Magnetic resonance evaluation of autonomous thyroid nodules treated by percutaneous ethanol injection

Magnetic resonance (MR) imaging was used to evaluate the effect of ultrasound-guided percutaneous ethanol injection (PEI) of autonomous thyroid nodules (ATNs). Nine patients affected with ATN (3.7–32.2 mL volume) underwent PEI (4–19 mL ethanol, subdivided in 3–6 weekly procedures). MR imaging (1.5 T) was performed before each alcoholization and 1 month after the last PEI procedure with the following parameters:T ₁-(550/12) andT ₂-weighted (2200/160) spin-echo images; 4-mm slices, 10% gap; coronal planes. A further seven patients with normal thyroid function, who had undergone PEI 6–18 months before, underwent an MR examination with the same parameters. The signal-to-noise ratio (S/N) of ATN and extranodular gland, as well as ATN volume, were evaluated on theT ₂-weighted images. OnT ₁-weighted images, ATNs appeared mostly hypointense before treatment, with hyperintense areas during treatment, and were lightly hyperintense 6–18 months after treatment. S/N onT ₂-weighted images: extranodular gland 3.5–9.2; ATNs, before treatment 13.2–19.7, before the last procedure 7.7–11.6, 1 month after the last procedure 5.6–10.9; previously treated ATNs, 4.3–8.2. No significant volume reduction was observed with MR 1 month after the last procedure. The MR examination time was about 15 minutes. In conclusion, the effect of PEI on ATNs can be evaluated with an MR examination that is not very time consuming.     

Contrast-enhanced abdominal echo planar imaging: Dynamic signal-intensity changes following intravenous injection of gadolinium-DOTA

Objectives: After I.V. administration of gadolinium-DOTA, the early contrast enhancement pattern and related signal-intensity (SI) changes in normal abdominal organs (kidney, spleen, liver) are evaluated over the first 4 min by using ultrafast spin-echo echo planar imaging (SE-EPI). Methods: On a 1.5-T magnetic resonance unit ultrafast EPI of the upper abdomen was performed in 12 patients in order to show the contrast enhancement pattern and related measurable SI changes onT ₁ andT ₂-weighted (w) images over the first 4 min after I.V. bolus injection of 0.1 mmol kg^–1 gadolinium (Gd)-DOTA in the spleen, liver, renal cortex, and renal medulla. A TR/TE of 500/44 or 45 ms inT ₁w SE-EPI and a TR/TE of 2000/80 or 100 ms inT ₂-w SE-EPI were used. Results: Typical time-dependent SI changes were noticed onT ₁w images: Subsequent to a SI increase in the renal cortex (starting 7 s after the I.V. injection of Gd-DOTA) SI increased first in the outer renal medulla (6 s later) and then in the inner renal medulla (21 s later). A SI increase was observed in the spleen (starting after 15 s) and in the liver (starting 7 s later). OnT ₂-w images, a SI decrease in the renal cortex (starting after 14 s) was followed by migration of a dark band from the outer (after 46 s) to the inner medulla (after 70 s). Only minimal changes were noticed in the spleen and liver. Conclusions: Ultrafast SE-EPI following I.V. bolus injection of Gd-DOTA enables the observation of the very early contrast agent kinetics in various abdominal organs. The associated SI changes onT ₁- andT ₂- SE EPI are related to organ perfusion and contrast agent tissue concentration and biodistribution.Additional reprints of this chapter may be obtained from the Reprints Department, Chapman & Hall, One Penn Plaza, New York, NY 10119.     

