Practical visualization of internal structure of white matter for image interpretation: staining a spin-echo T2-weighted image with three echo-planar diffusion-weighted images

BACKGROUND AND PURPOSE: To our knowledge, no method satisfactory for clinical use has been developed to visualize white matter fiber tracts with diffusion-weighted MR imaging. The purpose of this study was to determine whether superposition of a spin-echo T2-weighted image and a color-coded image derived from three orthogonal diffusion-weighted images could show fiber tract architecture of the brain with an image quality appropriate for accurate reading with a computer monitor. METHODS: MR images from 50 consecutive cases were reviewed. Three diffusion-weighted images per section were acquired with three orthogonal motion-probing gradients. These images were registered to a corresponding spin-echo T2-weighted image. A color-coded image was synthesized from three diffusion-weighted images by assigning red, green, or blue to each diffusion-weighted image and then adding a spin-echo T2-weighted image with a weighting factor. The ability of the superposed image to delineate the white matter pathways was evaluated on the basis of the known anatomy of these pathways and qualitatively compared with that of the spin-echo T2-weighted image. RESULTS: The main white matter fiber pathways, in particular the superior longitudinal fascicle, corpus callosum, tapetum, optic radiation, and internal capsule, were more clearly and easily identified on the superposed image than on the spin-echo T2-weighted image. The time required to produce the superposed image was approximately 40 minutes. CONCLUSION: Superposition of a spin-echo T2-weighted image and a color-coded image created from three orthogonal diffusion-weighted images showed structures of the brain that were not clearly visible on the spin-echo T2-weighted image alone. Such superposition presents images that are easy to interpret correctly.     

Diffusion weighted MR imaging of acute Wernicke's encephalopathy

We report a case of Wernicke's encephalopathy in which diffusion-weighted MR images demonstrated symmetrical hyperintense lesions in the paraventricular area of the third ventricles and medial thalami. Apparent diffusion coefficient mapping showed isointensity in the aforementioned areas. Diffusion-weighted MR images may provide evidence of vasogenic edema associated with thiamine deficiency, proven in the histopathology of experimental animals. In addition, diffusion-weighted MRI has many advantages over T2 or FLARE-weighted brain MRI in detecting structural and functional abnormalities in Wernicke's encephalopathy.     

PC机辅助MR人脑表观扩散系数图的成像研究

目的 研究PC机辅助MR人脑平均表观扩散系数(ADCav)图的成像软件，探讨其I临床应用价值。资料与方法 在PC机上使用MR脑ADCav图成像软件，对6例正常人和12例亚急性期脑梗死患者扩散加权图像进行后处理，计算出ADCav图。结果 应用MR脑ADCav图成像软件可以在PC机上实现扩散加权图像的后处理，计算出人脑ADCav图，进行ADC值的定量分析，图像以伪彩色显示，能够更加明确病变的范围。结论 PC机辅助MR人脑ADCav图成像软件简单易行，对临床和科研具有重要价值。     

Image-matching as a medical diagnostic support tool (DST) for brain diseases in children.

Imaging-matching is an important research area in imaging informatics. We have developed and evaluated a novel diagnostic support tool (DST) based on medical image matching using MR brain images. The approach consists of two steps, database generation and image matching. The database contains pre-diagnosed MR brain images. As the images are added to the database, they are registered to the 3D Talairach coordinate system. In addition, regions of interests (ROI) are generated, and image-processing techniques are used to extract relevant image parameters related to the brain and diseases from the ROIs and from the entire MR image. The second step is to retrieve relevant information from the database by performing image matching. In this step, the physician first submits a query image. The DST computes the similarity between the query image and each of the images in the database, and then presents the most similar images to the user. Since the database contains pre-diagnosed images, the retrieved cases tend to contain relevant diagnostic information. To evaluate the usefulness of the DST in a clinical setting, pediatric brain diseases were used. The database contains 2500 pediatric patients between ages 0 and 18 with brain Magnetic Resonance (MR) images of known brain lesions. A testbed was established at the Children's Hospital Los Angeles (CHLA) for acquiring MR images from the PACS server of patients with known lesions. These images were matched against those in the DST pediatric brain MR database. An expert pediatric neuroradiologist evaluated the matched results. We found that in most cases, the image-matching method was able to quickly retrieve images with relevant diagnostic content. The evaluation method and results are given.     

