Normal Brain and Brain Tumor ADC: Changes Resulting From Variation of Diffusion Time and/or Echo Time in Pulsed-Gradient Spin Echo Diffusion Imaging

OBJECTIVES

Increasing gradient performance on modern magnetic resonance imaging scanners has profoundly reduced the attainable diffusion and echo times for clinically available pulsed-gradient spin echo (PGSE) sequences. This study investigated how this may impact the measured apparent diffusion coefficient (ADC), which is considered an important diagnostic marker for differentiation between normal and abnormal brain tissue and for therapeutic follow-up.

MATERIALS AND METHODS

Diffusion time and echo time dependence of the ADC were evaluated on a high-performance 3 T magnetic resonance imaging scanner. Diffusion PGSE brain scans were performed in 10 healthy volunteers and in 10 brain tumor patients using diffusion times of 16, 40, and 70 ms, echo times of 60, 75, and 104 ms at 3 b-values (0, 100, and 1000 s/mm 2 ), and a maximum gradient amplitude of 68 mT/m. A low gradient performance system was also emulated by reducing the diffusion encoding gradient amplitude to 19 mT/m. In healthy subjects, the ADC was measured in 6 deep gray matter regions and in 6 white matter regions. In patients, the ADC was measured in the solid part of the tumor.

RESULTS

With increasing diffusion time, a small but significant ADC increase of up to 2.5% was observed for 6 aggregate deep gray matter structures. With increasing echo time or reduced gradient performance, a small but significant ADC decrease of up to 2.6% was observed for 6 aggregate white matter structures. In tumors, diffusion time-related ADC changes were inconsistent without clear trend. For tumors with diffusivity above 1.0 μm 2 /ms, with prolonged echo time, there was a pronounced ADC increase of up to 12%. Meanwhile, for tumors with diffusivity at or below 1.0 μm 2 /ms, no change or a reduction was observed. Similar results were observed for gradient performance reduction, with an increase of up to 21%. The coefficient of variation determined in repeat experiments was 2.4%.

CONCLUSIONS

For PGSE and the explored parameter range, normal tissue ADC changes seem negligible. Meanwhile, observed tumor ADC changes can be relevant if ADC is used as a quantitative biomarker and not merely assessed by visual inspection. This highlights the importance of reporting all pertinent timing parameters in ADC studies and of considering these effects when building scan protocols for use in multicenter investigations.

Human prostate MRI at ultrahigh-performance gradient: A feasibility study

PURPOSE

To demonstrate the technical feasibility and the value of ultrahigh-performance gradient in imaging the prostate in a 3T MRI system.

METHODS

In this local institutional review board-approved study, prostate MRI was performed on 4 healthy men. Each subject was scanned in a prototype 3T MRI system with a 42-cm inner-diameter gradient coil that achieves a maximum gradient amplitude of 200 mT/m and slew rate of 500 T/m/s. PI-RADS V2.1-compliant axial T2 -weighted anatomical imaging and single-shot echo planar DWI at standard gradient of 70 mT/m and 150 T/m/s were obtained, followed by DWI at maximum performance (i.e., 200 mT/m and 500 T/m/s). In comparison to state-of-the-art clinical whole-body MRI systems, the high slew rate improved echo spacing from 1020 to 596 μs and, together with a high gradient amplitude for diffusion encoding, TE was reduced from 55 to 36 ms.

RESULTS

In all 4 subjects (waist circumference = 81-91 cm, age = 45-65 years), no peripheral nerve stimulation sensation was reported during DWI. Reduced image distortion in the posterior peripheral zone prostate gland and higher signal intensity, such as in the surrounding muscle of high-gradient DWI, were noted.

CONCLUSION

Human prostate MRI at simultaneously high gradient amplitude of 200 mT/m and slew rate of 500 T/m/s is feasible, demonstrating that improved gradient performance can address image distortion and T2 decay-induced SNR issues for in vivo prostate imaging.

Manual prostate MRI segmentation by readers with different experience: a study of the learning progress

OBJECTIVE

To evaluate the learning progress of less experienced readers in prostate MRI segmentation.

MATERIALS AND METHODS

One hundred bi-parametric prostate MRI scans were retrospectively selected from the Göteborg Prostate Cancer Screening 2 Trial (single center). Nine readers with varying degrees of segmentation experience were involved: one expert radiologist, two experienced radiology residents, two inexperienced radiology residents, and four novices. The task was to segment the whole prostate gland. The expert's segmentations were used as reference. For all other readers except three novices, the 100 MRI scans were divided into five rounds (cases 1-10, 11-25, 26-50, 51-76, 76-100). Three novices segmented only 50 cases (three rounds). After each round, a one-on-one feedback session between the expert and the reader was held, with feedback on systematic errors and potential improvements for the next round. Dice similarity coefficient (DSC) > 0.8 was considered accurate.

RESULTS

Using DSC > 0.8 as the threshold, the novices had a total of 194 accurate segmentations out of 250 (77.6%). The residents had a total of 397/400 (99.2%) accurate segmentations. In round 1, the novices had 19/40 (47.5%) accurate segmentations, in round 2 41/60 (68.3%), and in round 3 84/100 (84.0%) indicating learning progress.

CONCLUSIONS

Radiology residents, regardless of prior experience, showed high segmentation accuracy. Novices showed larger interindividual variation and lower segmentation accuracy than radiology residents. To prepare datasets for artificial intelligence (AI) development, employing radiology residents seems safe and provides a good balance between cost-effectiveness and segmentation accuracy. Employing novices should only be considered on an individual basis.

CLINICAL RELEVANCE STATEMENT

Employing radiology residents for prostate MRI segmentation seems safe and can potentially reduce the workload of expert radiologists. Employing novices should only be considered on an individual basis.

KEY POINTS

• Using less experienced readers for prostate MRI segmentation is cost-effective but may reduce quality. • Radiology residents provided high accuracy segmentations while novices showed large inter-reader variability. • To prepare datasets for AI development, employing radiology residents seems safe and might provide a good balance between cost-effectiveness and segmentation accuracy while novices should only be employed on an individual basis.

Quantitative diffusion MRI in prostate cancer: Image quality, what we can measure and how it improves clinical assessment

Diffusion-weighted imaging is a dependable method for detection of clinically significant prostate cancer. In prostate tissue, there are several compartments that can be distinguished from each other, based on different water diffusion decay signals observed. Alterations in cell architecture, such as a relative increase in tumor infiltration and decrease in stroma, will influence the observed diffusion signal in a voxel due to impeded random motion of water molecules. The amount of restricted diffusion can be assessed quantitatively by measuring the apparent diffusion coefficient (ADC) value. This is traditionally calculated using a monoexponential decay formula represented by the slope of a line produced between the logarithm of signal intensity decay plotted against selected b-values. However, the choice and number of b-values and their distribution, has a significant effect on the measured ADC values. There have been many models that attempt to use higher-order functions to better describe the observed diffusion signal decay, requiring an increased number and range of b-values. While ADC can probe heterogeneity on a macroscopic level, there is a need to optimize advanced diffusion techniques to better interrogate prostate tissue microstructure. This could be of benefit in clinical challenges such as identifying sparse tumors in normal prostate tissue or better defining tumor margins. This paper reviews the principles of diffusion MRI and novel higher order diffusion signal analysis techniques to improve the detection of prostate cancer.

Truly reproducible uniform estimation of the ADC with multi-b diffusion data- Application in prostate diffusion imaging

PURPOSE

The ADC is a well-established parameter for clinical diagnostic applications, but lacks reproducibility because it is also influenced by the choice diffusion weighting level. A framework is evaluated that is based on multi-b measurement over a wider range of diffusion-weighting levels and higher order tissue diffusion modeling with retrospective, fully reproducible ADC calculation.

METHODS

Averaging effect from curve fitting for various model functions at 20 linearly spaced b-values was determined by means of simulations and theoretical calculations. Simulation and patient multi-b image data were used to compare the new approach for diffusion-weighted image and ADC map reconstruction with and without Rician bias correction to an active clinical trial protocol probing three non-zero b-values.

RESULTS

Averaging effect at a certain b-value varies for model function and maximum b-value used. Images and ADC maps from the novel procedure are on-par with the clinical protocol. Higher order modeling and Rician bias correction is feasible, but comes at the cost of longer computation times.

CONCLUSIONS

Application of the new framework makes higher order modeling more feasible in a clinical setting while still providing patient images and reproducible ADC maps of adequate quality.

