MR perfusion imaging in human brain using the UNFAIR technique. Un-inverted flow-sensitive alternating inversion recovery.

Pulsed arterial spin labeling magnetic resonance techniques have been developed recently to estimate cerebral blood flow (CBF). Flow-sensitive alternating inversion recovery (FAIR) is one such technique that has been implemented successfully in humans. Un-inverted FAIR (UNFAIR) is an alternative technique in which the flow-sensitive image is acquired following inversion of all spins outside the slice of interest, and the control image is acquired without any spin labeling. This approach is potentially more efficient than FAIR since the UNFAIR control image is entirely flow independent and need only be acquired once. Here, we describe implementation of the sequence on a clinical 1.5 T magnetic resonance system. Both FAIR and UNFAIR perfusion-weighted images were obtained from six normal volunteers. Wash-in/wash-out curves measured in cortical gray and white matter were practically identical for the two techniques, as predicted by our model.     

Correlation between flow-sensitive alternating inversion recovery perfusion imaging with different inversion times and cerebral flow reserve evaluated by single-photon-emission computed tomography

The purpose of this study was to evaluate the effect of different inversion times (TIs) on flow-sensitive alternating inversion recovery (FAIR) perfusion imaging and compare them with the cerebral blood flow reserve evaluated by acetazolamide challenge using single-photon-emission computed tomography (SPECT). The subjects were nine patients with unilateral obstruction of the internal carotid artery. The signal ratio (SR16/8) of two images with different TIs (1,600 ms and 800 ms) was calculated, and the cerebral blood flow reserve (CFR) was evaluated by the increase in the ratio of cerebral perfusion after administration of acetazolamide in the SPECT study. A reversed linear correlation ( r =0.75) was found between SR and CFR, indicating that differences of FAIR images with changes of TI will be affected by cerebral flow reserve.     

磁共振FAIR灌注成像技术在急性脑梗死中的临床研究进展

急性脑梗死是一类发病率、致残率和致死率均较高的疾病,急性脑梗死前期脑血流灌注即会发生变化,反映在影像学上即是缺血半暗带的演变.其相当于潜在可挽救的缺血组织,因此了解急性脑梗死血流灌注的变化是研究治疗的关键.多种影像学技术可用于脑血流灌注的检测,但其都具有电离辐射,操作复杂,加之对比剂副作用,广泛应用受到一定限制.近年,MRI血流敏感性交替反转恢复(flowsensitive alternating inversion recovery,FAIR)技术得到了快速发展,它无创,不需对比剂,可重复操作并能敏感地反映梗死前期脑血流灌注的变化.因此,本文就最近几年有关急性脑梗死血流灌注变化的FAIR研究概况加以综述,为本病的临床诊治及进一步研究提供参考.     

Imaging pulmonary blood flow and perfusion using phase-sensitive selective inversion recovery.

A technique is described for imaging pulmonary blood flow using a phase-sensitive selective inversion recovery (PS-SIR) sequence. PS-SIR image reconstruction provides excellent contrast, differentiating fully relaxed inflowing blood from inverted blood and lung tissue. The magnetization of the inverted tissues remains negative at any inversion delay less than that at which the magnetization of the lung tissue is nulled, whereas that of the fully relaxed inflowing blood is always positive. Pulmonary blood flow can be observed by tracking the propagation of the pixels with positive values. Five healthy volunteers were imaged. The normal pattern of blood flow advancing from the central arteries toward the peripheries and into the lung parenchyma with return toward the center via draining veins was depicted. The method offers promise for evaluating pulmonary blood flow without the need for image subtraction or contrast administration. Magn Reson Med 43:793-795, 2000.     

Optimal inversion time for acquiring flow-sensitive alternating inversion recovery images to quantify regional cerebral blood flow

The purpose of this study was to correlate regional cerebral blood flow (rCBF) measured by I-123-IMP and flow-sensitive alternating inversion recovery (FAIR) studies with different inversion time (TI) values to find out the optimum TI that gives comparable rCBF and images on FAIR study. Nine patients with symptoms and signs of internal carotid or major cerebral arterial stenosis were enrolled in this study. Both I-123-IMP single photon emission computed tomography (SPECT) and FAIR images were acquired in all patients. Single-slice FAIR images (with different TI values) were acquired using a 1.5-T MRI unit. The rCBF was calculated from all I-123-IMP and FAIR images. Receiver operating characteristics (ROC) analysis was performed to detect hypoperfused segments on FAIR images. The rCBF calculated from FAIR and I-123-IMP studies were compared and correlated with each other. The ROC analysis showed no significant differences among the readers or TI values, but a trend of higher sensitivity, specificity, and accuracy was observed with TI of 1400 ms. The rCBF values of FAIR and I-123-IMP studies significantly correlated with each other. The FAIR images with TI value of 1400 ms gave more comparable CBF. A TI value of 1400 ms might be optimum for 1.5-T MR strength to get high quality FAIR images and comparable CBF. Electronic Publication     

