妊娠期怀疑肺栓塞的CT肺血管成像检查的质量

本研究的主要目的是评价怀疑肺栓塞的妊娠期人群CT肺血管成像（CTPA）检查的质量。我们回顾了2005年1月——2006年12月间进行过CTPA检查的连续的40例妊娠病人,连续的40名年龄匹配的非妊娠女性作为对照组。以随机和双盲的方式,由2名意见一致的放射科医生对整体影像质量进行了主观分级。     

Peritumoral brain regions in gliomas and meningiomas: investigation with isotropic diffusion-weighted MR imaging and diffusion-tensor MR imaging

PURPOSE: To retrospectively measure the diffusion-weighted (DW) imaging characteristics of peritumoral hyperintense white matter (WM) and peritumoral normal-appearing WM, as seen on T2-weighted magnetic resonance (MR) images of infiltrative high-grade gliomas and meningiomas. MATERIALS AND METHODS: Seventeen patients with biopsy-proved glioma and nine patients with imaging findings consistent with meningioma and an adjacent hyperintense region on T2-weighted MR images were examined with DW and diffusion-tensor MR imaging. Apparent diffusion coefficients (ADCs) were measured on maps generated from isotropic DW images of enhancing tumor, hyperintense regions adjacent to enhancing tumor, normal-appearing WM adjacent to hyperintense regions, and analogous locations in the contralateral WM corresponding to these areas. Fractional anisotropy (FA) was measured in similar locations on maps generated from diffusion-tensor imaging data. Changes in ADC and FA in each type of tissue were compared across tumor types by using a two-sample t test. P <.05 indicated statistical significance. RESULTS: Mean ADCs in peritumoral hyperintense regions were 1.309 x 10(-3) mm2/sec (mean percentage of 181% of normal WM) for gliomas and 1.427 x 10(-3) mm2/sec (192% of normal value) for meningiomas (no significant difference). Mean ADCs in peritumoral normal-appearing WM were 0.723 x 10(-3) mm2/sec (106% of normal value) for gliomas and 0.743 x 10(-3) mm2/sec (102% of normal value) for meningiomas (no significant difference). Mean FA values in peritumoral hyperintense regions were 0.178 (43% of normal WM value) for gliomas and 0.224 (65% of normal value) for meningiomas (P =.05). Mean FA values for peritumoral normal-appearing WM were 0.375 (83% of normal value) for gliomas and 0.404 (100% of normal value) for meningiomas (P =.01). CONCLUSION: The difference in FA decreases in peritumoral normal-appearing WM between gliomas and meningiomas was significant, and the difference in FA decreases in peritumoral hyperintense regions between these tumors approached but did not reach significance. These findings may indicate a role for diffusion MR imaging in the detection of tumoral infiltration that is not visible on conventional MR images.     

Voxel-based morphometry and diffusion-tensor MR imaging of the brain in long-term survivors of childhood leukemia

The aims of this study were to detect morphological changes in neuroanatomical components in adult survivors of acute lymphoblastic leukemia (ALL). Voxel-based morphometry (VBM) can be used to detect subtle structural changes in brain morphology and via analysis of fractional anisotropy (FA), diffusion-tensor imaging (DTI) can non-invasively probe white matter (WM) integrity. We used VBM and DTI to examine 20 long-term survivors of ALL and 21 healthy matched controls. Ten ALL survivors received chemotherapy and irradiation; ten survivors received chemotherapy alone during childhood. Imaging was performed on a 3.0-T MRI. For VBM, group comparisons of segmented T1-weighted grey matter (GM) and WM images from controls and ALL survivors were performed separately for patients who received chemotherapy alone and who received chemotherapy and irradiation. For DTI, FA in WM was compared for the same groups. Survivors of childhood ALL who underwent cranial irradiation during childhood had smaller WM volumes and reduced GM concentration within the caudate nucleus and thalamus. The FA in WM was reduced in adult survivors of ALL but the effect was more severe after combined treatment with irradiation and chemotherapy. Our results indicate that DTI and VBM can reveal persistent long-term WM and caudate changes in children after ALL treatment, even without T2 changes in conventional imaging. L. Porto and C. Preibisch contributed equally to this study     

Quantitative diffusion-tensor anisotropy brain MR imaging: normative human data and anatomic analysis.

