Atlas-Based Quantification of DTI Measures in a Typically Developing Pediatric Spinal Cord

BACKGROUND AND PURPOSE

Multi-parametric MRI, provides a variety of biomarkers sensitive to white matter integrity, However, spinal cord MRI data in pediatrics is rare compared to adults. The purpose of this work was 3-fold: 1) to develop a processing pipeline for atlas-based generation of the typically developing pediatric spinal cord WM tracts, 2) to derive atlas-based normative values of the DTI indices for various WM pathways, and 3) to investigate age-related changes in the obtained normative DTI indices along the extracted tracts.

MATERIALS AND METHODS

DTI scans of 30 typically developing subjects (age range, 6-16 years) were acquired on a 3T MR imaging scanner. The data were registered to the PAM50 template in the Spinal Cord Toolbox. Next, the DTI indices for various WM regions were extracted at a single section centered at the C3 vertebral body in all the 30 subjects. Finally, an ANOVA test was performed to examine the effects of the following: 1) laterality, 2) functionality, and 3) age, with DTI-derived indices in 34 extracted WM regions.

RESULTS

A postprocessing pipeline was developed and validated to delineate pediatric spinal cord WM tracts. The results of ANOVA on fractional anisotropy values showed no effect for laterality (P = .72) but an effect for functionality (P < .001) when comparing the 30 primary WM labels. There was a significant (P < .05) effect of age and maturity of the left spinothalamic tract on mean diffusivity, radial diffusivity, and axial diffusivity values.

CONCLUSIONS

The proposed automated pipeline in this study incorporates unique postprocessing steps followed by template registration and quantification of DTI metrics using atlas-based regions. This method eliminates the need for manual ROI analysis of WM tracts and, therefore, increases the accuracy and speed of the measurements.

Validation of the National Institute of Neurological Disorders and Stroke Spinal Cord Injury MRI Common Data Elements Instrument

BACKGROUND AND PURPOSE

The National Institute of Neurological Disorders and Stroke common data elements initiative was created to provide a consistent method for recording and reporting observations related to neurologic diseases in clinical trials. The purpose of this study is to validate the subset of common data elements related to MR imaging evaluation of acute spinal cord injury.

MATERIALS AND METHODS

Thirty-five cervical and thoracic MR imaging studies of patients with acute spinal cord injury were evaluated independently in 2 rounds by 5 expert reviewers. Intra- and interrater agreement were calculated for 17 distinct MR imaging observations related to spinal cord injury. These included ordinal, categoric, and continuous measures related to the length and location of spinal cord hemorrhage and edema as well as spinal canal and cord measurements. Level of agreement was calculated using the interclass correlation coefficient and kappa.

RESULTS

The ordinal common data elements spinal cord injury elements for lesion center and rostral or caudal extent of edema or hemorrhage demonstrated agreement ranging from interclass correlation coefficient 0.68 to 0.99. Reproducibility ranged from 0.95 to 1.00. Moderate agreement was observed for absolute length of hemorrhage and edema (0.54 to 0.60) with good reproducibility (0.78 to 0.83). Agreement for the Brain and Spinal Injury Center score showed the lowest interrater agreement with an overall kappa of 0.27 (0.20, 0.34). For 7 of the 8 variables related to spinal cord injury, agreement improved between the first and second evaluation. Continuous diameter measures of the spinal cord and spinal canal using interclass correlation coefficient varied substantially (0.23 to 0.83).

CONCLUSIONS

Agreement was more consistent for the ordinal measures of spinal cord injury than continuous measures. Good to excellent agreement on length and location of spinal cord hemorrhage and edema can be achieved with ordinal measures alone.

