Minimum detectable difference of MR diffusion maps in acute ischemic stroke

PURPOSE: To determine the minimum detectable difference (MDD) and investigate variability of region-of-interest (ROI) analysis of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in acute ischemic stroke. MATERIALS AND METHODS: Ten patients with acute stroke (<24 hours) and moderate-to-large infarcts were imaged using a fast diffusion tensor technique. Four observers repeated three trials, during which each of two ROI types (free-hand polygon and ellipse) were drawn in white and gray matter (WM and GM) on FA and ADC maps. Analysis-of-variance techniques examined tissue and ROI type effects as well as inter- and intraobserver variability. F-tests examined the variability differences between ROI types. RESULTS: The MDD for ADC was 0.160 x 10(-3) mm(2) s(-1) in WM and 0.212 x 10(-3) mm(2) s(-1) in GM. The FA MDD was 0.19 in WM and 0.10 in GM. Tissue but not ROI type affected the mean values for both ADC and FA maps. Intraobserver reliability was substantial, while interobserver reliability was poor-to-moderate. No variability differences were found by ROI types. CONCLUSION: The MDD for WM and GM in normal and ischemic tissue were calculated. Inter- and intraobserver variability and tissue type affect ROI analysis of ADC and FA maps.     

Multiple sclerosis: diffusion tensor MR imaging for evaluation of normal-appearing white matter

PURPOSE: To determine whether the normal-appearing white matter (NAWM) regions surrounding and remote from multiple sclerosis (MS) plaques have abnormal diffusional anisotropy and to compare anisotropy maps with apparent diffusion coefficient (ADC) maps for sensitivity in the detection of white matter (WM) abnormalities. MATERIALS AND METHODS: Conventional and diffusion tensor magnetic resonance (MR) imaging examinations were performed in 26 patients with MS and in 26 age-matched control subjects. Fractional anisotropy (FA) and ADC maps were generated and coregistered with T2-weighted MR images. Uniform regions of interest were placed on plaques, periplaque white matter (PWM) regions, NAWM regions in the contralateral side of the brain, and WM regions in control subjects to obtain FA and ADC values, which were compared across the WM regions. RESULTS: The mean FA was 0.280 for plaques, 0.383 for PWM, 0.493 for NAWM, and 0.537 for control subject WM. The mean ADC was 1.025 x 10(-3) mm(2)/sec for plaques, 0.786 x 10(-3) mm(2)/sec for PWM, 0.739 x 10(-3) mm(2)/sec for NAWM, and 0.726 x 10(-3) mm(2)/sec for control subject WM. Significant differences in anisotropy and ADC values were observed among all WM regions (P <.001 for all comparisons, except ADC in NAWM vs control subject WM [P =.018]). CONCLUSION: The anisotropy and ADC values were abnormal in all WM regions in the patients with MS and were worse in the periplaque regions than in the distant regions. Diffusion tensor MR imaging may be more accurate than T2-weighted MR imaging for assessment of disease burden.     

Diffusion tensor eigenvector directional color imaging patterns in the evaluation of cerebral white matter tracts altered by tumor

PURPOSE: To categorize the varied appearances of tumor-altered white matter (WM) tracts on diffusion tensor eigenvector directional color maps. MATERIALS AND METHODS: Diffusion tensor imaging (DTI) was obtained preoperatively in 13 patients with brain tumors ranging from benign to high-grade malignant, including primary and metastatic lesions, and maps of apparent diffusion coefficient (ADC), fractional anisotropy (FA), and major eigenvector direction were generated. Regions of interest (ROIs) were drawn within identifiable WM tracts affected by tumor, avoiding grossly cystic and necrotic regions, known fiber crossings, and gray matter. Patterns of WM tract alteration were categorized on the basis of qualitative analysis of directional color maps and correlation analysis of ADC and FA. RESULTS: Four basic patterns of WM alteration were identified: 1) normal or nearly normal FA and ADC, with abnormal tract location or tensor directions attributable to bulk mass displacement, 2) moderately decreased FA and increased ADC with normal tract locations and tensor directions, 3) moderately decreased FA and increased ADC with abnormal tensor directions, and 4) near isotropy. FA and ADC were inversely correlated for Patterns 1-3 but did not discriminate edema from infiltrating tumor. However, in the absence of mass displacement, infiltrating tumor was found to produce tensor directional changes that were not observed with vasogenic edema, suggesting the possibility of discrimination on the basis of directional statistics. CONCLUSION: Tumor alteration of WM tracts tends to produce one of four patterns on FA and directional color maps. Clinical application of these patterns must await further study.     