PURPOSE: To obtain normative human cerebral data and evaluate the anatomic information in quantitative diffusion anisotropy magnetic resonance (MR) imaging. MATERIALS AND METHODS: Quantitative diffusion anisotropy MR images were obtained in 13 healthy adults by using single-shot echo-planar MR imaging and a combination of tetrahedral and orthogonal gradient encoding (whole-brain coverage in about 1 minute). White matter (WM) anatomy was assessed at visual inspection, and values were measured in various brain regions. Different anisotropy measures, including total anisotropy (A sigma), were compared on the basis of information content, rotational invariance, and susceptibility to noise. Partial volume and noise effects were simulated. RESULTS: Anisotropy MR images depicted WM features not typically seen on conventional MR images (e.g., external capsule, thalamic substructures, basal ganglia, occipital WM, thickness of the internal capsule). Statistically significant anisotropy differences occurred across brain regions, which were reproducible within and across subjects. A sigma was highest in commissural WM and progressively lower in projection and association WM. This order paralleled that of known resistance to spread of vasogenic edema, which suggested that anisotropy may be sensitive to WM histologic structure. Gray matter (GM) A sigma data were consistent with zero anisotropy, and partial volume WM-GM effects were approximately linear. A sigma image quality could be effectively improved by means of averaging. CONCLUSION: Quantitative diffusion anisotropy images can be obtained rapidly and demonstrate subtle WM anatomy. Different histologic types of WM have significant and reproducible anisotropy differences.     

Correlation of white matter diffusivity and anisotropy with age during childhood and adolescence: a cross-sectional diffusion-tensor MR imaging study.

PURPOSE: To evaluate differences in white matter diffusion properties as a function of age in healthy children and adolescents. MATERIALS AND METHODS: Echo-planar diffusion-tensor magnetic resonance (MR) imaging was performed in 33 healthy subjects aged 5-18 years who were recruited from a functional imaging study of normal language development. Results of neurologic, psychologic, and structural MR imaging examinations were within the normal range for all subjects. The trace of the apparent diffusion coefficient and fractional anisotropy in white matter were correlated as a function of age by using Spearman rank correlation. RESULTS: Statistically significant negative correlation of the trace of the apparent diffusion coefficient with age was found throughout the white matter. Significant positive correlation of fractional anisotropy with age was found in the internal capsule, corticospinal tract, left arcuate fasciculus, and right inferior longitudinal fasciculus. CONCLUSION: Diffusion-tensor MR imaging results indicate that white matter maturation assessed at different ages involves increases in both white matter density and organization during childhood and adolescence. The trace of the apparent diffusion coefficient and fractional anisotropy may reflect different physiologic processes in healthy children and adolescents.     

Reversible posterior leukoencephalopathy syndrome: evaluation with diffusion-tensor MR imaging

PURPOSE: To characterize the changes in brain water diffusion caused by reversible posterior leukoencephalopathy syndrome (RPLS). MATERIALS AND METHODS: Twelve patients with the clinical features and conventional magnetic resonance (MR) imaging findings of RPLS underwent diffusion-tensor echo-planar MR imaging. The isotropic diffusion coefficient (D) and diffusion anisotropy (A(sigma)) were measured in posterior regions of diffusion abnormality and in anterior areas of normal-appearing brain. RESULTS: Across all 12 subjects, the mean D of (1.09 +/- 0.13 [SD]) x 10(-3) mm(2)/sec in affected posterior regions was 26% greater than its value of (0.87 +/- 0.07) x 10(-3) mm(2)/sec in normal-appearing anterior regions. The mean A(sigma) of 0.15 +/- 0.03 in posterior regions was 35% less than its value of 0.23 +/- 0.02 in anterior regions (t(11) = 9.58; P <.001). There was a significant inverse correlation between D and A(sigma) in posterior regions (r = -0.67; P <.018) but not in anterior regions (r = -0.12; P =.719). A follow-up study performed in one patient after resolution of symptoms documented reversal of elevated isotropic diffusion and at least partial recovery of anisotropy loss. CONCLUSION: The increased magnitude of brain water diffusion characteristic of RPLS is accompanied by reduced A(sigma). The magnitudes of these two effects are correlated and may be reversible. These observations support the proposal that vasogenic edema due to cerebrovascular autoregulatory dysfunction is the underlying pathophysiologic mechanism in uncomplicated RPLS.     

