Serial MR imaging with MS-325 for evaluating female sexual arousal response: determination of intrasubject reproducibility

PURPOSE: To determine if a similar sexual arousal response in normal, healthy women could be obtained and monitored by serial magnetic resonance (MR) imaging at two separate sessions. MATERIALS AND METHODS: Serial imaging of the external genitalia was performed on nine healthy, sexually functional women at two separate MR sessions after administration of the contrast agent, MS-325. Images were obtained every three minutes during a 45-minute study period during each MR session. The second MR session began approximately 45 minutes after the end of the first MR session. While undergoing imaging, subjects viewed videotapes that contained neutral and sexually-explicit material through an audiovisual system. Analysis performed at each time point consisted of visual evaluation of the images, clitoral and femoral vein signal intensity measurements, relative regional blood volume calculations, and clitoral volume measurements. Statistical analysis of the results consisted of calculating correlation coefficients of the two MR sessions by using the least square fit method. RESULTS: All nine subjects reported sexual arousal on subjective questionnaires at each MR session. Post-contrast MS-325 MR images showed strong enhancement of the external genitalia at each session. There was excellent correlation between the two sessions for the clitoral volume measurements of all nine subjects. The correlation coefficient, r(2), was 0.95. CONCLUSION: The sexual arousal response in normal, healthy women can be monitored by serial imaging combined with the use of the contrast agent, MS-325, and similar results can be reproduced at two different MR sessions. This method holds promise for future studies of women with female sexual arousal dysfunction.     

Reproducibility of visual activation in functional MR imaging and effects of postprocessing

BACKGROUND AND PURPOSE: Functional MR imaging studies of the brain should be interpreted in the context of their reproducibility. We assessed the reproducibility of visual activation measured by functional MR imaging and analyzed the effect of image transformation to standard space. METHODS: Seven healthy volunteers were studied twice with echo-planner functional MR imaging at 1.5 T during visual stimulation. The studies were separated by an interval of 2 to 7 days. Functional images were analyzed after spatial normalization to the space described by Talairach and Tournoux and/or after coregistration of the images of the second study with the images of the first study. The number of active voxels for each study was determined at three thresholds. In addition, the change in the center of the mass of activation, the mean change in signal intensity, and the mean t value within the activated area were measured. These reproducibility indexes were calculated for the spatially normalized and nonnormalized data for each subject. RESULTS: Variations in visual activation were observed between the two studies in the same individual as well as across subjects. There was no evidence of an effect from image transformation on reproducibility on any of the measures. CONCLUSION: Our findings show that the reproducibility of activation in functional MR imaging may be much more variable across subjects than suggested in previous studies. The use of different types of image transformation (coregistration, spatial normalization) does not significantly affect the reproducibility of visual activation.     

The effect of age on odor-stimulated functional MR imaging.

BACKGROUND AND PURPOSE: The effects of age, sex, and handedness on olfaction have not been adequately addressed with odor-stimulated functional MR imaging studies. We sought to determine the effect of age on functional MR imaging experiments performed with odor stimulation. METHODS: Five right-handed subjects with a mean age of 73 years and five right-handed subjects with a mean age of 24 years underwent gradient-echo echo-planar functional MR imaging using binasal olfactory stimulation. Imaging parameters included 3000/30 (TR/TE) and a 5-mm section thickness in a 6-minute sequence with 30 seconds of pulsed odorants alternating with 30 seconds of room air. The data were normalized to a standard atlas, and individual and group statistical parametric maps (SPMs) were generated for each task. The SPMs were thresholded for a P < .01, and the volumes of activation and distribution of cluster maxima were compared for the two groups. RESULTS: Analysis of the group SPMs revealed activated voxels in the frontal lobes, perisylvian regions, and cingulate gyri, with greater volume in the younger group than in the older group. The right inferior frontal, right perisylvian, and right and left cingulum had the largest number of voxels activated. The most common sites of activation on individual maps in both groups were the right inferior frontal regions and the right and left superior frontal and perisylvian zones. CONCLUSION: Given similar olfactory task paradigms, younger subjects showed a greater number of activated voxels than did older subjects. One must be cognizant of this effect when designing studies of odor-stimulated functional MR imaging.     