MR imaging of focal liver lesions: comparison between turbo spin-echo and conventional spin-echo pulse sequences

The aim of this study was to compare conventional spin-echo (CSE)T ₂-weighted (T2W) images with turbo spin-echo (TSE) T2W pulse sequences in their ability to detect focal liver lesions. Seventy-eight consecutive patients with focal liver lesions were entered into this study. All patients were imaged using the gradient-echo (GE) sequence with the breath-hold technique forT ₁-weighted (T1W) images, and CSE and TSE sequences for T2W images. Qualitative evaluation included lesion detection (number of lesions detected) and conspicuity (extent of visualization of lesional borders); quantitative evaluation included the signal-to-noise (S/N) ratio and the contrast-to-noise (C/N) ratio. TSE showed the best performance in terms of lesion detection; however, the difference between TSE and CSE was significant only in the case of benign cysts (p<0.01). Conspicuity was higher with TSE and CSE, and lower with GE. The S/N and C/N ratios of the two T2W sequences were also comparable, and better than those of GE. However, the combined use of GE and TSE resulted in improved lesion detection. The results show that, because the acquisition time is greatly reduced with TSE sequences, these should be considered as first-line approach to magnetic resonance imaging of the liver for the study of focal lesions.     

NMR microscopy of single neurons at 500 MHZ

Previous NMR microimaging studies at 360 MHz have demonstrated a clear differentiation between the nucleus and cytoplasm in isolated single neurons. In particular, theT ₂ of the cell nucleus is 2.5 times larger than that of the cytoplasm. In order to determine the magnitude of possibleT ₂ ^* influences on these observations, images of single cells have been obtained at 500 MHz using spin-echo and line-narrowing sequences. Comparison of the images acquired by the two sequences, and of the spin-echo images at 360 and 500 MHz, imply that anyT ₂ ^* contributions are relatively small. Consequently, the measuredT ₂ differences in spin-echo imaging represent a true difference in theT ₂ relaxation in the two cellular compartments.     

Low-field magnetic resonance imaging of the pelvis in patients with anal dynamic graciloplasty: initial experience

The aim of this study was to determine whether low-field magnetic resonance (MR) imaging can safely and accurately depict inflammatory changes in patients with anal dynamic graciloplasty, in whom high-field MR imaging is contraindicated and ultrasonography and computed tomography are inadequate. A 0.2-T field-strength MR examination was performed in six patients with anal dynamic graciloplasty malfunction in whom reoperation was contemplated. The following sequences were applied:T ₂-weighted turbo spinecho with fat saturation,T ₁-weighted conventional spin-echo, and contrastenhancedT ₁-weighted conventional spin-echo with fat saturation. Results indicated that none of the patients experienced relevant discomfort, pacemaker malfunction, or electrode dislocation with low-field MR imaging. Inflammatory pelvic changes were visualized in four patients and atrophy of the transposed gracilis muscle in another. Surgery was thus avoided in the four, who underwent conservative treatment for their pelvic inflammation. It was concluded that these prelininary results demonstrate the feasibility of MR imaging with a low field strength in patients with anal dynamic graciloplasty. In such patients, in whom diagnostic imaging had been problematic, the potential for safe and accurate visualization will be a boon to treatment planning.     

Dynamic snapshot gradient-echo imaging of head and neck malignancies: time dependency and quality of contrast-to-noise ratio

The purpose of this study was to evaluate the time dependency of the contrast-to-noise ratio (CNR) of head and neck malignancies during contrast-enhanced MR imaging. Then we would compare the CNR of dynamic snapshot gradient-echo (SGE) images with conventional spin-echo (SE) and fast spin-echo (FSE) sequences. Fifteen patients with squamous cell carcinomas were examined with T1W-SE, T2W-FSE, contrast-enhanced Gd-TlW-SE, and T1W-SGE sequences, the latter statically and contrast-enhanced dynamically. The CNR for all sequences and adjacent tissues was computed and the time to reach maximal CNR (T_max) was determined for dynamic studies. The CNR was time dependent with two distinct T_max at 6–18 and 60–160 s which corresponded to two different tumor enhancement patterns. Neither enhancement pattern correlated with distinct histologic findings or tumor grading. The CNR improved for the Gd-TlW-SGE images. The improvement was statistically significant in relation to T1W-SE and Gd-TlW-SE images at the floor of the mouth and at the tongue base. The good CNR of the dynamic Gd-TlW-SGE measurements justifies further investigations of this method in order to improve tumor delineation.     

Quantitative T<Subscript>1</Subscript> and T<Subscript>2</Subscript> MRI signal characteristics in the human brain: different patterns of MR contrasts in normal ageing

Objective

The objective of this study was to examine age-dependent changes in both T₁-weighted and T₂-weighted image contrasts and spin-echo T₂ relaxation time in the human brain during healthy ageing.