Underestimation of cerebral perfusion on flow-sensitive alternating inversion recovery image: semiquantitative evaluation with time-to-peak values

BACKGROUND AND PURPOSE: We assessed the underestimation of cerebral perfusion measured by the flow-sensitive alternating inversion recovery (FAIR) technique in patients with carotid stenosis and compared the technique with dynamic susceptibility contrast (DSC) MR images. MATERIALS AND METHODS: We studied 42 areas of decreased cerebral blood flow (CBF) using 3 FAIR images with different inversion times (TIs) in 42 consecutive patients with unilateral carotid stenosis of more than 50%. The width of decreased CBF area (wCBF) was qualitatively assessed. We analyzed the ratio of CBF (rCBF) and the time-to-peak (TTP) difference (dTTP) between the ipsilateral hemisphere to carotid stenosis and contralateral normal area using regions of interest (ROIs) at the same location. RESULTS: In the areas with more prolonged TTP (dTTP > or =3.2 s), the wCBF obtained from the FAIR images with TI of 1600 ms was smaller than those from the FAIR images with a TI of 800 ms and 1200 ms in all cases. The mean rCBF obtained from the FAIR images with a TI of 1200 ms was significantly lower than that obtained from the FAIR images with a TI of 1600 ms (P < .01) in the areas with more prolonged TTP. In the areas with less prolonged TTP (dTTP <3.2 s), the wCBF and mean rCBF were not significantly different between the 2 FAIR images (TI, 1200 and 1600 ms). CONCLUSION: If TTP is delayed significantly (dTTP > or =3.2 s), the FAIR with intermediate or short TI showed underestimation of perfusion in the same area with delay in TTP.     

Comparison of inversion recovery asymmetrical spin-echo EPI and gradient-echo EPI for brain motor activation study

An inversion recovery asymmetric spin-echo (IR-ASE) echo-planar imaging (EPI) sequence has been developed for functional studies of the brain. This technique uses an 180° inversion pulse with a long inversion time (TI) to suppress the pulsatile cerebrospinal fluid and an asymmetric spin-echo readout to obtain activation signals from brain capillaries. Because gradient-echo sequences are most sensitive to large vessels, motor cortex activation studies using a gradient-echo technique also were conducted for comparison with the IR-ASE method. The results suggest that the IR-ASE pulse sequence may be a useful complement to the gradient-echo technique for the study of neuronal activity of the human brain.     

Measurement of myocardial blood flow.

This paper represents a review of the recent literature on techniques to measure myocardial blood flow in man. A short discussion on flow meters in followed by a more detailed discussion of the radionuclide techniques used to measure myocardial blood flow. The radionuclide techniques are discussed in two groups: (1) qualitative measurement of blood flow using static images; and (2) quantitative measurements of blood flow using diffusible substances that actively enter the cell, radioactive labeled particles, and radioactive diffusible gases.     

Phase-sensitive inversion recovery for detecting myocardial infarction using gadolinium-delayed hyperenhancement.

After administration of gadolinium, infarcted myocardium exhibits delayed hyperenhancement and can be imaged using an inversion recovery (IR) sequence. The performance of such a method when using magnitude-reconstructed images is highly sensitive to the inversion recovery time (TI) selected. Using phase-sensitive reconstruction, it is possible to use a nominal value of TI, eliminate several breath-holds otherwise needed to find the precise null time for normal myocardium, and achieve a consistent contrast. Phase-sensitive detection is used to remove the background phase while preserving the sign of the desired magnetization during IR. Experimental results are presented which demonstrate the benefits of both phase-sensitive IR image reconstruction and surface coil intensity normalization for detecting myocardial infarction (MI). The phase-sensitive reconstruction method reduces the variation in apparent infarct size that is observed in the magnitude images as TI is changed. Phase-sensitive detection also has the advantage of decreasing the sensitivity to changes in tissue T(1) with increasing delay from contrast agent injection.     