Functional connectivity in the thalamus and hippocampus studied with functional MR imaging

BACKGROUND AND PURPOSE: With functional connectivity functional MR imaging, co-variance in signal intensity has been shown in functionally related regions of brain in participants instructed to perform no cognitive task. These changes are thought to represent synchronous fluctuations in blood flow, which imply neuronal connections between the regions. The purpose of this study was to map functional connectivity in subcortical nuclei with functional connectivity functional MR imaging. METHODS: Imaging data were acquired with an echo-planar sequence from six volunteers who performed no specific cognitive task. For functional connectivity functional MR imaging, a "seed" voxel or group of voxels was selected from the resting data set in the thalamus or in the hippocampus. Control voxels in gray matter presumed not to be eloquent cortex were also chosen. The correlation coefficient of the seed voxels and the control voxels with every other voxel in the resting data set was calculated. The voxels with correlation coefficients greater than or equal to 0.5 were mapped onto anatomic images for the functional connectivity functional MR images. The anatomic location of these voxels was determined by conventional parcellation methods. RESULTS: For each participant, functional connectivity functional MR imaging maps based on four seed voxels in the thalamus or hippocampus showed clusters of voxels in the ipsilateral and contralateral thalamus or hippocampus. For control voxels, few voxels in the hippocampus or thalamus showed significant correlation. Significantly more pixels in the ipsilateral hippocampus correlated with the seed voxel than in the contralateral hippocampus. The differences between numbers of functionally connected voxels in ipsilateral thalamus and those in contralateral thalamus were not significant. CONCLUSIONS: The thalamus and hippocampus show functional connectivity, presumably representing synchronous changes in blood flow.     

A comparison of chemoembolization endpoints using angiographic versus transcatheter intraarterial perfusion/MR imaging monitoring

PURPOSE: Transcatheter arterial chemoembolization (TACE) is an established treatment for unresectable liver cancer. This study was conducted to test the hypothesis that angiographic endpoints during TACE are measurable and reproducible by comparing subjective angiographic versus objective magnetic resonance (MR) endpoints of TACE. MATERIALS AND METHODS: The study included 12 consecutive patients who presented for TACE for surgically unresectable HCC or progressive hepatic metastases despite chemotherapy. All procedures were performed with a dedicated imaging system. Angiographic series before and after TACE were reviewed independently by three board-certified interventional radiologists. A subjective angiographic chemoembolization endpoint (SACE) classification scheme, modified from an established angiographic grading system in the cardiology literature, was designed to assist in reproducibly classifying angiographic endpoints. Reproducibility in SACE classification level was compared among operators, and MR imaging perfusion reduction was compared with SACE levels for each observer. RESULTS: Twelve patients successfully underwent 15 separate TACE sessions. SACE levels ranged from I through IV. There was moderate agreement in SACE classification (kappa = 0.46 +/- 0.12). There was no correlation between SACE level and MR perfusion reduction (r = 0.16 for one operator and 0.02 for the other two). CONCLUSIONS: Angiographic endpoints during TACE vary widely, have moderate reproducibility among operators, and do not correlate with functional MR imaging perfusion endpoints. Future research should aim to determine ideal angiographic and functional MR imaging endpoints for TACE according to outcome measures such as imaging response, pathologic response, and survival.     

T2-weighted MR imaging in the assessment of cirrhotic liver

PURPOSE: To assess if T2-weighted magnetic resonance (MR) imaging provides added diagnostic value in combination with dynamic gadolinium-enhanced MR imaging in the detection and characterization of nodular lesions in cirrhotic liver. MATERIALS AND METHODS: Two readers retrospectively and independently analyzed 54 MR imaging studies in 52 patients with cirrhosis. In session 1, readers reviewed T1-weighted and dynamic gadolinium-enhanced images. In session 2, readers reviewed T1-weighted, dynamic gadolinium-enhanced, and respiratory-triggered T2-weighted fast spin-echo images. Readers identified and characterized all focal lesions by using a scale of 1-4 (1, definitely benign; 4, definitely malignant). Multireader correlated receiver operating characteristic (ROC) analysis was employed to assess radiologist performance in session 2 compared with session 1. The difference in the areas under the ROC curves for the two sessions was tested. In a third session, readers assessed conspicuity of biopsy-proved lesions on T2-weighted MR images by using a scale of 1-3 (1, not seen; 3, well seen) and identified causes of reduced conspicuity. RESULTS: Two additional benign lesions were detected by each reader in session 2. Fifty-five lesions had pathologic verification, including 32 malignant, three high-grade dysplastic, and 20 benign nodules. There was no significant difference in the area under the ROC curves between the two sessions (P =.48). Thirty-two lesions were inconspicuous on T2-weighted MR images because of parenchymal heterogeneity, breathing artifacts (particularly in patients with ascites), and lesion isointensity with liver parenchyma. T2-weighted MR imaging was useful in the evaluation of cysts and lymph nodes. CONCLUSION: T2-weighted MR imaging does not provide added diagnostic value in the detection and characterization of focal lesions in cirrhotic liver.     