Methods

A total of 37 participants between the ages of 49 and 87 years old were scanned with a 3 Tesla system, using T₁-weighted, T₂ weighted and quantitative spin-echo T₂ imaging. Contrast between image intensities and T₂ values was calculated for various regions, including between individual hippocampal subfields.

Results

The T₁ contrast-to-noise (CNR) and gray:white signal intensity ratio (GWR) did not change in the hippocampus, but it declined in the cingulate cortex with age. In contrast, T₂ CNR and GWR declined in both brain regions. T₂ relaxation time was almost constant in gray matter and most (but not all) hippocampal subfields, but increased substantially in white matter, pointing to an age effect on water relaxation in white matter.

Conclusions

Changes in T₁ and T₂ MR characteristics influence the appearance of brain images in later life and should be considered in image analyses of aged subjects. It is speculated that alterations at the cell biology level, with concomitant alterations to the local magnetic environment, reduce dephasing and subsequently prolong spin-echo T₂ through reduced diffusion effects in later life.

     

Magnetic resonance imaging of bovine ovaries in vitro

A sample of 20 bovine ovaries were imaged in vitro using nuclear magnetic resonance (NMR) techniques to determine the visibility of various physiologic structures. In particular, the possibility of using NMR imaging to differentiate atretic follicles from physiologically selected and ovulatory follicles was examined. Five of the 20 ovaries were preserved in formalin, whereas the remaining 15 were preserved in a saline solution and imaged within 18 hours of death. Images weighted by T₁ and T₂ proton spin relaxation rates were obtained along with some three-dimensional (3-D) data sets acquired via a fast imaging with steady-state precession technique. Physiologically different structures were easily identified in the images from their morphology, especially in the 3-D images. Weighting by T₁ and T₂ was able to separate structures in the fresh ovaries in the following manner. Atretic and cohort follicles appear dark in T₁-weighted images and bright in T₂-weighted images. Ovulatory follicles appear bright in both T₁-and T₂-weighted images, whereas prephysiologic selection follicles present an intermediate brightness in T₁-weighted images and appear dark in T₂-weighted images. The corpus luteum appears bright in T₁-weighted images and dark in T₂-weighted images, whereas cysts in the corpus luteum appear dark in T₁-weighted images and bright in T₂-weighted images. The varying brightness of the follicles at different stages of development is hypothesized to be related to different hormone and protein concentrations in the follicular fluid. For example, it is known that physiologically selected preovulatory follicles contain high concentrations of estrogens in a viscous follicular fluid. The increased viscosity may occur only when the follicle fluid contains high concentrations of estrogen and contributes to bright T₁-weighted images. The possibility of using nuclear relaxation-weighted NMR imaging for the study of follicular dynamics and other ovarian biology therefore shows great promise.     

MR T2-weighted image of subacute cerebral infarct can be isointense to the surrounding brain: MR fogging in cerebral infarct

Cerebral infarcts initially showing as markedly hyperintense on magnetic resonance (MR)T ₂-weighted images decreased in intensity and became nearly isointense to normal brain tissue in subsequent MR studies. This MR fogging was observed in 7 (23%) out of 31 cases of cortical infarct and 4 (20%) out of 20 cases of perforator infarct in the second to sixth weeks of the disease. In all fogging cases, significant contrast enhancement (CE) was seen in the fogging area after intravenous administration of MR contrast agent. The CE study is recommended in MR of cerebral infarct during the subacute and early chronic stage.     