Brain diffusion MRI with multiplexed sensitivity encoding for reduced distortion in a pediatric patient population

BACKGROUND

Diffusion-weighted imaging (DWI) is a valuable tool for routine imaging of the pediatric brain. However, the commonly used single-shot (ss) echo-planar imaging (EPI) DWI sequence is prone to geometric distortions and T₂*-blurring. This study aimed to investigate in a pediatric population the benefits of using multiplexed sensitivity-encoding (MUSE) without and with reversed polarity gradients (RPG) instead.

METHODS

This retrospective study compared image quality, geometric distortions, and diffusion values between three different approaches for DWI (ssEPI, MUSE, and RPG-MUSE) in 14 patients (median age = 4 (0.6-15) years, 11 males). Distortion levels were quantified and compared in two brain regions, i.e., the brain stem and the temporal lobes, using the Dice Coefficient and the Hausdorff Distance, with T₂-weighted images as reference. Expected geometrical distortion was further evaluated by comparing the effective echo spacing between the DWI sequences. Apparent diffusion coefficient (ADC) values were determined in the genu of the corpus callosum and the optic nerves. Two raters graded overall image quality and image distortions on a Likert scale.

RESULTS

Distortion levels assessed with Dice coefficient and Hausdorff distance were significantly lower for MUSE (p < 0.05) and RPG-MUSE (p < 0.01) compared to ssEPI. No significant difference in ADC values was observed between methods. The RPG-MUSE method was graded by one rater as significantly higher in overall image quality than ssEPI (p < 0.05) and by both raters as significantly lower in levels of image distortions than both MUSE (p < 0.05) and ssEPI (p < 0.05). These results were in agreement with the reduced effective echo spacing was that was attained with MUSE and RPG-MUSE.

CONCLUSION

For imaging of the pediatric brain, MUSE and even more so RPG-MUSE offers both improved geometric fidelity and image quality compared to ssEPI.

A Pilot Study of Multidimensional Diffusion MRI for Assessment of Tissue Heterogeneity in Prostate Cancer

OBJECTIVES

The objectives of this exploratory study were to investigate the feasibility of multidimensional diffusion magnetic resonance imaging (MddMRI) in assessing diffusion heterogeneity at both a macroscopic and microscopic level in prostate cancer (PCa).

MATERIALS AND METHODS

Informed consent was obtained from 46 subjects who underwent 3.0-T prostate multiparametric MRI, complemented with a prototype spin echo-based MddMRI sequence in this institutional review board-approved study. Prostate cancer tumors and comparative normal tissue from each patient were contoured on both apparent diffusion coefficient and MddMRI-derived mean diffusivity (MD) maps (from which microscopic diffusion heterogeneity [MKi] and microscopic diffusion anisotropy were derived) using 3D Slicer. The discriminative ability of MddMRI-derived parameters to differentiate PCa from normal tissue was determined using the Friedman test. To determine if tumor diffusion heterogeneity is similar on macroscopic and microscopic scales, the linear association between SD of MD and mean MKi was estimated using robust regression (bisquare weighting). Hypothesis testing was 2 tailed; P values less than 0.05 were considered statistically significant.

RESULTS

All MddMRI-derived parameters could distinguish tumor from normal tissue in the fixed-effects analysis (P < 0.0001). Tumor MKi was higher (P < 0.05) compared with normal tissue (median, 0.40; interquartile range, 0.29-0.52 vs 0.20-0.18; 0.25), as was tumor microscopic diffusion anisotropy (0.55; 0.36-0.81 vs 0.20-0.15; 0.28). The MKi could not be predicted (no significant association) by SD of MD. There was a significant correlation between tumor volume and SD of MD (R2 = 0.50, slope = 0.008 μm2/ms per millimeter, P < 0.001) but not between tumor volume and MKi.

CONCLUSIONS

This explorative study demonstrates that MddMRI provides novel information on MKi and microscopic anisotropy, which differ from measures at the macroscopic level. MddMRI has the potential to characterize tumor tissue heterogeneity at different spatial scales.

Prostate Cancer Screening with Magnetic Resonance Imaging: Results from the Second Round of the Göteborg Prostate Cancer Screening 2 Trial

BACKGROUND

The Göteborg 2 prostate cancer (PC) screening (G2) trial evaluates screening with prostate-specific antigen (PSA) followed by magnetic resonance imaging (MRI) in case of elevated PSA levels.

OBJECTIVE

To assess the safety of using a 2-yr interval in men who were previously screened positive with PSA but had negative MRI or positive MRI with a negative biopsy.

DESIGN, SETTING, AND PARTICIPANTS

A total of 61 201 men aged 50-60 yr were randomized and 38 366 were invited for screening (years 2015-2020). Men with positive MRI (Prostate Imaging Reporting and Data System [PI-RADS] score ≥3) were scheduled for targeted biopsies. Men with negative MRI or negative biopsies were reinvited after 2 yr. Round 1 and 2 MRI scans (PI-RADS ≥3) of men not diagnosed with PC in round 1 were re-read and classified according to Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) by two radiologists. Interval PCs (detected outside the program before invitation to round 2) were identified by linking to the Regional PC Registry.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Tabulation of overall detection of PC was done.

RESULTS AND LIMITATIONS

Between October 2017 and June 2020, 474 men with round 1 elevated PSA and MRI underwent a second screening. Of those, 19% had nonelevated PSA in round 2 and were not examined further. Of the remaining 376 men, 89% had negative MRI. Targeted biopsies yielded 14 PCs: nine grade group (GG) 1 and five GG 2-3. In men with PI-RADS ≥3 and PC diagnosed in round 2, only two (GG 1) progressed according to the PRECISE criteria and the remainder were stable. Ten interval PCs were diagnosed: seven GG 1, one GG 2, and two GG 5. The two GG 5 PCs were PI-RADS 4 and 5 with negative round 1 biopsy.

CONCLUSIONS

A 2-yr interval seems to be safe in men with negative MRI, while men with PI-RADS 4 and 5 lesions with negative biopsies should have a closer follow-up.

PATIENT SUMMARY

In prostate cancer screening, a 2-yr follow-up seems to be safe if magnetic resonance imaging did not show highly suspicious findings.

Prostate Cancer Diffusion-Weighted Magnetic Resonance Imaging: Does the Choice of Diffusion-Weighting Level Matter?

BACKGROUND

Diffusion-weighted magnetic resonance imaging plays an important role in multiparametric assessment of prostate lesions. The derived apparent diffusion coefficient (ADC) could be a useful quantitative biomarker for malignant growth, but lacks acceptance because of low reproducibility.

PURPOSE

To investigate the impact of the choice of diffusion-weighting levels (b-values) on contrast-to-noise ratio and quantitative measures in prostate diffusion-weighted MRI.

STUDY TYPE

Retrospective and simulation based on published data.

SUBJECTS

Patient cohort (21 men with Prostate Imaging-Reporting and Data System (PI-RADS) version 2 score ≥3) from a single-center study.

FIELD STRENGTH/SEQUENCE

3 T/diffusion-weighted imaging with single-shot echo-planar imaging.

ASSESSMENT

Both clinical data and simulations based on previously acquired data were used to quantify the influence of b-value choice in normal peripheral zone (PZ) and PZ tumor lesions. For clinical data, ADC was determined for different combinations of b-values. Contrast-to-noise ratio and quantitative diffusion measures were simulated for a wide range of b-values.

STATISTICAL TESTS

Tissue ADC and the lesion-to-normal tissue ADC ratios of different b-value combinations were compared with paired two-tailed Student's t-tests. A P-value <0.05 was considered statistically significant.

RESULTS

Findings about b-value dependence derived from clinical data and from simulations agreed with each other. Provided measurement was limited to two b-values, simulation-derived optimal b-value choices coincided with PI-RADSv2 recommendations. For two-point measurements, ADC decreased by 15% when the maximum b-value increased from 1000 to 1500 seconds/mm² , but corresponding lesion-to-normal tissue ADC ratio showed no significant change (P = 0.86 for acquired data). Simulations with three or more measurement points produced ADCs that declined by only 8% over this range of maximum b-value. Corresponding ADC ratios declined between 2.6% (three points) and 3.8% (21 points). Simulations also revealed an ADC reduction of about 19% with the shorter echo and diffusion time evaluated.

DATA CONCLUSION

The comprehensive assessment of b-value dependence permits better formulation of protocol and analysis recommendations for obtaining reproducible results in prostate cancer diffusion-weighted MRI.

LEVEL OF EVIDENCE

4 TECHNICAL EFFICACY: Stage 2.

Validity and reliability of the medial temporal lobe atrophy scale in a memory clinic population

Background

Visual rating of medial temporal lobe atrophy (MTA) is often performed in conjunction with dementia workup. Most prior studies involved patients with known or probable Alzheimer’s disease (AD). This study investigated the validity and reliability of MTA in a memory clinic population.