Reduction of eddy-current-induced distortion in diffusion MRI using a twice-refocused spin echo.

Image distortion due to field gradient eddy currents can create image artifacts in diffusion-weighted MR images. These images, acquired by measuring the attenuation of NMR signal due to directionally dependent diffusion, have recently been shown to be useful in the diagnosis and assessment of acute stroke and in mapping of tissue structure. This work presents an improvement on the spin-echo (SE) diffusion sequence that displays less distortion and consequently improves image quality. Adding a second refocusing pulse provides better image quality with less distortion at no cost in scanning efficiency or effectiveness, and allows more flexible diffusion gradient timing. By adjusting the timing of the diffusion gradients, eddy currents with a single exponential decay constant can be nulled, and eddy currents with similar decay constants can be greatly reduced. This new sequence is demonstrated in phantom measurements and in diffusion anisotropy images of normal human brain.     

Navigated Diffusion Imaging of Normal and Ischemic Human Brain

The principal barrier to clinical application of diffusion-weighted MR imaging is the severe image degradation caused by patient motion. One way to compensate for motion effects is the use of a “navigator echo” phase correction scheme. In this work, a modification of this technique is introduced, in which the phase correction step is performed in the frequency domain (i.e., after the readout Fourier transform). This significantly improves the robustness of the navigator echo approach and, when combined with cardiac gating, allows diagnostic quality diffusion-weighted images of the brain to be routinely obtained on standard clinical scanner hardware. The technique was evaluated in phantom studies and in 23 humans (3 normal volunteers and 20 patients). Diffusion anisotropy and apparent diffusion coefficient maps were generated from the image data and showed decreased apparent diffusion in acute stroke lesions and, in several cases, increased apparent diffusion in chronic stroke lesions.     

High-b-value diffusion-weighted MR imaging of suspected brain infarction

BACKGROUND AND PURPOSE: Recent technological advances in MR instrumentation allow acquisition of whole-brain diffusion-weighted MR scans to be obtained with b values greater than 1,000. Our purpose was to determine whether high-b-value diffusion-weighted MR imaging improved contrast and detection of signal changes in acute and chronic brain infarction. METHODS: We prospectively evaluated the MR scans of 30 subjects with a history of possible brain infarction on a 1.5-T MR imager with 40 mT/meter gradients (slew rate 150 T/m/s) by use of the following single-shot echo-planar diffusion-weighted MR sequences: 1) 7,999/ 71.4/1 (TR/TE/excitations, b = 1,000; 2) 999/ 88.1/3, b = 2,500; and 3) 7,999/ 92.1/4, b = 3,000. Diffusion-weighted MR imaging was performed in three orthogonal directions during all sequences. All subjects were scanned with fast fluid-attenuated inversion recovery (FLAIR) (10,006/145/2,200/1 [TR/TE/TI/excitations]) and fast spin-echo T2-weighted (3,650/95/3 [TR/TE/excitations], echo train length, 8). The diagnosis of brain infarction was established by clinical criteria. RESULTS: Twenty women and 10 men with a mean age of 67.7 years were enrolled in the study. One subject was excluded owing to poor image quality. Twelve of 29 subjects had a clinical diagnosis of acute infarction. All 12 had lesions that were hyperintense on diffusion-weighted images at all three b values; five were cortical and seven subcortical. There was increased contrast of all lesions on high-b-value scans (b = 2,500 and 3,000). Lesions that were hypointense on diffusion-weighted images were identified and evaluated at the three different b values. At b = 1,000, there were 19 hypointense lesions, whereas at b = 2,500 and 3,000 there were 48 and 55 lesions, respectively. On FLAIR and T2-weighted images, these low-signal lesions were predominantly chronic, subcortical, ischemic lesions and lacunar infarcts, but four chronic cortical infarcts, one porencephalic cyst, and one primary brain tumor were also found. Low-signal lesions were also noted to have increased contrast on high-b-value diffusion-weighted scans. CONCLUSION: High-b-value diffusion-weighted MR imaging (b = 2,500 or b = 3,000) had no impact on diagnosis of acute infarction. High-b-value diffusion-weighted MR imaging (b = 2,500) combined with diffusion-weighted MR imaging at b = 1,000 improves tissue characterization by increasing the spectrum of observed imaging abnormalities in patients with suspected brain infarction.     