Brain perfusion measured by flow-sensitive alternating inversion recovery (FAIR) and dynamic susceptibility contrast-enhanced magnetic resonance imaging: comparison with nuclear medicine technique

The aim of this study was to compare cerebral perfusion images and regional cerebral blood flow (rCBF) of SPECT study with the images and regional intensity of relative cerebral blood flow (CBF) images acquired by contrast-enhanced perfusion MR imaging (pMRI) and flow-sensitive alternating inversion recovery (FAIR). Twelve patients with various cerebral diseases were underwent I-123-IMP SPECT, pMRI, and FAIR studies to measure rCBF. A total of 12 regions of interest (ROI) were created over cerebrum and cerebellum to acquire the corresponding rCBF from I-123-IMP study and regional average signal intensity from CBF images of pMRI and FAIR studies. Left-to-right (L/R) and cerebral-to-cerebellar (CCR) ratios were created from the rCBF of I-123-IMP and signal intensity of CBF images of pMRI and FAIR. Image quality of FAIR was the poorest among all; however, CBF images of pMRI and FAIR images show comparatively decreased intensity at the corresponding site of decreased perfusion on I-123-IMP images. Both FAIR and pMRI images showed high intensity along the sinuses, choroid plexus, and large vessels in sulci. No significant correlation was found among all imaging modalities. But L/R ratio of I-123-IMP showed significant correlation with those of pMRI and FAIR, but for CCR, significant correlation was observed only between I-123-IMP and FAIR. Perfusion images of both pMRI and FAIR may produce images comparable to SPECT study. But to calculate absolute CBF more easy-to-apply and accurate algorithms are needed to overcome the artifacts from large vessels. Received: 25 January 2000 Revised: 7 June 2000 Accepted: 8 June 2000     

Quantitative breath-hold monitoring of myocardial gadolinium enhancement using inversion recovery TrueFISP.

The purpose of this work was to develop and evaluate the accuracy of a breath-hold IR-TrueFISP acquisition capable of monitoring gadolinium (Gd) concentrations through T1 measurements in the left ventricular blood pool and segments of the myocardium over an extended duration. Measurements using a phantom were performed to assess the accuracy of the technique. Accurate T1 measurements in the expected range after contrast agent administration were obtained with several theoretical formulations. Accurate T1 values before the administration of the contrast agent were obtained only when the incomplete recovery of magnetization during the delay time (TD) between imaging segments was incorporated into the observed signal intensity calculations. T1 measurements over a 1-hr time period were performed in four subjects with known myocardial infarctions. In this small study, Gd differences between recent and old myocardial infarctions were observed.     

Single-shot inversion recovery TrueFISP for assessment of myocardial infarction

OBJECTIVE: The aim of the study was to assess the diagnostic accuracy of imaging the myocardium with a fast multislice inversion recovery 2D single-shot true fast imaging with steady-state precession (trueFISP) sequence during a single breath-hold in comparison with an established segmented inversion recovery turbo fast low-angle shot (turboFLASH) sequence. SUBJECTS AND METHODS: Forty-three patients with myocardial infarction were examined on a 1.5-T MR system 10 min after administration of contrast material (gadodiamide, 0.2 mmol/kg) with a single-shot 2D multislice technique (single-shot inversion recovery trueFISP) that allows one to image the entire short axis during one breath-hold (18 heartbeats) and with a segmented 2D single-slice technique (inversion recovery turboFLASH) that requires one breath-hold per slice (12 heartbeats). Signal intensity was determined in normal myocardium, in infarcted myocardium, and in the left ventricle. The contrast-to-noise ratio (CNR) of normal and infarcted myocardium was determined. The areas of hyperintense infarctions on selected slices and the entire volumes were compared for both sequence techniques. RESULTS: The inversion recovery trueFISP sequence has a lower CNR than the inversion recovery turboFLASH sequence (mean values, 10.0 vs 12.9, respectively; p = 0.005) for differentiation of viable from nonviable myocardium. The CNR of injured myocardium and blood in the left ventricular cavity also has a lower value for the multislice technique compared with the single-slice technique (0.6 vs 1.2, respectively; p = 0.045). Assessment of the area of infarction within one slice (r = 0.97, p < 0.002) and of the volume of the entire infarction (r = 0.96, p < 0.003) is possible with excellent correlation of both techniques. CONCLUSION: Despite having a lower CNR, the inversion recovery 2D single-shot trueFISP sequence allows fast and accurate identification of the area and volume of infarction with high spatial resolution within a single breath-hold.     