MRI abnormalities in normal-appearing brain tissue of treated adult PKU patients

PURPOSE: To detect possible subclinical pathological brain changes a study on adult phenylketonuria (PKU) patients by using quantitative MRI methods was performed, since neuropsychological and cognitive deficits in treated patients with PKU have not yet been shown to correlate clearly with the brain lesions identified by conventional MRI. MATERIALS AND METHODS: Eight subjects, four PKU patients with well-documented dietary treatment and four age- and sex-matched adult controls, underwent MRI, including a triple echo sequence and a diffusion tensor imaging sequence. Brain maps of T2 relaxation time (T2), relative proton density (PD), and fractional anisotropy (FA) as well as apparent diffusion coefficient (ADC) were derived for each subject. T2, PD, FA, and ADC were measured in 22 predefined regions of gray matter (GM) and white matter (WM) on the corresponding maps, and compared with those of four age-matched healthy adult controls. RESULTS: In addition to a prolonged T2 value measured in affected WM, as expected, we observed a significant shortening of the T2 relaxation time and reduction of ADC in normal-appearing brain tissue and an increased proton density in both GM and WM of the patients. No differences were observed in FA values between controls and patients. CONCLUSION: Repeatedly reduced T2 relaxation time, ADC, and increased proton density without changes in FA indicate a higher cell-packing density in normal-appearing brain without changes in the directedness of fibers. These structural changes may be related to neuropsychological and cognitive deficits in treated PKU patients.     

正常成人大脑白质纤维磁共振弥散张量成像的定量研究

目的:运用弥散张量成像(DTI)定量研究正常成人脑白质不同解剖部位的各向异性特点.方法:对60名正常成人按年龄分成四组,均行DTI检查,分析其表面弥散系数(ADC)图及各向异性分数(FA)图的特点,并对不同解剖部位的脑白质进行ADC值及FA值的定量分析,通过统计学分析得出其弥散系数和各向异性特点.结果:不同年龄组间相同解剖部位脑白质ADC值及FA值的差异无统计学意义;不同解剖部位间FA值及ADC值的差异具有显著性.结论:DTI可清晰显示脑内白质的走行及方向,FA能准确定量分析正常成人不同部位脑白质纤维的各向异性程度.     

新生儿和婴幼儿脑髓鞘发育的DTI

目的：探讨平均扩散率（MD）和部分各向异性（FA）在新生儿和婴幼儿脑髓鞘发育过程中的变化规律。方法：将97例围产史正常、无器质性神经系统疾病的足月新生儿和婴幼儿按年龄段分为7组,行颅脑扩散张量成像（DTI）扫描,测量主要白质结构的MD值和FA值,分析其在不同脑区的差异及随年龄变化的规律。结果：脑各部位的MD值随着年龄的增长而减低（P〈0.01）,FA值随年龄的增长而增高（P〈0.01）。脑同一部位的MD值和FA值在不同年龄段的变化速率有所不同,同一年龄段脑不同部位MD值和FA值的变化幅度不尽相同,不同部位的MD值和FA值也存在差异。结论：MD值和FA值相结合,能定量的分析髓鞘化进程,评估脑白质发育情况。     

Early postnatal development of corpus callosum and corticospinal white matter assessed with quantitative tractography

