Diffusion-weighted MRI of the prostate without susceptibility artifacts: Undersampled multi-shot turbo-STEAM with rotated radial trajectories

The aim of this study was to develop and evaluate a clinically feasible approach to diffusion-weighted (DW) MRI of the prostate without susceptibility-induced artifacts. The proposed method relies on an undersampled multi-shot DW turbo-STEAM sequence with rotated radial trajectories and a multi-step inverse reconstruction with denoised multi-shot phase maps. The total acquisition time was below 6 min for a resolution of 1.4 × 1.4 × 3.5 mm³ and six directions at b = 600 s mm^-2 . Studies of eight healthy subjects and two patients with prostate cancer were performed at 3 T employing an 18-channel body-array coil and elements of the spine coil. The method was compared with conventional DW echo-planar imaging (EPI) of the prostate. The results confirm that DW STEAM MRI avoids geometric distortions and false image intensities, which were present for both single-shot EPI (ssEPI) and readout-segmented EPI, particularly near the intestinal wall of the prostate. Quantitative accuracy of the apparent diffusion coefficient (ADC) was validated with use of a numerical phantom providing ground truth. ADC values in the central prostate gland of healthy subjects were consistent with those measured using ssEPI and with literature data. Preliminary results for patients with prostate cancer revealed a correct anatomical localization of lesions with respect to T₂ -weighted MRI in both mean DW STEAM images and ADC maps. In summary, DW STEAM MRI of the prostate offers clinically relevant advantages for the diagnosis of prostate cancer compared with state-of-the-art EPI-based approaches. The method warrants extended clinical trials.

Spinal CSF flow in response to forced thoracic and abdominal respiration

Background

Respiration-induced pressure changes represent a powerful driving force of CSF dynamics as previously demonstrated using flow-sensitive real-time magnetic resonance imaging (MRI). The purpose of the present study was to elucidate the sensitivity of CSF flow along the spinal canal to forced thoracic versus abdominal respiration.

Methods

Eighteen subjects without known illness were studied using real-time phase-contrast flow MRI at 3 T in the aqueduct and along the spinal canal at levels C3, Th1, Th8 and L3. Subjects performed a protocol of forced breathing comprising four cycles of 2.5 s inspiration and 2.5 s expiration.

Results

The quantitative results for spinal CSF flow rates and volumes confirm previous findings of an upward movement during forced inspiration and reversed downward flow during subsequent exhalation—for both breathing types. However, the effects were more pronounced for abdominal than for thoracic breathing, in particular at spinal levels Th8 and L3. In general, CSF net flow volumes were very similar for both breathing conditions pointing upwards in all locations.

Conclusions

Spinal CSF dynamics are sensitive to varying respiratory performances. The different CSF flow volumes in response to deep thoracic versus abdominal breathing reflect instantaneous adjustments of intrathoracic and intraabdominal pressure, respectively. Real-time MRI access to CSF flow in response to defined respiration patterns will be of clinical importance for patients with disturbed CSF circulation like hydrocephalus, pseudotumor cerebri and others.

Electronic supplementary material

The online version of this article (10.1186/s12987-019-0130-0) contains supplementary material, which is available to authorized users.

Multi-slice real-time MRI of temporomandibular joint dynamics

OBJECTIVES

The purpose of this work was to improve the clinical versatility of high-speed real-time MRI studies of temporomandibular joint (TMJ) dynamics by simultaneous recordings of multiple MRI movies in different sections.

METHODS

Real-time MRI at 3 T was realized using highly undersampled radial FLASH acquisitions and image reconstruction by regularized nonlinear inversion (NLINV). Multi-slice real-time MRI of two, three or four slices at 0.75 mm resolution and 6 to 8 mm thickness was accomplished at 50.0 ms, 33.3 ms or 25.5 ms temporal resolution, respectively, yielding simultaneous movies at 2 × 10, 3 × 10 or 4 × 10 frames per second in a frame-interleaved acquisition mode. Real-time MRI movies were evaluated by three blinded raters for visibility of the anterior and posterior border of disc, shape of the disk body and condyle head as well as movement of the disc and condyle (1 = excellent, 5 = no visibility).

RESULTS

Effective delineation of the disk atop the mandibular condyle was achieved by T1-weighted images with opposed-phase water-fat contrast. Compared to 8 mm sections, multi-slice recordings with 6 mm thickness provided sharper delineation of relevant structures as confirmed by inter-rater evaluation. Respective dual-slice and triple-slice recordings of a single TMJ as well as dual-slice recordings of both joints (one slice per TMJ) received the highest visibility ratings of ≤ 2 corresponding to high confidence in diagnostic content.

CONCLUSIONS

The improved access to TMJ dynamics by multi-slice real-time MRI will contribute to more effective treatment of temporomandibular disorders.

Respiration and the watershed of spinal CSF flow in humans

The dynamics of human CSF in brain and upper spinal canal are regulated by inspiration and connected to the venous system through associated pressure changes. Upward CSF flow into the head during inspiration counterbalances venous flow out of the brain. Here, we investigated CSF motion along the spinal canal by real-time phase-contrast flow MRI at high spatial and temporal resolution. Results reveal a watershed of spinal CSF dynamics which divides flow behavior at about the level of the heart. While forced inspiration prompts upward surge of CSF flow volumes in the entire spinal canal, ensuing expiration leads to pronounced downward CSF flow, but only in the lower canal. The resulting pattern of net flow volumes during forced respiration yields upward CSF motion in the upper and downward flow in the lower spinal canal. These observations most likely reflect closely coupled CSF and venous systems as both large caval veins and their anastomosing vertebral plexus react to respiration-induced pressure changes.

