Simulation of two-dimensional tagged MRI

MR tagging is a recent imaging development that, in cardiac applications, makes possible the tracking of points in the myocardium during the cardiac cycle. Researchers have developed semiautomated, computer-based methods for analyzing tagged images, but the images are complex and present a challenge to automated tracking systems. Simulation can provide an inexhaustible supply of images for testing and validation of tag tracking software and preview the effect of parameter changes in acquisition. SIMTAG is an interactive computer program that simulates two-dimensional tagged-MR experiments. The mathematic model used in the simulation and algorithms for simulating image noise and object deformation are described. Examples of the use of simulated images in SPAMM parameter selection, a comparison of tag contrast in signal-averaged SPAMM and CSPAMM, and simulated images as test sets for tag-tracking software are presented.     

Verification of accuracy of several algorithms to quantitate left ventricular regional wall motion: a study using cine MR imaging with myocardial tagging

To verify the accuracy of several algorithms used to quantitate left ventricular (LV) regional wall motion, five volunteers were examined by cine MR imaging with presaturation myocardial tagging in short-axis and 4-chamber sections. Three algorithms for the wall motion analysis, radial, centerline, and originally developed "modified-Hildreth" methods, were applied to the cine MR images, and dissociation of the end-systolic position of the tags estimated by each algorithm from the true position was examined. The modified-Hildreth method was comparable in accuracy to the other methods for estimating end-systolic tag position. Significantly worse estimation of the tag position by the three algorithms occurred in the 4-chamber section compared with the short-axis section (p < 0.001, 0.005), indicating difficulties in the wall motion analysis of "long-axis" LV images. Among the algorithms, the centerline method showed the highest accuracy of the estimation in the 4-chamber section, and the modified-Hildreth method was the best in the short-axis section. In the 4-chamber section, correction of the position of end-diastolic and end-systolic images around the luminal centroids improved the estimation (p < 0.01, 0.05). Tagging cine MR imaging was proved to be useful for determining the most suitable algorithm for quantitative wall motion analysis of LV images obtained from conventional angiocardiography and other imaging modalities.     

Induction of broad drug resistance in small cell lung cancer cells and its reversal by paclitaxel

In the pulsed arterial spin labeling (ASL) techniques EPISTAR, PICORE, and FAIR, subtraction of two images in which inflowing blood is first tagged and then not tagged yields a qualitative map of perfusion. An important reason this map is not quantitative is that there is a spatially varying delay in the transit of blood from the tagging region to the imaging slice that cannot be measured from a single subtraction. We introduce here two modifications of pulsed ASL (QUIPSS and QUIPSS II) that avoid this problem by applying additional saturation pulses to control the time duration of the tagged bolus, rendering the technique relatively insensitive to transit delays and improving the quantitation of perfusion.     

Myocardial perfusion and function in dogs with moderate coronary stenosis

MRI studies of first-pass contrast enhancement with polylysine-Gd-DTPA and myocardial tagging using spatial modulation of magnetization (SPAMM) were performed to assess the feasibility of a combined regional myocardial blood flow and 2D deformation exam. Instrumented closed-chest dogs were imaged at a baseline control state (Cntl) followed by two interventions: moderate coronary stenosis (St) achieved by partial occlusion of the left anterior descending (LAD) and moderate coronary stenosis with dobutamine loading (StD). Hypoperfusion of the anterior region (ANT) of the myocardium (LAD distribution) relative to the posterior wall (POS) based on the upslope of the signal intensity time curve from the contrast-enhanced MR images was demonstrated only with dobutamine loading (ANT:POS Cntl = 1.077 +/- 0.15 versus ANT:POS StD = 0.477 +/- 0.11, P < 0.03) and was confirmed with radiolabeled microspheres measurements (ANT:POS Cntl = 1.18 +/- 0.2 ml/min/g versus ANT:POS StD = 0.44 +/- 0.1 ml/min/g; P < 0.002). Significant changes in regional myocardial shortening were only seen in the StD state (P < 0.02); the anterior region showed impaired myocardial shortening with dobutamine loading (P = NS), whereas the nonaffected POS region showed a marked increase in shortening when compared with Cntl (Cntl = 0.964 +/- 0.02 versus StD = 0.884 +/- 0.03; P < 0.001). These results demonstrate that an integrated quantitative assessment of regional myocardial function and semiquantitative assessment of myocardial blood flow can be performed noninvasively with ultrafast MRI.     

