Quantitative hepatic phosphorus-31 magnetic resonance spectroscopy in compensated and decompensated cirrhosis

Few studies have examined the physiological/biochemical status of hepatocytes in patients with compensated and decompensated cirrhosis in situ. Phosphorus-31 magnetic resonance spectroscopy ((31)P MRS) is a noninvasive technique that permits direct assessments of tissue bioenergetics and phospholipid metabolism. Quantitative (31)P MRS was employed to document differences in the hepatic metabolite concentrations among patients with compensated and decompensated cirrhosis as well as healthy controls. All MRS examinations were performed on a 1.5-T General Electric Signa whole body scanner. The concentration of hepatic phosphorylated metabolites among patients with compensated cirrhosis (n = 7) was similar to that among healthy controls (n = 8). However, patients with decompensated cirrhosis (n = 6) had significantly lower levels of hepatic ATP compared with patients with compensated cirrhosis and healthy controls (P < 0.02 and P < 0.009, respectively) and a higher phosphomonoester/phosphodiester ratio than controls (P < 0.003). The results of this study indicate that metabolic disturbances in hepatic energy and phospholipid metabolism exist in patients with decompensated cirrhosis that are not present in patients with compensated cirrhosis or healthy controls. These findings provide new insights into the pathophysiology of hepatic decompensation.

Functional MRI of motor and sensory activation in the human spinal cord

MR imaging of the cervical spinal cord was carried out on volunteers during alternated rest and either motor or sensory stimulation of one hand, in order to detect image intensity changes arising concomitant to neuronal activity. We employed both spin-echo and gradient-echo echo-planar imaging, on the right and left hands, with both symmetric and asymmetric temporal patterns of rest and stimulation. Intensity changes correlated with the time course of stimulation were consistently detected, and the magnitude of the intensity changes depended on the duration of stimulation. The activated regions in the spinal cord extended along a column on the side of the body being stimulated and included localized regions on the contralateral side, in agreement with the neural anatomy.

Analysis of ovariectomy and estrogen effects on body composition in rats by X-ray and magnetic resonance imaging techniques

Resistance of bone to fracture--bone strength--has been shown to depend on both the amount of bone and its architectural spatial organization. In vivo magnetic resonance (MR) techniques have the capability of imaging bone tissue, including the trabecular microarchitecture and the marrow composition. We have applied in vivo and ex vivo MR methods to the tibia in an ovariectomized rat model of osteoporosis. Specifically, in vivo high-resolution three-dimensional MR imaging and localized MRS were facilitated by specialized coils and high field magnets, resulting in enhanced sensitivity of detection. As a result, in vivo and ex vivo differences in marrow composition were found between sham-ovariectomized, ovariectomized, and ovariectomized animals treated with 17-beta-estradiol. Estrogen effects were detected in vivo 7 days after surgery (3 days into treatment) as a decrease in the tibial fat signal level. The in vivo effects of ovariectomy were observed 56 days after surgery as an increase in MR image fat signal level and spectral fat/water ratio in the proximal tibia. Ex vivo measurements of tibial marrow water signal discriminated clearly between the sham and ovariectomized groups and showed increased individual variations in the treatment group. Imaging further showed that the highest fat content is observed in the epiphysis. Computed tomography confirmed ovariectomy-induced loss of bone in the proximal tibial metaphysis compared with the sham group. This loss of cancellous bone with ovariectomy is consistent with the MR observations of increases in both fat and water in the metaphysis. These data showed that MR techniques complement X-ray techniques in the bone, water, and fat compositional analysis of the appendicular skeleton in response to ovariectomy and pharmacological treatment.

Unilateral antegrade cerebral perfusion through the right axillary artery provides uniform flow distribution to both hemispheres of the brain: A magnetic resonance and histopathological study in pigs

BACKGROUND

Bilateral antegrade cerebral perfusion (ACP) has decreased in popularity over the past decade because of its complexity and the risk of cerebral embolism. We used magnetic resonance (MR) perfusion imaging to assess flow distribution in both hemispheres of the brain during unilateral ACP through the right carotid artery via a cannula placed in the right axillary artery in conjunction with hypothermic circulatory arrest.