Evaluating pediatric brain tumor cellularity with diffusion-tensor imaging.

OBJECTIVE: MR imaging of central nervous system (CNS) malignancies falls short of a definitive evaluation. Tissue diagnosis remains the gold standard. Diffusion-tensor MR imaging measures the apparent diffusion coefficient and diffusion anisotropy of water in tissue. The purpose of this study was to test the hypothesis that the apparent diffusion coefficient may improve the MR imaging evaluation of newly diagnosed CNS neoplasms. We examined the relationship between the apparent diffusion coefficient, anisotropy, and tumor cellularity in 12 pediatric patients. MATERIALS AND METHODS: On the basis of histopathologic evaluation, tumors in this case series were segregated into three types: low-grade gliomas, embryonal tumors, and nonembryonal high-grade tumors. Mean apparent diffusion coefficient and anisotropy values obtained from the solid components of each tumor were compared with cellularity, total cellular area, and total nuclear area derived from biopsy material. RESULTS: The apparent diffusion coefficient ratio (tumor to normal brain) correlated well with tumor classification (p = 0.001). Anisotropy was decreased similarly in all tumor classifications. The absolute apparent diffusion coefficient correlated well with cellularity (p = 0.014) and total nuclear area (p = 0.005) per high-power field. The correlation between apparent diffusion coefficient and total cellular area per high-power field was not statistically significant. CONCLUSION: The apparent diffusion coefficient may be predictive of tumor classification and may be a useful tool in characterizing tumor cellularity and total nuclear area. These parameters are not available in standard MR imaging. Therefore, diffusion-tensor imaging may enhance the diagnostic process in pediatric CNS malignancies.     

Normal and abnormal thymus in childhood: MR imaging

Magnetic resonance (MR) imaging studies of 47 children without thymic disease were compared with those of 14 children with proved thymic abnormalities (eg, lymphoma, leukemia, hyperplasia) to evaluate the spectrum of MR features of the normal and abnormal thymus and to determine the best indicators of thymic disease. In healthy children younger than 5 years of age, the thymus had a quadrilateral shape and biconvex lateral contours. Older children and adolescents had a triangular thymus with straight lateral margins. The thymus appeared homogeneous with a signal intensity slightly greater than that of muscle on T1-weighted images and close to that of fat on T2-weighted images. Qualitative evaluation of gross thymic morphology (size, shape, margins, and signal intensity) usually was sufficient for distinguishing between the normal and abnormal thymus. The abnormal thymus generally was enlarged, multilobular, or inhomogeneous because of the presence of cystic degeneration, hemorrhage, septations, fibrosis, or calcification on pathologic sections. In patients with lymphoma, the presence of associated lymphadenopathy also was helpful in distinguishing the normal from the abnormal thymus.     

强迫症病人脑微结构异常的3.0 T MR扩散张量成像研究

目的应用MR扩散张量成像(DTI)研究强迫症(OCD)病人脑白质的完整性及连接性,探讨DTI参数与临床指数的相关性。材料与方法该研究经当地伦理委员会批准,     

Normal deposition of brain iron in childhood and adolescence: MR imaging at 1.5 T

Magnetic resonance (MR) images of the brain in 285 patients between the ages of 2 and 25 years were retrospectively studied to determine the appearance of brain iron accumulation. The globus pallidus, red nucleus, substantia nigra, and dentate nucleus were evaluated with long TR/TE (repetition time/echo time) spin-echo sequences and staged. All four regions in most patients were initially hyperintense compared with white matter (stage I) before becoming isointense (stage II) and subsequently hypointense (stage III). The globus pallidus was the first to reach stage III, the red nucleus and substantia nigra were next, and the dentate nucleus was last. In general, decreased signal intensity (stage III) was not seen in these regions in patients less than 10 years old; in most patients it was seen by age 25 years. The dentate nucleus decreased in signal intensity more slowly and inconsistently; only one-third of patients had reached stage III by age 25 years. The temporal sequence of normal iron deposition as detected with MR imaging is helpful not only in the diagnosis of known iron-deposition diseases but also in the detection of iron-related pathologic changes.     