BACKGROUND AND PURPOSE: The early postnatal period is perhaps the most dynamic phase of white matter development. We hypothesized that the early postnatal development of the corpus callosum and corticospinal tracts could be studied in unsedated healthy neonates by using novel approaches to diffusion tensor imaging (DTI) and quantitative tractography. MATERIALS AND METHODS: Isotropic 2 x 2 x 2 mm(3) DTI and structural images were acquired from 47 healthy neonates. DTI and structural images were coregistered and fractional anisotropy (FA), mean diffusivity (MD), and normalized T1-weighted (T1W) and T2-weighted (T2W) signal intensities were determined in central midline and peripheral cortical regions of the white matter tracts of the genu and splenium of the corpus callosum and the central midbrain and peripheral cortical regions of the corticospinal tracts by using quantitative tractography. RESULTS: We observed that central regions exhibited lower MD, higher FA values, higher T1W intensity, and lower T2W intensity than peripheral cortical regions. As expected, MD decreased, FA increased, and T2W signal intensity decreased with increasing age in the genu and corticospinal tract, whereas there was no significant change in T1W signal intensity. The central midline region of the splenium fiber tract has a unique pattern, with no change in MD, FA, or T2W signal intensity with age, suggesting different growth trajectory compared with the other tracts. FA seems to be more dependent on tract organization, whereas MD seems to be more sensitive to myelination. CONCLUSIONS: Our novel approach may detect small regional differences and age-related changes in the corpus callosum and corticospinal white matter tracts in unsedated healthy neonates and may be used for future studies of pediatric brain disorders that affect developing white matter.     

Diffusion tensor imaging in the assessment of normal-appearing brain tissue damage in relapsing neuromyelitis optica

BACKGROUND AND PURPOSE: Normal-appearing brain tissue (NABT) damage was established in multiple sclerosis by histology, MR spectroscopy, magnetization transfer imaging and diffusion tensor imaging (DTI). However, whether this phenomenon can be detected in relapsing neuromyelitis optica (RNMO) remains unclear. The aim of this study was to use DTI to investigate the presence of NABT damage in RNMO patients and its possible mechanism. METHODS: Conventional MR imaging and DTI scans were performed in 16 patients with RNMO without visible lesions on brain MR imaging and in 16 sex- and age-matched healthy control subjects. Histogram analysis of mean diffusivity (MD) and fractional anisotropy (FA) was performed in the entire brain tissue (BT), white matter (WM), and gray matter (GM). Region of interest (ROI) analysis of MD and FA was also performed in WM regions connected with the spinal white matter tracts or optic nerve (including medulla oblongata, cerebral peduncle, internal capsule, and optic radiation), in corpus callosum without direct connection with them, and in some GM regions. RESULTS: From histogram analysis, we found the RNMO group had a higher average MD of the BT, WM, and GM, a lower average MD peak height and a higher average MD peak location of the GM, and a higher average FA peak height of the WM than did the control group. From ROI analysis, compared with control subjects, RNMO patients had a higher average MD and a lower average FA in ROIs of WM connected with the spinal white matter tracts or optic nerve and a normal average MD and FA in corpus callosum without direct connection with them. In addition, a high average MD was found in parietal GM in these patients. CONCLUSIONS: Our findings confirm the presence of abnormal diffusion in brain tissue in patients with RNMO and suggest that secondary degeneration caused by lesions in the spinal cord and optic nerve might be an important mechanism for this abnormality.     

Quantitative apparent diffusion coefficient measurements in term neonates for early detection of hypoxic-ischemic brain injury: initial experience

PURPOSE: To determine the utility of using quantitative apparent diffusion coefficient (ADC) values as an objective means of early detection of brain injury caused by hypoxic-ischemic encephalopathy (HIE) in term neonates. MATERIALS AND METHODS: Conventional images, diffusion-weighted images, ADC maps, and clinical charts from 13 term neonates clinically suspected of having HIE were retrospectively reviewed. Four term neonates without HIE served as control subjects. ADC values were calculated in predefined regions in patients and compared with those in control subjects. A Student t test was performed for each region to compare patients and control subjects. RESULTS: Abnormalities were more easily detected on diffusion-weighted images and ADC maps, compared with conventional images. ADC values in patients with HIE were significantly different from those of control subjects in the posterior limb of the internal capsule, corona radiata, posterior frontal white matter, and parietal white matter bilaterally. CONCLUSION: Evaluation of ADC maps can improve conspicuity of hypoxic-ischemic injury in the acute and/or subacute setting (within 12 days of insult), and calculation of ADC values can provide an objective measure of hypoxic-ischemic injury.     