"Asymptomatic" primary hyperparathyroidism: is parathyroidectomy indicated?

OBJECTIVE: We assessed the efficacy of magnetization transfer contrast (MTC) imaging of the cervical spine in conjunction with a gradient recalled echo (GRE) technique using a 0.3 T permanent magnet imager. MATERIALS AND METHODS: Seventy patients were prospectively investigated. Multislice sagittal and axial images of the cervical spine with and without MTC were obtained using a GRE sequence (TR/TE/flip angle = 750 ms/23 ms/25 degrees). The contrast-to-noise ratios (C/Ns) for CSF versus cord or disk were calculated for quantitative analysis. Qualitative image analysis was also performed. RESULTS: Both sagittal and axial MTC images had significantly higher C/N values than conventional GRE images. The MTC images showed better differentiation between the CSF and the cord or thecal sac as well as better delineation of the nerve roots. Furthermore, MTC images demonstrated syringomyelia more clearly than conventional images. CONCLUSION: Magnetization transfer contrast images at 0.3 T are effective for diagnosing diseases of the cervical spine.     

Hemostatic efficacy of a fibrin sealant dressing in an animal model of kidney injury

Arterial spin tagging techniques have been used to image tissue perfusion in MR without contrast injection or ionizing radiation. Currently, spin tagging studies are performed primarily using single-slice imaging sequences, which are time consuming. This note reports a multislice echo-planar arterial spin tagging technique (Simultaneous Multislice Acquisition with aRterial-flow Tagging, or "SMART"). Multiband RF encoding (Hadamard) is used to provide simultaneous multislice acquisition capability for spin tagging techniques (such as echo planar imaging signal targeting with alternating radio frequency and flow-sensitive alternative inversion recovery). The method is illustrated with a two-slice pulse sequence that was implemented using the FAIR technique to generate two perfusion weighted images simultaneously. Compared with single-slice sequences, this two-slice sequence provided similar image quality, signal-to-noise ratio, and twice the spatial coverage compared with the single-slice technique within the same scan time.     

Implementation of quantitative perfusion imaging techniques for functional brain mapping using pulsed arterial spin labeling

We describe here experimental considerations in the implementation of quantitative perfusion imaging techniques for functional MRI using pulsed arterial spin labeling. Three tagging techniques: EPISTAR, PICORE, and FAIR are found to give very similar perfusion results despite large differences in static tissue contrast. Two major sources of systematic error in the perfusion measurement are identified: the transit delay from the tagging region to the imaging slice; and the inclusion of intravascular tagged signal. A modified technique called QUIPSS II is described that decreases sensitivity to these effects by explicitly controlling the time width of the tag bolus and imaging after the bolus is entirely deposited into the slice. With appropriate saturation pulses the pulse sequence can be arranged so as to allow for simultaneous collection of perfusion and BOLD data that can be cleanly separated. Such perfusion and BOLD signals reveal differences in spatial location and dynamics that may be useful both for functional brain mapping and for study of the BOLD contrast mechanism. The implementation of multislice perfusion imaging introduces additional complications, primarily in the elimination of signal from static tissue. In pulsed ASL, this appears to be related to the slice profile of the inversion tag pulse in the presence of relaxation, rather than magnetization transfer effects as in continuous arterial spin labeling, and can be alleviated with careful adjustment of inversion pulse parameters.     

Early expression of interleukin-12, p40 subunit and IFN-gamma inhibits regression of AK-5 tumor

The Magnetic Resonance Imaging technique myocardial tagging allows the tracking and measurement of local parameters of heart wall motion. Tagging provides detailed information about regional cardiac function never before available with non-invasive techniques. The growth of this technique has been limited in part by the availability of post-processing tools. We introduce the TAGged cine AnalySIS Tools package (TAGASIST) for the processing of images from this technique. TAGASIST includes a graphical user interface for image segmentation, kinematic analysis, plotting of regional averages as well as multiple subjects (or patient populations) simultaneously, statistical analysis, and a database of all studies processed.     