Methods

MTA was rated in 752 MRI examinations, of which 105 were performed in cognitively healthy participants (CH), 184 in participants with subjective cognitive impairment, 249 in subjects with mild cognitive impairment, and 214 in patients with dementia, including AD, subcortical vascular dementia and mixed dementia. Hippocampal volumes, measured manually or using FreeSurfer, were available in the majority of cases. Intra- and interrater reliability was tested using Cohen’s weighted kappa. Correlation between MTA and quantitative hippocampal measurements was ascertained with Spearman’s rank correlation coefficient. Moreover, diagnostic ability of MTA was assessed with receiver operating characteristic (ROC) analysis and suitable, age-dependent MTA thresholds were determined.

Results

Rater agreement was moderate to substantial. MTA correlation with quantitative volumetric methods ranged from -0.20 (p< 0.05) to -0.68 (p < 0.001) depending on the quantitative method used. Both MTA and FreeSurfer are able to distinguish dementia subgroups from CH. Suggested age-dependent MTA thresholds are 1 for the age group below 75 years and 1.5 for the age group 75 years and older.

Conclusions

MTA can be considered a valid marker of medial temporal lobe atrophy and may thus be valuable in the assessment of patients with cognitive impairment, even in a heterogeneous patient population.

Optimized bias and signal inference in diffusion-weighted image analysis (OBSIDIAN)

PURPOSE

Correction of Rician signal bias in magnitude MR images.

METHODS

A model-based, iterative fitting procedure is used to simultaneously estimate true signal and underlying Gaussian noise with standard deviation σ g on a pixel-by-pixel basis in magnitude MR images. A precomputed function that relates absolute residuals between measured signals and model fit to σ g is used to iteratively estimate σ g . The feasibility of the method is evaluated and compared to maximum likelihood estimation (MLE) for diffusion signal decay simulations and diffusion-weighted images of the prostate considering 21 linearly spaced b-values from 0 to 3000 s/mm² . A multidirectional analysis was performed with publically available brain data.

RESULTS

Model simulations show that the Rician bias correction algorithm is fast, with an accuracy and precision that is on par to model-based MLE and direct fitting in the case of pure Gaussian noise. Increased accuracy in parameter prediction in a low signal-to-noise ratio (SNR) scenario is ideally achieved by using a composite of multiple signal decays from neighboring voxels as input for the algorithm. For patient data, good agreement with high SNR reference data of diffusion in prostate is achieved.

CONCLUSIONS

OBSIDIAN is a novel, alternative, simple to implement approach for rapid Rician bias correction applicable in any case where differences between true signal decay and underlying model function can be considered negligible in comparison to noise. The proposed composite fitting approach permits accurate parameter estimation even in typical clinical scenarios with low SNR, which significantly simplifies comparison of complex diffusion parameters among studies.

Bi- or multiparametric MRI in a sequential screening program for prostate cancer with PSA followed by MRI? Results from the Göteborg prostate cancer screening 2 trial

Objectives

The PIRADS Steering Committee has called for “higher quality data before making evidence-based recommendations on MRI without contrast enhancement as an initial diagnostic work up,” however, recognizing biparametric (bp) MRI as a reasonable option in a low-risk setting such as screening. With bpMRI, more men can undergo MRI at a lower cost and they can be spared the invasiveness of intravenous access. The aim of this study was to assess cancer detection in bpMRI vs mpMRI in sequential screening for prostate cancer (PCa).

Methods

Within the ongoing Göteborg PCa screening 2 trial, we assessed cancer detection in 551 consecutive participants undergoing prostate MRI. In the same session, readers first assessed bpMRI and then mpMRI. Four targeted biopsies were performed for lesions scored PIRADS 3–5 with bpMRI and/or mpMRI.

Results

Cancer was detected in 84/551 cases (15.2%; 95% CI: 12.4–18.4) with mpMRI and in 83/551 cases (15.1%; 95% CI: 12.3–18.2%) with bpMRI. The relative risk (RR) for cancer detection with bpMRI compared to mpMRI was 0.99 (95% one-sided CI: > 94.8); bpMRI was non-inferior to mpMRI (10% non-inferiority margin). bpMRI resulted in fewer false positives, 45/128 (35.2%), compared to mpMRI, 52/136 (38.2%), RR = 0.92; 95% CI: 0.84–0.98. Of 8 lesions scored positive only with mpMRI, 7 were false positives. The PPV for MRI and targeted biopsy was 83/128 (64.8%) for bpMRI and 84/136 (61.8%) for mpMRI, RR = 1.05, 95% CI: 1.01–1.10.

Conclusions

In a PSA-screened population, bpMRI was non-inferior to mpMRI for cancer detection and resulted in fewer false positives.

Key Points

• In screening for prostate cancer with PSA followed by MRI, biparametric MRI allows radiologists to detect an almost similar number of prostate cancers and score fewer false positive lesions compared to multiparametric MRI.

• In a screening program, high sensitivity should be weighed against cost and risks for healthy men; a large number of men can be saved the exposure of gadolinium contrast medium by adopting biparametric MRI and at the same time allowing for a higher turnover in the MRI room.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00330-021-07907-9.

Probing in vivo cortical myeloarchitecture in humans via line-scan diffusion acquisitions at 7 T with 250-500 micron radial resolution

PURPOSE

The goal of this study was to measure diffusion signals within the cerebral cortex using the line-scan technique to achieve extremely high resolution in the radial direction (ie, perpendicular to the cortical surface) and to demonstrate the utility of these measurements for investigating laminar architecture in the living human brain.

METHODS

Line-scan diffusion data with 250-500 micron radial resolution were acquired at 7 T on 8 healthy volunteers, with each line prescribed perpendicularly to primary somatosensory cortex (S1) and primary motor cortex (M1). Apparent diffusion coefficients, fractional anisotropy values, and radiality indices were measured as a function of cortical depth.

RESULTS

In the deep layers of S1, we found evidence for high anisotropy and predominantly tangential diffusion, with low anisotropy observed in superficial S1. In M1, moderate anisotropy and predominantly radial diffusion was seen at almost all cortical depths. These patterns were consistent across subjects and were conspicuous without averaging data across different locations on the cortical sheet.

CONCLUSION

Our results are in accord with the myeloarchitecture of S1 and M1, known from prior histology studies: in S1, dense bands of tangential myelinated fibers run through the deep layers but not the superficial ones, and in M1, radial myelinated fibers are prominent at most cortical depths. This work therefore provides support for the idea that high-resolution diffusion signals, measured with the line-scan technique and receiving a boost in SNR at 7 T, may serve as a sensitive probe of in vivo laminar architecture.

Improved spatial localization in magnetic resonance spectroscopic imaging with two-dimensional PSF-Choice encoding

PURPOSE

Magnetic resonance spectroscopic imaging (MRSI), under low-spatial resolution settings, often suffers signal contamination from neighboring voxels due to ringing artifacts. Spatial localization can be improved by constraining the point-spread-function (PSF). Here the effectiveness of the two-dimensional PSF-Choice technique in providing improved spatial localization for MRSI is demonstrated.

THEORY AND METHODS

The PSF-Choice technique constrains the PSF to a desired shape by manipulating the weighting of RF excitation pulse throughout phase-encode steps. Based on a Point REsolved SpectroScopy (PRESS)-type sequence, PSF-Choice encoding was implemented along two dimensions to excite a two-dimensional Gaussian profile, by replacing the usual RF excitation pulse with a train of pulses that is modified at each phase-encoding step. The method was proven mathematically, and demonstrated experimentally in phantoms containing prostate relevant metabolic compounds of choline, creatine and citrate.

RESULTS

Using a dedicated prostate-mimicking spectroscopy phantom surrounded by oil, it was found that there is significantly less signal contamination from oil for PSF-Choice encoding compared with standard phase encoding. In particular, with standard phase encoding, there was a significant difference (p = 0.014) between ratios of Choline + Creatine to Citrate for voxels well within the phantom compared to voxels within the phantom but near the boundary with oil. The ratios in boundary voxels were also significantly different (p = 0.035) from reference values obtained using the prostate phantom with no oil present. In contrast, no significant differences were found in comparisons of these ratios when encoding with PSF-Choice.

CONCLUSION

The PSF-Choice scheme applied along two dimensions produces MR spectroscopic images with substantially reduced truncation artifacts and spectral contamination.

Evaluation of fitting models for prostate tissue characterization using extended-range b-factor diffusion-weighted imaging

PURPOSE

To compare the fitting and tissue discrimination performance of biexponential, kurtosis, stretched exponential, and gamma distribution models for high b-factor diffusion-weighted images in prostate cancer.