Abstract TP201: Carotid Artery Flow as Determined by Real-Time Phase-Contrast Flow Mri and Neurovascular Ultrasound: a Comparative Study of Healthy Subjects

Background: The assessment of carotid artery flow by neurovascular ultrasound (nvUS) may be complemented by real-time phase-contrast (RT-PC) flow MRI which apart from quantitative flow parameters offers velocity distributions across the entire vessel lumen.

Methods: The feasibility and diagnostic potential of RT-PC flow MRI was evaluated in 20 healthy volunteers in comparison to conventional nvUS. RT-PC flow MRI at 40 ms temporal resolution and 0.8 mm in-plane resolution resulted in velocity maps with low phase noise and high spatiotemporal accuracy by exploiting respective advances of a recent nonlinear inverse model-based reconstruction. Peak-systolic velocities (PSV), end-diastolic velocities (EDV), flow volumes and comprehensive velocity profiles were determined in the common, internal and external carotid artery on both sides.

Results: Characteristics in pulsatility and laminar flow, including individual flow abnormalities shown on nvUS, could be reproduced and visualized in detail by RT-PC flow MRI. Fig. 1 shows a representative color-coded duplex sonography with doppler spectrum (A), flow volume measurement by RT-PC flow MRI (B) and a three-dimensional representation of through-plane velocities at peak systole (C) and end diastole (D) in the internal carotid artery. PSV to EDV differences revealed good agreement between both techniques, mean PSV and EDV were significantly lower and flow volumes were higher for MRI.

Conclusions: Our findings suggest that RT-PC flow MRI may add to clinical diagnostics, e.g. by alterations of dynamic velocity distributions in patients with carotid stenosis. Lower PSV and EDV values than for nvUS mainly reflect the longer MRI acquisition time which attenuates short peak velocities, while higher flow volumes benefit from a proper assessment of the true vessel lumen.

Real-time magnetic resonance imaging of deep venous flow during muscular exercise-preliminary experience

BACKGROUND

The accurate assessment of peripheral venous flow is important for the early diagnosis and treatment of disorders such as deep-vein thrombosis (DVT) which is a major cause of post-thrombotic syndrome or even death due to pulmonary embolism. The aim of this work is to quantitatively determine blood flow in deep veins during rest and muscular exercise using a novel real-time magnetic resonance imaging (MRI) method for velocity-encoded phase-contrast (PC) MRI at high spatiotemporal resolution.

METHODS

Real-time PC MRI of eight healthy volunteers and one patient was performed at 3 Tesla (Prisma fit, Siemens, Erlangen, Germany) using a flexible 16-channel receive coil (Variety, NORAS, Hoechberg, Germany). Acquisitions were based on a highly undersampled radial FLASH sequence with image reconstruction by regularized nonlinear inversion at 0.5×0.5×6 mm³ spatial resolution and 100 ms temporal resolution. Flow was assessed in two cross-sections of the lower leg at the level of the calf muscle and knee using a protocol of 10 s rest, 20 s flexion and extension of the foot, and 10 s rest. Quantitative analyses included through-plane flow in the right posterior tibial, right peroneal and popliteal vein (PC maps) as well as signal intensity changes due to flow and muscle movements (corresponding magnitude images).

RESULTS

Real-time PC MRI successfully monitored the dynamics of venous flow at high spatiotemporal resolution and clearly demonstrated increased flow in deep veins in response to flexion and extension of the foot. In normal subjects, the maximum velocity (averaged across vessel lumen) during exercise was 9.4±5.7 cm·s^-1 for the right peroneal vein, 8.5±4.6 cm·s^-1 for the right posterior tibial vein and 17.8±5.8 cm·s^-1 for the popliteal vein. The integrated flow volume per exercise (20 s) was 1.9, 1.6 and 50 mL (mean across subjects) for right peroneal, right posterior tibial and popliteal vein, respectively. A patient with DVT presented with peak flow velocities of only about 2 cm·s^-1 during exercise and less than 1 cm·s^-1 during rest.

CONCLUSIONS

Real-time PC MRI emerges as a new tool for quantifying the dynamics of muscle-induced flow in deep veins. The method provides both signal intensity changes and velocity information for the assessment of blood flow and muscle movements. It now warrants extended clinical trials to patients with suspected thrombosis.

High-resolution myocardial T1 mapping using single-shot inversion recovery fast low-angle shot MRI with radial undersampling and iterative reconstruction

OBJECTIVE

To develop a novel method for rapid myocardial T₁ mapping at high spatial resolution.

METHODS

The proposed strategy represents a single-shot inversion recovery experiment triggered to early diastole during a brief breath-hold. The measurement combines an adiabatic inversion pulse with a real-time readout by highly undersampled radial FLASH, iterative image reconstruction and T₁ fitting with automatic deletion of systolic frames. The method was implemented on a 3-T MRI system using a graphics processing unit-equipped bypass computer for online application. Validations employed a T₁ reference phantom including analyses at simulated heart rates from 40 to 100 beats per minute. In vivo applications involved myocardial T₁ mapping in short-axis views of healthy young volunteers.

RESULTS

At 1-mm in-plane resolution and 6-mm section thickness, the inversion recovery measurement could be shortened to 3 s without compromising T₁ quantitation. Phantom studies demonstrated T₁ accuracy and high precision for values ranging from 300 to 1500 ms and up to a heart rate of 100 beats per minute. Similar results were obtained in vivo yielding septal T₁ values of 1246 ± 24 ms (base), 1256 ± 33 ms (mid-ventricular) and 1288 ± 30 ms (apex), respectively (mean ± standard deviation, n = 6).

CONCLUSION

Diastolic myocardial T₁ mapping with use of single-shot inversion recovery FLASH offers high spatial resolution, T₁ accuracy and precision, and practical robustness and speed. Advances in knowledge: The proposed method will be beneficial for clinical applications relying on native and post-contrast T₁ quantitation.