Distribution of microstructural damage in the brains of professional boxers: a diffusion MRI study

PURPOSE: To investigate and localize cerebral abnormalities in professional boxers with no history of moderate or severe head trauma. MATERIALS AND METHODS: Diffusion tensor imaging (DTI) was used to determine the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in the brains of 81 professional male boxers and 12 male control subjects. Voxel-based analysis (VBA) of both the diffusion and anisotropy values was performed using statistical parametric mapping (SPM). From this objective analysis, regions of microstructural abnormalities in the brains of the boxers were located. RESULTS: Increases in the ADC, and decreases in FA were identified in deep white matter (WM), while decreases in ADC were identified in cortical gray matter (GM). Regions of positive correlation between ADC and age were also found in both the boxer and control groups, although the regions and strength of the correlation were not the same in each group. CONCLUSION: Using VBA, we localized previously unreported abnormalities in the brains of professional boxers. These abnormalities are assumed to reflect cumulative (chronic) brain injury resulting from nonsevere head trauma.     

Relationships between brain water content and diffusion tensor imaging parameters (apparent diffusion coefficient and fractional anisotropy) in multiple sclerosis

Fifteen multiple sclerosis patients were examined by diffusion tensor imaging (DTI) to determine fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in a superventricular volume of interest of 8×8×2 cm³ containing gray matter (GM) and white matter (WM) tissue. Point resolved spectroscopy 2D-chemical shift imaging of the same volume was performed without water suppression. The water contents and DTI parameters in 64 voxels of 2 cm³ were compared. The water content was increased in patients compared with controls (GM: 244±21 vs. 194±10 a.u.; WM: 245±32 vs. 190±11 a.u.), FA decreased (GM: 0.226±0.038 vs. 0.270±0.020; WM: 0.337±0.044 vs. 0.402±0.011) and ADC increased [GM: 1134±203 vs. 899±28 (×10⁻⁶ mm²/s); WM: 901±138 vs. 751±17 (×10⁻⁶ mm²/s)]. Correlations of water content with FA and ADC in WM were strong (r=−0.68, P<0.02; r=0.75; P<0.01, respectively); those in GM were weaker (r=−0.50, P<0.05; r=0.45, P<0.1, respectively). Likewise, FA and ADC were more strongly correlated in WM (r=−0.88; P<0.00001) than in GM (r=−0.69, P<0.01). The demonstrated relationship between DTI parameters and water content in multiple sclerosis patients suggests a potential for therapy monitoring in normal-appearing brain tissue.     

Comparison of generalized autocalibrating partially parallel acquisitions and modified sensitivity encoding for diffusion tensor imaging

BACKGROUND AND PURPOSE: Diffusion tensor magnetic resonance imaging (DTI) of the brain is usually acquired with single-shot echo-planar imaging, which is associated with localized signal loss, geometric distortions, and blurring. Parallel imaging can lessen these artifacts by shortening the length of the echo-train acquisition. The self-calibrating parallel acquisition techniques, image domain-based modified sensitivity encoding (mSENSE) and k-space-based generalized autocalibrating partially parallel acquisitions (GRAPPA), were evaluated with DTI of the brain in 5 healthy subjects. METHODS: GRAPPA and mSENSE with higher acceleration factors (R) up to 4 were compared with conventional DTI (with and without phase partial Fourier, another method of reducing the echo-train length) on a 1.5T Sonata scanner (Siemens, Erlangen, Germany). The resulting images and diffusion maps were evaluated qualitatively and quantitatively. Qualitative analysis was performed by 3 reviewers blinded to the technique using image sharpness and the level of artifacts as characteristics for scoring each set of images. Quantitative comparisons encompassed measuring signal-to-noise ratio, Trace/3 apparent diffusion coefficient (ADC), and fractional anisotropy (FA) in 6 white-matter (WM) and gray-matter (GM) regions. RESULTS: Reviewers scored the GRAPPA and mSENSE R = 2 images better than images acquired with conventional techniques. FA contrast was improved at the GM/WM junction in peripheral brain areas. Trace/3 ADC and FA measurements were consistent for all methods. However, R = 3,4 images suffered from reconstruction-related artifacts. CONCLUSIONS: GRAPPA and mSENSE (R = 2) minimized the susceptibility and off-resonance effects associated with conventional DTI methods, yielding high-quality images and reproducible quantitative diffusion measurements.     