Intraoperative diffusion-tensor MR imaging: shifting of white matter tracts during neurosurgical procedures--initial experience

PURPOSE: To prospectively evaluate the location of white matter tracts with diffusion-tensor imaging (DTI) during neurosurgical procedures. MATERIALS AND METHODS: Ethical committee approval and signed informed consent were obtained. A 1.5-T magnetic resonance imager with an adapted rotating surgical table that is placed in a radiofrequency-shielded operating theater was used for pre- and intraoperative imaging. DTI was performed by applying an echo-planar imaging sequence with six diffusion directions in 38 patients (20 female patients, 18 male patients; age range, 7-77 years; mean age, 45.6 years) who were undergoing surgery (35 craniotomy and three burr hole procedures). Color-encoded maps of fractional anisotropy were generated by depicting white matter tracts. A rigid registration algorithm was used to compare pre- and intraoperative images. RESULTS: Intraoperative DTI was technically feasible in all patients, and no major image distortions occurred in the areas of interest. Pre- and intraoperative color-encoded maps of fractional anisotropy could be registered; these maps depicted marked and highly variable shifting of white matter tracts during neurosurgical procedures. In the 27 patients who underwent brain tumor resection, white matter tract shifting ranged from an inward shift of 8 mm to an outward shift of 15 mm (mean shift +/- standard deviation, outward shift of 2.5 mm +/- 5.8). In 16 (59%) of 27 patients, outward shifting was detected; in eight (30%), inward shifting was detected. In eight patients who underwent temporal lobe resections for drug-resistant epilepsy, shifting was only inward and ranged from 2 to 14 mm (9 mm +/- 3.3). In two of the three patients who underwent burr hole procedures, outward shifting occurred. CONCLUSION: Intraoperative DTI can depict shifting of major white matter tracts that is caused by surgical intervention.     

Brain fiber tracking with clinically feasible diffusion-tensor MR imaging: initial experience

Two technical challenges must be overcome before brain fiber tracking with diffusion-tensor magnetic resonance (MR) imaging can be applied to clinical practice: Imaging time must be shortened, and image distortion must be minimized. Single-shot echo-planar MR imaging with parallel imaging technique enabled both objectives to be accomplished. Twenty-three consecutive patients with brain tumors underwent MR imaging with a 1.5-T whole-body MR system. Fiber tracts on the lesion side in the brain had varying degrees of displacement or disruption as a result of the tumor. Tract disruption resulted from direct tumor involvement, compression on the tract, and vasogenic edema surrounding the tumor. This diffusion-tensor MR imaging method with the parallel imaging technique allows clinically feasible brain fiber tracking.     

Normal brain maturation characterized with age-related T2 relaxation times: an attempt to develop a quantitative imaging measure for clinical use

OBJECTIVES: We studied age-related changes in T2 relaxation times from the normal maturating human brain under routine clinical MR examination conditions. MATERIALS AND METHODS: In 70 healthy subjects aged between 3 weeks and 39 years, T2 maps of the brain in which the intensity of each pixel corresponded to T2 relaxation times were generated based on magnetic resonance imaging data collected with a triple spin echo sequence. T2 relaxation times in white matter (WM) and gray matter (GM) were measured in 6 distinctive regions of interest of the T2 maps. The age dependence of the T2 values was mathematically simulated using a biexponential function. RESULTS: T2 values were largest at the age of 3 weeks (maximum: approximately 400 milliseconds for WM and 200 milliseconds for GM) and decreased continuously with increasing age, faster in the first few months and slower thereafter, until values achieved between 95 and 110 milliseconds for WM and 88 and 95 milliseconds for GM in adults. The relationship between T2 values and age could be well simulated using a biexponential function (R > 0.92). CONCLUSIONS: T2 relaxation time correlates well with the progress of brain maturation. The used biexponential function reflects the dynamic development of myelination in newborns and young children as well as the maturation of myelination during adolescence and could be used to develop a "normal" reference for neuroradiological diagnoses.     