A comparative study of warping and rigid body registration for the prostate and pelvic MR volumes.

A three-dimensional warping registration algorithm was created and compared to rigid body registration of magnetic resonance (MR) pelvic volumes including the prostate. The rigid body registration method combines the advantages of mutual information (MI) and correlation coefficient at different resolutions. Warping registration is based upon independent optimization of many interactively placed control points (CP's) using MI and a thin plate spline transformation. More than 100 registration experiments with 17 MR volume pairs determined the quality of registration under conditions simulating potential interventional MRI-guided treatments of prostate cancer. For image pairs that stress rigid body registration (e.g. supine, the diagnostic position, and legs raised, the treatment position), both visual and numerical evaluation methods showed that warping consistently worked better than rigid body. Experiments showed that approximately 180 strategically placed CP's were sufficiently expressive to capture important features of the deformation.     

Diffusion-weighted whole-body MR imaging with background body signal suppression: a feasibility study at 3.0 Tesla

The purpose was to provide a diffusion-weighted whole-body magnetic resonance (MR) imaging sequence with background body signal suppression (DWIBS) at 3.0 Tesla. A diffusion-weighted spin-echo echo-planar imaging sequence was combined with the following methods of fat suppression: short TI inversion recovery (STIR), spectral attenuated inversion recovery (SPAIR), and spectral presaturation by inversion recovery (SPIR). Optimized sequences were implemented on a 3.0- and a 1.5-Tesla system and evaluated in three healthy volunteers and six patients with various lesions in the neck, chest, and abdomen on the basis of reconstructed maximum intensity projection images. In one patient with metastases of malignant melanoma, DWIBS was compared with ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET). Good fat suppression for all regions and diagnostic image quality in all cases could be obtained at 3.0 Tesla with the STIR method. In comparison with 1.5 Tesla, DWIBS images at 3.0 Tesla were judged to provide a better lesion-to-bone tissue contrast. However, larger susceptibility-induced image distortions and signal intensity losses, stronger blurring artifacts, and more pronounced motion artifacts degraded the image quality at 3.0 Tesla. A good correlation was found between the metastases as depicted by DWIBS and those as visualized by FDG-PET. DWIBS is feasible at 3.0 Tesla with diagnostic image quality.     

Hypertensive encephalopathy: complication in children treated for myeloproliferative disorders--report of three cases

We routinely perform echo-planar diffusion-weighted sequences in all brain magnetic resonance (MR) imaging studies. When three children undergoing chemotherapy for acute leukemia presented with seizures, conventional MR images demonstrated what appeared to be acute, posterior, parasagittal infarcts. However, diffusion-weighted images were normal. These MR imaging findings were consistent with those of hypertensive encephalopathy. Early recognition and treatment of minimal hypertension in these patients allows reversal of encephalopathy.     

A case of intravascular lymphomatosis with sinus thrombosis]

We report a rare case of intravascular lymphomatosis with massive tumor in the superior sagittal sinus (SSS), which caused sinus thrombosis. A 63-year-old man was incidentally found to have an enhancing mass in the superior sagittal sinus on MRI. The tumor manifested spontaneous regression during with 4 month's follow-up. Five months after the initial MR examination, T2-weighted MR images revealed a area of hyperintensity in the right occipital lobe. The area showed hypointensity on diffusion-weighted image and showed hyperintensity on ADC mapping, findings that are compatible with vasogenic edema.     