METHODS

Diffusion-weighted images with 15 b-factors ranging from b = 0 to 3500 s/mm² were obtained in 62 prostate cancer patients. Pixel-wise signal decay fits for each model were evaluated with the Akaike Information Criterion (AIC). Parameter values for each model were determined within normal prostate and the index lesion. Their potential to differentiate normal from cancerous tissue was investigated through receiver operating characteristic analysis and comparison with Gleason score.

RESULTS

The biexponential slow diffusion fraction f_slow , the apparent kurtosis diffusion coefficient ADC_K , and the excess kurtosis factor K differ significantly among normal peripheral zone (PZ), normal transition zone (TZ), tumor PZ, and tumor TZ. Biexponential and gamma distribution models result in the lowest AIC, indicating a superior fit. Maximum areas under the curve (AUCs) of all models ranged from 0.93 to 0.96 for the PZ and from 0.95 to 0.97 for the TZ. Similar AUCs also result from the apparent diffusion coefficient (ADC) of a monoexponential fit to a b-factor sub-range up to 1250 s/mm² . For kurtosis and stretched exponential models, single parameters yield the highest AUCs, whereas for the biexponential and gamma distribution models, linear combinations of parameters produce the highest AUCs. Parameters with high AUC show a trend in differentiating low from high Gleason score, whereas parameters with low AUC show no such ability.

CONCLUSION

All models, including a monoexponential fit to a lower-b sub-range, achieve similar AUCs for discrimination of normal and cancer tissue. The biexponential model, which is favored statistically, also appears to provide insight into disease-related microstructural changes. Magn Reson Med 79:2346-2358, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Fast diffusion imaging with high angular resolution

PURPOSE

High angular resolution diffusion imaging (HARDI) is a well-established method to help reveal the architecture of nerve bundles, but long scan times and geometric distortions inherent to echo planar imaging (EPI) have limited its integration into clinical protocols.

METHODS

A fast imaging method is proposed here that combines accelerated multishot diffusion imaging (AMDI), multiplexed sensitivity encoding (MUSE), and crossing fiber angular resolution of intravoxel structure (CFARI) to reduce spatial distortions and reduce total scan time. A multishot EPI sequence was used to improve geometrical fidelity as compared to a single-shot EPI acquisition, and acceleration in both k-space and diffusion sampling enabled reductions in scan time. The method is regularized and self-navigated for motion correction. Seven volunteers were scanned in this study, including four with volumetric whole brain acquisitions.

RESULTS

The average similarity of microstructural orientations between undersampled datasets and their fully sampled counterparts was above 85%, with scan times below 5 min for whole-brain acquisitions. Up to 2.7-fold scan time acceleration along with four-fold distortion reduction was achieved.

CONCLUSION

The proposed imaging strategy can generate HARDI results with relatively good geometrical fidelity and low scan duration, which may help facilitate the transition of HARDI from a successful research tool to a practical clinical one. Magn Reson Med 77:696-706, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Segmented diffusion-weighted imaging of the prostate: Application to transperineal in-bore 3T MR image-guided targeted biopsy

OBJECTIVE

This study aims to evaluate the applicability of using single-shot and multi-shot segmented diffusion-weighted imaging (DWI) techniques to support biopsy target localization in a cohort of targeted MRI-guided prostate biopsy patients.

MATERIALS AND METHODS

Single-shot echo-planar diffusion-weighted imaging (SS-DWI) and multi-shot segmented (MS-DWI) were performed intra-procedurally on a 3Tesla system in a total of 35 men, who underwent in-bore prostate biopsy inside the scanner bore. Comparisons between SS-DWI and MS-DWI were performed with (in 16 men) and without (in 19 men) parallel coil acceleration (iPAT) for SS-DWI. Overall image quality and artifacts were scored by a radiologist and scores were compared with the Wilcoxon-Mann-Whitney rank test. Correlation between the presence of air and image quality scores was evaluated with Spearman statistics. To quantify distortion, the anteroposterior prostate dimension was measured in SS and MS b=0 diffusion- and T2-weighted images. Signal-to-noise ratio was estimated in a phantom experiment. Agreement and accuracy of targeting based on retrospective localization of restricted diffusion areas in DWI was evaluated with respect to the targets identified using multi-parametric MRI (mpMRI).

RESULTS

Compared to SS-DWI without iPAT, the average image quality score in MS-DWI improved from 2.0 to 3.3 (p<0.005) and the artifact score improved from 2.3 to 1.4 (p<0.005). When iPAT was used in SS-DWI, the average image quality score in MS-DWI improved from 2.6 to 3.3 (p<0.05) and the artifact score improved from 2.1 to 1.4 (p<0.01). Image quality (ρ=-0.74, p<0.0005) and artifact scores (ρ=0.77, p<0.0005) both showed strong correlation with the presence of air in the rectum for the SS-DWI sequence without iPAT. These correlations remained significant when iPAT was enabled (ρ=-0.52, p<0.05 and ρ=0.64, p<0.01). For the comparison MS-DWI vs SS-DWI without iPAT, median differences between diffusion- and T2-weighted image gland measurements were 1.1(0.03-10.4)mm and 4.4(0.5-22.7)mm, respectively. In the SS-DWI-iPAT cohort, median gland dimension differences were 2.7(0.4-5.9)mm and 4.2(0.7-8.9)mm, respectively. Out of the total of 89 targets identified in mpMRI, 20 had corresponding restricted diffusion areas in SS-DWI and 28 in MS-DWI. No statistically significant difference was observed between the distances for the targets in the target-concordant SS- and MS-DWI restricted diffusion areas (5.5mm in SS-DWI vs 4.5mm in MS-DWI, p>0.05).

CONCLUSIONS

MS-DWI applied to prostate imaging leads to a significant reduction of image distortion in comparison with SS-DWI. There is no sufficient evidence however to suggest that intra-procedural DWI can serve as a replacement for tracking of the targets identified in mpMRI for the purposes of targeted MRI-guided prostate biopsy.

Three-dimensional printing of MRI-visible phantoms and MR image-guided therapy simulation

PURPOSE

To demonstrate the use of anatomic MRI-visible three-dimensional (3D)-printed phantoms and to assess process accuracy and material MR signal properties.

METHODS

A cervical spine model was generated from computed tomography (CT) data and 3D-printed using an MR signal-generating material. Printed phantom accuracy and signal characteristics were assessed using 120 kVp CT and 3 Tesla (T) MR imaging. The MR relaxation rates and diffusion coefficient of the fabricated phantom were measured and ¹ H spectra were acquired to provide insight into the nature of the proton signal. Finally, T₂ -weighted imaging was performed during cryoablation of the model.

RESULTS

The printed model produced a CT signal of 102 ± 8 Hounsfield unit, and an MR signal roughly 1/3^rd that of saline in short echo time/short repetition time GRE MRI (456 ± 36 versus 1526 ± 121 arbitrary signal units). Compared with the model designed from the in vivo CT scan, the printed model differed by 0.13 ± 0.11 mm in CT, and 0.62 ± 0.28 mm in MR. The printed material had T₂ ∼32 ms, T2*∼7 ms, T₁ ∼193 ms, and a very small diffusion coefficient less than olive oil. MRI monitoring of the cryoablation demonstrated iceball formation similar to an in vivo procedure.

CONCLUSION

Current 3D printing technology can be used to print anatomically accurate phantoms that can be imaged by both CT and MRI. Such models can be used to simulate MRI-guided interventions such as cryosurgeries. Future development of the proposed technique can potentially lead to printed models that depict different tissues and anatomical structures with different MR signal characteristics. Magn Reson Med 77:613-622, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Multicomponent T2 relaxation studies of the avian egg

PURPOSE

To investigate the tissue-like multiexponential T2 signal decays in avian eggs.

METHODS

Transverse relaxation studies of raw, soft-boiled and hard-boiled eggs were performed at 3 Tesla using a three-dimensional Carr-Purcell-Meiboom-Gill imaging sequence. Signal decays over a TE range of 11 to 354 ms were fitted assuming single- and multicomponent signal decays with up to three separately decaying components. Fat saturation was used to facilitate spectral assignment of observed decay components.

RESULTS

Egg white, yolk and the centrally located latebra all demonstrate nonmonoexponential T2 decays. Specifically, egg white exhibits two-component decays with intermediate and long T2 times. Meanwhile, yolk and latebra are generally best characterized with triexponential decays, with short, intermediate and very long T2 decay times. Fat saturation revealed that the intermediate component of yolk could be attributed to lipids. Cooking of the egg profoundly altered the decay curves.