Feasibility of diffusion and probabilistic white matter analysis in patients implanted with a deep brain stimulator

Deep brain stimulation (DBS) for Parkinson's disease (PD) is an established advanced therapy that produces therapeutic effects through high frequency stimulation. Although this therapeutic option leads to improved clinical outcomes, the mechanisms of the underlying efficacy of this treatment are not well understood. Therefore, investigation of DBS and its postoperative effects on brain architecture is of great interest. Diffusion weighted imaging (DWI) is an advanced imaging technique, which has the ability to estimate the structure of white matter fibers; however, clinical application of DWI after DBS implantation is challenging due to the strong susceptibility artifacts caused by implanted devices. This study aims to evaluate the feasibility of generating meaningful white matter reconstructions after DBS implantation; and to subsequently quantify the degree to which these tracts are affected by post-operative device-related artifacts. DWI was safely performed before and after implanting electrodes for DBS in 9 PD patients. Differences within each subject between pre- and post-implantation FA, MD, and RD values for 123 regions of interest (ROIs) were calculated. While differences were noted globally, they were larger in regions directly affected by the artifact. White matter tracts were generated from each ROI with probabilistic tractography, revealing significant differences in the reconstruction of several white matter structures after DBS. Tracts pertinent to PD, such as regions of the substantia nigra and nigrostriatal tracts, were largely unaffected. The aim of this study was to demonstrate the feasibility and clinical applicability of acquiring and processing DWI post-operatively in PD patients after DBS implantation. The presence of global differences provides an impetus for acquiring DWI shortly after implantation to establish a new baseline against which longitudinal changes in brain connectivity in DBS patients can be compared. Understanding that post-operative fiber tracking in patients is feasible on a clinically-relevant scale has significant implications for increasing our current understanding of the pathophysiology of movement disorders, and may provide insights into better defining the pathophysiology and therapeutic effects of DBS.

Zonally Magnified Oblique Multislice and Non-Zonally Magnified Oblique Multislice DWI of the Cervical Spinal Cord

BACKGROUND AND PURPOSE

The zonally magnified oblique multislice EPI (ZOOM-EPI) diffusion-weighted sequence has been visually shown to provide superior MR diffusion image quality compared with the full-FOV single-shot EPI sequence (non-ZOOM-EPI) in the adult cervical spinal cord. The purpose of this study was to examine the diffusion tensor imaging indices in the normal human cervical spinal cord between ZOOMED and non-ZOOMED DTI acquisitions and determine whether DTI values are comparable between direct and indirect age-matched groups.

MATERIALS AND METHODS

Fifty-four subjects 23-58 years of age (9 direct age-matched and 45 indirect age-matched) were scanned using a 1.5T scanner. Diffusion tensor indices including fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were generated from the DTI dataset. These DTI values were calculated for both ZOOM and non-ZOOM acquisitions and compared at each intervertebral disc level. The variability of the DTI values for ZOOM and non-ZOOM sequences was measured using a coefficient of variation within direct and indirect age-matched controls.

RESULTS

The mean diffusivity, axial diffusivity, and radial diffusivity values obtained along the cervical spinal cord in the age-matched controls showed a significant decrease using the ZOOM sequence (P = .05, P = .002, and P < .001). Mean fractional anisotropy showed a significant increase (P = .04) using the ZOOM sequence. The indirect age-matched controls showed a statistically significant increase in fractional anisotropy (P = .03) and a decrease in mean diffusivity (P = .002), axial diffusivity (P < .001), and radial diffusivity (P = .002) using the ZOOM sequence. Less variability has been shown in DTI using the ZOOM sequence compared with the non-ZOOM sequence in both direct and indirect age groups. The ZOOM sequence exhibited higher SNR (SNR_ZOOM = 22.84 ± 7.59) compared with the non-ZOOM sequence (SNR_non-ZOOM = 19.7 ± 7.05). However, when we used a 2-tailed t test assuming unequal variances, the ZOOM sequence did not demonstrate a statistically significant increase.

CONCLUSIONS

ZOOM DTI acquisition methods provide superior image quality and precision over non-ZOOM techniques and are recommended over conventional full-FOV single-shot EPI DTI for clinical applications in cervical spinal cord imaging.

Diffusion Tensor Imaging of the Normal Cervical and Thoracic Pediatric Spinal Cord

BACKGROUND AND PURPOSE

DTI data of the normal healthy spinal cord in children are limited compared with adults and are typically focused on the cervical spinal cord. The purpose of this study was the following: to investigate the feasibility of obtaining repeatable DTI parameters along the entire cervical and thoracic spinal cord as a function of age in typically developing pediatric subjects; to analyze the DTI parameters among different transverse levels of the cervical and thoracic spinal cord; and to examine the sex differences in DTI parameters along the cervical and thoracic spinal cord.