Diffusion-weighted MR imaging of acute stroke: correlation with T2-weighted and magnetic susceptibility-enhanced MR imaging in cats

We evaluated the temporal and anatomic relationships between changes in diffusion-weighted MR image signal intensity, induced by unilateral occlusion of the middle cerebral artery in cats, and tissue perfusion deficits observed in the same animals on T2-weighted MR images after administration of a nonionic intravascular T2 shortening agent. Diffusion-weighted images obtained with strong diffusion-sensitizing gradient strengths (5.6 gauss/cm, corresponding to gradient attenuation factor, b, values of 1413 sec/mm2) displayed increased signal intensity in the ischemic middle cerebral artery territory less than 1 hr after occlusion, whereas T2-weighted images without contrast usually failed to detect injury for 2-3 hr after stroke. After contrast administration (0.5-1.0 mmol/kg by Dy-DTPA-BMA, IV), however, T2-weighted images revealed perfusion deficits (relative hyperintensity) within 1 hr after middle cerebral artery occlusion that corresponded closely to the anatomic regions of ischemic injury shown on diffusion-weighted MR images. Close correlations were also found between early increases in diffusion-weighted MR image signal intensity and disrupted phosphorus-31 and proton metabolite levels evaluated with surface coil MR spectroscopy, as well as with postmortem histopathology. These data indicate that diffusion-weighted MR images more accurately reflect early-onset pathophysiologic changes induced by acute cerebral ischemia than do T2-weighted spin-echo images.     

Anatomic validation of spatial normalization methods for PET.

Spatial normalization methods, which are indispensable for intersubject analysis in current PET studies, have been improved in many aspects. These methods have not necessarily been evaluated as anatomic normalization methods because PET images are functional images. However, in view of the close relation between brain function and morphology, it is very intriguing how precisely normalized brains coincide with each other. In this report, the anatomic precision of spatial normalization is validated with three different methods. METHODS: Four PET centers in Japan participated in this study. In each center, six normal subjects were recruited for both H2(15)O-PET and high-resolution MRI studies. Variations in the location of the anterior commissure (AC) and size and contours of the brain and the courses of major sulci were measured in spatially normalized MR images for each method. Spatial normalization was performed as follows. (a) Linear: The AC-posterior commissure and midsagittal plane were identified on MRI and the size of the brain was adjusted to the Talairach space in each axis using linear parameters. (b) Human brain atlas (HBA): Atlas structures were manually adjusted to MRI to determine linear and nonlinear transformation parameters and then MRI was transformed with the inverse of these parameters. (c) Statistical parametric mapping (SPM) 95: PET images were transformed into the template PET image with linear and nonlinear parameters in a least-squares manner. Then, coregistered MR images were transformed with the same parameters used for the PET transformation. RESULTS: The AC was well registered in all methods. The size of the brain normalized with SPM95 varied to a greater extent than with other approaches. Larger variance in contours was observed with the linear method. Only SPM95 showed significant superiority to the linear method when the courses of major sulci were compared. CONCLUSION: The results of this study indicate that SPM95 is as effective a spatial normalization as HBA, although it does not use anatomic images. Large variance in structures other than the AC and size of the brain in the linear method suggests the necessity of nonlinear transformations for effective spatial normalization. Operator dependency of HBA also must be considered.     

Diffusion-weighted MR imaging after angioplasty or angioplasty plus stenting of arteries supplying the brain

BACKGROUND AND PURPOSE: There has been concern regarding the safety of revascularization procedures of vessels supplying the brain vessels because of the risk of cerebral embolization during the procedure. We have observed a high incidence of hyperintense lesions on diffusion-weighted MR images of the brain after stenting at the carotid bifurcation. The hypothesis of this study is that diffusion-weighted MR imaging of the brain can reveal new diffusion abnormalities after angioplasty or angioplasty plus stenting of arteries supplying the brain, other than at the carotid bifurcation. Therefore, we prospectively obtained diffusion-weighted MR images of the brain before and after such revascularization procedures. METHODS: Thirty-seven revascularization procedures were performed in 32 patients. Eleven interventions were performed at the distal internal carotid artery, two at the external carotid artery, two at the common carotid artery, five at the innominate artery, five at the vertebral artery, and 12 at the proximal subclavian artery. Diffusion-weighted MR imaging of the brain was performed before and 24 hours after the procedures. RESULTS: After eight (22%) of 37 procedures, new hyperintensities were visible on the diffusion-weighted MR images. With six of these eight procedures, the hyperintensities occurred in the vascular territory supplied by the treated vessel. In total, 35 new cerebral lesions could be seen, 33 (94%) of which occurred in the vascular territory supplied by the treated vessel. None of the patients in whom new diffusion abnormalities were found had new neurologic symptoms or deficits. No new lesions could be seen after procedures at the subclavian artery. CONCLUSION: Revascularization procedures of arteries supplying the brain were associated with new lesions on the diffusion-weighted MR images of the brain after 22% of the procedures, provided that MR imaging could be performed, indicating the occurrence of cerebral microemboli during such procedures. Diffusion-weighted MR imaging of the brain can be used as a tool to assess the impact of modifications of procedural technique and/or the use of cerebral protection devices on the occurrence of such lesions.     