CONCLUSION

Avian egg T2 decay curves cover a wide range of decay times. Observed T2 components in yolk and latebra as short as 10 ms, may prove valuable for testing clinical sequences designed to measure short T2 components, such as myelin-associated water in the brain. Thus we propose that the egg can be a versatile and widely available MR transverse relaxation phantom.

Prostate cancer discrimination in the peripheral zone with a reduced field-of-view T(2)-mapping MRI sequence

OBJECTIVES

To evaluate the performance of T2 mapping in discriminating prostate cancer from normal prostate tissue in the peripheral zone using a practical reduced field-of-view MRI sequence requiring less than 3 minutes of scan time.

MATERIALS AND METHODS

Thirty-six patients with biopsy-proven peripheral zone prostate cancer without prior treatment underwent routine multiparametric MRI at 3.0T with an endorectal coil. An Inner-Volume Carr-Purcell-Meiboom-Gill imaging sequence that required 2.8 minutes to obtain data for quantitative T2 mapping covering the entire prostate gland was added to the routine multiparametric protocol. Suspected cancer (SC) and suspected healthy (SH) tissue in the peripheral zone were identified in consensus by three radiologists and were correlated with available biopsy results. Differences in mean T2 values in SC and SH regions-of-interest (ROIs) were tested for significance using unpaired Student's two-tailed t-test. The area under the receiver operating characteristic curve was used to assess the optimal threshold T2 value for cancer discrimination.

RESULTS

ROI analyses revealed significantly (p<0.0001) shorter T2 values in SC (85.4±12.3ms) compared to SH (169.6±38.7ms). An estimated T2 threshold of 99ms yielded a sensitivity of 92% and a specificity of 97% for prostate cancer discrimination.

CONCLUSIONS

Quantitative values derived from this clinically practical T2-mapping sequence allow high precision discrimination between healthy and cancerous peripheral zone in the prostate.

Multiparametric MRI of prostate cancer: an update on state-of-the-art techniques and their performance in detecting and localizing prostate cancer

Magnetic resonance (MR) examinations of men with prostate cancer are most commonly performed for detecting, characterizing, and staging the extent of disease to best determine diagnostic or treatment strategies, which range from biopsy guidance to active surveillance to radical prostatectomy. Given both the exam's importance to individual treatment plans and the time constraints present for its operation at most institutions, it is essential to perform the study effectively and efficiently. This article reviews the most commonly employed modern techniques for prostate cancer MR examinations, exploring the relevant signal characteristics from the different methods discussed and relating them to intrinsic prostate tissue properties. Also, a review of recent articles using these methods to enhance clinical interpretation and assess clinical performance is provided. J. Magn. Reson. Imaging 2013;37:1035-1054. © 2013 Wiley Periodicals, Inc.

Avian egg latebra as brain tissue water diffusion model

PURPOSE

Simplified models of non-monoexponential diffusion signal decay are of great interest to study the basic constituents of complex diffusion behavior in tissues. The latebra, a unique structure uniformly present in the yolk of avian eggs, exhibits a non-monoexponential diffusion signal decay. This model is more complex than simple phantoms based on differences between water and lipid diffusion, but is also devoid of microscopic structures with preferential orientation or perfusion effects.

METHODS

Diffusion scans with multiple b-values were performed on a clinical 3 Tesla system in raw and boiled chicken eggs equilibrated to room temperature. Diffusion encoding was applied over the ranges 5-5,000 and 5-50,000 s/mm(2). A low read-out bandwidth and chemical shift was used for reliable lipid/water separation. Signal decays were fitted with exponential functions.

RESULTS

The latebra, when measured over the 5-5,000 s/mm(2) range, exhibited independent of preparation clearly biexponential diffusion, with diffusion parameters similar to those typically observed in in vivo human brain. For the range 5-50,000 s/mm(2), there was evidence of a small third, very slow diffusing water component.

CONCLUSION

The latebra of the avian egg contains membrane structures, which may explain a deviation from a simple monoexponential diffusion signal decay, which is remarkably similar to the deviation observed in brain tissue.

Accelerated multi-shot diffusion imaging

PURPOSE

To reduce image distortion in MR diffusion imaging using an accelerated multi-shot method.

METHODS

The proposed method exploits the fact that diffusion-encoded data tend to be sparse when represented in the kb-kd space, where kb and kd are the Fourier transform duals of b and d, the b-factor and the diffusion direction, respectively. Aliasing artifacts are displaced toward under-used regions of the kb-kd plane, allowing nonaliased signals to be recovered. A main characteristic of the proposed approach is how thoroughly the navigator information gets used during reconstruction: The phase of navigator images is used for motion correction, while the magnitude of the navigator signal in kb-kd space is used for regularization purposes. As opposed to most acceleration methods based on compressed sensing, the proposed method reduces the number of ky lines needed for each diffusion-encoded image, but not the total number of images required. Consequently, it tends to be most effective at reducing image distortion rather than reducing total scan time.

RESULTS

Results are presented for three volunteers with acceleration factors ranging from 4 to 8, with and without the inclusion of parallel imaging.

CONCLUSION

An accelerated motion-corrected diffusion imaging method was introduced that achieves good image quality at relatively high acceleration factors.

Restricted diffusion in spinal cord infarction demonstrated by magnetic resonance line scan diffusion imaging

BACKGROUND AND PURPOSE

We report on the use of line scan diffusion magnetic resonance imaging in the evaluation of spinal cord infarctions.

METHODS

Data on 19 patients with clinical findings consistent with spinal cord infarctions and abnormal findings on line scan diffusion imaging were reviewed. The Apparent Diffusion Coefficient (ADC) measurements for the normal spinal cord and for the areas of abnormality were calculated from trace ADC maps.

RESULTS

Restricted diffusion was found in all 19 patients. Absolute ADC values in the ischemic area ranged between 395.4 and 575.8 × 10(-6) mm(2)/s, with ADC ratios ranging between 39.4% and 57.4%.

CONCLUSIONS

Line scan diffusion imaging is technically feasible and appears to be a reliable method to diagnose spinal cord infarction in the acute setting.

Forensic application of postmortem diffusion-weighted and diffusion tensor MR imaging of the human brain in situ

BACKGROUND AND PURPOSE

DWI and DTI of the brain have proved to be useful in many neurologic disorders and in traumatic brain injury. This prospective study aimed at the evaluation of the influence of the PMI and the cause of death on the ADC and FA for the application of DWI and DTI in forensic radiology.

MATERIALS AND METHODS

DWI and DTI of the brain were performed in situ in 20 deceased subjects with mapping of the ADC and FA. Evaluation was performed in different ROIs, and the influence of PMI and cause of death was assessed.

RESULTS

Postmortem ADC values of the brain were decreased by 49%-72% compared with healthy living controls. With increasing PMI, ADCs were significantly reduced when considering all ROIs together and, particularly, GM regions (all regions, P < .05; GM, P < .01), whereas there was no significant effect in WM. Concerning the cause of death, ADCs were significantly lower in mechanical and hypoxic brain injury than in brains from subjects having died from heart failure (traumatic brain injury, P < .005; hypoxia, P < .001). Postmortem FA was not significantly different from FA in living persons and showed no significant influence of PMI or cause of death.

CONCLUSIONS

Performing postmortem DWI and DTI of the brain in situ can provide valuable information for application in forensic medicine. ADC could be used as an indicator of PMI and could help in the assessment of the cause of death.

Pixel-based comparison of spinal cord MR diffusion anisotropy with axon packing parameters

Water diffusion in nerve fibers is strongly influenced by axon architecture. In this study, fractional diffusion anisotropy and transverse and longitudinal diffusion coefficients were measured in excised human cervical spinal cord with MR line-scan diffusion imaging, at 625 microm in-plane resolution and 3 mm slice thickness. A pixel-based comparison of fractional diffusion anisotropy, transverse diffusion coefficient, and longitudinal diffusion coefficient data with axon packing parameters derived from corresponding stained histological sections was performed for four slices. The axon packing parameters, axon density, axon area-fraction, and average axon size for entire specimen cross-sections were calculated by computerized segmentation of optical microscopy data obtained at 0.53 microm resolution. Salient features could be recognized on fractional diffusion anisotropy, transverse diffusion coefficient, axon density, axon area fraction, and average axon size maps. For white matter regions only, the average correlation coefficients for fractional diffusion anisotropy compared to histology-based parameters axon density and axon area fraction were 0.37 and 0.21, respectively. For transverse diffusion coefficient compared to axon density and axon area fraction, they were -0.40 and -0.36, and for longitudinal diffusion coefficient compared to axon density and axon area fraction, -0.14 and -0.30. All average correlation coefficients for average axon size were low. Correlation coefficients for collectively analyzed white and gray matter regions were significantly higher than correlation coefficients derived from analysis of white matter regions only.

