Proton density-weighted MR imaging of the knee: fat suppression versus without fat suppression

Objective  

To prospectively evaluate the diagnostic accuracy of proton density-weighted imaging with and without fat suppression for detecting meniscal tears.     

Proton MR spectroscopic imaging in multiple sclerosis

We studied 24 patients with multiple sclerosis (MS) by proton magnetic resonance spectroscopic imaging (1H-MRSI) to assess the neurochemical pathology of the white-matter lesions (WML) and normal-appearing white matter (NAWM). Our 1H-MRSI technique allowed simultaneous measurement of N-acetylaspartate (NAA), choline-containing compounds (Cho), and creatine plus phosphocreatine (Cr) signal intensities from four 15-mm slices divided into 0.84 ml single-volume elements. In WML we found significantly lower NAA/Cr and NAA/Cho ratios and a significantly higher Cho/Cr ratio than in NAWM or control white matter. In NAWM, NAA/Cr and Cho/Cr were significantly lower than in control white matter. 1H-MRSI was compatible with damage to myelin in WML, and with axonal damage and/or dysfunction in WML and NAWM. These findings extend data on involvement of NAWM in MS beyond the abnormalities visible on MRI.     

Proton MR spectroscopic imaging in Pelizaeus-Merzbacher disease

BACKGROUND AND PURPOSE: Pelizeaus-Merzbacher disease (PMD) is a clinically and molecularly heterogeneous disorder linked to deletion, mutations, or duplication of the proteolipid protein (PLP1) gene locus at Xq22. The current study was conducted to characterize the results of proton MR spectroscopic (MRS) imaging in PMD. METHODS: Three boys with PMD (one with the severe connatal form and two with a more mild clinical phenotype [spastic paraplegia type 2]). and three age-matched healthy control subjects (age range, 2-7 years) underwent MR and MRS imaging. All imaging was performed at 1.5 T. For MRS imaging, oblique-axial sections (thickness, 15 mm; intersection gap, 2.5 mm) were recorded parallel to the anterior commissure-posterior commissure line (TR/TE/NEX, 2300/272/1) with lipid and water suppression. Ratios of metabolite peak areas were calculated, and spectra were bilaterally evaluated. RESULTS: Diffuse or focal reductions in N-acetylaspartate were observed in the affected white matter in all three cases. These reductions seemed to be consistent with axonal damage. In addition, mild increases in choline and creatine levels were observed; these may have been due to astrocytic changes. CONCLUSION: Proton MRS imaging may be helpful in evaluating regional pathophysiologic abnormalities in PMD and in distinguishing PMD from other leukodystrophies, which exhibit different metabolic profiles.     

Dual‐band water and lipid suppression for MR spectroscopic imaging at 3 Tesla

A dual‐band water and lipid suppression sequence was developed for multislice sensitivity‐encoded proton MR spectroscopic imaging of the human brain. The presaturation scheme consisted of five dual‐band frequency‐modulated radiofrequency pulses based on hypergeometric functions integrated with eight outer volume suppression (OVS) pulses. The flip angles of the dual‐band pulses were optimized through computer simulations to maximize suppression factors over a range of transmitter amplitude of radiofrequency field and water and lipid T₁ values. The resulting hypergeometric dual band with OVS (HGDB + OVS) sequence was implemented at 3 T in a multislice sensitivity‐encoded proton MR spectroscopic imaging experiment and compared to a conventional water suppression scheme (variable pulse power and optimized relaxation delays (VAPOR)) with OVS. The HGDB sequence was significantly shorter than the VAPOR sequence (230 versus 728 msec). Both HGDB + OVS and VAPOR + OVS produced good water suppression, while lipid suppression with the HGDB + OVS sequence was far superior. In sensitivity‐encoded proton MR spectroscopic imaging data, artifacts from extracranial lipid signals were significantly lower with HGDB + OVS. The shorter duration of HGDB compared to VAPOR also allows reduced pulse repetition time values in the multislice acquisition. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