Thoracic MR aortography: imaging techniques and strategies

Three-dimensional (3D) gadolinium-enhanced magnetic resonance (MR) angiography is a promising technique for thoracic aortography that complements electrocardiographically gated T1-weighted spin-echo imaging and cine MR imaging. Axial and left anterior oblique T1-weighted spin-echo images are well suited to measurement of aortic dimensions and evaluation of aortic aneurysms. Sagittal and coronal spin-echo images are helpful in evaluation of vascular rings and aortic dissection. Cine gradient-echo and cine phase-contrast imaging allow dynamic evaluation of aortic and valvular flow. Cine phase-contrast imaging also enables noninvasive quantification of blood flow. Capable of being performed during a single breath hold, 3D gadolinium-enhanced MR angiography provides high-resolution 3D data that can be readily used for projection angiography and multiplanar reformation. This technique enables further demonstration of subtle pathologic conditions. Three-dimensional gadolinium-enhanced MR angiography allows more comprehensive and efficient evaluation of the thoracic aorta.     

SPLICE: sub-second diffusion-sensitive MR imaging using a modified fast spin-echo acquisition mode

Recent human studies for measuring of the apparent diffusion coefficient in tissue by magnetic resonance imaging have been conducted by time-consuming standard spin-echo acquisition sequences and phase correction with navigator echoes. Diffusion-weighted echo-planar sequences have been shown to be rapid alternatives for brain imaging. Both methods show inherent disadvantages in applications on thoracic or abdominal sites. A new approach combining single-shot diffusion-weighted imaging with a modified fast spin-echo acquisition mode is reported here. The modification is necessary, because normal fast spin-echo acquisition requires a particular phase relation between the magnetization and the refocusing pulses. Unfortunately, this phase relation is not provided after diffusion sensitive preparation. Therefore, the split echo acquisition mode was developed and is shown to be insensitive to the phase of the magnetization. The advantages of both fast spin-echo acquisition and diffusion weighting can be combined in the SPLICE sequence (split aqcuisition of fast spin-echo signals for diffusion imaging). The applicability of the new technique is shown by series of sub-second diffusion-weighted images from different parts of the body.     

Myocardial wall motion analysis with phase shift imaging: cine phase contrast technique

MR imaging can be used to measure proton velocity directly as a phase shift with the bipolar gradient method. This method is applied in MR angiography as a phase contrast(PC) technique. We attempted to evaluate myocardial motion utilizing the PC technique. With the cine PC technique, 16-cardiac phased 3D velocity images of the myocardium were obtained. In normal subjects, the myocardial velocity throughout the cardiac cycle were changes regular in space as well as in time, and there was no inconsistency between the motion directions. Whereas, in cases with myocardial infarction, 3D velocity images revealed some regions with zero velocity and/or some regions which showed reverse direction motions compared with the surrounding normal myocardium.     

The low sensitivity of fluid-attenuated inversion-recovery MR in the detection of multiple sclerosis of the spinal cord

PURPOSE: To confirm the expected superiority of fluid-attenuated inversion-recovery (FLAIR) over conventional fast spin-echo MR imaging in the detection of multiple sclerosis (MS) of the spinal cord. METHODS: Fifteen subjects with known MS involving the spinal cord and brain were studied prospectively. The entire cord was imaged with a phased-array coil on a 1.5-T MR system. Sagittal T1-weighted and fast spin-echo proton density- and T2-weighted images were followed by fast FLAIR images. FLAIR parameters were varied to optimize lesion conspicuity with optimal inversion times (TIs) ranging from 2400 to 2600. Lesion conspicuity and detection were compared between the fast spin-echo and FLAIR images by three radiologists who reached agreement by consensus. RESULTS: The FLAIR technique effectively suppressed cerebrospinal fluid (CSF) signal and reduced CSF pulsation and truncation artifacts in all cases. Shorter imaging parameters (repetition time of 4000 to 6000, TI of 1500 to 2000) uniformly decreased lesion conspicuity in all subjects. Of 11 cord lesions in five subjects imaged with the longer parameters (repetition time of 8000 to 11,000, TI of 2400 to 2600), three were not seen on FLAIR images, four were less conspicuous on FLAIR images, and four were seen equally or better on FLAIR images. CONCLUSION: Although successful in suppressing CSF signal and reducing imaging artifacts, fast FLAIR imaging appears unreliable in the detection of MS lesions in the spinal cord.     

Retinoic acid receptor expression abnormalities in lung cancer: important clues or major obstacles?