Sensitivity of Diffusion-Weighted STEAM MRI and EPI-DWI to Infratentorial Ischemic Stroke

OBJECTIVES

To assess the sensitivity of stimulated echo acquisition mode diffusion weighted imaging (STEAM-DWI) to ischemic stroke in comparison to echo-planar imaging diffusion weighted imaging (EPI-DWI) in the infratentorial compartment.

METHODS

Fifty-seven patients presenting with clinical features of infratentorial stroke underwent STEAM-DWI, high-resolution EPI-DWI (HR-DWI, 2.5 mm slice thickness) and low-resolution EPI-DWI (LR-DWI, 5 mm slice thickness). Four readers assessed the presence of ischemic lesions and artifacts. Agreement between sequences and interobserver agreement on the presence of ischemia were calculated. The sensitivities of the DWI sequences were calculated in 45 patients with a confirmed diagnosis of infratentorial stroke.

RESULTS

Median time from symptom onset to imaging was 24 hours. STEAM-DWI agreed with LR-DWI in 89.5% of cases (kappa = 0.72, p<0.0001) and with HR-DWI in 89.5% of cases (kappa = 0.68, p<0.0001). STEAM-DWI showed fewer intraparenchymal artifacts (1/57) than HR-DWI (44/57) and LR-DWI (41/57). Ischemia was visible in 87% of cases for LR-DWI, 93% of cases for HR-DWI, and 89% of cases for STEAM-DWI. Interobserver agreement was good for STEAM-DWI (kappa = 0.62, p<0.0001).

CONCLUSIONS

Compared to the best currently available MR sequence for detecting ischemia (HR-DWI), STEAM-DWI shows fewer artifacts and a similar sensitivity to infratentorial stroke.

Real-time magnetic resonance imaging of cardiac function and flow-recent progress

Cardiac structure, function and flow are most commonly studied by ultrasound, X-ray and magnetic resonance imaging (MRI) techniques. However, cardiovascular MRI is hitherto limited to electrocardiogram (ECG)-synchronized acquisitions and therefore often results in compromised quality for patients with arrhythmias or inabilities to comply with requested protocols-especially with breath-holding. Recent advances in the development of novel real-time MRI techniques now offer dynamic imaging of the heart and major vessels with high spatial and temporal resolution, so that examinations may be performed without the need for ECG synchronization and during free breathing. This article provides an overview of technical achievements, physiological validations, preliminary patient studies and translational aspects for a future clinical scenario of cardiovascular MRI in real time.

Real-time phase-contrast flow MRI of the ascending aorta and superior vena cava as a function of intrathoracic pressure (Valsalva manoeuvre)

OBJECTIVE

Real-time phase-contrast flow MRI at high spatiotemporal resolution was applied to simultaneously evaluate haemodynamic functions in the ascending aorta (AA) and superior vena cava (SVC) during elevated intrathoracic pressure (Valsalva manoeuvre).

METHODS

Real-time phase-contrast flow MRI at 3 T was based on highly undersampled radial gradient-echo acquisitions and phase-sensitive image reconstructions by regularized non-linear inversion. Dynamic alterations of flow parameters were obtained for 19 subjects at 40-ms temporal resolution, 1.33-mm in-plane resolution and 6-mm section thickness. Real-time measurements were performed during normal breathing (10 s), increased intrathoracic pressure (10 s) and recovery (20 s).

RESULTS

Real-time measurements were technically successful in all volunteers. During the Valsalva manoeuvre (late strain) and relative to values during normal breathing, the mean peak flow velocity and flow volume decreased significantly in both vessels (p < 0.001) followed by a return to normal parameters within the first 10 s of recovery in the AA. By contrast, flow in the SVC presented with a brief (1-2 heartbeats) but strong overshoot of both the peak velocity and blood volume immediately after pressure release followed by rapid normalization.

CONCLUSION

Real-time phase-contrast flow MRI may assess cardiac haemodynamics non-invasively, in multiple vessels, across the entire luminal area and at high temporal and spatial resolution.

ADVANCES IN KNOWLEDGE

Future clinical applications of this technique promise new insights into haemodynamic alterations associated with pre-clinical congestive heart failure or diastolic dysfunction, especially in cases where echocardiography is technically compromised.

Real-time phase-contrast flow MRI of haemodynamic changes in the ascending aorta and superior vena cava during Mueller manoeuvre

AIM

To evaluate the potential of real-time phase-contrast flow magnetic resonance imaging (MRI) at 40 ms resolution for the simultaneous determination of blood flow in the ascending aorta (AA) and superior vena cava (SVC) in response to reduced intrathoracic pressure (Mueller manoeuvre).

MATERIALS AND METHODS

Through-plane flow was assessed in 20 healthy young subjects using real-time phase-contrast MRI based on highly undersampled radial fast low-angle shot (FLASH) with image reconstruction by regularized non-linear inversion. Haemodynamic alterations (three repetitions per subject = 60 events) were evaluated during normal breathing (10 s), inhalation with nearly closed epiglottis (10 s), and recovery (20 s).

RESULTS

Relative to normal breathing and despite interindividual differences, reduced intrathoracic pressure by at least 30 mmHg significantly decreased the initial peak mean velocity (averaged across the lumen) in the AA by -24 ± 9% and increased the velocity in the SVC by +28 ± 25% (p < 0.0001, n = 23 successful events). Respective changes in flow volume per heartbeat were -25 ± 9% in the AA and +49 ± 44% in the SVC (p < 0.0001, n = 23). Flow parameters returned to baseline during sustained pressure reduction, while the heart rate was elevated by 10% (p < 0.0001) after the start (n = 24) and end (n = 17) of the manoeuvre.

CONCLUSIONS

Real-time flow MRI during low intrathoracic pressure non-invasively revealed quantitative haemodynamic adjustments in both the AA and SVC.