Multiple reproducibility indices for evaluation of cognitive functional MR imaging paradigms

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate a variety of reproducibility indices for cognitive functional MR imaging (fMRI) paradigms that account for both overlapping and extraneous regions of activation. METHODS: Eight right-handed volunteers were imaged with fMRI by using a word-generation paradigm and a forward-backward text-listening paradigm. The paradigms were performed twice in the session and repeated 1 week later. Reproducibility indices for the four repeated studies were determined on the basis of pair-wise computation of the ratio of the probability-weighted intersection volume divided by the union volume of surviving activation clusters. The intersection volume was determined by using several iterations of the morphologic dilatation operator with additional voxels accrued in the intersection weighted by an exponential function. Computed indices included global reproducibility, language area reproducibility, extraneous activation reproducibility, and laterality. RESULTS: The word-generation paradigm had reproducibility values that were significantly greater than those of the forward-backward text-listening paradigm (global reproducibility, 0.75 vs 0.5, P <.005; language area reproducibility, 0.85 vs 0.6, P <.008; mean extraneous activation reproducibility, 0.68 vs 0.41, P <.002). The forward-backward text-listening paradigm demonstrated more focal activations, whereas the word-generation demonstrated larger activations outside the dominant language areas that were highly reproducible. CONCLUSION: For clinically relevant language paradigms, multiple reproducibility indices should be taken into account in selecting an appropriate paradigm. Compared with a forward-backward text-listening task, a word-generation task has higher reproducibility indices at the expense of localizing ability. The forward-backward paradigm demonstrates more focal activations with less extraneous activation.     

Reproducibility of activations in Broca area with two language tasks: a functional MR imaging study

BACKGROUND AND PURPOSE: Functional MR imaging (fMRI) is rapidly evolving and claims to complement or even substitute intraoperative mapping (IOM) of language functions. However, little is known about the reproducibility of imaging data in the language domain. The aim of our study was to assess the reproducibility of activations for 2 widely used paradigms: naming and word generation. Individual analysis was focused on the Broca area and the left insula. MATERIALS AND METHODS: We examined 13 healthy right-handed subjects in 3 sessions with fMRI. Two conditions were assessed: overt naming and overt naming plus noun generation. The same stimuli were used in all of the sessions. A random-effects analysis was performed to analyze whole-brain activation on a group level. For the regions of interest, the number of voxels classified as active were counted for each subject, and individual reproducibility coefficients were calculated over sessions. RESULTS: For the naming condition, the random-effects analysis did not reveal significant activations in the specified regions; small individual activations were not reproducible. For the combined task, all of the subjects showed activations in the Broca area that were more extensive and reproducible than in the naming task. Activations in the insula were only poorly reproducible. CONCLUSION: Naming is an approved task in IOM but does not identify the Broca area with fMRI in a reproducible way. Priming may have affected our results, but the use of a combined task, in which naming is paired with noun generation, improves the reproducibility of activations and is also suitable for IOM.     