Magnetic resonance imaging at 1.5 T with immunospecific contrast agent in vitro and in vivo in a xenotransplant model

Object: Demonstrating the feasibility of magnetic resonance imaging (MRI) at 1.5 T of ultrasmall particle iron oxide (USPIO)-antibody bound to tumor cells in vitro and in a murine xenotransplant model. Methods: Human D430B cells or Raji Burkitt lymphoma cells were incubated in vitro with different amounts of commercially available USPIO-anti-CD20 antibodies and cell pellets were stratified in a test tube. For in vivo studies, D430B cells and Raji lymphoma cells were inoculated subcutaneously in immunodeficient mice. MRI at 1.5 T was performed with T1-weighted three-dimensional fast field echo sequences (17/4.6/13°) and T2-weighted three-dimensional fast-field echo sequences (50/12/7°). For in vivo studies MRI was performed before and 24 h after USPIO-anti-CD20 administration. Results: USPIO-anti-CD20-treated D430B cells, showed a dose-dependent decrease in signal intensity (SI) on T2*-weighted images and SI enhancement on T1-weighted images in vitro. Raji cells showed lower SI changes, in accordance to the fivefold lower expression of CD20 on Raji with respect to D430B cells. In vivo 24 h after USPIO-anti-CD20 administration, both tumors showed an inhomogeneous decrease of SI on T2*-weighted images and SI enhancement on T1-weighted images. Conclusions: MRI at 1.5 T is able to detect USPIO-antibody conjugates targeting a tumor-associated antigen in vitro and in vivo.     

Nmr contrast enhancement of brain tumours: comparison of the blood brain barrier tracer GdDTPA and the tumour-selective contrast agent MnTPPS

Contrast enhancement of two different NMR contrast agents, GdDTPA and MnTPPS, was compared. Sequential recording ofT ₁-weighted images at 50s intervals allowed the observation of the temporal and spatial evolution of the contrast effect in rats with glioma implanted into the right brain hemisphere. The maximum signal intensity ratio of tumour over contralateral striatum was 1.80±0.10 for GdDTPA and 1.61±0.15 for MnTPPS. The enhancement was maximal 3min after application of GdDTPA and fell rapidly to reach half maximum after 24 min. MnTPPS led to maximum tumour enhancement within 11 min and did not return to control level within the observation period (150 min). In the peritumoural edema, an enhancement effect was absent for MnTPPS, but GdDTPA spread out from the tumour resulting in a delayed but strong enhancement outside the tumour. Thus, GdDTPA, as a blood-brain-barrier tracer, led only to a transient contrast enhancement between tumour and surrounding tissue and no unambiguous demarcation of the tumour against peritumoural edema. Application of MnTPPS resulted in a long-lasting strong tumour enhancement and reliable delineation from peritumoural edema.     

Volumetric assessment of myocardial viability in rats using 3D double contrast enhanced T1 and T2-weighted MRI

Objective: Volumetric evaluation of the myocardial viability post-infarction in rats using 3D in vivo MR imaging at 7 T using injection of an extracellular paramagnetic contrast agent and intravascular superparamagnetic iron oxide nanoparticles in the same imaging session. Materials and methods: Five hours after induction of permanent myocardial infarction in rats (n=6), 3D in vivo T1- and T2-weighted MR Imaging was performed prior to and after Gd-DOTA injection (0.2 mmol/kg) and prior to and after nanoparticle injection (5 mg Fe/kg) to assess infarct size and myocardial viability. Results: 3D MR Imaging using a successive contrast agent injection showed a difference of infarct size after Gd-DOTA injection on T1-weighted images compared to the one measured on T2-weighted images after Gd-DOTA and nanoparticle injection. Conclusion: The use of 3D T1- and T2-weighted MR Imaging using a double contrast agents protocol made possible the accurate characterization of myocardial infarction volume and allowed the detection of myocardial viability post-infarction in rats     

DynamicT 1 studies of gadolinium uptake in brain tumors using LL-EPI

Using ultrafastT ₁ mapping (LL-EPI), the uptake from a bolus injection of Gd-DO3A (ProHance) into the sagittal sinus and a brain tumor has been monitored. The measurement of absoluteT ₁ removes the possible error in uptake curves created fromT ₁-weighted sequences caused by changes inT ₂ ^* and simplifies the calculation of ProHance concentration. The LL-EPI sequence has an acquisition time of 1.2 s and is repeated every 4 s to obtain uptake curves with a high temporal and spatial resolution. Optimization of the LL-EPI sequence has been performed to obtain a precision of 5% over theT ₁ range 0.3–1.2 s.     