Proton MR spectroscopic imaging of the medulla and cervical spinal cord

PURPOSE: To demonstrate the feasibility of quantitative, one-dimensional proton MR spectroscopic imaging (1D-MRSI) of the upper cervical spine and medulla at 3.0 Tesla. MATERIALS AND METHODS: A method was developed for 1D-point-resolved spectroscopy sequence (PRESS)-MRSI, exciting signal in five voxels extending from the pontomedullary junction to the level of the C3 vertebra, and performed in 10 healthy volunteers to generate control data. RESULTS: High-resolution 1D-MRSI data were obtained from all 10 subjects. Upper cervical spine concentrations of choline, creatine, and N-acetyl aspartate were estimated to be 2.8 +/- 0.5, 8.8 +/- 1.8, and 10.9 +/- 2.7 mM, respectively, while in the medulla they were 2.6 +/- 0.5, 9.1 +/- 1.7, and 10.8 +/- 0.9 mM. CONCLUSION: Quantitative 1D-MRSI of the upper cervical spine has been shown to be feasible at 3.0 Tesla.     

Proton spectroscopy without water suppression: The oversampled J-resolved experiment

A method is introduced for obtaining proton spectra in vivo with all the advantages of a full water signal. The method, based on F₁ oversampled J-resolved spectroscopy, makes it possible to separate metabolite signals from unwanted baseline artifacts. The dominant water resonance is used as a 2D reference signal for the phase-sensitive reconstruction of the 2D J-resolved metabolite spectra. The powerful specificity of this method is demonstrated with model compound spectra, phantoms, and in vivo examples.     

Proton MR spectroscopic and diffusion tensor brain MR imaging in X-linked adrenoleukodystrophy: initial experience

PURPOSE: To compare conventional magnetic resonance (MR) imaging, proton MR spectroscopic imaging, and diffusion tensor (DT) MR imaging findings in patients with X chromosome-linked adrenoleukodystrophy (X-ALD). MATERIALS AND METHODS: Multisection proton MR spectroscopy and DT imaging were performed in 11 patients with X-ALD and in 11 healthy control subjects. Quantitative measures of N-acetylaspartate (NAA), choline, and creatine values and of isotropic apparent diffusion coefficient (IADC) and fractional anisotropy (FA) were obtained from coregistered regions of interest. DT imaging and metabolic parameters were compared by using regression analysis. In addition, differences in DT imaging and metabolite measurements between normal- and abnormal-appearing white matter on conventional MR images were evaluated by using a nonparametric (Mann-Whitney) test. RESULTS: A strong logarithmic relationship between NAA value and FA (r = 0.64, P <.001) and an inverse logarithmic relationship were found between NAA value and IADC (r = -0.69, P <.001). Creatine and choline values correlated poorly with IADC and FA. In the normal-appearing white matter of asymptomatic patients, the NAA value was 17% lower than that in the healthy control subjects (P =.016), whereas no significant difference in DT imaging measures was seen in these regions. CONCLUSION: In patients with X-ALD, MR spectroscopic imaging can depict abnormalities in white matter that have a normal appearance on both conventional MR and DT images; this finding suggests that it may be the most sensitive technique for detecting early abnormalities of demyelination or axonal loss in patients with X-ALD.     

Proton MR spectroscopy in patients with pyogenic brain abscess: MR spectroscopic imaging versus single-voxel spectroscopy

Purpose

Single-voxel spectroscopy (SVS) has been the gold standard technique to diagnose the pyogenic abssess. Two-dimensional magnetic resonance spectroscopic imaging (MRSI) is able to provide spatial distribution of metabolic concentration, and is potentially more suitable for differential diagnosis between abscess and necrotic tumors. Therefore, the purpose of this study was to evaluate the equivalence of MRSI and SVS in the detection of the metabolites in pyogenic brain abscesses.

Materials and methods

Forty-two patients with pyogenic abscesses were studied by using both SVS and MRSI methods. Two neuroradiologists reviewed the MRS data independently. A κ value was calculated to express inter-reader agreement of the abscesses metabolites, and a correlation coefficient was calculated to show the similarity of two spectra. After consensus judgment of two readers, the binary value of metabolites of pyogenic abscesses (presence or absence) was compared between SVS and MRSI.

Results

The consistency of spectral interpretation of the two readers was very good (κ ranged from 0.95 to 1), and the similarity of two spectra was also very high (cc = 0.9 ± 0.05). After consensus judgment of two readers, the sensitivities of MRSI ranged from 91% (acetate) to 100% (amino acids, succinate, lactate, lipid), and the specificities of MRSI were 100% for detecting all metabolites with SVS as reference.