Correlation of reaction time in and out of the functional MR unit

RATIONALE AND OBJECTIVES: The authors performed this study to determine whether reaction times (RTs) recorded in the functional magnetic resonance (MR) imaging environment reflect the performance of the patient outside the imaging room. MATERIALS AND METHODS: Fifteen healthy control subjects (mean age, 61.6 years) performed a simple reaction time (SRT) task outside the MR magnet and a visuomotor response time task inside the magnet with use of block-design and event-related paradigms. For both behavioral and functional MR imaging tests, subjects tapped the right index finger upon the appearance of a visual cue. The mean RTs for out-of-magnet and functional MR imaging paradigms were compared. Results. There was a statistically significant difference in RTs between block-design and single-event paradigms (t = 3.458, P < .004). The RT values during functional MR imaging and SRT tasks did not show significant differences (.65 < P < .7, paired t test). However, no correlation was found in RT values between event-related (p = -0.004, P = .15) or block-design (p = 0.03, P = .13) paradigms and SRT data. With the block-design functional MR imaging paradigm, the RT was significantly faster (P < .0003) at the beginning of the session than the end, illustrating the effect of anticipation. CONCLUSION: Functional MR imaging RTs must be used to determine the correlation between subjects' performance and the volume of brain activation in a functional MR imaging experiment. The effect of anticipation should be minimized, which could best be achieved by using event-related paradigms.     

Endorectal MR imaging and MR spectroscopic imaging for locally recurrent prostate cancer after external beam radiation therapy: preliminary experience

PURPOSE: To evaluate endorectal magnetic resonance (MR) imaging and MR spectroscopic imaging for the depiction of locally recurrent prostate cancer after external beam radiation therapy. MATERIALS AND METHODS: Endorectal MR imaging and MR spectroscopic imaging were performed in 21 patients with biochemical failure after external beam radiation therapy for prostate cancer. Two readers independently and retrospectively reviewed MR images and rated the likelihood of recurrent tumor on a five-point scale. Spectroscopic voxels were considered suspicious for malignancy if the choline level was elevated and citrate was absent. Receiver operating characteristic curve analysis was used to assess cancer detection in each side of the prostate with endorectal MR imaging and spectroscopic imaging at different thresholds based on the scores assigned by the two readers and on the number of suspicious voxels in each hemiprostate, respectively. The presence or absence of cancer at subsequent transrectal biopsy was used as the standard of reference. RESULTS: Biopsy demonstrated locally recurrent prostate cancer in nine hemiprostates in six patients. The area under the receiver operating characteristic curve for the detection of locally recurrent cancer with MR imaging was 0.49 and 0.51 for readers 1 and 2, respectively. By using the number of suspicious voxels to define different diagnostic thresholds, the area under the receiver operating characteristic curve for MR spectroscopic imaging was significantly (P < .005) higher, at 0.81. In particular, the presence of three or more suspicious voxels in a hemiprostate showed a sensitivity and specificity of 89% and 82%, respectively, for the diagnosis of local recurrence. Seven hemiprostates demonstrated complete metabolic atrophy at spectroscopic imaging and only postirradiation atrophy at biopsy. CONCLUSION: Preliminary data suggest that MR spectroscopic imaging, but not endorectal MR imaging, may be of value for the depiction of locally recurrent prostate cancer after radiation therapy.     

Contrast-to-noise ratio (CNR) as a quality parameter in fMRI

PURPOSE: To evaluate the impact of data quality on the localization of brain activation in functional magnetic resonance imaging (fMRI) and to explore whether the temporal contrast-to-noise-ratio (CNR) provides a quantitative parameter to estimate fMRI quality. MATERIALS AND METHODS: We investigated two methods for defining the CNR by comparing them on a single-run, single session, as well as on a group-wise basis. The CNRs of healthy subjects and a group of patients with brain lesions were calculated using two different strategies: one based on a general linear model (GLM) analysis (CNR_SPM), and one that acts as an adaptive low-pass filter and assumes that the high-frequency components contain the temporal noise (CNR_SG). Runs with low CNR were identified as outliers using a common exclusion criterion (2 x standard deviation (SD)). RESULTS: The results of the two CNR methods are highly correlated. Both between and within subjects and patients the CNR showed quite large variations, but the average CNR did not differ between a group of healthy subjects and a patient group. In total, seven of 213 runs (3.3% of all runs) had to be excluded when CNR_SG was used, and 14 of 213 (6.6%) runs had to be excluded when CNR_SPM was used. CONCLUSION: Calculating the CNR using an adaptive low-pass filter gives similar results to a GLM-based approach and could be advantageous for cases in which the hemodynamic response function (HRF) differs significantly from common assumptions. The CNR can be used to identify and exclude runs with suboptimal CNR, and to identify sessions with insufficient data quality. The CNR may serve as a quantitative and intuitive parameter to assess the performance and quality of clinical fMRI investigations, including information on both functional performance (contrast) and data quality (noise caused by the system and physiology).     