Measurements of T1 and T2 relaxation times of colon cancer metastases in rat liver at 7 T

The purpose of this study was to investigate the magnetic resonance imaging (MRI) characteristics of colon cancer metastases in rat liver at 7 T. A dedicated RF microstrip coil of novel design was built in order to increase the signal-to-noise ratio and, in combination with respiratory triggering, to minimize motion artifacts. T₁- and T₂-weighted MR imaging was performed to follow tumor growth. T₁-weighted images provided a good anatomical delineation of the liver structure, while the best contrast between metastases and normal liver tissue was achieved with T₂-weighted images.Measurements of T₁ and T₂ relaxation times were performed with inversion recovery FLASH and Carr–Purcell–Meiboom–Gill and inversion recovery FLASH imaging sequences, respectively, for quantitative MR characterization of metastases. Both the T₁ and T₂ of the metastases were significantly higher than those of normal liver tissue. Further, an increase in the T₁ relaxation time of the metastases was observed with tumor growth. These findings suggest that quantitative in vivo MR characterization provides information on tumor development and possibly response to therapy, though additional studies are needed to elucidate the correlation between the changes in relaxation times and tumor microenvironment.     

A comparison of phase imaging and quantitative susceptibility mapping in the imaging of multiple sclerosis lesions at ultrahigh field

Objective

The aim of this study was to compare the use of high-resolution phase and QSM images acquired at ultra-high field in the investigation of multiple sclerosis (MS) lesions with peripheral rings, and to discuss their usefulness for drawing inferences about underlying tissue composition.

Materials and methods

Thirty-nine Subjects were scanned at 7 T, using 3D T ₂*-weighted and T ₁-weighted sequences. Phase images were then unwrapped and filtered, and quantitative susceptibility maps were generated using a thresholded k-space division method. Lesions were compared visually and using a 1D profiling algorithm.

Results

Lesions displaying peripheral rings in the phase images were identified in 10 of the 39 subjects. Dipolar projections were apparent in the phase images outside of the extent of several of these lesions; however, QSM images showed peripheral rings without such projections. These projections appeared ring-like in a small number of phase images where no ring was observed in QSM. 1D profiles of six well-isolated example lesions showed that QSM contrast corresponds more closely to the magnitude images than phase contrast.

Conclusions

Phase images contain dipolar projections, which confounds their use in the investigation of tissue composition in MS lesions. Quantitative susceptibility maps correct these projections, providing insight into the composition of MS lesions showing peripheral rings.

     

MDEFT imaging of the human brain at 8 T

T ₁-weighted images of the human brain obtained with the MDEFT sequence at 8 T are presented. These images are characterized by an excellent contrast and good signal to noise ratio. Importantly, results were obtained with adiabatic spin inversion and demonstrate that such pulses can be used event in the ultra high frequency (>300 MHz) range. It is thus possible to obtain high quality results at this field strength without violating SAR guidelines.     

Liver and spleen enhancement after intravenous injection of carboxydextran magnetite: effect of dose,delay of imaging,and field strength in anex vivo model

It has been predicted that liver and spleen enhancement after administration of superparamagnetic contrast agents may be different, depending on the strength of the main magnetic field. With the use of anex vivo model, we investigated at 0.3, 0.5, and 1.5 T the effects on liver and spleen signal intensity of 5, 15, and 45 µmol/kg body weight of dextran magnetite (SHU 555A) in 54 rats. Nine rats served as controls. At different time delays since injection, the animals were killed, and after perfusion with saline, the liver, brain, and spleen were fixed in formalin. The specimens were embedded in an agar gel matrix and imaged with inversion recovery T1-weighted, proton density spin echo, and T2*-weighted gradient recalled echo (GRE) sequences. At each magnetic field strength, peak liver and spleen signal loss increased with increasing dose of the contrast medium. Signal loss was significantly more conspicuous after a dose of 15 than 5 µmol/kg body weight, but not after a dose of 45 compared with 15 µmol/kg. No signal change was observed in the brain. GRE images showed higher enhancement than proton density-weighted spin echo and inversion recovery images but were noisier. The enhancement showed a plateau between 30 min and 24 hours. Only the signal decrease of the liver after a low dose of contrast medium on GRE images was significantly higher (p<0.01) at 1.5 than at 0.5 and 0.3 T. Other differences in respect to the field strength were less significant (p<0.05) or nonsignificant. Differences in the spleen enhancement were nonsignificant. SHU 555A at a dose of 15 µmol/kg is an efficient intracellular contrast agent for liver and spleen at low, mid, and high field strength. Proton density spin echo images are probably the sequence of choice to exploit SHU 555A contrast effects and a wide time window for imaging after its intravenous injection does exist.     