Diffusion imaging of brain tumors

MRI offers a tremendous armamentarium of different methods that can be employed in brain tumor characterization. MR diffusion imaging has become a widely accepted method to probe for the presence of fluid pools and molecular tissue water mobility. For most clinical applications of diffusion imaging, it is assumed that the diffusion signal vs diffusion weighting factor b decays monoexponentially. Within this framework, the measurement of a single diffusion coefficient in brain tumors permits an approximate categorization of tumor type and, for some tumors, definitive diagnosis. In most brain tumors, when compared with normal brain tissue, the diffusion coefficient is elevated. The presence of peritumoral edema, which also exhibits an elevated diffusion coefficient, often precludes the delineation of the tumor on the basis of diffusion information alone. Serially obtained diffusion data are useful to document and even predict the cellular response to drug or radiation therapy. Diffusion measurements in tissues over an extended range of b factors have clearly shown that the monoparametric description of the MR diffusion signal decay is incomplete. Very high diffusion weighting on clinical systems requires substantial compromise in spatial resolution. However, after suitable analysis, superior separation of malignant brain tumors, peritumoral edema and normal brain tissue can be achieved. These findings are also discussed in the light of tissue-specific differences in membrane structure and the restrictions exerted by membranes on diffusion. Finally, measurement of the directional dependence of diffusion permits the assessment of white matter integrity and dislocation. Such information, particularly in conjunction with advanced post-processing, is considered to be immensely useful for therapy planning. Diffusion imaging, which permits monoexponential analysis and provides directional diffusion information, is performed routinely in brain tumor patients. More advanced methods require improvement in acquisition speed and spatial resolution to gain clinical acceptance.

On high b diffusion imaging in the human brain: ruminations and experimental insights

Interest in the manner in which brain tissue signal decays with b factor in diffusion imaging schemes has grown in recent years following the observation that the decay curves depart from purely monoexponential decay behavior. Regardless of the model or fitting function proposed for characterizing sufficiently sampled decay curves (vide infra), the departure from monoexponentiality spells increased tissue characterization potential. The degree to which this potential can be harnessed to improve specificity, sensitivity and spatial localization of diseases in brain, and other tissues, largely remains to be explored. Furthermore, the degree to which currently popular diffusion tensor imaging methods, including visually impressive white matter fiber "tractography" results, have almost completely ignored the nonmonoexponential nature of the basic signal decay with b factor is worthy of communal introspection. Here we limit our attention to a review of the basic experimental features associated with brain water signal diffusion decay curves as measured over extended b-factor ranges, the simple few parameter fitting functions that have been proposed to characterize these decays and the more involved models, e.g.,"ruminations," which have been proposed to account for the nonmonoexponentiality to date.

Convection-enhanced drug delivery of interleukin-4 Pseudomonas exotoxin (PRX321): increased distribution and magnetic resonance monitoring

Convection-enhanced drug delivery (CED) enables achieving a drug concentration within brain tissue and brain tumors that is orders of magnitude higher than by systemic administration. Previous phase I/II clinical trials using intratumoral convection of interleukin-4 Pseudomonas exotoxin (PRX321) have demonstrated an acceptable safety and toxicity profile with promising signs of therapeutic activity. The present study was designed to assess the distribution efficiency and toxicity of this PRX321 using magnetic resonance imaging (MRI) and to test whether reformulation with increased viscosity could enhance drug distribution. Convection of low- [0.02% human serum albumin (HSA)] and high-viscosity (3% HSA) infusates mixed with gadolinium-diethylenetriamine pentaacetic acid and PRX321 were compared with low- and high-viscosity infusates without the drug, in normal rat brains. MRI was used for assessment of drug distribution and detection of early and late toxicity. Representative brain samples were subjected to histological examination. Distribution volumes calculated from the magnetic resonance images showed that the average distribution of 0.02% HSA was larger than that of 0.02% HSA with PRX321 by a factor of 1.98 (p < 0.02). CED of 3.0% HSA, with or without PRX321, tripled the volume of distribution compared with 0.02% HSA with PRX321 (p < 0.015). No drug-related toxicity was detected. These results suggest that the impeded convection of the PRX321 infusate used in previous clinical trials can be reversed by increasing infusate viscosity and lead to tripling of the volume of distribution. This effect was not associated with any detectable toxicity. A similar capability to reverse impeded convection was also demonstrated in a CED model using acetic acid. These results will be implemented in an upcoming phase IIb PRX321 CED trial with a high-viscosity infusate.

MRI-based thermal dosimetry and diffusion-weighted imaging of MRI-guided focused ultrasound thermal ablation of uterine fibroids

PURPOSE

To investigate tissue changes observed in diffusion-weighted imaging (DWI) and its relation to contrast imaging, thermal dosimetry, and changes in the apparent diffusion coefficient (ADC) after MRI-guided focused ultrasound surgery (MRgFUS) of uterine fibroids.

MATERIALS AND METHODS

Imaging data were analyzed from 45 fibroids in 42 women treated with MRgFUS. The areas of the hyperintense regions in DWI and of nonperfused regions in T1-weighted contrast enhanced imaging (both acquired immediately after treatment) were compared with each other and to thermal dosimetry based estimates. Changes in ADC were also calculated.

RESULTS

Hyperintense regions were observed in 35/45 fibroids in DWI. When present, the areas of these regions were comparable on average to the thermal dose estimates and to the nonperfused regions, except for in several large treatments in which the nonperfused region extended beyond the treated area. ADC increased in 19 fibroids and decreased in the others.

CONCLUSION

DWI changes, which includes changes in both in T2 and ADC, may be useful in many cases to delineate the treated region resulting from MRgFUS. However, clear DWI changes were not always observed, and in some large treatments, the extent of the nonperfused region was under estimated. ADC changes immediately after MRgFUS were unpredictable.

Magnetic resonance acoustic radiation force imaging

Acoustic radiation force impulse imaging is an elastography method developed for ultrasound imaging that maps displacements produced by focused ultrasound pulses systematically applied to different locations. The resulting images are "stiffness weighted" and yield information about local mechanical tissue properties. Here, the feasibility of magnetic resonance acoustic radiation force imaging (MR-ARFI) was tested. Quasistatic MR elastography was used to measure focal displacements using a one-dimensional MRI pulse sequence. A 1.63 or 1.5 MHz transducer supplied ultrasound pulses which were triggered by the magnetic resonance imaging hardware to occur before a displacement-encoding gradient. Displacements in and around the focus were mapped in a tissue-mimicking phantom and in an ex vivo bovine kidney. They were readily observed and increased linearly with acoustic power in the phantom (R2=0.99). At higher acoustic power levels, the displacement substantially increased and was associated with irreversible changes in the phantom. At these levels, transverse displacement components could also be detected. Displacements in the kidney were also observed and increased after thermal ablation. While the measurements need validation, the authors have demonstrated the feasibility of detecting small displacements induced by low-power ultrasound pulses using an efficient magnetic resonance imaging pulse sequence that is compatible with tracking of a dynamically steered ultrasound focal spot, and that the displacement increases with acoustic power. MR-ARFI has potential for elastography or to guide ultrasound therapies that use low-power pulsed ultrasound exposures, such as drug delivery.

Biexponential analysis of diffusion-related signal decay in normal human cortical and deep gray matter

Diffusion imaging with high-b factors, high spatial resolution and cerebrospinal fluid signal suppression was performed in order to characterize the biexponential nature of the diffusion-related signal decay with b-factor in normal cortical gray and deep gray matter (GM). Integration of inversion pulses with a line scan diffusion imaging sequence resulted in 91% cerebrospinal fluid signal suppression, permitting accurate measurement of the fast diffusion coefficient in cortical GM (1.142+/-0.106 microm2/ms) and revealing a marked similarity with that found in frontal white matter (WM) (1.155+/-0.046 microm2/ms). The reversal of contrast between GM and WM at low vs high b-factors is shown to be due to a significantly faster slow diffusion coefficient in cortical GM (0.338+/-0.027 microm2/ms) than in frontal WM (0.125+/-0.014 microm2/ms). The same characteristic diffusion differences between GM and WM are observed in other brain tissue structures. The relative component size showed nonsignificant differences among all tissues investigated. Cellular architecture in GM and WM are fundamentally different and may explain the two- to threefold higher slow diffusion coefficient in GM.