Conclusion

SVS and MRSI provide similar metabolites in the cavity of pyogenic brain abscess. With additional metabolic information of cavity wall and contralateral normal-appearing brain tissue, MRSI would be a more suitable technique to differentiate abscesses from necrotic tumors.     

Proton MR spectroscopic imaging of rhesus macaque brain in vivo at 7T

Due to the overall similarity of their brains' structure and physiology to its human counterpart, nonhuman primates provide excellent model systems for the pathogenesis of neurological diseases and their response to treatments. Its much smaller size, 80 versus 1250 cm(3), however, requires proportionally higher spatial resolution to study, nondestructively, as many analogous regions as efficiently as possible in anesthetized animals. The confluence of these requirements underscores the need for the highest sensitivity, spatial coverage, resolution, and exam speed. Accordingly, we demonstrate the feasibility of 3D multi-voxel, proton ((1)H) MRSI at (0.375 cm)(3)=0.05 cm(3) isotropic spatial resolution over 21 cm(3) (approximately 25%) of the anesthetized rhesus macaques brain at 7T in 25 min. These voxels are x10(2)-10(1) times smaller than the 8-1 cm(3) common to (1)H-MRS in humans, retaining similar proportions between the macaque and human brain. The spectra showed a signal-to-noise-ratio (SNR) approximately 9-10 for the major metabolites and the interanimal SNR spatial distribution reproducibility was in the +/-10% range for the standard error of their means (SEMs). Their metabolites' linewidths, 9+/-2 Hz, yield excellent spectral resolution as well. These results indicate that 3D (1)H-MRSI can be integrated into comprehensive MR studies in primates at such high fields.     

Proton MR spectroscopic imaging depicts diffuse axonal injury in children with traumatic brain injury

BACKGROUND AND PURPOSE: Diffuse axonal injury (DAI) after traumatic brain injury (TBI) is important in patient assessment and prognosis, yet they are underestimated with conventional imaging techniques. We used MR spectroscopic imaging (MRSI) to detect DAI and determine whether metabolite ratios are accurate in predicting long-term outcomes and to examine regional differences in injury between children with TBI and control subjects. METHODS: Forty children with TBI underwent transverse proton MRSI through the level of the corpus callosum within 1-16 days after injury. T2-weighted, fluid-attenuated inversion recovery, and susceptibility-weighted MR imaging was used to identify voxels as normal-appearing or as nonhemorrhagic or hemorrhagic injury. Neurologic outcome was evaluated at 6-12 months after injury. Metabolite ratios for total (all voxels), normal-appearing, and hemorrhagic brain were compared and used in a logistic regression model to predict long-term outcome. Total and regional metabolite ratios were compared with control data. RESULTS: A significant decrease in N-acetylaspartate (NAA)/creatine (Cr) and increase in choline (Cho)/Cr (evidence of DAI) was observed in normal-appearing (P < .05) and visibly injured (hemorrhagic) brain (P < .001) compared with controls. In normal-appearing brain NAA/Cr decreased more in patients with poor outcomes (1.32 +/- 0.54) than in those with good outcomes (1.61 +/- 0.50, P = .01) or control subjects (1.86 +/- 0.1, P = .00). In visibly injured brains, ratios were similarly altered in all patients. In predicting outcomes, ratios from normal-appearing and visibly-injured brain were 85% and 67% accurate, respectively. CONCLUSION: MRSI can depict injury in brain that appears normal on imaging and is useful for predicting long-term outcomes.     

Proton MR spectroscopic characteristics of pediatric pilocytic astrocytomas.