High-resolution MR imaging appearance of colonic tissue in rabbits using an endoluminal coil

Purpose: This study assessed the value of high-resolution magnetic resonance imaging (MRI) of the distal colon by means of a dedicated endoluminal magnetic resonance receiver coil on a 1.5-T clinical scanner. Materials and Methods: To this end, single-loop, receive-only radio-frequency coils, housed in 18 F sheaths, were built. A 1.5-T clinical imager was used. A 18 French diameter internal MRI receiver coil was inserted into the distal colon in 15 New Zealand rabbits to obtain high-resolution magnetic resonance images by using T1-weighted Flash sequences with and without Fat Saturation (FS), T2-weighted True-Fisp, turbo spin-echo, and T1-weighted Flash FS after contrast media injection. Images were compared to histological sections. Results: An adequate image quality was obtained in all specimens without significant artefacts. Based on histological reports, a five-layer structure of the wall was considered normal. On different MR sequences, only two layers were identified on the images of all rabbits specimens. The nearest layer to the mucosal surface was usually seen as a hyper intense layer and likely corresponds to the mucosa. The highest difference of signal value between internal and external layers was performed on 2D Fat saturation T1 weighted gradient echo. Comparison of mean signal value between the internal and external layers was statistically different in for each sequence used in our protocol (P< 0.05). Conclusion: Dedicated endoluminal RF coil provides good spatial resolution at the region of interest. On this prospective study of in vivo rabbit, evaluation of colon walls allowed to provide detailed information.     

Investigation of blood-brain barrier permeability to magnetite-dextran nanoparticles (MD3) after osmotic disruption in rats

The permeability of experimentally disrupted blood-brain barrier (BBB) to superparamagnetic nanoparticles (MD3) was studied in rats. BBB opening was induced by intracarotid injection of mannitol. One hundred eighty rats were used for the study. Rats were examined at two time points, 30 minutes and 12 hours after intracarotid mannitol injection. Different preparations intravenously injected 30 minutes before rat sacrifice were used for characterization of BBB disruption. BBB integrity was determined with^99mTc-diethylenetriamine pentaacetic acid (DTPA) and^99mTc-albumin. Iron oxide-glucose particles (12-nm mean diameter),^99mTc-labeled lecithin-cholesterol liposomes of three different sizes (50, 100, and 200 nm), and polyethylene glycol (PEG)-coated^99mTc liposomes (50 nm) were used for investigations of the dependence of BBB permeability on particle system size or surface. Magnetite-dextran nanoparticles (MD3) were evaluated as superparamagnetic contrast agent to monitor with magnetic resonance imaging (MRI) the BBB breakdown.In vitro T₁ and T₂ relaxation times of the brain tissue were measured at 40 MHz and 37°C, and T₂-weighted MR images were acquired at 0.5 T. After intracarotid mannitol infusion, as expected, the BBB breakdown was immediate and temporary as judged by soluble molecule diffusion. MD3 nanoparticles crossed the BBB 12 hours after intravenous mannitol injection, at a time when brain permeability for molecules or small particles returns to normal. Magnetite crystals were found in cytoplasmic vesicles of glial cells. On MRI, signal intensity decreased after injection of MD3, even 12 hours after mannitol injection. This particularity could be useful in the study of focal pathological lesions accompanied by BBB permeability modifications. In such conditions, superparamagnetic particle contrast agents could be caught by the BBB, allowing the observation of impaired BBB areas without detectable cellular lesions. V. Rousseau was supported by a grant from the city of Angers.