Age dependence of cerebral perfusion assessed by magnetic resonance continuous arterial spin labeling

PURPOSE: To study the normal dependence of cerebral perfusion changes on age, to measure values of perfusion early in life, and to create a reference dataset. MATERIALS AND METHODS: Perfusion maps were collected from a total of 44 healthy subjects (from four to 78 years old) using the arterial spin labeling (ASL) technique. The population was retrospectively divided into three age groups: children, teenagers, and adults. For each group, mean values of cerebral blood flow (CBF) were calculated in gray matter (GM) and white matter (WM). Results were compared across the three different age groups. RESULTS: CBF values decreased with age (97+/-5 mL/100 g/minute in GM and 26+/-1 mL/100 g/minute in WM for the children, GM 79+/-3 mL/100 g/minute and WM 22+/-1 mL/100 g/minute for the teenagers, and GM 58+/-4 mL/100 g/minute, WM 20+/-1 mL/100 g/minute for the adults). The quantitative results suggest a rapid drop, rather than a gradual decrease, in cerebral perfusion between children and adult subjects, especially in the GM. This step in CBF occurs during adolescence, at approximately the 16th year of age. CONCLUSION: ASL is a practical and quantitative technique suitable for perfusion measurement in children as well as adults. Perfusion measurements with ASL appear sensitive to neurophysiological changes occurring during brain maturation.     

Altered diffusion tensor in multiple sclerosis normal-appearing brain tissue: cortical diffusion changes seem related to clinical deterioration

PURPOSE: To investigate normal-appearing white (NAWM) and cortical gray (NAGM) matter separately in multiple sclerosis (MS) in vivo using diffusion tensor imaging (DTI). MATERIALS AND METHODS: In 64 MS patients (12 primary progressive [PP], 38 relapsing remitting [RR], 14 secondary progressive [SP]) and 20 healthy controls, whole-brain apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps were acquired. A stimulated echo acquisition mode (STEAM) DTI sequence was used with minimal geometrical distortion in comparison to echo-planar imaging (EPI). NAWM and NAGM were identified using conventional magnetic resonance (MR) images, allowing a cautious assessment of FA in cortex. RESULTS: Histogram analyses showed significant global FA decreases and ADC increases in MS NAWM compared to control WM. MS cortical NAGM had no significant global ADC increase, but FA was decreased significantly. In regional analyses, nearly all NAWM regions-of-interest (ROIs) had significantly increased ADC compared to controls, but FA was not changed. In nearly all cortical NAGM ROIs, ADC was significantly increased and FA significantly reduced. In multiple linear regression analyses in RR/SPMS patients, NAGM-ADC histogram peak height was associated more strongly with clinical disability than T2 lesion load. CONCLUSION: Tissue damage occurs in both NAWM and cortical NAGM. The cortical damage appears to have more clinical impact than T2 lesions.     

Whole-brain T1 mapping in multiple sclerosis: global changes of normal-appearing gray and white matter