Effect of routine MR imaging of the brain at 1.5 T on subsequent magnetoencephalography: results in nine volunteers

PURPOSE: To investigate whether routine magnetic resonance (MR) imaging of the brain with a whole-body 1.5-T imager affects the results of subsequent magnetoencephalography (MEG). MATERIALS AND METHODS: Nine healthy volunteers (six women, mean age of 23 years, age range of 20-27 years; three men, mean age of 24 years, age range of 23-25 years) underwent one MEG session before and two MEG sessions after MR imaging of the brain. The first MEG session was completed about 20 minutes before brain MR imaging began, the second MEG session (MEG 2) was performed within 30 minutes after MR imaging, and the third MEG session was performed 2 hours after MEG 2. Each MEG session involved measurement of spontaneous brain activity and, in seven patients, of brain activity during stimulation of the median nerve. MR imaging included T1- and T2-weighted fast spin-echo and gradient-echo sequences applied with a 1.5-T clinical imager. Data were compared by using a repeated-measures analysis of variance (general linear model) both with and without Greenhouse-Geisser correction. RESULTS: MEG signals were detected and measured without difficulty in all volunteers. No statistically significant difference was seen between estimated noise at MEG before and after MR imaging (P =.588 with correction, P =.665 without correction). MEG records obtained in all volunteers enabled localization of evoked response to median nerve stimulation before and after MR imaging. No measurable differences were observed between relative power spectra of spontaneous brain activity before and after MR imaging (P >.290 with correction, P >or=.295 without correction). CONCLUSION: No measurable effect of 1.5-T brain MR imaging on subsequent MEG was detected.     

MR imaging in the presurgical workup of patients with drug-resistant epilepsy

BACKGROUND AND PURPOSE: Whether an epileptic lesion is detected with MR imaging depends on the quality of the images and the expertise of the reader. We analyzed the role of 1.5-T MR imaging in the presurgical evaluation of patients with drug-resistant epilepsy at one center. METHODS: In a 2-year prospective study, 385 patients with drug-resistant epilepsy underwent standardized MR imaging at 1.5 T. We analyzed whether lesions were detected, whether they were precisely characterized by MR imaging, and whether lesion characterization allowed us to estimate seizure outcomes. RESULTS: Lesions were found on MR images in 318 patients (83%). Following presurgical evaluation, 209 (66%) underwent surgery, and 109 (34%) did not. Freedom from seizures was achieved in 130 (70%) of 186 patients. Nine (14%) of 66 patients without an MR imaging lesion underwent surgery; histopathologic findings were unrevealing in seven patients, and five (56%) achieved freedom from seizures. Hippocampal sclerosis was the most common lesion (52%) and correctly characterized in 101 (97%) of 104 patients. Glioneuronal tumors (20%) were sometimes imprecisely characterized: Four nonenhancing gangliogliomas were mistaken for focal cortical dysplasias. Outcomes were not different between lesion groups. However, there were trends toward a favorable outcome for focal cortical dysplasias with balloon cells and an unfavorable outcome for gyral scars. CONCLUSION: MR imaging detection of lesions influences further presurgical workup, though lesion characterization does not allow us to predict seizure outcome. If MR imaging fails to depict a lesion and patients undergo surgery because of electrophysiologic findings, histopathologic findings are often unrevealing.     

Global and regional reproducibility of T2 relaxation time measurements in human patellar cartilage.

Seven T2 maps (multiecho (ME) sequence: 3000 ms, eight echoes with 13.2 ms of echo spacing, 20 sections) and T1-weighted (T1-w) fast low-angle shot (FLASH-water excitation (WE)) data sets from four imaging sessions (right patellae of 10 healthy volunteers) were obtained. A segmentation of cartilage (WE sequence) was overlaid on the ME data and T2 values were calculated for total cartilage, three layers, three facets (global), and 240 ROIs (regional). Reproducibility (precision error) was calculated as the root mean square average (RMSA) of the individual coefficients of variation (COVs, %) and standard deviations (SDs, ms) for intra- and intersession reproducibility. The precision error was 3-7% and 6-29% for global and regional T2, respectively. There was no difference between intra- and intersession reproducibility, but there was worse reproducibility in the superficial layers compared to the deeper layers. Peripheral ROI reproducibility (mean=13%) was worse than in the central portions (mean=11%), but omission of the periphery did not positively affect the globally calculated T2 reproducibility. The precision errors were small compared to reported changes in diseased cartilage, suggesting good discriminatory power of the technique. Our data provide a first estimate of global and regional reproducibility errors of T2 in healthy cartilage, and may serve as a basis for sample size calculations and aid study designs for longitudinal and cross-sectional trials in osteoarthritis (OA).     