Real-time flow MRI of the aorta at a resolution of 40 msec

PURPOSE

To evaluate a novel real-time phase-contrast magnetic resonance imaging (MRI) technique for the assessment of through-plane flow in the ascending aorta.

MATERIALS AND METHODS

Real-time MRI was based on a radial fast low-angle shot (FLASH) sequence with about 30-fold undersampling and image reconstruction by regularized nonlinear inversion. Phase-contrast maps were obtained from two (interleaved or sequential) acquisitions with and without a bipolar velocity-encoding gradient. Blood flow in the ascending aorta was studied in 10 healthy volunteers at 3 T by both real-time MRI (15 sec during free breathing) and electrocardiogram (ECG)-synchronized cine MRI (with and without breath holding). Flow velocities and stroke volumes were evaluated using standard postprocessing software.

RESULTS

The total acquisition time for a pair of phase-contrast images was 40.0 msec (TR/TE = 2.86/1.93 msec, 10° flip angle, 7 spokes per image) for a nominal in-plane resolution of 1.3 mm and a section thickness of 6 mm. Quantitative evaluations of spatially averaged flow velocities and stroke volumes were comparable for real-time and cine methods when real-time MRI data were averaged across heartbeats. For individual heartbeats real-time phase-contrast MRI resulted in higher peak velocities for values above 120 cm s(-1).

CONCLUSION

Real-time phase-contrast MRI of blood flow in the human aorta yields functional parameters for individual heartbeats. When averaged across heartbeats real-time flow velocities and stroke volumes are comparable to values obtained by conventional cine MRI.

Real-time phase-contrast MRI of cardiovascular blood flow using undersampled radial fast low-angle shot and nonlinear inverse reconstruction

Velocity-encoded phase-contrast MRI of cardiovascular blood flow commonly relies on electrocardiogram-synchronized cine acquisitions of multiple heartbeats to quantitatively determine the flow of an averaged cardiac cycle. Here, we present a new method for real-time phase-contrast MRI that combines flow-encoding gradients with highly undersampled radial fast low-angle shot acquisitions and phase-sensitive image reconstructions by regularized nonlinear inversion. Apart from calibration studies using steady and pulsatile flow, preliminary in vivo applications focused on through-plane flow in the ascending aorta of healthy subjects. With bipolar velocity-encoding gradients of alternating polarity that overlap the slice-refocusing gradient, the method yields flow-encoded images with an in-plane resolution of 1.8 mm, section thickness of 6 mm and measuring time at 3 T of 24 ms (TR/TE = 3.44/2.76 ms; flip angle, 10º; seven radial spokes per image). Accordingly, phase-contrast maps and corresponding velocity profiles achieve a temporal resolution of 48 ms. The evaluated peak velocities, stroke volumes, flow rates and respective variances over at least 20 consecutive heartbeats are in general agreement with literature data.

Real-time MRI at a resolution of 20 ms

The desire to visualize noninvasively physiological processes at high temporal resolution has been a driving force for the development of MRI since its inception in 1973. In this article, we describe a unique method for real-time MRI that reduces image acquisition times to only 20 ms. Although approaching the ultimate limit of MRI technology, the method yields high image quality in terms of spatial resolution, signal-to-noise ratio and the absence of artifacts. As proposed previously, a fast low-angle shot (FLASH) gradient-echo MRI technique (which allows for rapid and continuous image acquisitions) is combined with a radial encoding scheme (which offers motion robustness and moderate tolerance to data undersampling) and, most importantly, an iterative image reconstruction by regularized nonlinear inversion (which exploits the advantages of parallel imaging with multiple receiver coils). In this article, the extension of regularization and filtering to the temporal domain exploits consistencies in successive data acquisitions and thereby enhances the degree of radial undersampling in a hitherto unexpected manner by one order of magnitude. The results obtained for turbulent flow, human speech production and human heart function demonstrate considerable potential for real-time MRI studies of dynamic processes in a wide range of scientific and clinical settings.

Real-time cardiovascular magnetic resonance at high temporal resolution: radial FLASH with nonlinear inverse reconstruction

BACKGROUND

Functional assessments of the heart by dynamic cardiovascular magnetic resonance (CMR) commonly rely on (i) electrocardiographic (ECG) gating yielding pseudo real-time cine representations, (ii) balanced gradient-echo sequences referred to as steady-state free precession (SSFP), and (iii) breath holding or respiratory gating. Problems may therefore be due to the need for a robust ECG signal, the occurrence of arrhythmia and beat to beat variations, technical instabilities (e.g., SSFP "banding" artefacts), and limited patient compliance and comfort. Here we describe a new approach providing true real-time CMR with image acquisition times as short as 20 to 30 ms or rates of 30 to 50 frames per second.

METHODS

The approach relies on a previously developed real-time MR method, which combines a strongly undersampled radial FLASH CMR sequence with image reconstruction by regularized nonlinear inversion. While iterative reconstructions are currently performed offline due to limited computer speed, online monitoring during scanning is accomplished using gridding reconstructions with a sliding window at the same frame rate but with lower image quality.

RESULTS

Scans of healthy young subjects were performed at 3 T without ECG gating and during free breathing. The resulting images yield T1 contrast (depending on flip angle) with an opposed-phase or in-phase condition for water and fat signals (depending on echo time). They completely avoid (i) susceptibility-induced artefacts due to the very short echo times, (ii) radiofrequency power limitations due to excitations with flip angles of 10 degrees or less, and (iii) the risk of peripheral nerve stimulation due to the use of normal gradient switching modes. For a section thickness of 8 mm, real-time images offer a spatial resolution and total acquisition time of 1.5 mm at 30 ms and 2.0 mm at 22 ms, respectively.

CONCLUSIONS

Though awaiting thorough clinical evaluation, this work describes a robust and flexible acquisition and reconstruction technique for real-time CMR at the ultimate limit of this technology.

