal lesions. In conclusion, Gd may modify the signal intensity of WM and brain lesions but does not affect the susceptibility artifacts and does not interfere with SWI interpretation.

Diffusion tensor-based analysis of white matter in dogs with idiopathic epilepsy

Introduction

The understanding of epileptic seizure pathogenesis has evolved over time, and it is now generally accepted that not only are cortical and subcortical areas involved but also the connection of these regions in the white matter (WM). Recent human neuroimaging studies confirmed the involvement of the WM in several epilepsy syndromes. Neuroimaging studies investigating WM integrity with diffusion tensor imaging (DTI) in canine idiopathic epilepsy are lacking. This study aimed to test the hypothesis that WM diffusion changes can be found in dogs affected by idiopathic epilepsy.

Method

Twenty-six dogs with idiopathic epilepsy (15 Border Collies and 11 Greater Swiss Mountain dogs) and 24 healthy controls (11 Beagle dogs, 5 Border Collies, and 8 Greater Swiss Mountain dogs) were prospectively enrolled. Most dogs with idiopathic epilepsy (17/26) were enrolled within 3 months after seizure onset. Diffusion tensor imaging of the brain with 32 diffusion directions (low b value = 0 s/mm2; maximal b value = 800 s/mm2) was performed in a 3 Tesla scanner. Tract-based spatial statistics (TBSS), a voxel-based approach, was used to investigate changes in fractional anisotropy (FA) and mean diffusivity (MD) in the idiopathic epilepsy group compared to the healthy control group. Additionally, FA and MD were investigated in the region of corpus callosum and cingulate white matter in both groups.

Results

We observed subtle changes in WM DTI between the idiopathic epilepsy group and the healthy control group limited to cingulate WM, with a significantly lower FA in the idiopathic epilepsy group compared to the healthy control group in the region of interest (ROI) approach (p = 0.027). No significant changes were found between the idiopathic epilepsy group and the healthy control group in the TBSS analysis and in the corpus callosum in the ROI approach.

Conclusion

This study supports the cingulate area as a target structure in canine epilepsy. The subtle changes only might be explained by the short duration of epilepsy, small sample sizes, and the higher variability in canine brain anatomy. Furthermore, all included dogs showed generalized tonic-clonic seizures, possibly affected by generalized epilepsy syndrome, which are also associated with less pronounced DTI changes in humans than focal epilepsy syndromes.

Magnetic resonance imaging features of presumed intracerebral hemorrhages in dogs show a significant association between apparent diffusion coefficient peripheral layer and estimated bleeding age and commonly exhibit a T2 blackout effect

In humans, intracranial hematomas commonly exhibit a T2 blackout effect (BOE) with diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps. Published descriptions of comparable findings in dogs with intracerebral hemorrhages are lacking. Aims of this retrospective observational study were to describe the appearance of presumed intracerebral hemorrhages (PICHs) in DWI regardless of the underlying etiology and presence of T2 blackout effect (T2 BOE) in dogs and to test potential associations with DWI and ADC findings versus the estimated age of the hemorrhage. Magnetic resonance imaging studies of dogs with presumed PICHs based on the combined evaluation of T2*W gradient echo and/or susceptibility-weighted imaging, T1W and T2W images were enrolled. The age of the hemorrhage was estimated according to published criteria based on T1W and T2W sequences. The association between the age of the hemorrhage and the appearance of each finding (stratified or mixed), their signal intensities in DWI/ADC and the presence of the T2 BOE, was evaluated. A total of 35 PICHs were included: 13 of them were stratified and 22 had a mixed aspect. Only the ADC appearance of the peripheral layer in stratified PICHs was significantly associated with estimated age of the hemorrhage (p = .033), being hypointense in all hyperacute cases and hypo-/isointense in acute cases. The T2 BOE was present in 29/35 PICHs. The DWI sequences showed limited utility to date PICHs in this study population. As in humans, the T2 BOE was commonly seen in DWI and ADC maps of dogs with PICHs.

Susceptibility artifact morphology is more conspicuous on susceptibility-weighted imaging compared to T2* gradient echo sequences in the brains of dogs and cats with suspected intracranial disease

Susceptibility-weighted imaging (SWI) has been found to be more reliable in the detection of vessels and blood products than T2*-weighted gradient echo (GE) in several human brain diseases. In veterinary medicine, published information on the diagnostic usefulness of SWI is lacking. The aim of this retrospective observational study was to investigate the value of SWI compared to T2*-weighted GE images in a population of dogs and cats with presumed, MRI-based diagnoses grouped as neoplastic (27), cerebrovascular (14), inflammatory (14), head trauma (5), other pathologies (4), or that were normal (36). Areas of signal void (ASV) were assessed based on shape, distribution, number, and conspicuity. Presence of ASV was found in 31 T2*-weighted GE and 40 SWI sequences; the conspicuity of lesions increased in 92.5% of cases with SWI. A 44.7% increase in the number of cerebral microbleeds (CMBs) was identified within the population using SWI (110) compared to T2*-weighted GE (76). Linear ASV presumed to be abnormal vascular structures, as are reported in humans, were identified in 12 T2*-weighted GE and 19 SWI sequences. In presumed brain tumors, abnormal vascular structures were detected in 11 of 27 (40.7%) cases on T2*-weighted GE and in 16 of 27 (59.3%) cases on SWI, likely representing tumor neovascularization; amorphous ASV interpreted as presumed hemorrhages on T2*-weighted GE were diagnosed as vessels on SWI in five of 27 (18.5%) cases. Since SWI shows ASV more conspicuously than T2*-weighted GE, the authors advocate the use of SWI in veterinary patients.

Ex vivo susceptibility-weighted imaging anatomy of canine brain–comparison of imaging and histological sections

Now that access of large domestic mammals to high-field MRI becomes more common, techniques initially implemented for human patients can be used for the structural and functional study of the brain of these animals. Among them, susceptibility-weighted imaging (SWI) is a recent technique obtained from gradient echo (GE) imaging that allow for an excellent anatomical tissue contrast and a non-invasive assessment of brain iron content. The goal of this study was to design an optimal GE SWI imaging protocol to be used in dogs undergoing an MRI examination of the brain in a 3-Tesla scanner. This imaging protocol was applied to ex vivo brains from four dogs. The imaging protocol was validated by visual inspection of the SWI images that provided a high anatomical detail, as demonstrated by their comparison with corresponding microscopic sections. As resolvable brain structures were labeled, this study is the first to provide an anatomic description of SWI images of the canine brain. Once validated in living animals, this GE SWI imaging protocol could be easily included in routine neuroimaging protocols to improve the diagnosis of various intracranial diseases of dogs, or be used in future comparative studies aiming at evaluating brain iron content in animals.