We have developed a cine display of postprocessed 3D MR images of the thoracic aorta. Maximum intensity projection (MIP) images of the thoracic aorta in each phase were reconstructed from consecutive 2D-cine MR data sets, and displayed in a cine loop. The postprocessed 3D MR images clearly showed the relationship between major cervical branches and aortic pathologies such as aneurysms, and cine display presented the flow pattern in the aorta. 3D-cine MR angiography seems to be useful for follow-up studies of thoracic aortic diseases especially in patients with renal dysfunction.     

Fast fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging of the brain: a comparison of multi-shot echo-planar and fast spin-echo techniques

PURPOSE: To evaluate fast spin-echo and multi-shot echo-planar fluid-attenuated inversion recovery (FLAIR) sequences in paediatric brain imaging. MATERIALS AND METHODS: Matched images from 32 patients with suspected tumour or white matter disease were independently evaluated by two paediatric neuroradiologists. The observer preferences for image quality and lesion detection were analysed for differences between fast spin-echo FLAIR and multi-shot echo-planar FLAIR. Diagnostic quality was compared with that of fast spin-echo T2-weighted images. RESULTS: Images of a diagnostic quality equivalent to that of fast spin-echo T2-weighted images were achieved with both FLAIR techniques. Grey and white matter differentiation and cerebrospinal fluid (CSF) nulling were significantly better on fast spin-echo FLAIR sequences. CSF flow artefact was reduced on multi-shot echo-planar FLAIR. There was no difference in lesion detection. Fast spin-echo FLAIR images were visually preferred at the expense of longer imaging time. CONCLUSION: Fast FLAIR techniques are complementary to fast spin-echo T2-weighted sequences in imaging of the paediatric brain. We find that the fast spin-echo FLAIR sequence is preferable to the multi-shot echo-planar technique.     

Use of three-dimensional segmented FLASH sequence with magnetization transfer contrast to improve Gd-DTPA-enhanced intrahepatic MR portography

Twenty healthy volunteers underwent gadopentetate dimeglumine (gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA))-enhanced MR angiography (MRA) using three-dimensional-segmented fast low angle shot images (FLASH) with magnetization transfer contrast (MTC) pulses. MRA was obtained at 75 seconds (early phase) and 135 seconds (late phase) after bolus injection of Gd-DTPA (MTC+ group) during one period of breath-holding. Within 1 week. MRA without MTC was performed under the same scanning conditions. Visualization of intrahepatic portal branches with these methods was compared in both phases. Portal vein-liver contrast-to-noise ratios were significantly higher in the MTC+ group in both phases. For third- and fourth-order portal branches, visualization was significantly better in the MTC+ group in both phases. Use of three-dimensional-segmented FLASH shortened acquisition time and facilitated imaging during breath-holding and also reduced whole-body average specific absorption rate values. Visualization of intrahepatic portal vein branches was improved by MTC pulses, and effective imaging time was prolonged.     

Agenesis of gall bladder--a diagnostic dilemma

Before laparoscopic cholecystectomy, it is important to clarify the anatomy of the cystic duct. This study assessed three-dimensional CT images (3D images) of the cystic duct obtained non-invasively using helical DIC CT and these images were compared with those obtained with ERCP and DIC. The three-dimensional technique using Helical DIC-CT was applied in 168 patients for laparoscopic cholecystectomy. The cystic duct detected by 3D imaging was evaluated for patency, length and bifurcation. Three-dimensional images showed the cystic duct in 157 of 168 cases (93.5%) and in 81 of 89 cases (91%) in which the cystic duct was not clearly visualized on DIC. Among the 23 cases in which were both 3D images and ERCP undergone, 3D images were equal to those of ERCP in detection of the cystic duct in 20 cases, superior to ERCP in two cases, and inferior to ERCP in one. The technique of 3D images proved useful in demonstrating the patency, length and variations in bifurcation of the cystic duct for surgeons performing laparoscopic cholecystectomy and might be substitute ERCP in preoperative assessment.     