Efficacy of EMG-triggered electrical arm stimulation in chronic hemiparetic stroke patients

PURPOSE

EMG-triggered electrostimulation (EMG-ES) may improve the motor performance of affected limbs of hemiparetic stroke patients even in the chronic stage. This study was designed to characterize cortical activation changes following intensified EMG-ES in chronic stroke patients and to identify predictors for successful rehabilitation depending on disease severity.

METHODS

We studied 9 patients with severe residual hemiparesis, who underwent 8 weeks of daily task-orientated multi-channel EMG-ES of the paretic arm. Before and after treatment, arm function was evaluated clinically and cortical activation patterns were assessed with functional MRI (fMRI) and/or transcranial magnetic stimulation (TMS).

RESULTS

As response to therapy, arm function improved in a subset of patients with more capacity in less affected subjects, but there was no significant gain for those with Box & Block test values below 4 at inception. The clinical improvement, if any, was accompanied by an ipsilesional increase in the sensorimotor cortex (SMC) activation area in fMRI and enhanced intracortical facilitation (ICF) as revealed by paired TMS. The SMC activation change in fMRI was predicted by the presence or absence of motor-evoked potentials (MEPs) on the affected side.

CONCLUSIONS

The present findings support the notion that intensified EMG-ES may improve the arm function in individual chronic hemiparetic stroke patients but not in more severely impaired individuals. Functional improvements are paralleled by increased ipsilesional SMC activation and enhanced ICF supporting neuroplasticity as contributor to rehabilitation. The clinical score at inception and the presence of MEPs have the best predictive potential.

TTC post-processing is beneficial for functional MRI at low magnetic field: a comparative study at 1 T and 3 T

This study aimed to broaden the diagnostic possibilities of low-field MRI systems (i) by examining the feasibility of functional MRI of human brain activation at 1 T, and (ii) by assessing its reliability in comparison with acquisitions at 3 T. Eight subjects were studied at 1 T and 3T using standard echo-planar-imaging sequences at 3-mm isotropic spatial resolution. Paradigms included silent word generation, sequential finger-to-thumb opposition, and passive finger movements. Image post-processing was carried out either with statistical parametric mapping (SPM5, single-subject and group analysis) or with a two-threshold correlation (TTC, single-subject analysis only) analysis. Single-subject analysis with SPM5 resulted in 3-5 times more activated pixels at 3 T than at 1 T in the examined Broca and sensorimotor regions. By comparison, the TTC single-subject analysis yielded the same amount of activated pixels at 3 T and 1 T. Moreover, this number was identical to that obtained with SPM at 3 T. The group analysis with SPM5 resulted in very similar numbers of activated pixels at both field strengths. The present findings suggest that a field strength of 1 T combined with adequate post-processing allows for reliable functional MRI studies of human brain activation. High-field advantages are therefore best invested in higher spatial resolution.

Black-blood imaging of the human heart using rapid stimulated echo acquisition mode (STEAM) MRI

PURPOSE

To develop a rapid stimulated echo acquisition mode (STEAM) MRI technique for "black-blood" imaging of the human heart that overcomes the single-slice limitation and partially compromised blood suppression associated with double inversion-recovery techniques.

MATERIALS AND METHODS

Black-blood multislice images of the heart along anatomic orientations and triggered to end diastole were obtained from healthy human subjects at 3T using rapid STEAM MRI sequences with five-eighths partial Fourier encoding and variable flip angles. Single-shot STEAM images at 2.5 x 2.5 mm2 in-plane resolution and 6-mm section thickness were recorded in 230 msec from individual heartbeats. Improved signal-to-noise ratio (SNR) and higher spatial resolution of 2.0 x 2.0 mm2 and 1.5 x 1.5 mm2 were achieved by segmented multishot STEAM MRI with interleaved k-space acquisitions (160 msec each) from several heartbeats. In a single breathhold covering 18 heartbeats selected applications employed either three segments with six sections or six segments with three sections.

RESULTS

Because stimulated echoes (STEs) dephase signals from moving spins, rapid STEAM images are free from blood signal contamination. The method offers a flexible tradeoff between spatial resolution, imaging speed (i.e., number of segments), and volume coverage (i.e., number of sections).

CONCLUSION

Rapid STEAM MRI of the heart emerges as a simple technique for multislice imaging of the myocardial wall with efficient flow suppression.

A novel group analysis for functional MRI of the human brain based on a two-threshold correlation (TTC) method

This work presents a new group analysis for functional MRI of human brain activation. The two-threshold correlation (TTC) method determines two statistical thresholds by estimating the noise distribution underlying the summed histogram of correlation coefficients (CC) from all sections and subjects. The probabilistic CC thresholds (p<0.0001 for the identification of highly significant activation centers and p<0.05 for limiting the iterative addition of directly neighboring voxels to these centers) are applied to the group CC maps for each section. These maps may be reconstructed by taking the maximum (MAX) or mean (MEAN) CC value of all subjects for a particular voxel. Experimental analyses involved functional echo-planar imaging of sequential finger-to-thumb opposition and silent word generation at 3T (eight subjects). Preprocessing included motion correction, spatial filtering, and normalization to MNI space. While the results for the TTC MAX approach were very similar to those obtained for a standard SPM analysis, the TTC MEAN approach turned out to be more conservative emphasizing voxels that are activated in most rather than in only a few subjects. The new method is simple, fast, and robust by linking two thresholds in a physiologically meaningful manner.