Transition zone prostate cancer: metabolic characteristics at 1H MR spectroscopic imaging--initial results

PURPOSE: To determine whether cancers of the prostate transition zone (TZ) possess a unique metabolic pattern by which they may be identified at proton magnetic resonance (MR) spectroscopic imaging. MATERIALS AND METHODS: Findings in 40 patients who underwent combined endorectal MR imaging and hydrogen 1 MR spectroscopic imaging before radical prostatectomy and who had TZ tumor identified subsequently at step-section pathologic analysis were retrospectively reviewed. Within this population, a subset of 16 patients whose TZ tumor had a largest diameter of 1 cm or greater and was included in the MR spectroscopic imaging excitation volume was identified. In these 16 patients, the ratios of choline-containing compounds (Cho) and creatine/phosphocreatine (Cr) to citrate (Cit) (ie, [Cho + Cr]/Cit), Cho/Cr, and Cho/Cit were compared in tumor and control tissues. The presence of only Cho and the absence of all metabolites were also assessed. RESULTS: The mean values of (Cho + Cr)/Cit, Cho/Cr, and Cho/Cit were different between TZ cancer and control tissues (P =.001, P =.003, and P =.001, respectively; Wilcoxon signed rank test). Nine (56%) of 16 patients had at least one tumor voxel in which Cho comprised the only detectable peak, while no control voxels showed only Cho (P =.008, McNemar test). The percentage of voxels in which no metabolites were detected did not differ between tumor and control tissues (P =.134, McNemar test). CONCLUSION: TZ cancer has a metabolic profile that is different from that of benign TZ tissue; however, the broad range of metabolite ratios observed in TZ cancer precludes the use of a single ratio to differentiate TZ cancer from benign TZ tissue.     

Temporal lobe activation demonstrates sex-based differences during passive listening.

PURPOSE: To evaluate potential sex differences in temporal lobe activation during the performance of a functional magnetic resonance (MR) imaging passive-listening paradigm. MATERIALS AND METHODS: Twenty strongly right-handed volunteers (10 men, 10 women) underwent imaging with a 1.5-T machine by using a gradient-echo echo-planar sequence. The task consisted of passive listening to simple narrative text interleaved with same-narrative text played backward. Volumes of interest were drawn around anterior and posterior areas of activation in bilateral temporal lobes. The peak percentage of activation and the percentage of activated voxels at single-voxel significance levels of 10(-2), 10(-3), and 10(-4) within each volume of interest were measured. An asymmetry index A was then calculated for both anterior and posterior volumes of interest such that A = (L - R)/(L + R), where R is either the peak percentage activation or the percentage of activated voxels within the right volume of interest and L is either the peak percentage activation or the percentage of activated voxels within the left volume of interest. The asymmetry indexes were compared between men and women by using a standard t test. RESULTS: Men showed a significantly higher degree of asymmetric activation than did women in both the anterior and posterior volumes of interest by using peak percentage activation and at all single-voxel significance levels. The degree of activation asymmetry was greater by using single-voxel significance measurements, compared with peak percentage activation measures. CONCLUSION: Women demonstrate a higher degree of bilateral language representation in temporal lobe regions than do men during passive listening. These findings, combined with the variable results of prior functional MR imaging language studies of sex differences, suggest that they may be task specific.     