MATERIALS AND METHODS

Twenty-two subjects underwent 2 identical scans by using a 3T MR imaging scanner. Axial diffusion tensor images were acquired by using 2 overlapping slabs to cover the cervical and thoracic spinal cord. After postprocessing, DTI parameters were calculated by using ROIs drawn on the whole cord along the entire spinal cord for both scans.

RESULTS

An increase in fractional anisotropy and a decrease in mean diffusivity, axial diffusivity, and radial diffusivity were observed with age along the entire spinal cord. Significantly lower fractional anisotropy and higher mean diffusivity values were observed in the lower cervical cord compared with the upper cervical cord. Axial diffusivity values in the cervical cord were higher compared with the thoracic cord. No statistically significant sex differences were observed for all DTI parameters. There was a moderate-to-strong repeatability for all DTI parameters.

CONCLUSIONS

This study provides an initial understanding of DTI values of the spinal cord relevant to age and sex and shows that obtaining repeatable DTI values of the entire cord in children is feasible.

Hot topics in functional neuroradiology

Functional neuroradiology represents a relatively new and ever-growing subspecialty in the field of neuroradiology. Neuroradiology has evolved beyond anatomy and basic tissue signal characteristics and strives to understand the underlying physiologic processes of central nervous system disease. The American Society of Functional Neuroradiology sponsors a yearly educational and scientific meeting, and the educational committee was asked to suggest a few cutting-edge functional neuroradiology techniques (hot topics). The following is a review of several of these topics and includes "Diffusion Tensor Imaging of the Pediatric Spinal Cord"; "Diffusional Kurtosis Imaging"; "From Standardization to Quantification: Beyond Biomarkers toward Bioscales as Neuro MR Imaging Surrogates of Clinical End Points"; Resting-State Functional MR Imaging"; and "Current Use of Cerebrovascular Reserve Imaging."

Diagnostic accuracy of diffusion tensor imaging for pediatric cervical spinal cord injury

STUDY DESIGN

Cross-sectional non-experimental study.

OBJECTIVES

To examine diagnostic accuracy of diffusion tensor imaging (DTI) for pediatric spinal cord injury (SCI).

SETTING

Pediatric Orthopedic Hospital.

METHODS

Thirty-five subjects, 10 SCI and 25 controls, mean age 13.38 years underwent two scans with 3.0 T MR scanner. Fractional anisotropy (FA), axial diffusivity (AD) and radial diffusivity (RD) values were calculated. Subjects with SCI underwent examination of muscle strength, sensation and sacral sparing. Mean and s.d. values for FA, AD and RD were compared by group (controls, SCI with sacral sparing, SCI without sacral sparing) using analysis of variance for repeated measures. Comparisons were also made of DTI values at the injury site to values from cervical regions outside of the injury site. Specificity, sensitivity, receiver operating characteristics area under the curve (ROC AUC) and corresponding 95% confidence intervals were calculated. Resampling methods were used to validate the estimates from the final models.

RESULTS

FA values differed among SCI subjects with intact sacral sparing, absent sacral sparing and controls, P<0.003 (adjusted). DTI values in combination showed the strongest diagnostic accuracy for predicting the presence of anal contraction (AD, RD; ROC AUC=0.90), deep anal pressure (FA; ROC AUC=0.88), S4-5 sensation (FA, RD; ROC AUC=0.93), motor level (FA, AD, RD; ROC AUC=0.92) and MRI level (FA, AD, RD; ROC AUC=0.92). Bootstrap and Jackknife median values indicated consistency of the parameter estimates.

CONCLUSION

The predictive accuracy of DTI for sacral sparing end points and motor and MRI level of injury was good to strong.

Diffusion tensor imaging of the normal pediatric spinal cord using an inner field of view echo-planar imaging sequence

BACKGROUND AND PURPOSE

DTI in the brain has been well established, but its application in the spinal cord, especially in pediatrics, poses several challenges. The small cord size has inherent low SNR of the diffusion signal intensity, respiratory and cardiac movements induce artifacts, and EPI sequences used for obtaining diffusion indices cause eddy-current distortions. The purpose of this study was to 1) evaluate the accuracy of cervical spinal cord DTI in children using a newly developed iFOV sequence with spatially selective 2D-RF excitations, and 2) examine reproducibility of the DTI measures.