Rhesus monkey and human share a similar topography of the corpus callosum as revealed by diffusion tensor MRI in vivo

A recent study of the corpus callosum (CC) in humans revealed a new topographical arrangement of the cortical connectivity pattern. To explore the CC topography in nonhuman primates, we applied magnetic resonance diffusion tensor imaging and tract tracing techniques in individual rhesus monkeys in vivo. The results demonstrate that the CC topography of primates and humans is surprisingly similar. In particular, the relatively large representation and caudal extension of commissural frontal fibers in the CC is observed in both the monkey and human brain. If evolutionary changes in relative brain volumes are reflected in the arrangement of related fibers crossing the CC, the current study is in line with the fact that the relative volume of the frontal lobe did not significantly increase after the split of the hominid line from other primates.

Task- and EEG-correlated analyses of BOLD MRI responses to eyes opening and closing

Variations of a subject's vigilance may pose a severe confound during functional brain mapping. Here, we focused on BOLD MRI responses to eyes opening and closing in complete darkness and the associated changes in the EEG's alpha frequency band (Berger's effect) as a possible approach to this problem. In awake subjects, BOLD MRI activation patterns were positively correlated to eyes opening and negatively to alpha power. In contrast, activation patterns of subjects with diminished wakefulness as determined by alpha band analysis were negatively correlated to eyes opening. We conclude that a control of the subjects' state of wakefulness must be of prime concern for functional MRI, especially for paradigms which allow for a free shift of vigilance.

The cost of parallel imaging in functional MRI of the human brain

While the advantages of parallel acquisition techniques for echo-planar imaging (EPI) are well documented for studies affected by magnetic field inhomogeneities, this work focuses on the costs in functional MRI of brain regions without artifacts due to susceptibility effects. For a visual stimulation paradigm and relative to conventional EPI (2.9 T; TR/TE=2000/36 ms), the use of parallel acquisition at a reduction factor of 2 decreased the mean number of activated voxels by 21% at 2 x 2 x 2-mm(3) resolution (n=6) and by 15% at 3 x 3 x 3-mm(3) resolution (n=6). The loss of sensitivity reflects both a decreased signal-to-noise ratio of the native images due to a lower number of contributing gradient echoes and a decreased BOLD MRI sensitivity due to the coverage of a smaller range of TEs.

Simultaneous recordings of visual evoked potentials and BOLD MRI activations in response to visual motion processing

Visual motion processing in humans was studied by simultaneous 32-channel electroencephalography (EEG) recordings of visual evoked potentials and BOLD MRI activations at 2.9 T. The paradigms compared three different random dot patterns (12 s duration) with stationary random dots (18 s) or with each other. The stimuli represented pattern reversal (500 ms switches between two stationary patterns), motion onset (200 ms of starfield motion followed by 1000 ms of stationary dots) and motion reversal (reversal of moving starfield directions every 1000 ms). Whereas motion-evoked visual potentials, and in particular the N2 component in occipito-temporal channels, were most prominent for motion onset, the most extended BOLD MRI activations and strongest signal changes in V5/MT+ were obtained in response to motion reversal. These apparently contradictory findings most likely reflect different physiological aspects of the neural activity associated with visual motion processing. For example, desynchronized activity of subpopulations of cortical neurons inside V5/MT+ is expected to attenuate visual evoked potentials in scalp recordings while continuously driving metabolic demands that lead to sustained BOLD MRI responses. The understanding of the physiological correlates and neural processes underlying either technique is fundamental to exploring fully the potential of combined EEG-MRI for studying human brain function at both high temporal and spatial resolution.

Diffusion tensor imaging using partial Fourier STEAM MRI with projection onto convex subsets reconstruction

Diffusion-weighted single-shot STEAM MRI allows for diffusion mapping of the human brain without sensitivity to resonance offset effects. In order to compensate for its inherently lower SNR and speed than echo-planar imaging, this work describes the use of partial Fourier encoding in combination with image reconstruction by the projection onto convex subsets algorithm. The method overcomes phase distortions in diffusion-weighted partial Fourier acquisitions that disturb the conjugate complex symmetry of k-space and preclude the use of respective reconstruction techniques. In comparison with full Fourier encoding and a static flip angle for the STEAM readout pulses, experimental results at 2.9 T demonstrate a gain in relative SNR per unit time by 20% for 5/8 phase encoding with optimized variable flip angles. Simultaneously, the imaging time is reduced from about 670 ms (80 echoes) to 440 ms (50 echoes). Current implementations at 2 x 2 mm2 in-plane resolution comprise a protocol for clinical anisotropy studies (12 diffusion-encoding gradient directions at 1000 s mm(-2)) covering 18 sections of 4-mm thickness within a measurement time of 8.5 min (5 averages) and a version optimized for fiber tracking using 24 gradient directions and 38 sections of 2-mm thickness yielding a measurement time of 29.5 min (4 averages).

Is the human primary motor cortex involved in motor imagery?

Participation of the primary motor cortex (M1) in motor imagery was addressed using functional magnetic resonance imaging at 2.0 T and 2 x 2 x 4 mm3 resolution in six right-handed subjects. Paradigms comprised visually cued execution and imagination of a sequential finger-to-thumb opposition task (12 s) contrasted with motor rest and visual imagery (18 s), respectively. Motor execution activated M1 as well as other parts of the motor system including supplementary motor area (SMA) and premotor areas (PM). In contrast, motor imagery did not lead to activations in M1 except for 1/6 subjects but involved SMA and PM bilaterally as well as the anterior intraparietal cortex. Moreover, a region-of-interest analysis revealed a weak initial MRI signal increase in M1 in 4/6 subjects. This novel finding of a transient response reflecting the onset of imagination which does not lead to sustained M1 activation may explain previous contradictory reports.