Traumatic brain injury: diffusion-weighted MR imaging findings.

BACKGROUND AND PURPOSE: Diffuse axonal injury (DAI) accounts for a significant portion of primary intra-axial lesions in cases of traumatic brain injury. The goal of this study was to use diffusion-weighted MR imaging to characterize DAI in the setting of acute and subacute traumatic brain injury. METHODS: Nine patients ranging in age from 26 to 78 years were examined with conventional MR imaging (including fast spin-echo T2-weighted, fluid-attenuated inversion-recovery, and gradient-echo sequences) as well as echo-planar diffusion-weighted MR imaging 1 to 18 days after traumatic injury. Lesions were characterized as DAI on the basis of their location and their appearance on conventional MR images. Trace apparent diffusion coefficient (ADC) maps were computed off-line with the diffusion-weighted and base-line images. Areas of increased signal were identified on the diffusion-weighted images, and regions of interests were used to obtain trace ADC values. RESULTS: In the nine patients studied, isotropic diffusion-weighted images showed areas of increased signal with correspondingly decreased ADC. In one case, decreased ADC was seen 18 days after the initial event. CONCLUSION: Decreased ADC can be demonstrated in patients with DAI in the acute setting and may persist into the subacute period, beyond that described for cytotoxic edema in ischemia.     

Geometric distortion correction of high-resolution 3 T diffusion tensor brain images.

Diffusion-weighted images based on echo planar sequences suffer from distortions due to field inhomogeneities from susceptibility differences as well as from eddy currents arising from diffusion gradients. In this paper, a novel approach using nonlinear warping based on optic flow to correct distortions of baseline and diffusion weighted echo planar images (EPI) acquired at 3 T is presented. The distortion correction was estimated by warping the echo planar images to the anatomically correct T2-weighted fast spin echo images (T2-FSE). A global histogram intensity matching of the T2-FSE precedes the base line EPI image distortion correction. A local intensity-matching algorithm was used to transform labeled T2-FSE regions to match intensities of diffusion-weighted EPI images prior to distortion correction of these images. Evaluation was performed using three methods: (i) visual comparison of overlaid contours, (ii) a global mutual information index, and (iii) a local distance measure between homologous points. Visual assessment and the global index demonstrated a decrease in geometrical distortion and the distance measure showed that distortions are reduced to a subvoxel level. In conclusion, the warping algorithm is effective in reducing geometric distortions, enabling generation of anatomically correct diffusion tensor images at 3 T.     

Turbo spin-echo diffusion-weighted MR of ischemic stroke.