MATERIALS AND METHODS

Twenty-five typically developing subjects were imaged twice using a 3T scanner. Axial DTI images of the cervical spinal cord were acquired with this sequence. After motion correction, DTI indices were calculated using regions of interest manually drawn at every axial section location along the cervical spinal cord for both acquisitions. Various DTI indices were calculated: FA, AD, RD, MD, RA, and VR. Geometric diffusion measures were also calculated: Cp, Cl, and Cs.

RESULTS

The following average values for each index were obtained: FA = 0.50 ± 0.11; AD = 0.97 ± 0.20 × 10(-3)mm(2)/s; RD = 0.41 ± 0.13 × 10(-3)mm(2)/s; MD = 0.59 ± 0.15 × 10(-3)mm(2)/s; RA = 0.35 ± 0.08; VR = 0.03 ± 0.00; Cp = 0.13 ± 0.07; Cl = 0.29 ± 0.09; and Cs = 0.58 ± 0.11. The reproducibility tests showed moderate to strong ICC in all subjects for all DTI parameters (ICC>0.72).

CONCLUSIONS

This study showed that accurate and reproducible DTI parameters can be estimated in the pediatric cervical spinal cord using an iFOV EPI sequence.

Diffusion tensor imaging of the pediatric spinal cord at 1.5T: preliminary results

BACKGROUND AND PURPOSE

Recent studies suggest that pediatric subjects as old as 8-years-of-age may have difficulty with the ISNCSCI examinations. Our aim was to investigate DTI parameters of healthy spinal cord in children with noncervical IS for comparison with children with SCI and to prospectively evaluate reliability measures of DTI and to correlate the measures obtained in children with SCI with the ISNCSCI.

MATERIALS AND METHODS

Five controls with thoracic and lumbar IS and 5 children with cervical SCI were imaged twice by using a single-shot echo-planar diffusion-weighted sequence. Axial imaging was performed to cover the entire cervical spinal cord in controls. For the SCI subjects, 2 vertebral bodies above and below the injury were imaged. FA and D values were obtained at different levels of the cervical spinal cord. All subjects with SCI had undergone ISNCSCI clinical examinations. Statistical analysis was performed to access differences of the DTI indices between the controls and SCI subjects, reproducibility measurements, and correlations between DTI and ISNCSCI.

RESULTS

Subjects with SCI showed reduced FA and increased D values compared with controls. Test-retest reproducibility showed good ICC coefficients in all the DTI index values among controls (≥0.9), while the SCI group showed moderate ICC (≥0.77). There were statistically significant correlations between the various DTI indices and ISNCSCI scores.

CONCLUSIONS

Preliminary DTI indices in children were determined and showed good reproducibility. Reduced FA and increased D values were seen in children with SCI in comparison with controls and showed good clinical correlation with ISNCSCI examinations.

Increased differentiation of intracranial white matter lesions by multispectral 3D-tissue segmentation: preliminary results

MRI is a very sensitive imaging modality, however with relatively low specificity. The aim of this work was to determine the potential of image post-processing using 3D-tissue segmentation technique for identification and quantitative characterization of intracranial lesions primarily in the white matter. Forty subjects participated in this study: 28 patients with brain multiple sclerosis (MS), 6 patients with subcortical ischemic vascular dementia (SIVD), and 6 patients with lacunar white matter infarcts (LI). In routine MR imaging these pathologies may be almost indistinguishable. The 3D-tissue segmentation technique used in this study was based on three input MR images (T(1), T(2)-weighted, and proton density). A modified k-Nearest-Neighbor (k-NN) algorithm optimized for maximum computation speed and high quality segmentation was utilized. In MS lesions, two very distinct subsets were classified using this procedure. Based on the results of segmentation one subset probably represent gliosis, and the other edema and demyelination. In SIVD, the segmented images demonstrated homogeneity, which differentiates SIVD from the heterogeneity observed in MS. This homogeneity was in agreement with the general histological findings. The LI changes pathophysiologically from subacute to chronic. The segmented images closely correlated with these changes, showing a central area of necrosis with cyst formation surrounded by an area that appears like reactive gliosis. In the chronic state, the cyst intensity was similar to that of CSF, while in the subacute stage, the peripheral rim was more prominent. Regional brain lesion load were also obtained on one MS patient to demonstrate the potential use of this technique for lesion load measurements. The majority of lesions were identified in the parietal and occipital lobes. The follow-up study showed qualitatively and quantitatively that the calculated MS load increase was associated with brain atrophy represented by an increase in CSF volume as well as decrease in "normal" brain tissue volumes. Importantly, these results were consistent with the patient's clinical evolution of the disease after a six-month period. In conclusion, these results show there is a potential application for a 3D tissue segmentation technique to characterize white matter lesions with similar intensities on T(2)-weighted MR images. The proposed methodology warrants further clinical investigation and evaluation in a large patient population.