PURPOSE: To prospectively investigate whether T1 changes in normal-appearing white matter (WM) and normal-appearing gray matter (GM) in multiple sclerosis (MS) are global or regional and their relationship to disease type. MATERIALS AND METHODS: The institutional ethics review board approved study; written informed consent was obtained. Whole-brain T1 maps were obtained in 67 patients with MS and 24 healthy control subjects with three-dimensional fast low-angle shot flip angle-array method, with correction for B(1) imperfections. Analysis of variance was performed on T1 histogram parameters of global normal-appearing WM and GM. Regional mean T1 values were analyzed with a multilevel approach. Multiple linear regression analysis was performed to investigate associations with clinical disability and overall atrophy. For patients, T2 lesion load was determined. RESULTS: T1 histograms of normal-appearing WM had significantly higher peak positions for patients with MS (792 msec +/- 36 in secondary progressive [SP] MS) than for control subjects (746 msec +/- 23) and were significantly broader and lower (all P < .001). Histograms for cortical normal-appearing GM were significantly shifted (peak positions, 1263 msec +/- 44 in control subjects and 1355 msec +/- 62 in patients with SP MS) (P < .001). Histogram peak positions were significantly higher in SP MS than in relapsing-remitting (RR) and primary progressive MS (P < .05). In SP disease, at least 31% of normal-appearing WM and 20% of cortical normal-appearing GM were affected. In MS, T1 was significantly elevated in all normal-appearing WM and cortical normal-appearing GM regions (all P < .01) but was elevated only in the thalamus in deep GM (P < .05). Cortical T1 histogram peak position was associated with clinical disability; T2 lesion load was not. CONCLUSION: Results suggest that a global disease process affects large parts of both normal-appearing WM and GM in MS and effects are worse for SP MS than for RR MS.     

Effects of chemotherapy on the brain in childhood: diffusion tensor imaging of subtle white matter damage

Introduction

With reducing mortality in children with hematological malignancies, the survivors' quality of life regarding development of chronic neurological disturbances is important. We aimed to determine whether chemotherapy affects white matter (WM).

Methods

Using brain diffusion tensor imaging, we evaluated 17 patients (15 with acute lymphoblastic leukemia, 2 with non-Hodgkin's lymphoma; 9 male, 8 female; age, 1.6–13 years) before and after chemotherapy. We measured the quantitative values of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) at the regions of interest (ROIs) such as periventricular WM, corona radiata, posterior limb of the internal capsule, and corpus callosum. We assessed sensorimotor and callosal tracts by tractography.

Results

Reduction in FA and increase in ADC were significant at the ROIs of the left and right anterior periventricular WM and corona radiata and at the tract passing through the genu. A significant reduction in FA with a nonsignificant increase in ADC was seen at the ROI of the genu and at the tracts passing through the body and isthmus.

Conclusion

Chemotherapy in children with hematological malignancies predominantly affects the frontal WM. This finding might indicate a negative effect of chemotherapy on neurological development in children with hematological malignancies.     

High-contrast 3D neonatal brain imaging with combined T1- and T2-weighted MP-RAGE.

Optimization of magnetization-prepared rapid gradient-echo (MP-RAGE) sequence variations for maximum white matter (WM) versus gray matter (GM) contrast in neonates at 3T was investigated. Numerical simulations were applied to optimize and compare three contrast preparation modules and to assess the effect of phase encoding (PE) order on contrast between WM and thin cortical GM layers. Simulations predict that a new sequence, which combines both T(1)- and T(2)-weighting into the contrast preparation and utilizes an interleaved elliptical-spiral PE order, should provide the strongest contrast between neonatal WM and cortical GM. This sequence was compared to a conventional MP-RAGE acquisition (i.e., T(1)-weighted preparation, centric PE order) for in vivo imaging of seven preterm newborn infants. Regional measurements of the contrast-to-noise ratio (CNR) between WM and GM demonstrated an increase of 50-70% (depending on GM region) using the new sequence, in good agreement with theoretical predictions. This improved contrast resulted in superior WM versus GM discrimination in intensity-based brain tissue segmentations.     

Age-related total gray matter and white matter changes in normal adult brain. Part II: quantitative magnetization transfer ratio histogram analysis