METHODS AND RESULTS

Twelve pigs were randomly exposed to 120 minutes of either bilateral ACP through both carotid arteries (n=6) or unilateral ACP through the right axillary artery (n=6) at pressures of 60 to 65 mm Hg at 15 degrees C, followed by 60 minutes of cardiopulmonary bypass at 37 degrees C. MR perfusion images were acquired every 30 minutes before, during, and after ACP. The brain was perfusion fixed for histopathology. During initial normothermic cardiopulmonary bypass, MR perfusion imaging showed a uniform distribution of flow in the brain. In both the bilateral and unilateral ACP groups, the same pattern was maintained, with an increase in regional cerebral blood volume during ACP and reperfusion. The changes in regional cerebral blood volume and mean transit time were similar in both hemispheres during and after unilateral ACP. No difference was observed between the 2 groups. Histopathology showed normal morphology in all regions of the brain in both groups.

CONCLUSIONS

Both bilateral ACP and unilateral ACP provide uniform blood distribution to both hemispheres of the brain and preserve normal morphology of the neurons after prolonged hypothermic circulatory arrest.

MR spectroscopy using multi-ring surface coils

A spatially uniform B(1)-field is preferred for MR imaging and spectroscopy. Unfortunately, volume coils are sometimes unavailable, or do not provide adequate RF power or SNR for some applications. In quantitative MRS, mean metabolite concentration cannot be evaluated when the coil response is nonuniform, unless an assumption is made concerning the metabolite spatial distribution. It is well known that standard single-loop surface coils, although offering high SNR characteristics, have poor B(1) homogeneity. New multi-ring surface coils are proposed which produce a locally uniform B(1) field, with sensitivity and power requirements comparable to those of standard surface coils. MR spectroscopy using two and three-ring versions of this "local volume coil" result in spatial localization essentially identical to that obtained with a volume coil but with much improved RF power and SNR characteristics. When compared to standard surface coils, the multi-ring coil offers much improved water suppression and localization, as well as reduced outer voxel contamination, with only a small loss in SNR and moderate increase in SAR. In summary, the multi-ring coil operates midway between the volume coil and the standard surface coil, retaining the most advantageous properties of both. Magn Reson Med 42:655-664, 1999. Published 1999 Wiley-Liss, Inc.

BOLD MRI of the human cervical spinal cord at 3 tesla

The feasibility of functional MRI of the spinal cord was investigated by carrying out blood oxygen-level dependent (BOLD) imaging of the human cervical spinal cord at a field of 3 T. BOLD imaging of the cervical spinal cord showed an average intensity increase of 7.0% during repeated exercise with the dominant hand with a return to baseline during rest periods. The areas of activation were predominantly on the same side of the spinal cord as the hand performing the exercise, between the levels of the sixth cervical and first thoracic spinal cord segments. The direct correspondence between these areas and those involved with the transmission of motor impulses to the hand, and reception of sensory information from the hand, demonstrates that spinal functional magnetic resonance imaging is feasible. Magn Reson Med 42:571-576, 1999.

Retrograde cerebral perfusion results in flow distribution abnormalities and neuronal damage. A magnetic resonance imaging and histopathological study in pigs

BACKGROUND

In the past few years, although significant efforts have been made to assess flow distribution during retrograde cerebral perfusion with microspheres, dye, or hydrogen clearance, flow distribution in real time is still undefined. We used MR perfusion imaging to monitor flow distribution in the brain during and after deep hypothermic circulatory arrest (DHCA) with antegrade or retrograde cerebral perfusion (ACP or RCP).

METHODS AND RESULTS

Thirteen pigs were divided into 2 groups and exposed to 120 minutes of either RCP (n = 7) or ACP (n = 6) at 15 degrees C, followed by 60 minutes of cardiopulmonary bypass (CPB) at 37 degrees C. During DHCA, the brain was perfused antegradely through the common carotid artery or retrogradely through the superior vena cava at pressures of 60 to 70 mm Hg and 20 to 25 mm Hg in the ACP and RCP groups, respectively. Esophageal temperature was monitored continuously. MR perfusion images were acquired every 30 minutes before, during, and after DHCA. The brain was perfusion-fixed with formaldehyde solution for histopathology at the completion of each experiment. During initial normothermic CPB, MR perfusion imaging showed a nearly uniform distribution of flow in the brain. The same pattern was maintained with a significant increase in regional cerebral blood volume during ACP and reperfusion in the ACP group. RCP provided little or no detectable blood distribution to the brain, resulting in poor reperfusion of many areas of the brain on reflow with CPB at 37 degrees C. The total area suffering poor reperfusion was significantly higher in the RCP group than the ACP group. Histopathology showed no morphological changes in any area of the brain in the ACP group, whereas varying severity of neuronal damage was observed in different regions of the brain in the RCP group.