Investigation of alternating and continuous experimental task designs during single finger opposition fMRI: a comparative study

The purpose of this study was to empirically investigate and compare the effects of alternating and continuous experimental task designs on blood oxygenation level dependent (BOLD) signal contrast. Six healthy volunteers underwent single-finger opposition functional magnetic resonance imaging (fMRI) using T2*-weighted echo planar imaging technique on a 1.5 T MR scanner. Two different acquisition patterns were tested: alternating (ABABAB) and continuous (AAABBB), rest: A, activation: B. The BOLD signal contrast within a primary motor cortex region of interest (ROI) was evaluated using normalized t-values (z-scores) and mean region of interest (ROI) intensity for the two patterns. Analysis of variance (ANOVA) on ROI mean z-score and signal intensities demonstrate that the alternating pattern of administering rest and activation epochs produced a more robust statistical difference than a continuous pattern. The results showed that different patterns of acquisition yield differences in the BOLD signal at field strength of 1.5 T, and that an alternating task design can be considered more optimal than a continuous task design.

Functional localization of a "Time Keeper" function separate from attentional resources and task strategy

The functional neuroanatomy of time estimation has not been well-documented. This research investigated the fMRI measured brain response to an explicit, prospective time interval production (TIP) task. The study tested for the presence of brain activity reflecting a primary time keeper function, distinct from the brain systems involved either in conscious strategies to monitor time or attentional resource and other cognitive processes to accomplish the task. In the TIP task participants were given a time interval and asked to indicate when it elapsed. Two control tasks (counting forwards, backwards) were administered, in addition to a dual task format of the TIP task. Whole brain images were collected at 1.5 Tesla. Analyses (n = 6) yielded a statistical parametric map (SPM ¿z¿) reflecting time keeping and not strategy (counting, number manipulation) or attention resource utilization. Additional SPM ¿z¿s involving activation associated with the accuracy and magnitude the of time estimation response are presented. Results revealed lateral cerebellar and inferior temporal lobe activation were associated with primary time keeping. Behavioral data provided evidence that the procedures for the explicit time judgements did not occur automatically and utilized controlled processes. Activation sites associated with accuracy, magnitude, and the dual task provided indications of the other structures involved in time estimation that implemented task components related to controlled processing. The data are consistent with prior proposals that the cerebellum is a repository of codes for time processing, but also implicate temporal lobe structures for this type of time estimation task.

A simple method to improve image nonuniformity of brain MR images at the edges of a head coil

One of the major sources of image nonuniformity in the high field MR scanners is the radiofrequency (RF) coil inhomogeneity. It degrades conspicuity of lesion(s) in the MR images of the brain and surrounding tissues and reduces accuracy of image postprocessing particularly at the edges of the coil. In this investigation, we have devised and tested a simple method to correct for nonuniformity of MR images of the brain at the edges of the RF head coil. Initially, a cylindrical oil phantom, which fit exactly in the head coil, was scanned on a 1.5 T imager. Then, a correction algorithm identified a reference pixel value in the phantom at the most homogeneous region of the RF coil. Next, every pixel inside the phantom was normalized relative to this reference value. The resulting set of coefficients or "correction matrices" was obtained for different types of MR contrast agent. Finally, brain MR images of normal subjects and multiple sclerosis patients were acquired and processed by the corresponding correction matrices obtained with different pulse sequences. Application of correction matrices to brain MR images showed a gain in pixel intensity particularly in the slices at the edge of the coil.