PURPOSEWe report the common characteristics of juvenile pilocytic astrocytomas revealed by proton MR spectroscopy.METHODSEight children with pilocytic astrocytomas were studied with proton MR spectroscopy. The selected sampling volume was approximately 4 cm3, obtained from solid tumor. To localize the sampling volume, we used point-resolved spectroscopy (PRESS) and stimulated-echo acquisition mode (STEAM) techniques to acquire long- and short-TE spectra, respectively. Spectra from PRESS and STEAM sequences were processed using Lorentzian-to-Gaussian transformation and exponential apodization, respectively. For PRESS (2000/270) spectra, peaks of creatine, choline, N-acetylaspartate (NAA), and lactate resonances were integrated; for STEAM (2000/20) spectra, we measured the amplitude of the peaks at 3.2, 2.0, 1.3 and 0.9 ppm.RESULTSAn elevated lactate doublet was observed in the PRESS spectra. The choline/NAA ratio was 3.40. The amplitude ratios of the lipid pattern (0.9, 1.3 and 2.0 ppm) to choline were all below one.CONCLUSIONDespite the benign histology of the tumor, which generally lacks necrosis, a lactate signal was detected in all eight patients studied. A dominant lipid pattern was not observed.     

Proton MR spectroscopic changes in Parkinson's diseases after thalamotomy

To investigate whether there are significant changes in regional brain metabolism in patients with Parkinson's disease before and after thalamotomy using proton magnetic resonance spectroscopy (1H MRS). Fifteen patients underwent 15 stereotactic thalamotomies for control of medically refractory parkinsonian tremor. Single-voxel 1H MRS was carried out on a 1.5 T unit using stimulated-echo acquisition mode (STEAM) sequence (TR/TM/TE, 2000/14/20 ms). Spectra were obtained from substantia nigra, thalamus and putamen areas with volumes of interests (7-8 ml) in patients before and after the surgery. Metabolite ratios of NAA/Cho, NAA/Cr and Cho/Cr were calculated from relative peak area measurements. We evaluated alterations of metabolite ratios in brain metabolism in Parkinson's disease patients with clinical outcome following thalamotomy. NAA/Cho ratios showed generally low levels in substantia nigra and thalamus in Parkinson's disease patients with clinical improvement following thalamotomy. In 80% (12/15) patients, decreased NAA/Cho ratios were observed from the selected voxels in substantia nigra after thalamic surgery (P<0.05). The ratios were also significantly decreased in thalamus in 67% (10/15) patients with clinical improvement (P<0.05). Our results suggest that NAA/Cho ratio may be a valuable criterion for evaluation of Parkinson's disease patients with the clinical improvement following surgery. 1H MRS may be a useful utility for the aid in better understanding the pathophysiologic process in Parkinson's disease patients on the basis of the variation of NAA/Cho ratio.     

Sensitivity encoding for fast 1H MR spectroscopic imaging water reference acquisition

Purpose: Accurate and fast ¹H MR spectroscopic imaging (MRSI) water reference scans are important for absolute quantification of metabolites. However, the additional acquisition time required often precludes the water reference quantitation method for MRSI studies. Sensitivity encoding (SENSE) is a successful MR technique developed to reduce scan time. This study quantitatively assesses the accuracy of SENSE for water reference MRSI data acquisition, compared with the more commonly used reduced resolution technique. Methods: 2D MRSI water reference data were collected from a phantom and three volunteers at 3 Tesla for full acquisition (306 s); 2× reduced resolution (64 s) and SENSE R = 3 (56 s) scans. Water amplitudes were extracted using MRS quantitation software (TARQUIN). Intensity maps and Bland‐Altman statistics were generated to assess the accuracy of the fast‐MRSI techniques. Results: The average mean and standard deviation of differences from the full acquisition were 2.1 ± 3.2% for SENSE and 10.3 ± 10.7% for the reduced resolution technique, demonstrating that SENSE acquisition is approximately three times more accurate than the reduced resolution technique. Conclusion: SENSE was shown to accurately reconstruct water reference data for the purposes of in vivo absolute metabolite quantification, offering significant improvement over the more commonly used reduced resolution technique. Magn Reson Med 73:2081–2086, 2015. © 2014 The Authors. Magnetic Resonance in Medicine Published by Wiley Periodicals, Inc. on behalf of International Society of Medicine in Resonance.     

Toward quantitative short-echo-time in vivo proton MR spectroscopy without water suppression.