Apparent diffusion coefficient of subcutaneous epidermal cysts in the head and neck comparison with intracranial epidermoid cysts

RATIONALE AND OBJECTIVES

Subcutaneous epidermal cysts and intracranial epidermoid cysts are pathologically identical. Although diffusion-weighted imaging (DWI) studies of intracranial epidermoid cysts have been numerously reported, those of subcutaneous epidermal cysts have not been sufficiently investigated. Our hypothesis for this study is that the apparent diffusion coefficient (ADC) values of subcutaneous epidermal cysts and intracranial epidermoid cysts are not different. This study was intended to evaluate the ADC of subcutaneous epidermal cysts of the head and neck in comparison with that of intracranial epidermoid cysts.

MATERIALS AND METHODS

The MR studies were performed in 14 patients with head and neck subcutaneous epidermal cysts and 10 patients with intracranial epidermoid cysts using line scan DWI (LSDWI). The ADC was measured and compared between the two types of cyst.

RESULTS

The ADC values (mean +/- SD) were 0.81 +/- 0.14 x 10(-3) mm(2)/s in subcutaneous epidermal cysts and 1.06 +/- 0.12 x 10(-3) mm(2)/s in intracranial epidermoid cysts. A significant difference was found in ADC values between the two types (P = .0019).

CONCLUSION

Our preliminary study has shown that the ADC provides useful information regarding tissue characterization of subcutaneous epidermal cysts. However, the ADC of subcutaneous epidermal cysts was significantly lower than that of intracranial epidermoid cysts.

Soft-tissue tumors evaluated by line-scan diffusion-weighted imaging: influence of myxoid matrix on the apparent diffusion coefficient

PURPOSE

To compare the apparent diffusion coefficients (ADCs) of myxoid and nonmyxoid soft-tissue tumors using line-scan diffusion-weighted imaging (LSDWI), and to investigate the myxoid matrix influence on ADCs of soft-tissue tumors.

MATERIALS AND METHODS

This study enrolled 44 patients with soft tissue tumors. They were divided into two groups: one with myxoid-containing soft-tissue tumors (N = 23) and the other with nonmyxoid soft-tissue tumors (N = 21). The 44 patients were also classified histologically into 26 with malignant soft-tissue tumors and 18 with benign soft-tissue tumors. LSDWI was performed using b values of 5 and 1000 second/mm(2). The ADCs of the tumors were calculated and compared for myxoid and nonmyxoid tumors and for benign and malignant tumors.

RESULTS

The ADC (mean +/- SD) was 1.92 +/- 0.41 x 10(-3) mm(2)/second in myxoid containing tumors, whereas the ADC was 0.97 +/- 0.33 x 10(-3) mm(2)/second in nonmyxoid tumors. The ADCs of the myxoid and nonmyxoid tumors were significantly different (P < 0.01). The ADCs were 1.45 +/- 0.59 x 10(-3) mm(2)/second in malignant tumors and 1.50 +/- 0.64 x 10(-3) mm(2)/second in benign tumors. The ADCs of benign and malignant soft-tissue tumors were not significantly different.

CONCLUSION

The ADCs of myxoid-containing soft-tissue tumors were significantly higher than those of nonmyxoid soft-tissue tumors. The myxoid matrix influences ADCs of both benign and malignant soft-tissue tumors.

Examination of spinal cord tissue architecture with magnetic resonance diffusion tensor imaging

Magnetic resonance diffusion tensor imaging yields images with detailed information about tissue water diffusion. Diffusion-weighted imaging of the human spinal cord requires dedicated magnetic resonance pulse sequences that minimize the effects of subject motion, distortions, and artifacts from lipids and CSF flow. These problems are accentuated by the anatomic properties of the spinal cord (i.e., a small cross-sectional dimension and a location deep inside the body). The diffusion tensor (a simplified model for complex diffusion in structured tissues) can be estimated for each image pixel by measuring diffusion along a minimum of six independent directions. It can then be used to derive mean diffusivity, diffusion anisotropy, and the dominant orientation of the diffusion process. The observation that diffusion along nerve fibers is much higher than across fibers, allows a noninvasive reconstruction of the spinal cord nerve fiber architecture. This includes not only the primary cranio-caudad running connections, but also secondary, transverse running collateral fibers. With fiber tracking, the pixel-based diffusion information can be integrated to obtain a three-dimensional view of axonal fiber connectivity between the spinal cord and different brain regions. The development and myelination during infancy and early childhood is reflected in a gradual decrease of mean diffusivity and increase in anisotropy. There are several diseases that lead to either local or general changes in spinal cord water diffusion. For therapy research, such changes can be studied noninvasively and repeatedly in animal models.

Quantification of water compartmentation in cell suspensions by diffusion-weighted and T(2)-weighted MRI

When studying water diffusion in biological systems, any specific signal attenuation curve may be reproduced by a broad range of mathematical functions. Our goals were to quantify the diffusion and T(2) relaxation properties of water in a simple biological system and to study the changes that occur in osmotically stressed cells. Human breast cancer cells were incubated in isotonic or hypotonic osmotic buffers. Diffusion-weighted and T(2)-weighted magnetic resonance images were acquired during sedimentation over 12 h. Diffusion-weighted imaging (DWI) data were analyzed with a biexponential fit, the Kärger model for exchange between two freely diffusing populations and the Price-modified Kärger model accounting for restricted diffusion in spherical geometry. We found that only the Price model provided an accurate quantitative description for water diffusion in both cell systems, independent of acquisition parameters, over the entire density range. Model-derived cell radii, intracellular volume fractions and transmembrane water exchange times were in good agreement with results calculated from light microscopy and with model-free exchange times. T(2) data indicated two populations in fast exchange, with volume fractions clearly different from DWI populations. Hypotonic stress led to higher slow apparent diffusion coefficient, longer T(2) and lower membrane permeability. The tortuosity in a hypotonic cell suspension complied with the Wang model for spherical geometry. Quantitative characterization of biological systems is obtainable by DWI, using appropriate modeling, accounting for water restriction and exchange between compartments.

Complimentary aspects of diffusion imaging and fMRI: II. Elucidating contributions to the fMRI signal with diffusion sensitization

Tissue water molecules reside in different biophysical compartments. For example, water molecules in the vasculature reside for variable periods of time within arteries, arterioles, capillaries, venuoles and veins, and may be within blood cells or blood plasma. Water molecules outside of the vasculature, in the extravascular space, reside, for a time, either within cells or within the interstitial space between cells. Within these different compartments, different types of microscopic motion that water molecules may experience have been identified and discussed. These range from Brownian diffusion to more coherent flow over the time scales relevant to functional magnetic resonance imaging (fMRI) experiments, on the order of several 10s of milliseconds. How these different types of motion are reflected in magnetic resonance imaging (MRI) methods developed for "diffusion" imaging studies has been an ongoing and active area of research. Here we briefly review the ideas that have developed regarding these motions within the context of modern "diffusion" imaging techniques and, in particular, how they have been accessed in attempts to further our understanding of the various contributions to the fMRI signal changes sought in studies of human brain activation.

Developmental changes and injury induced disruption of the radial organization of the cortex in the immature rat brain revealed by in vivo diffusion tensor MRI

During brain development, morphological changes modify the cortex from its immature radial organization to its mature laminar appearance. Applying in vivo diffusion tensor imaging (DTI), the microstructural organization of the cortex in the immature rat was analyzed and correlated to neurohistopathology. Significant differences in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were detected between the external (I-III) and deep (IV-VI) cortical layers in postnatal day 3 (P3) and P6 pups. With cortical maturation, ADC was reduced in both cortical regions, whereas a decrease in FA was only seen in the deep layers. A distinct radial organization of the external cortical layers with the eigenvectors perpendicular to the pial surface was observed at both ages. Histology revealed maturational differences in the cortical architecture with increased neurodendritic density and reduction in the radial glia scaffolding. Early DTI after hypoxia-ischemia at P3 shows reduced ADC and FA in the ipsilateral cortex that persisted at P6. Cortical DTI eigenvector maps reveal microstructural disruption of the radial organization corresponding to regions of neuronal death, radial glial disruption, and astrocytosis. Thus, the combined use of in vivo DTI and histopathology can assist in delineating normal developmental changes and postinjury modifications in the immature rodent brain.

Magnetic resonance imaging-guided, high-intensity focused ultrasound for brain tumor therapy

OBJECTIVE

Magnetic resonance imaging-guided high-intensity focused ultrasound (MRIgFUS) is a novel technique that may have the potential for precise image-guided thermocoagulation of intracranial lesions. The system delivers small volumetric sonications from an ultrasound phased array transmitter that focuses energy selectively to destroy the target with verification by magnetic resonance imaging-generated thermal maps. A Phase I clinical study was initiated to treat patients with recurrent glioma with MRIgFUS.