Optimization of tissue segmentation of brain MR images based on multispectral 3D feature maps

The purpose of this work was to optimize and increase the accuracy of tissue segmentation of the brain magnetic resonance (MR) images based on multispectral 3D feature maps. We used three sets of MR images as input to the in-house developed semi-automated 3D tissue segmentation algorithm: proton density (PD) and T2-weighted fast spin echo and, T1-weighted spin echo. First, to eliminate the random noise, non-linear anisotropic diffusion type filtering was applied to all the images. Second, to reduce the nonuniformity of the images, we devised and applied a correction algorithm based on uniform phantoms. Following these steps, the qualified observer "seeded" (identified training points) the tissue of interest. To reduce the operator dependent errors, cluster optimization was also used; this clustering algorithm identifies the densest clusters pertaining to the tissues. Finally, the images were segmented using k-NN (k-Nearest Neighborhood) algorithm and a stack of color-coded segmented images were created along with the connectivity algorithm to generate the entire surface of the brain. The application of pre-processing optimization steps substantially improved the 3D tissue segmentation methodology.

Rapid ventricular pacing in a pacemaker patient undergoing magnetic resonance imaging

Magnetic resonance imaging (MRI) generates potent electromagnetic forces in the form of a static, gradient, or pulsed radiofrequency magnetic field that can result in pacemaker malfunction. This report documents a case of rapid cardiac pacing during MRI in a patient with a dual chamber pacemaker. Although the mechanism of rapid cardiac pacing is unclear, it was directly related to radiofrequency pulsing. We postulated that the lead acts as an antenna for radiofrequency energy that interacts with the pacemaker's output circuit, thus, causing cardiac pacing at a cycle length representing a multiple of the repetition time; or perhaps rapid pacing is related to induced currents generated between the MRI unit and the pacing lead.

Carotid artery bifurcation: multiple-flip-angle, three-dimensional, time-of-flight MR angiographic technique

Multiple-flip-angle, three-dimensional, time-of-flight magnetic resonance (MR) angiography was performed in vitro and in vivo in the carotid artery bifurcation. Composite MR angiographic images were created from multiple data sets. Compared with images obtained with a low (20 degrees) flip angle, composite images obtained with flip angles of 20 degrees and 60 degrees demonstrated improved image quality and statistically significant improvement in signal-to-noise ratio (P < .05).

Paraganglioma of the cauda equina with associated intramedullary cyst: MR findings

The MR imaging features of a paraganglioma of the cauda equina with associated spinal cord cysts are presented. MR imaging showed the tumor to be isointense with the spinal cord on all pulse sequences and to enhance homogeneously. The intramedullary cysts had increased signal intensity on proton density- and T2-weighted images, and involved the cervical and thoracic regions.

Carotid magnetic resonance angiography: improved image quality with dual 3-inch surface coils

Magnetic resonance angiography (MRA) hs inherent artifacts due to variation in velocity and direction of flowing blood in the carotid bulb and regions of stenosis. We examined the efficiency of dual 3-inch surface coils to delineate carotid artery flow better. Carotid MRA was performed on ten healthy volunteers and six patients, on a 1.5 T system. A special adapter was constructed to use with 3-inch (receive-only) coils, which were placed over the carotid bifurcations. Routine anterior neck coils were also used. Contiguous axial two-dimensional (45/8.7, 1.5 mm, flip angle 60 degrees) time-of-flight sequences were used. Image matrix was 256 x 256 with two signals averaged and acquisition time 6-10 min. These images were postprocessed and reformatted into angiographic views using a maximum intensity projection algorithm. Computer simulation of carotid artery blood flow throughout the cardiac cycle based on vessel contours derived from digital subtraction angiography was carried out by finite element analysis. Improved definition of vessel margin, particularly at the carotid bifurcation, and substantially increased signal-to-background ratio of flowing blood were obtained with 3-in-chcoils. Apparent loss of signal in the carotid bulb was diminished. In one patient, contiguous flow throughout a high-grade stenosis was well defined, with the surface coil method, while drop-off of signal was observed with routine neck coil imaging.