CONCLUSIONS

ACP preserves uniform blood distribution and normal morphology of brain tissue after prolonged DHCA. RCP provides very little blood to the tissue of the brain. A 120-minute period of RCP results in abnormal flow distribution and neuronal damage during reperfusion. The damage resulting from shorter periods of RCP remains to be assessed.

Flip angle effects in STEAM and PRESS-optimized versus sinc RF pulses

Flip angle dependence of the localized single-voxel 1H NMR spectroscopic sequences STEAM and PRESS using numerically optimized Shinnar-Le Roux (SLR) and conventional sinc RF pulses has been evaluated. Phantom experiments were used to evaluate voxel profiles from MR images of the selected voxels. Information on the total excited volume was recorded from the integrated area under the water peak in the localized spectrum at different flip angles (theta = 0 degrees-180 degrees). The voxel profiles for both the STEAM and PRESS sequences using the SLR RF pulses were found to be identical, unlike the case for the sinc RF pulses. The SLR RF pulses in the PRESS sequence were found to be more sensitive to flip angle variations. Localized, water-suppressed 1H NMR spectra recorded from the frontal gray matter in healthy volunteers (n = 3) showed less lipid contamination using the SLR RF pulses compared with the sinc RF pulses.

Cerebral hypoxia during cardiopulmonary bypass: a magnetic resonance imaging study

BACKGROUND

Neurocognitive deficits after open heart operations have been correlated to jugular venous oxygen desaturation on rewarming from hypothermic cardiopulmonary bypass (CPB). Using a porcine model, we looked for evidence of cerebral hypoxia by magnetic resonance imaging during CPB. Brain oxygenation was assessed by T2*-weighted imaging, based on the blood oxygenation level-dependent effect (decreased T2*-weighted signal intensity with increased tissue concentrations of deoxyhemoglobin).

METHODS

Pigs were placed on normothermic CPB, then cooled to 28 degrees C for 2 hours of hypothermic CPB, then rewarmed to baseline temperature. T2*-weighted, imaging was undertaken before CPB, during normothermic CPB, at 30-minute intervals during hypothermic CPB, after rewarming, and then 15 minutes after death. Imaging was with a Bruker 7.0 Tesla, 40-cm bore magnetic resonance scanner with actively shielded gradient coils. Regions of interest from the magnetic resonance images were analyzed to identify parenchymal hypoxia and correlated with jugular venous oxygen saturation. Post-hoc fuzzy clustering analysis was used to examine spatially distributed regions of interest whose pixels followed similar time courses. Attention was paid to pixels showing decreased T2* signal intensity over time.

RESULTS

T2* signal intensity decreased with rewarming and in five of seven experiments correlated with the decrease in jugular venous oxygen saturation. T2* imaging with fuzzy clustering analysis revealed two diffusely distributed pixel groups during CPB. One large group of pixels (50% +/- 13% of total pixel count) showed increased T2* signal intensity (well-oxygenated tissue) during hypothermia, with decreased intensity on rewarming. Changes in a second group of pixels (34% +/- 8% of total pixel count) showed a progressive decrease in T2* signal intensity, independent of temperature, suggestive of increased brain hypoxia during CPB.

CONCLUSIONS

Decreased T2* signal intensity in a diffuse spatial distribution indicates that a large proportion of cerebral parenchyma is hypoxic (evidenced by an increased proportion of tissue deoxyhemoglobin) during CPB in this porcine model. Neuronal damage secondary to parenchymal hypoxia may explain the postoperative neuropsychological dysfunction after cardiac operations.