Thresholding in correlation analyses of magnetic resonance functional neuroimaging

The definition of objective and effective thresholds in MRI of human brain function is a crucial step in the analysis of paradigm-related activations. This paper introduces a user-independent and robust procedure that calculates statistical parametric maps based on correlation coefficients. Thresholds are introduced as p values and defined with respect to the physiologic noise distribution of the individual maps. Experimental examples from the human visual and motor system rely on dynamic acquisitions of gradient-echo echo-planar images (2.0 T, TR = 2,000 ms, 96 x 128 matrix) with blood oxygenation level-dependent contrast. The results demonstrate the disadvantages of thresholding with fixed correlation coefficients. In contrast, taking the individual noise into account allows for a derivation of p values and a reliable identification of highly significant activation centers. An adequate delineation of the spatial extent of activation may be achieved by adding directly neighboring pixels provided their correlation coefficients comply with a second lower p value threshold.

Functional MRI of self-controlled stereoscopic depth perception

Stereoscopic depth perception was studied in healthy young adults using fMRI imaging at 2.0 T. In a novel paradigm we compared the cortical activation elicited by single-image stereograms which create alternating 2D and 3D percepts (event-related analysis triggered on the self-controlled switches between the two percepts) with the activation caused by a more conventional approach contrasting pairs of stereoscopic images with pairs of identical images (block design). The data show a distributed network of cortical areas embedded within the visual pathways that included about one-quarter of the cortical surface activated by 2D visual stimulation and about one-half of the area activated by 3D percepts based on stereoscopic image pair. 3D perception recruited mostly neuronal populations in higher order visual areas: whereas about 40% of the visually activated locations along the intraparietal sulcus were also activated by 3D perception based on single-image stereograms (resp. 90% stereoscopic images), only 10% such overlap was found in striate cortex. The study revealed no sup-port for a right-hemispheric lateralization of depth perception.

On the effects of spatial filtering--a comparative fMRI study of episodic memory encoding at high and low resolution

The effects of spatial filtering in functional magnetic resonance imaging were investigated by reevaluating the data of a previous study of episodic memory encoding at 2 x 2 x 4-mm(3) resolution with use of a SPM99 analysis involving a Gaussian kernel of 8-mm full width at half maximum. In addition, a multisubject analysis of activated regions was performed by normalizing the functional images to an approximate Talairach brain atlas. In individual subjects, spatial filtering merged activations in anatomically separated brain regions. Moreover, small foci of activated pixels which originated from veins became blurred and hence indistinguishable from parenchymal responses. The multisubject analysis resulted in activation of the hippocampus proper, a finding which could not be confirmed by the activation maps obtained at high resolution. It is concluded that the validity of multisubject fMRI analyses can be considerably improved by first analyzing individual data sets at optimum resolution to assess the effects of spatial filtering and minimize the risk of signal contamination by macroscopically visible vessels.

Functional MRI of the human amygdala?

In view of an increasing number of publications that deal with functional mapping of the human amygdala using blood oxygenation-level-dependent (BOLD) magnetic resonance imaging, we reevaluated the underlying image quality of T2*-weighted echoplanar imaging (EPI) and fast low angle shot (FLASH) sequences at 2.0-T with regard to susceptibility-induced signal losses and geometric distortions. Apart from the timing of the gradient echoes, the degree of susceptibility influences is controlled by the image voxel size. Whereas published amygdala studies report voxel sizes ranging from 22 to 125 microl, the present results suggest that reliable imaging of the amygdala with BOLD sensitivity requires voxel sizes of 4 to 8 microl or less. Preferentially, acquisitions should be performed with a coronal section orientation. Although high-resolution BOLD MRI is at the expense of temporal resolution and volume coverage, it seems to provide the only solution to this physical problem.

Functional MRI with reduced susceptibility artifact: high-resolution mapping of episodic memory encoding

Visual episodic memory encoding was investigated using echoplanar magnetic resonance imaging at 2.0 x 2.0 mm2 resolution and 1.0 mm section thickness, which allows for functional mapping of hippocampal, parahippocampal, and ventral occipital regions with reduced magnetic susceptibility artifact. The memory task was based on 54 image pairs each consisting of a complex visual scene and the face of one of six different photographers. A second group of subjects viewed the same set of images without memory instruction as well as a reversing checkerboard. Apart from visual activation in occipital cortical areas, episodic memory encoding revealed consistent activation in the parahippocampal gyrus but not in the hippocampus proper. This finding was most prominently evidenced in sagittal maps covering the right hippocampal formation. Mean activated volumes were 432 +/- 293 microl and 259 +/- 179 microl for intentional memory encoding and non-instructed viewing, respectively. In contrast, the checkerboard paradigm elicited pure visual activation without parahippocampal involvement.

Reducing inhomogeneity artifacts in functional MRI of human brain activation-thin sections vs gradient compensation

We evaluated two methods for correcting inhomogeneity-induced signal losses in magnetic resonance gradient-echo imaging that either use gradient compensation or simply acquire thin sections. The strategies were tested in the human brain in terms of achievable quality of T2*-weighted images at the level of the hippocampus and of functional activation maps of the visual cortex. Experiments were performed at 2.0 T and based on single-shot echo-planar imaging at 2. 0 x 2.0 mm(2) resolution, 4 mm section thickness, and 2.0 s temporal resolution. Gradient compensation involved a sequential 16-step variation of the refocusing lobe of the slice-selection gradient (TR/TE = 125/53 ms, flip angle 15 degrees ), whereas thin sections divided the 4-mm target plane into either four 1-mm or eight 0.5-mm interleaved multislice acquisitions (TR/TE = 2000/54 ms, flip angle 70 degrees ). Both approaches were capable of alleviating the inhomogeneity problem for structures in the base of the brain. When compared to standard 4-mm EPI, functional mapping in the visual cortex was partially compromised because of a lower signal-to-noise ratio of inhomogeneity-corrected images by either method. Relative to each other, consistently better results were obtained with the use of contiguous thin sections, in particular for a thickness of 1 mm. Multislice acquisitions of thin sections require minimal technical adjustments.