Fast mapping of myocardial blood flow with MR first-pass perfusion imaging.

Accurate and fast quantification of myocardial blood flow (MBF) with MR first-pass perfusion imaging techniques on a pixel-by-pixel basis remains difficult due to relatively long calculation times and noise-sensitive algorithms. In this study, Zierler's central volume principle was used to develop an algorithm for the calculation of MBF with few assumptions on the shapes of residue curves. Simulation was performed to evaluate the accuracy of this algorithm in the determination of MBF. To examine our algorithm in vivo, studies were performed in nine normal dogs. Two first-pass perfusion imaging sessions were performed with the administration of the intravascular contrast agent Gadomer at rest and during dipyridamole-induced vasodilation. Radiolabeled microspheres were injected to measure MBF at the same time. MBF measurements in dogs using MR methods correlated well with the microsphere measurements (R2=0.96, slope=0.9), demonstrating a fair accuracy in the perfusion measurements at rest and during the vasodilation stress. In addition to its accuracy, this method can also be optimized to run relatively fast, providing potential for fast and accurate myocardial perfusion mapping in a clinical setting.     

PET心肌灌注显像测定心肌血流量及冠状动脉血流储备的研究进展

PET心肌灌注显像可绝对定量测定局部心肌血流量（MBF）和冠状动脉血流储备（CFR）。由于显像剂半衰期短,允许在短时间内重复进行PET心肌灌注显像,获得静息态、冷加压试验和药物负荷试验等不同状态下的MBF,进而评价冠状动脉血管内皮依赖性和非依赖性的CFR功能。在早期诊断冠心病,准确诊断冠状动脉多支病变,评价微血管病变,早期检测冠状动脉内皮细胞功能异常及CFR功能的异常,估测预后,帮助临床治疗方案的制定以及检测疗效等方面,PET心肌灌注显像有重要的临床价值。该文将介绍PET心肌灌注显像相关知识及其在心血管领域的主要应用。     

Perfusion imaging by a flow-sensitive alternating inversion recovery (Fair) technique: Application to functional brain imaging

Perfusion is a crucial physiological parameter for tissue function. To obtain perfusion-weighted images and consequently to measure cerebral blood flow (CBF), a newly developed flow-sensitive alternating inversion recovery (FAIR) technique was used. Dependency of FAIR signal on inversion times (TI) was examined; signal is predominantly located in large vessels at short TI, whereas it is diffused into gray matter areas at longer TI. CBF of gray matter areas in the human brain is 71 ± 15 SD ml/100 g/min (n = 6). In fMRI studies, micro- and macrovessel inflow contributions can be obtained by adjusting TIs. Signal changes in large vessel areas including the scalp were seen during finger opposition at a TI of 0.4 s; however, these were not observed at a longer TI of 1.4 s. To compare with commonly used BOLD and slice selective inversion recovery techniques, FAIR and BOLD images were acquired at the same time during unilateral finger opposition. Generally, activation sites determined by three techniques are consistent. However, activation of some areas can be detected only by FAIR, not by BOLD, suggesting that the oxygen consumption increase couples with the CBF change completely. Relative and absolute CBF changes in the contralateral motor cortex are 53 ± 17% SD (n = 9) and 27 ± 11 SD ml/100 g/min (n = 9), respectively.     

Single-shot EPI with signal recovery from the susceptibility-induced losses.

A major problem in the gradient-recalled echo-planar imaging (EPI) method that also uses a long echo time (TE) is the severe signal loss in regions with large static field inhomogeneities. These regions include the ventral frontal, medial temporal, and inferior temporal lobes, which experience inhomogeneities induced by susceptibility effects commonly found near air/tissue interfaces. For functional magnetic resonance imaging (fMRI) studies that use both gradient-recalled EPI at relatively long TE and high-field scanners, this signal loss is severe, preventing investigation of certain human cognitive processes that involve these regions, such as memory and attention. Methods have been developed to recover this signal loss; however, most of them require multiple excitations and thus compromise temporal resolution. In this report, a new technique is described which achieves good signal recovery within a single excitation. It is anticipated that this technique will prove useful for fMRI studies in inhomogeneous areas that require high temporal resolution.     

MR angiography by selective inversion recovery

A modified inversion-recovery sequence is introduced which performs subtraction angiography by varying time-of-flight effects of blood flowing into an imaged slab. The selective 180 degrees excitation inverts different regions between measurements to isolate arterial and/or venous blood. On normal human subjects, high-resolution carotid artery angiograms have been obtained.