BACKGROUND AND PURPOSE: The magnetization transfer ratio (MTR) is a sensitive and quantitative identifier of underlying structural changes in the brain. We quantitatively evaluated age- and sex-related MTR changes in global gray matter (GM) and global white matter (WM) in healthy adults. METHODS: Fifty-two healthy volunteers (21 men, 31 women) aged 20-86 years underwent dual-echo fast spin-echo and magnetization transfer imaging performed with and then without a saturation pulse. GM and WM were distinguished by using a computer-assisted semiautomated segmentation technique. MTR histograms were generated for each segmented tissue in each subject and compared among age and sex groups. RESULTS: The mean, median, first quartile, and peak height of the MTR histogram were significantly lower in the older group (> or =50 years) than those in the younger group (<50 years) for both GM and WM. The age dependency of these values can be expressed in a quadratic fashion over the entire span of adulthood. The MTRs started to decline only after the age of approximately 40 years in both tissues. No statistically significant differences in MTR histogram measurements between the sexes were observed. CONCLUSION: The different MTR values for both GM and WM in the two age groups suggest that notable microscopic changes occur in GM and WM with advancing age, yet no significant sex-related variations in MTR measurements were found in these neurologically healthy adults. Such normative data based on the inherent contrast in MTRs are essential in studies of specific disorders of aging, and they may have implications for our understanding of the gross structural changes in both GM and WM in the aging brain.     

Quantitative assessment of diffusion abnormalities in posterior reversible encephalopathy syndrome

BACKGROUND AND PURPOSE: Previous studies have shown that lesions in posterior reversible encephalopathy syndrome are often isointense on diffusion-weighted MR images. We hypothesized that 1) apparent diffusion coefficient (ADC) maps using various thresholds would show larger abnormalities in posterior white matter (WM) and 2) isointense appearance of lesions on isotropic diffusion-weighted images results from a balance of T2 prolongation effects and diffusibility effects. METHODS: T2-weighted MR images from 11 patients were reviewed. Hyperintense lesions were located in both anterior and posterior WM in eight patients and solely in posterior WM in three patients. The ADC maps were produced by use of ADC values > or = 3 SD and > or = 10 SD above the mean value of normal WM. Lesions on diffusion-weighted images were classified as isointense or hypointense. ADC values within lesions (ADC(L)) were compared with those of normal WM (ADC(N)), and compared for isointense lesions and hypointense lesions. RESULTS: The distribution of lesions with ADC values > or = 3 SD was essentially identical to that on T2-weighted images. Regions with ADC values > or = 10 SD were found in both anterior WM and posterior WM in two patients and solely in posterior WM in nine patients. On diffusion-weighted images, lesions appeared isointense in seven patients and hypointense in four patients. Mean ADC(L)/ADC(N) for all lesions was 1.81; for hypointense lesions, 2.30. CONCLUSION: Vasogenic edema was more severe in posterior WM. Isointense lesions result from a balance of T2 effects and increased water diffusibility. Hypointense lesions have higher ADC values, which are not balanced by T2 effects.     

Water diffusion anisotropy in white and gray matter of the human spinal cord

PURPOSE: To develop a reliable technique for diffusion imaging of the human spinal cord at 1.5 Tesla and to assess potential differences in diffusion anisotropy in cross-sectional images. MATERIALS AND METHODS: A single-shot echo-planar imaging sequence with double spin-echo diffusion preparation was optimized regarding cerebrospinal fluid artifacts, effective resolution, and contrast-to-noise ratios. Eleven healthy volunteers participated in the study for quantitative characterization of diffusion anisotropy in white matter (WM) and gray matter (GM) by means of two diffusion encoding schemes: octahedral-six-directions for fractional anisotropy (FA) evaluation and orthogonal-three-directions for anisotropy index (AI) calculation. RESULTS: Pulse-trigger gated sequences with optimal matrix size (read x phase = 64 x 32) and b-value (700 s/mm(2)) allowed the acquisition of high-resolved images (voxel size = 0.9 x 0.9 x 5.0 mm(3)). The GM butterfly shape was recognizable in both AI and FA maps. Both encoding schemes yielded high diffusion anisotropy in dorsal WM (FA = 0.79 +/- 0.07; AI = 0.39 +/- 0.04). Lateral WM showed slightly lower anisotropy (FA = 0.69 +/- 0.08; AI = 0.35 +/- 0.03) than dorsal WM. Clearly smaller anisotropy was found in regions containing GM (FA = 0.45 +/- 0.06; AI = 0.21 +/- 0.05). CONCLUSION: Diffusion anisotropy data of the spinal cord can be obtained in a clinical setting. Its application seems promising for the assessment of neurological disorders.