A methodological development for quantitative short-echo-time (TE) in vivo proton MR spectroscopy (MRS) without water suppression (WS) is described that integrates experimental and software approaches. Experimental approaches were used to eliminate frequency modulation sidebands and first-order phase errors. The dominant water signal was modeled and extracted by the matrix pencil method (MPM) and was used as an internal reference for absolute metabolite quantification. Spectral fitting was performed by combining the baseline characterization by a wavelet transform (WT)-based technique and time-domain (TD) parametric spectral analysis using full prior knowledge of the metabolite model spectra. The model spectra were obtained by spectral simulation instead of in vitro measurements. The performance of the methodology was evaluated by Monte Carlo (MC) studies, phantom measurements, and in vivo measurements on rat brains. More than 10 metabolites were quantified from spectra measured at TE = 20 ms on a 4.7 T system.     

Automatic placement of outer volume suppression slices in MR spectroscopic imaging of the human brain

Spatial suppression of peripheral regions (outer volume suppression) is used in MR spectroscopic imaging to reduce contamination from strong lipid and water signals. The manual placement of outer volume suppression slices requires significant operator interaction, which is time consuming and introduces variability in volume coverage. Placing a large number of outer volume saturation bands for volumetric MR spectroscopic imaging studies is particularly challenging and time consuming and becomes unmanageable as the number of suppression bands increases. In this study, a method is presented that automatically segments a high‐resolution MR image in order to identify the peripheral lipid‐containing regions. This method computes an optimized placement of suppression bands in three dimensions and is based on the maximization of a criterion function. This criterion function maximizes coverage of peripheral lipid‐containing areas and minimizes suppression of cortical brain regions and regions outside of the head. Computer simulation demonstrates automatic placement of 16 suppression slices to form a convex hull that covers peripheral lipid‐containing regions above the base of the brain. In vivo metabolite mapping obtained with short echo time proton‐echo‐planar spectroscopic imaging shows that the automatic method yields a placement of suppression slices that is very similar to that of a skilled human operator in terms of lipid suppression and usable brain voxels. Magn Reson Med 63:592–600, 2010. © 2010 Wiley‐Liss, Inc.     

Design of cosine modulated very selective suppression pulses for MR spectroscopic imaging at 3T

The advantages of using a 3 Tesla (T) scanner for MR spectroscopic imaging (MRSI) of brain tissue include improved spectral resolution and increased sensitivity. Very selective saturation (VSS) pulses are important for maximizing selectivity for PRESS MRSI and minimizing chemical shift misregistration by saturating signals from outside the selected region. Although three‐dimensional (3D) PRESS MRSI is able to provide excellent quality metabolic data for patients with brain tumors and has been shown to be important for defining tumor burden, the method is currently limited by how much of the anatomic lesion can be covered within a single examination. In this study we designed and implemented cosine modulated VSS pulses that were optimized for 3T MRSI acquisitions. This provided improved coverage and suppression of unwanted lipid signals with a smaller number of pulses. The use of the improved pulse sequence was validated in volunteer studies, and in clinical 3D MRSI exams of brain tumors. Magn Reson Med, 2009. © 2008 Wiley‐Liss, Inc.     

Confidence images for MR spectroscopic imaging.

Automated spectral analysis and estimation of signal amplitudes from magnetic resonance data generally constitutes a difficult nonlinear optimization problem. Obtaining a measure of the degree of confidence that one has in the estimated parameters is as important as the estimates themselves. This is particularly important if clinical diagnoses are to be based on estimated metabolite levels, as in applications of MR Spectroscopic Imaging for human studies. In this report, a standard method of obtaining confidence intervals for nonlinear estimation is applied to simulated data and short-TE clinical proton spectroscopic imaging data sets of human brain. So-called "confidence images" are generated to serve as visual indicators of how much trust should be placed in interpretation of spatial variations seen in images derived from fitted metabolite parameter estimates. This method is introduced in a Bayesian framework to enable comparison with similar techniques using Cramer-Rao bounds and the residuals of fitted results.     

In-plane motion correction for MR spectroscopic imaging

A motion-detection method is described that is specifically suited for MR spectroscopic imaging (MRSI) studies. Information on in-plane rotation and translation of the subject was obtained using external spatial reference markers that are uniquely identified via their chemical shift. The marker locations were obtained directly from the acquired data at each encoding step, and no additional data acquisition was required. This method was applied to brain ¹H MRSI studies that include subcutaneous lipid signals, which otherwise result in enhanced sensitivity to subject motion.