METHODS

To date, three patients with histologically verified recurrent glioblastoma multiforme have been treated with MRIgFUS. All patients underwent craniectomy 7 to 10 days before therapy to create a bony window for the ultrasound treatment. Sonications were applied to induce thermocoagulation of the enhancing tumor mass. Long-term radiological follow-up and post-treatment tissue specimens were available for all patients.

RESULTS

MRIgFUS treatment resulted in immediate changes in contrast-enhanced T1-, T2-, and diffusion-weighted magnetic resonance imaging scans in the treated regions with subsequent histological evidence of thermocoagulation. In one patient, heating of brain tissue in the sonication path resulted in a secondary focus outside the target causing neurological deficit. New software modifications were developed to address this problem.

CONCLUSION

In this first clinical report, MRIgFUS was demonstrated to be a potentially effective means of destroying tumor tissue by thermocoagulation, although with an associated morbidity and the inherent invasive nature of the procedure requiring creation of a bone window. A modified technology to allow MRIgFUS treatment through a closed cranium is being developed.

Fornix integrity and hippocampal volume in male schizophrenic patients

BACKGROUND

The hippocampus has been shown to be abnormal in schizophrenia. The fornix is one of the main fiber tracts connecting the hippocampus with other brain regions. Few studies have evaluated the fornix in schizophrenia, however. A focus on fornix abnormalities and their association with hippocampal abnormalities might figure importantly in our understanding of the pathophysiology of schizophrenia.

METHODS

Line-scan diffusion tensor imaging (DTI) was used to evaluate diffusion in the fornix in 24 male patients with chronic schizophrenia and 31 male control subjects. Maps of fractional anisotropy (FA) and mean diffusivity (D(m)), which are indices sensitive to white-matter integrity, were generated to quantify diffusion within the fornix. We used high spatial resolution magnetic resonance imaging (MRI) to measure hippocampal volume.

RESULTS

FA and cross-sectional area of the fornix were significantly reduced in patients compared with control subjects. D(m) was significantly increased, whereas hippocampal volume was bilaterally reduced in patients. Reduced hippocampal volume was correlated with increased mean D(m) and reduced cross-sectional area of the fornix for patients. Patients also showed a significant correlation between reduced scores on neuropsychologic measures of declarative-episodic memory and reduced hippocampal volumes.

CONCLUSIONS

These findings demonstrate a disruption in fornix integrity in patients with schizophrenia.

Collateral nerve fibers in human spinal cord: Visualization with magnetic resonance diffusion tensor imaging

Diffusion tensor magnetic resonance imaging provides structural information about nerve fiber tissue. The first eigenvector of the diffusion tensor is aligned with the nerve fibers, i.e., longitudinally in the spinal cord. The underlying hypothesis of this study is that the presence of collateral nerve fibers running orthogonal to the longitudinal fibers results in an orderly arrangement of the second eigenvectors. Magnetic resonance diffusion tensor scans were performed with line scan diffusion imaging on a clinical MR scanner. Axial sections were scanned in a human cervical spinal cord specimen at 625 microm resolution and the cervical spinal cord of four normal volunteers at 1250 microm resolution. The spinal cord specimen was fixed and stained for later light microscopy of the collateral fiber architecture at 0.53 microm resolution. Diffusion measured by MR was found to be anisotropic for both white and gray matter areas of the spinal cord specimen; the average fractional anisotropy (FA) was 0.63 +/- 0.09 (diffusion eigenvalues lambda1 0.38 +/- 0.05 micros/mm2, lambda2 0.14 +/- 0.03 micros/mm2, lambda3 0.10 +/- 0.03 micros/mm2) in white matter and 0.27 +/- 0.04 (lambda1 0.36 +/- 0.04 micros/mm2, lambda2 0.28 +/- 0.03 micros/mm2, lambda3 0.21 +/- 0.04 micros/mm2 in gray matter. The normal-volunteer FA values were similar, i.e., 0.66 +/- 0.04 (lambda1 1.66 +/- 0.14 micros/mm2, lambda2 0.55 +/- 0.02 micros/mm2, lambda3 0.40 +/- 0.01 micros/mm2) in white matter and 0.35 +/- 0.03 (lambda1 1.14 +/- 0.07 micros/mm2, lambda2 0.70 +/- 0.03 micros/mm2, lambda3 0.58 +/- 0.02 micros/mm2) in gray matter. The first eigenvector pointed, as expected, in the longitudinal direction. The second eigenvector directions exhibited a striking arrangement, consistent with the distribution of interconnecting collateral nerve fibers discerned on the histology section. This finding was confirmed for the specimen by quantitative pixel-wise comparison of second eigenvector directions and collateral fiber directions assessed on light microscopy image data. Diffusion tensor MRI can reveal non-invasively and in great detail the intricate fiber architecture of the human spinal cord.

Complementary aspects of diffusion imaging and fMRI; I: structure and function

Studying the intersection of brain structure and function is an important aspect of modern neuroscience. The development of magnetic resonance imaging (MRI) over the last 25 years has provided new and powerful tools for the study of brain structure and function. Two tools in particular, diffusion imaging and functional MRI (fMRI), are playing increasingly important roles in elucidating the complementary aspects of brain structure and function. In this work, we review basic technical features of diffusion imaging and fMRI for studying the integrity of white matter structural components and for determining the location and extent of cortical activation in gray matter, respectively. We then review a growing body of literature in which the complementary aspects of diffusion imaging and fMRI, applied as separate examinations but analyzed in tandem, have been exploited to enhance our knowledge of brain structure and function.

Biexponential characterization of prostate tissue water diffusion decay curves over an extended b-factor range

Detailed measurements of water diffusion within the prostate over an extended b-factor range were performed to assess whether the standard assumption of monoexponential signal decay is appropriate in this organ. From nine men undergoing prostate MR staging examinations at 1.5 T, a single 10-mm-thick axial slice was scanned with a line scan diffusion imaging sequence in which 14 equally spaced b factors from 5 to 3,500 s/mm(2) were sampled along three orthogonal diffusion sensitization directions in 6 min. Due to the combination of long scan time and limited volume coverage associated with the multi-b-factor, multidirectional sampling, the slice was chosen online from the available T2-weighted axial images with the specific goal of enabling the sampling of presumed noncancerous regions of interest (ROIs) within the central gland (CG) and peripheral zone (PZ). Histology from prescan biopsy (n=9) and postsurgical resection (n=4) was subsequently employed to help confirm that the ROIs sampled were noncancerous. The CG ROIs were characterized from the T2-weighted images as primarily mixtures of glandular and stromal benign prostatic hyperplasia, which is prevalent in this population. The water signal decays with b factor from all ROIs were clearly non-monoexponential and better served with bi- vs. monoexponential fits, as tested using chi(2)-based F test analyses. Fits to biexponential decay functions yielded intersubject fast diffusion component fractions in the order of 0.73+/-0.08 for both CG and PZ ROIs, fast diffusion coefficients of 2.68+/-0.39 and 2.52+/-0.38 microm(2)/ms and slow diffusion coefficients of 0.44+/-0.16 and 0.23+/-0.16 um(2)/ms for CG and PZ ROIs, respectively. The difference between the slow diffusion coefficients within CG and PZ was statistically significant as assessed with a Mann-Whitney nonparametric test (P<.05). We conclude that a monoexponential model for water diffusion decay in prostate tissue is inadequate when a large range of b factors is sampled and that biexponential analyses are better suited for characterizing prostate diffusion decay curves.

On the strong field dependence and nonlinear response to gadolinium contrast agent of proton transverse relaxation rates in dairy cream

Dairy cream, as a suspension of lipid droplets in water, is a potentially useful magnetic resonance imaging (MRI) phantom material and an interesting material for studying fundamental relaxation mechanisms. Here we report a strong increase in the transverse relaxation rates with field strength for both the water and lipid protons in dairy cream. Also, studies at 4.7 T reveal a nonlinear response of transverse relaxation rates with increasing concentration of a common gadolinium (Gd)-based contrast agent, including an initial decrease of water relaxation rates as measured with Hahn spin echoes at the lower Gd concentrations. The results are treated within the framework of a model in which the magnetic susceptibility difference between the lipid droplets and the aqueous phase plays the prominent role for transverse relaxation. Second-order polynomial fits of the water proton transverse relaxation rate dependence on field strength and on Gd concentration at 4.7 T provided experimental parameters from which model parameters are extracted and compared with expectations available from the literature.