Peritumoral edema of meningiomas and metastatic brain tumors: differences in diffusion characteristics evaluated with diffusion-tensor MR imaging

Introduction We prospectively compared the fractional anisotropy (FA) and mean diffusivity (MD) of the peritumoral edema of meningiomas and metastatic brain tumors with diffusion-tensor magnetic resonance (MR) imaging. Methods The study protocol was approved by the local ethics committee, and written informed consent was obtained. Preoperative diffusion-tensor MR imaging was performed in 15 patients with meningiomas and 11 patients with metastatic brain tumors. Regions of interest (ROI) were placed in the peritumoral edema and normal-appearing white matter (NAWM) of the contralateral hemisphere to measure the FA and MD. The FA and MD ratios were calculated for each ROI in relation to the NAWM of the contralateral hemisphere. Changes in peritumoral MD and FA, in terms of primary values and ratios, were compared using a two-sample t-test; P < 0.05 was taken as indicating statistical significance. Results The mean MD values (×10⁻³ mm²/s) of the peritumoral edema for metastases and meningiomas, respectively, were 0.902 ± 0.057 and 0.820 ± 0.094, the mean MD ratios were 220.3 ± 22.6 and 193.1 ± 23.4, the mean FA values were 0.146 ± 0.026 and 0.199 ± 0.052, and the mean FA ratios were 32.3 ± 5.9 and 46.0 ± 12.1. All the values were significantly different between metastases and meningiomas (MD values P = 0.016, MD ratios P = 0.006, FA values P = 0.005, FA ratios P = 0.002). Conclusion The peritumoral edema of metastatic brain tumors and meningiomas show different MD and FA on diffusion-tensor MR imaging.     

FLAIR diffusion-tensor MR tractography: comparison of fiber tracking with conventional imaging

BACKGROUND AND PURPOSE: Partial volume with CSF is known to contaminate the quantification of white matter anisotropy depicted by diffusion tensor imaging (DTI). We hypothesized that the FLAIR technique helps to improve DTI white matter tractography in the normal adult brain by eliminating CSF partial volume effects. METHODS: Seven healthy adults aged 23-37 underwent both conventional and FLAIR DTI at 1.5T. Each subject was imaged five times. Neural fiber tractography was performed with both sequences by using two algorithms: a voxel-based method (EZ-tracing) with global seed points and another based on subvoxel tractography (tensor deflection) by using manual encircling of local seed points. Total volume of the fibers tracked was compared for the two types of images. RESULTS: Fiber tracking was substantially most successful on FLAIR DTI near the lateral ventricles and the sulci, where CSF partial volume effects were likely present. Minor false tracts on FLAIR images, possibly due to a reduced signal-to-noise ratio, were found in regions relatively free of CSF contamination; however, they did not affect tracking of major periventricular white matter bundles, such as those related to the corpus callosum or the corona radiata. When we excluded false tracts, the FLAIR technique depicted an average of 17% more fibers in volume than conventional DTI in the periventricular regions (P < .0005, paired Student t test). CONCLUSION: Despite the reduction of signal-to-noise ratio and longer imaging times, FLAIR improved tractography by eliminating CSF partial volume effects.     

Peroxisomal biogenesis disorder: comparison of conventional MR imaging with diffusion-weighted and diffusion-tensor imaging findings

BACKGROUND AND PURPOSE: Peroxisomal biogenesis disorders (PBDs) refer to a group of disorders of peroxisomal biogenesis causing neuronal migration disorder, delayed myelination, and demyelination. The aim of this study was to evaluate the added value of diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) compared with that of conventional T2-weighted imaging in assessing the extent of white matter damage in patients with PBDs. METHODS: Three patients (aged 12, 16, and 80 months) with PBD (type 1 protein targeting sequence [PTS1]) and three age-matched control subjects underwent MR imaging on a 1.5-T system. The protocol included axial T2-weighted, DWI, and DTI sequences. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) changes were calculated using regions of interest at several predefined white matter areas and compared with those of age-matched control subjects. Color-coded maps were obtained to visualize the range of FA values. RESULTS: On the T2-weighted images, one patient revealed severe hypomyelination throughout the brain; the two other patients showed focal abnormal high-signal-intensity areas. All patients had significantly decreased FA values in white matter areas that appeared abnormal on the T2-weighted images. In two of the three patients, significant FA reduction was also found in normal-appearing white matter. The ADC values of the patients were significantly increased compared with those of the age-matched controls. CONCLUSION: Although based on a small number of patients, our data suggest that DWI and DTI can be used to characterize and quantify white matter tract injury in patients with PBD-PTS1. Furthermore, our data suggest that these techniques have the potential to identify neurodegenerative changes not yet visible on T2-weighted images.     