Respiratory and postprandial changes in portal flow rate: assessment by phase contrast MR imaging

The objective of this study was to investigate the variability of several different phase contrast (PC) magnetic resonance techniques and duplex Doppler imaging (DDI) for measuring portal flow rate (PFR) with different patterns of respiration before and after a standard meal. PFR was measured in nine normal volunteers in both fasting and postprandial states, using both 2D and cine PC MR techniques. Two-dimensional PC technique was performed with and without breath-hold (BH). Four different patterns of BH (relaxed maximal inspiration, expiration, Valsalva maneuver, and Müller or reversed Valsalva) were used. Cine PC technique was performed without BH. DDI measurement of PFR was done in the fasting state with relaxed inspiration. PFR measurements made by means of PC MR techniques varied, depending on BH method, and were systematically less than those obtained by DDI. PFR measured during inspiration was significantly less than that measured during expiration and other respiratory maneuvers (P < .03). PFR increased significantly after a meal for PC and Doppler measurements, with a range of mean increases of 24 to 74%. Two-dimensional PC MR imaging techniques yielded differing measurements of PFR, depending on whether they were done with or without BH, as well as on the pattern of BH. PC mean measures of PFR were consistently less than those of DDI. The physiologic inspiratory decreases and postprandial increases of the PFR were evident from 2D and cine PC MRI techniques, as well as with DDI.

Use of Ferrum in MRI of lung parenchyma and pulmonary embolism

MRI of lung parenchyma and pulmonary embolism (PE) remains challenging. "Ferrum," a ferric hydroxide sucrose complex used clinically for iron deficiency anemia for more than 40 years, was investigated as a negative MRI contrast agent in five rabbits bearing experimental PE as well as in five normal volunteers. Clots were prepared by spontaneous coagulation of 0.1 ml In-111 labeled autologous red blood cells and introduced through the jugular vein. Scintigraphic imaging permitted anatomical localization of PE in vivo and thereby served as a control for MR imaging. MRI was performed on a 1.5 T GE Signa scanner before and after induction of PE, and before and after the injection of Ferrum. T1-weighted images were obtained continuously for up to 90 min using varying doses of Ferrum. In five normal human volunteers, a single dose of 100 mg each was administered. T1- and T2-weighted spin-echo and gradient-echo images of lung parenchyma were repeatedly obtained before and after agent administration. In rabbit, Ferrum remained in circulation for several hours where it shortened both T1 and T2 of blood, improving the contrast between PE and lung parenchyma (i.e., intravascular compartment). A dose of 3 mg/kg was enough to increase the contrast-to-noise ratio (CNR) between PE and lung parenchyma by almost three fold, substantially improving lesion detectability. CNR increased up to five-fold when the dose was increased up to 20 mg/kg at which point CNR reached a plateau. In humans, T2-weighted spin-echo sequence appeared to be most sensitive to changes in signal-to-noise ratio (SNR) of normal lung parenchyma. Within 60 min after injection of 100 mg of iron, SNR dropped by 34% (p < .025). However, 24 hr later, SNR returned to almost normal. Ferrum increased the contrast between PE and lung parenchyma in the rabbit and decreased the parenchymal SNR in humans in nontoxic doses. These results suggest that Ferrum is worthy of further investigation of PE imaging in humans.

Comparison of Kaopectate with barium for negative and positive enteric contrast at MR imaging

In an evaluation of safe, inexpensive, orally administered contrast agents for use at magnetic resonance imaging, different concentrations of the clay agents kaolin-pectate and attapulgite were compared in an in vitro phantom by performing spin-echo imaging with variable echo times to estimate T2 relaxation time. Additional phantoms containing from 0% to 100% attapulgite or barium preparations were compared by using spin-echo and spoiled-gradient-echo techniques to estimate T1, T2, and T2* relaxation times. In vivo spin-echo and gradient-echo images were obtained of 10 healthy volunteers and of five patients with pancreatic disease after oral administration of 12-16 oz of attapulgite preparation. T1 and T2 relaxation times obtained with use of attapulgite were slightly lower than those obtained with kaolin-pectate at both 50% and 25% concentrations. Compared with barium, attapulgite had shorter T1, T2, and T2* relaxation times, and concentration-dependent relaxivity was greater by nearly an order of magnitude. All subjects were able to drink the attapulgite, and the only complaints were of bad taste and mildly loose stools.