Effects of sedation, stimulation, and placebo on cerebral blood oxygenation: a magnetic resonance neuroimaging study of psychotropic drug action

The effects of pharmacologic depression and stimulation of cerebral activity were investigated in seven healthy young volunteers using blood oxygenation-sensitive MRI at 2.0 T. Dynamic gradient-echo imaging (7 min) was performed before, during and after the intravenous application of 10 mg diazepam and 15 mg metamphetamine as well as of the corresponding drug placebos (isotonic saline) in a brain section covering frontotemporal gray matter, subcortical gray matter structures, and cerebellum. The MRI responses were significantly different for the two drugs applied (p = 0.01). Relative to signal strength during injection, metamphetamine elicited a signal increase of 0.97 +/- 0.03% (mean +/- SD, p = 0.02) within the whole section 4-5 min after injection. Similarly, both placebo conditions led to a small signal increase, i.e. 0.50 +/- 0. 03% (n.s.) for the metamphetamine placebo and 0.40 +/- 0.07% (p = 0. 03) for the diazepam placebo. Diazepam abolished this signal increase. A topographic analysis revealed the metamphetamine-induced signal increase to be more pronounced in subcortical gray matter structures (p = 0.01) and cerebellum (p = 0.02) than in frontotemporal cortical gray matter (p = 0.04). This finding is in agreement with the hypothesis that pertinent responses not only reflect global cerebral hemodynamic adjustments, but also localized perfusion changes coupled to alterations in synaptic activity. The occurrence of a placebo response is best explained by expectancy and may provide a confounding factor in the design of functional activation experiments.

MRI of functional deactivation: temporal and spatial characteristics of oxygenation-sensitive responses in human visual cortex

Magnetic resonance imaging (MRI) of neuronal "activation" relies on the elevation of blood flow and oxygenation and a related increase of the blood oxygenation level-dependent (BOLD) MRI signal. Because most cognitive paradigms involve both switches from a low degree of activity to a high degree of activity and vice versa, we have undertaken a baseline study of the temporal and spatial characteristics of positive and negative BOLD MRI responses in human visual cortex. Experiments were performed at 2.0 T using a multislice gradient-echo EPI sequence (TR = 1 s, mean TE = 54 ms, flip angle 50 degrees) at 2x2-mm2 spatial resolution. Activation and "deactivation" processes were accomplished by reversing the order of stimulus presentations in paradigms using homogeneous gray light and an alternating checkerboard as distinct functional states. For sustained stimulation (> or = 60 s) the two conditions resulted in markedly different steady-state BOLD MRI signal strengths. The transient responses to brief stimulation (< or = 18 s) differed insofar as activation processes temporally separate positive BOLD and negative undershoot effects by about 10 s, whereas negative BOLD effects and undershoot contributions overlap for deactivation processes. Apart from differences in stimulus features (e.g., motion) the used activation and deactivation protocols revealed similar maps of neuronal activity changes.

Does stimulus quality affect the physiologic MRI responses to brief visual activation?

We studied the effect of stimulus quality on the basic physiological response characteristics of oxygenation-sensitive MRI signals. Paradigms comprised a contrast-reversing checkerboard vs. darkness or vs. gray light as well as gray light vs. darkness in a 2 s/52 s protocol (nine subjects). MRI was performed at 2.0 T using single-shot gradient-echo EPI (TR/TE = 500/54 ms, flip angle 30 degrees). All paradigms elicited almost identical signal intensity time courses comprising a latency period (1-2s), an activation-induced signal increase (4-4.5% at about 6-7 s after stimulus onset) and a post-stimulus signal undershoot (-1%) that slowly recovered to baseline (about 50 s). Thus, in contrast to findings for sustained stimulation, brief presentations of distinct visual stimuli exhibit similar physiological response characteristics that support the use of a uniform response profile for the evaluation of event related paradigms.

Temporal and spatial MRI responses to subsecond visual activation

The temporal and spatial characteristics of oxygenation-sensitive MRI responses to very brief visual stimuli (five Hz reversing black and white checkerboard pattern versus darkness) were investigated (nine subjects) by means of serial single-shot gradient-echo echo-planar imaging (2.0 T, TR=400 ms, mean TE=54 ms, flip angle 30 degrees). The use of a 0.2-s stimulus and a 90-s control phase resulted in an initial latency phase (about 2 s, no signal change), a positive MRI response (2.5% signal increase peaking at 5 s after stimulus onset), and a post-stimulus undershoot (1% signal decrease peaking at 15 s after stimulus onset) lasting for about 50-60 s. The finding that a subsecond visual stimulus elicits both a strong positive MRI response and a long-lasting undershoot provides further evidence for the neuronal origin of slow signal fluctuations seen in the absence of functional challenge and their utility for mapping functional connectivity. The additional observation that a reduction of the inter-stimulus control phase from 90 s to 9.8 s does not seem to affect the spatial extent of cortical activation in pertinent maps is of major relevance for the design and analysis of "event-related" MRI studies.

Physiologic aspects of event related paradigms in magnetic resonance functional neuroimaging

In order to substantiate event related paradigms in magnetic resonance functional neuroimaging, we assessed the temporal and spatial characteristics of oxygenation-sensitive MRI responses to 1 s periods of visual activation in repetitive protocols. A main finding is a reduction of the functional contrast between conditions (reversing checkerboard vs. darkness) for decreasing interstimulus intervals yielding 4.5% signal change for 89 s, 4% for 9 s, 3% for 6 s, and 1% for 3 s, respectively. Although rapid repetitions of identical stimuli preclude the development of the full positive and negative MRI signal deflections, pertinent responses leave the spatial pattern of activated brain regions unaffected and result in identical maps. These findings suggest the use of interstimulus intervals of the order of the response time from stimulus onset to maximum signal strength (5-6 s in the visual system). The resulting distinction in time will allow for separate mapping of stimulus-related responses with spatially overlapping cortical representations.