Multivoxel proton MR spectroscopy and hemodynamic MR imaging of childhood brain tumors: preliminary observations.

PURPOSETo assess multivoxel proton MR spectroscopy combined with MR imaging and hemodynamic MR imaging in the evaluation of brain tumors in children and young adults.METHODSFifteen patients with brain tumors and 10 healthy children underwent MR imaging and MR spectroscopy on a 1.5-T system. Ten patients with tumors had both MR spectroscopy and hemodynamic MR imaging. MR spectroscopy data sets with 1 cm3 to 3.4 cm3 resolution were acquired within 8.5 minutes by using a point-resolved spectroscopic, chemical-shift imaging technique in two dimensions with volume preselection. MR imaging was performed using fast spin-echo techniques. Hemodynamic MR imaging data were acquired every 2.5 seconds at one anatomic level using a spoiled gradient-echo sequence during intravenous bolus administration of contrast material.RESULTSAssessment with multivoxel MR spectroscopy and hemodynamic MR imaging added about 30 minutes to the total MR examination time. Normal tissue exhibited spectral peaks from biologically significant compounds such as N-acetylaspartate (NAA), choline-containing compounds (Cho), and total creatine (tCr). Twelve biopsy-proved tumors exhibited prominent Cho, reduced NAA, variable tCr, and/or lactate or lipids, and two showed increased hemodynamic parameters. Three of the tumors treated with radiation did not reveal prominent levels of Cho. Tissue necrosis had no Cho, NAA, or tCr, and reduced hemodynamics.CONCLUSIONSPreliminary findings by MR spectroscopy combined with MR imaging and hemodynamic MR imaging suggest that regions of active tumor may be differentiated from areas of normal tissue and areas of necrosis. These findings may enable metabolic and hemodynamic characterization of childhood brain tumors as well as suggest their response to therapy.     

Low-grade and anaplastic gliomas: differences in architecture evaluated with diffusion-tensor MR imaging

PURPOSE: To prospectively evaluate whether diffusion-tensor magnetic resonance (MR) imaging depicts differences in World Health Organization (WHO) grade II and III glial brain tumors on the basis of tumor architecture and peritumoral tract invasion. MATERIALS AND METHODS: The study protocol was approved by the local ethics committee, and written informed consent was obtained. Diffusion-tensor MR imaging was performed in 23 patients (15 men, eight women; mean age, 47 years) with histologically confirmed brain gliomas. Eleven of the 23 tumors were low-grade gliomas (WHO grade II) and 12 were anaplastic gliomas (WHO grade III). Regions of interest were placed in the tumor center, tumor border, normal-appearing white matter (NAWM) adjacent to the tumor, and NAWM of the contralateral hemisphere. fractional anisotropy (FA) ratios were calculated for regions of interest in relation to the NAWM of the contralateral hemisphere. Pairwise comparisons were performed by using the Mann-Whitney U test. RESULTS: Median FA ratios for grade II versus grade III gliomas were 0.406 versus 0.405, respectively, for tumor center, 0.733 versus 0.449, respectively, for tumor border, and 0.962 versus 0.943, respectively, for NAWM adjacent to the tumor. Differences in FA ratio between low-grade and high-grade tumors were significant in the tumor border only (P = .01). Differences in FA ratio were not significant between low-grade and high-grade gliomas in the tumor center or in the NAWM adjacent to the tumor. CONCLUSION: The periphery of low-grade gliomas contains a considerable amount of preserved fiber tracts. In high-grade gliomas, however, most of these tracts are disarranged. Low FA ratios in the tumor center are consistent with a high degree of disorganization of myelinated fiber tracts in the center of both low-grade and high-grade gliomas.