Vinorelbine and ifosfamide for unresectable non-small cell lung cancer

OBJECTIVE: The diagnostic value of cine magnetic resonance imaging (CMRI) that visualizes fluid and tissue movement was evaluated in patients with spinal intradural arachnoid cysts, a rare but increasingly detected cause of spinal cord dysfunction. METHODS: Four patients with thoracic spinal intradural arachnoid cysts were investigated with conventional T1- and T2-weighted and cardiac-gated CMRI. Four normal volunteers also underwent CMRI for comparison. RESULTS: Sagittal T1- and T2-weighted imaging showed lesions as an abnormal widening of the posterior spinal subarachnoid space, but mixed high- and low-signal intensities on T2-weighted imaging suggested cystic lesions. CMRI, using 16 to 20 sagittal gradient echo images during the cardiac cycle of normal volunteers, indicated synchronous signal changes along the subarachnoid space, suggesting a smooth cerebrospinal fluid flow. CMRI of patients detected that the caudal or cranial direction of the high-signal propagation suddenly reversed at some locations (as if rebounding) in an asynchronous fashion along the lesion (asynchronous rebound phenomenon), which was well demonstrated by the closed-loop video mode. Cystectomy revealed that the cysts consisted of multiple lobules and that the asynchronous rebound phenomenon corresponded with some boundaries of cyst lobules. CMRI also visualized dynamic spinal cord compression by the cyst. CONCLUSION: CMRI can demonstrate abnormal fluid flow and spinal cord compression caused by a spinal intradural arachnoid cyst.     

Sinusitis in the immunocompromised host

Using retrospective studies, we have investigated the possibility of obtaining characteristic findings of inflammatory pseudotumor of the liver by magnetic resonance (MR) imaging. We examined 8 patients (involving 8 masses) who had been histologically diagnosed as having an inflammatory pseudotumor in the liver. The histological studies were performed on an excised specimen of 1 mass, and on aspiration needle biopsy specimens and the clinical courses of the other 7 masses. T1 weighted images (T1WI) and T2 weighted images (T2WI) were obtained on MR imaging. MR imagings were analyzed for visualized patterns, patterns of internal structure and patterns of contrast enhancement of dynamic MR imaging. The 8 masses were visualized as hypointense on T1WI and hyperintense on T2WI by MR imaging. Dynamic MR imaging revealed that 1 mass was markedly enhanced peripherally while another mass was homogeneously enhanced, and that enhancement was most marked immediately after injection of contrast medium and then gradually disappeared. Vessels were observed in 4 masses (the portal vein in 2 masses, the hepatic vein in 1 mass, and portal and hepatic veins in 1 mass), and these vessels were clearly visualized on T1WI. The MR imaging findings from the early stage of an inflammatory pseudotumor showed a pattern similar to that of hepatic tumors with rich blood flow. The portal vein or hepatic vein was found in the tumor in half the patients, suggesting that this characteristic was useful for diagnosis of an inflammatory pseudotumor in the liver.     

In vitro verification of myocardial motion tracking from phase-contrast velocity data

The ability to track motion from cine phase-contrast (PC) magnetic resonance (MR) velocity measurements was investigated using an in vitro model. A computer-controlled deformable phantom was used for the characterization of the accuracy and precision of the forward-backward and the compensated Fourier integration techniques. Trajectory accuracy is limited by temporal resolution when the forward-backward technique is used. With this technique the extent of the calculated trajectories is underestimated by an amount related to the motion period and the sequence repetition time, because of the band-limiting caused in the cine interpolation step. When the compensated Fourier integration technique is used, trajectory accuracy is independent of temporal resolution and is better than 1 mm for excursions of less than 15 mm, which are comparable to those observed in the myocardium. Measurement precision is dominated by the artifact level in the phase-contrast images. If no artifacts are present precision is limited by the inherent signal-to-noise ratio of the images. In the presence of artifacts, similar in magnitude to those observed in vivo, the reproducibility of tracking a 2.2 x 2.2 mm2 region of interest is better than 0.5 mm. When the Fourier integration technique is used, the improved accuracy is accompanied by a reduction in precision. We verified that tracking three-dimensional (3D) motion from velocity measurements of a single slice can lead to underestimations of the trajectory if there is a through-plane component of the motion that is not truly represented by the measured velocities. This underestimation can be overcome if volumetric cine phase-contrast velocity data are acquired and full three-dimensional analysis is performed.     

Regional myocardial function

Methods for noninvasive tissue tracking and quantification of myocardial shortening with magnetic resonance imaging have been developed using presaturation tagging and velocity encoded phase maps. The concurrent development of rapid scanning techniques, such that a complete cine loop of a slice can be obtained in a breath-hold, has made the measurement of myocardial wall motion in patients a simple and reproducible examination. These methods make it possible to quantify the severity and extent of regional heart wall motion abnormalities both at rest and during stress.