PURPOSEOur objective was to determine whether a multisection technique, diffusion-weighted half-Fourier single-shot turbo spin-echo (HASTE) imaging, can compensate for the drawbacks common to other diffusion-weighted techniques; specifically, the need for echo-planar technology and the presence of susceptibility artifacts in areas close to the skull base.METHODSForty subjects who were referred to the stroke service with signs of acute (less than 24 hour) neurologic dysfunction were included in this prospective study. MR imaging of the brain was performed with diffusion-weighted echo-planar and diffusion-weighted HASTE sequences. The images obtained with both sequences were analyzed for the presence of hyperintensities corresponding to ischemic lesions as well as for the presence of image artifacts and distortions.RESULTSDiffusion-weighted HASTE images showed areas of hyperintensity corresponding to the infarcts present on diffusion-weighted echo-planar imaging studies without distortion or susceptibility artifacts in all the patients who had a stroke. Twelve patients had no acute ischemic lesions; of these, five had other findings, six had normal findings, and in one patient, a hyperintensity seen on diffusion-weighted echo-planar images proved to be an artifact on diffusion-weighted HASTE images.CONCLUSIONSDiffusion-weighted HASTE is equal to diffusion-weighted echo-planar imaging in the detection of early ischemia. Because of the absence of significant image distortions and other artifacts, diffusion-weighted HASTE permits fast multiplanar imaging in artifact-prone regions, such as the posterior fossa and the inferior frontal and temporal lobes. Diffusion imaging can be performed on conventional systems with strengths of 1.5 T that do not have echo-planar imaging capabilities.     

应用Snake模型进行海马结构MR图像分割的研究

目的应用Snake模型对海马结构MR图像进行分割研究。方法在MR图像工作站上采集垂直于海马结构长轴的颅脑T1加权像,并进行图像预处理。研究设计Snake模型的快速Greedy算法程序,在计算机上用自编程序对含整个海马结构的多幅MR图像进行分割。Snake模型分割方法与人工分割方法进行比较。结果除由操作者给出初始轮廓外,Snake模型能从多幅MR图像中自动分割出海马结构。Snake模型分割与人工分割总的重叠率是84%,标准差s=8.03。结论Snake模型是一种快速、有效的海马结构MR图像分割方法,具有重要的临床应用价值。     

Deformation invariant attribute vector for deformable registration of longitudinal brain MR images

This paper presents a novel approach to define deformation invariant attribute vector (DIAV) for each voxel in 3D brain image for the purpose of anatomic correspondence detection. The DIAV method is validated by using synthesized deformation in 3D brain MRI images. Both theoretic analysis and experimental studies demonstrate that the proposed DIAV is invariant to general nonlinear deformation. Moreover, our experimental results show that the DIAV is able to capture rich anatomic information around the voxels and exhibit strong discriminative ability. The DIAV has been integrated into a deformable registration algorithm for longitudinal brain MR images, and the results on both simulated and real brain images are provided to demonstrate the good performance of the proposed registration algorithm based on matching of DIAVs.     

Multi-level adaptive segmentation of multi-parameter MR brain images.

MR brain image segmentation into several tissue classes is of significant interest to visualize and quantify individual anatomical structures. Traditionally, the segmentation is performed manually in a clinical environment that is operator dependent and may be difficult to reproduce. Though several algorithms have been investigated in the literature for computerized automatic segmentation of MR brain images, they are usually targeted to classify image into a limited number of classes such as white matter, gray matter, cerebrospinal fluid and specific lesions. We present a novel model-based method for the automatic segmentation and classification of multi-parameter MR brain images into a larger number of tissue classes of interest. Our model employs 15 brain tissue classes instead of the commonly used set of four classes, which were of clinical interest to neuroradiologists for following-up with patients suffering from cerebrovascular deficiency (CVD) and/or stroke. The model approximates the spatial distribution of tissue classes by a Gauss Markov random field and uses the maximum likelihood method to estimate the class probabilities and transitional probabilities for each pixel of the image. Multi-parameter MR brain images with T(1), T(2), proton density, Gd+T(1), and perfusion imaging were used in segmentation and classification. In the development of the segmentation model, true class-membership of measured parameters was determined from manual segmentation of a set of normal and pathologic brain images by a team of neuroradiologists. The manual segmentation was performed using a human-computer interface specifically designed for pixel-by-pixel segmentation of brain images. The registration of corresponding images from different brains was accomplished using an elastic transformation. The presented segmentation method uses the multi-parameter model in adaptive segmentation of brain images on a pixel-by-pixel basis. The method was evaluated on a set of multi-parameter MR brain images of a twelve-year old patient 48h after suffering a stroke. The results of classification as compared to the manual segmentation of the same data show the efficacy and accuracy of the presented methods as well as its capability to create and learn new tissue classes.