Localized 2D J-resolved 1H MR spectroscopy of human brain tumors in vivo

Application of two-dimensional (2D) J-resolved MR spectroscopy, fully localized in three dimensions to monitor the metabolites in human brain tumors in vivo on a whole body MR scanner is presented. A modified PRESS sequence with [90 degrees - 180 degrees - t1/2 - 180 degrees - t1/ 2-acquisition] was used for voxel localization (2D J point-resolved spectroscopy [PRESS]); chemical shift selective (CHESS) sequence was used for suppression of water. The incremental delay (t1/2) added to the intervals before and after the last slice-selective 180 degrees RF pulse allowed the monitoring of the J-evolution in a localized 2D NMR spectrum. The addition of the second frequency dimension in 2D J-resolved spectroscopy to encode the indirect spin-spin coupling allowed the visualization of lactate peaks not observed in the 1D MR spectrum because of severe overlap with lipid peaks. 2D spectra of a two-layer phantom with 100 mM alanine and corn oil and also from three patients with tumors are presented here. The 2D spectra show that the J-coupled lactate peaks could be separated even when the lipids peaks severely overlap.

3D localized 2D NMR spectroscopy on an MRI scanner

Three-dimensionally localized versions of several two-dimensional NMR sequences have been implemented on a 1.5 T whole-body MRI/MRS scanner. In addition to the localization of voxels, the slice-selective RF pulses were also used for refocusing/transfer of various coherences in the 2D NMR sequences. Initial phantom and in vivo human studies are presented here. The sequences were localized versions of 2D J-resolved, 2D zero-quantum, 2D double-quantum, zero-quantum-filtered COSY and SECSY, and double-quantum-filtered COSY and SECSY. Two-dimensional plots for the J-resolved and multiple-quantum sequences are presented for a phantom containing an aqueous solution of 10 mM alanine. Sensitivity of different multiple-quantum-coherence orders to B0 inhomogeneity is discussed. Localized double-quantum-filtered COSY of a phantom containing physiological concentrations of several metabolites also is presented to demonstrate the feasibility of performing this technique within time limits reasonable for human comfort. The first-reported 2D J-resolved 1H in vivo MR spectrum localized in three dimensions in presented here, acquired predominantly from the cerebral white matter of a healthy volunteer and demonstrating the use of localized 2D NMR techniques in vivo.

Localized 2D J-resolved 1H MR spectroscopy: strong coupling effects in vitro and in vivo

A two-dimensional (2D) J-resolved MR spectroscopy sequence (2D J-PRESS), fully localized in three dimensions, has been implemented on a whole-body MR scanner. A modified PRESS sequence with [90 degrees-180 degrees-t1/2-180 degrees-t1/2-acquisition] was used for voxel localization. An incremental delay (t1/2) was added to the intervals before and after the last slice-selective 180 degree RF pulse to monitor the J-evolution in a localized 2D MR spectrum. Spectra were recorded with phantoms containing common cerebral metabolites--alanine, N-acetyl aspartate, glutamine, glutamate, taurine, myo-inositol, glucose, aspartate, GABA, and choline at 50 mM. In conformity with previously reported results, additional cross-peaks due to strong coupling were monitored in many metabolites. A brain phantom was developed to mimic the gray matter of human brain with the metabolites at physiological concentrations (0.5-12 mM). In vivo 2D J-PRESS spectra (n = 18) of healthy human brain were in conformity with those recorded from the brain phantom.

Feasibility study of an electret dosimetry technique

Characteristics of a radiation charged electret dosimeter are described. The dosimeter is based on a parallel-plate ionization chamber with the exception that the collecting electrode is covered by a thin polymer, Teflon or Mylar. During the charging of the dosimeter, ions produced in the sensitive volume by an external radiation source drift in the externally applied electric field and become trapped on the polymer surface forming an electret. Once the external supply is removed, a field across the sensitive volume is produced by the electret charge, such that during any subsequent irradiation, ions opposite in sign to those on the electret surface are attracted to the electret and deplete the charge layer in an amount proportional to the air kerma. The remaining charge on the electret is read by an electrometer, through further irradiation. This technique allows the dosimeter to be simultaneously charged and calibrated, used in the field, simultaneously discharged and read, and reused again in situ without dismantling the dosimeter. Various parameters, however, were considered by direct discharge, rather than by initial exposure and subsequent measurement. Calibration, energy dependence, air kerma range, and reproducibility are discussed, and guard-ring effects on the linearity of the chamber are presented. Measurements of natural charge decay on the electrets are introduced.