Repeatability of motor and working-memory tasks in healthy older volunteers: assessment at functional MR imaging

PURPOSE: To prospectively determine the repeatability of functional magnetic resonance (MR) imaging brain activation tasks in a group of healthy older male volunteers. MATERIALS AND METHODS: Local research ethics committee approval and informed consent were obtained. Sixteen men with a mean age of 69 years +/- 3 (standard deviation) performed finger-tapping and N-back (number of screens back) working-memory tasks. Each subject underwent MR imaging three times in weekly intervals. Within-subject task repeatability was analyzed in terms of the number of voxels classified as activated (activation extent), the mean activation amplitude, and (for finger tapping) the center of the mass of the activated region. A repeatability index was calculated to compare test-retest repeatability between subjects and between functional MR imaging tasks. Within-session, between-session, and between-subject variability was assessed by using analysis of variance testing of activation amplitude and extent. RESULTS: Nine of the 16 subjects generated useful data at all three MR imaging-functional task sessions. At single-subject, single-session analysis, cortical activation was identified in most subjects and at most sessions. The centers of the masses of motor cortex activation were highly reproducible (within 3 mm). Patterns of activation were qualitatively repeatable, but there was substantial variability in the amplitudes and extents of activated regions. Within-session coefficients of variation (CVs) for left- versus right-hand and right- versus left-hand finger tapping were, respectively, 65% and 43% for activation amplitude and 75% and 121% for activation extent. The between-session CVs for activation amplitude were similar to the within-session values, whereas between-session CVs for activation extent were much greater than within-session values, up to 206%. CONCLUSION: The generally poor quantitative task repeatability highlights the need for further methodologic developments before much reliance can be placed on functional MR imaging results of single-session experiments.     

Anal sphincter defects in patients with fecal incontinence: endoanal versus external phased-array MR imaging

PURPOSE: To prospectively compare external phased-array magnetic resonance (MR) imaging with endoanal MR imaging in depicting external and internal anal sphincter defects in patients with fecal incontinence and to prospectively evaluate observer reproducibility in the detection of external and internal anal sphincter defects with both MR imaging techniques. MATERIALS AND METHODS: The medical ethics committees of both participating hospitals approved the study, and informed consent was obtained. Thirty patients (23 women, seven men; mean age, 58.7 years; range, 37-78 years) with fecal incontinence underwent MR imaging with both endoanal and external phased-array coils. MR images were evaluated by three radiologists with different levels of experience for external and internal anal sphincter defects. Measures of inter- and intraobserver agreement of both MR imaging techniques and of differences between both imaging techniques were calculated. RESULTS: Both MR imaging techniques did not significantly differ in the depiction of external (P > .99) and internal (P > .99) anal sphincter defects. The techniques corresponded in 25 (83%) of 30 patients for the depiction of external anal sphincter defects and in 28 (93%) of 30 patients for the depiction of internal anal sphincter defects. Interobserver agreement was moderate to good for endoanal MR imaging and poor to fair for external phased-array MR imaging. Intraobserver agreement ranged from fair to very good for both imaging techniques. CONCLUSION: External phased-array MR imaging is comparable to endoanal MR imaging in the depiction of clinically relevant anal sphincter defects. Because of the weak interobserver agreement, both MR imaging techniques can be recommended in the diagnostic work-up of fecal incontinence only if sufficient experience is available.     

Quantification and reproducibility of tracking cortical extent of activation by use of functional MR imaging and magnetoencephalography

BACKGROUND AND PURPOSE: Functional MR imaging and magnetoencephalography are commonly used to study normal cortical sensory and cognitive processing as well as a variety of disease states. The usefulness of these techniques is dependent on the reproducibility and sensitivity to change of derived measures of brain function. The purpose of this study was to compare the efficacy of functional MR imaging and magnetoencephalography as measures of the extent of cortical activity in response to a graded stimulus. METHODS: Five participants underwent functional MR imaging and magnetoencephalography involving stimulation of one, two, three, and four digits of the left hand. Measurements of activation were repeated three times per participant. The cortical extent of activation was assessed for functional MR imaging by observing the number of "activated" pixels and the "amount of activation": the product of the number of activated pixels and the mean signal change. Activation was quantified for magnetoencephalography as the magnitude of the evoked magnetic field peak and as the strength of the modeled current source, Q. RESULTS: For functional MR imaging, the number of activated pixels tended to increase with the increasing number of stimulated digits. High intra- and interparticipant variability (66% and 85% variation, respectively) did not, however, allow statistical resolution of this trend. The amount of activation was similarly variable (interparticipant, 89%). Magnetoencephalography was more robust regarding quantification. The evoked field amplitude varied linearly with the number of digits stimulated; intra- and interparticipant variability was 18% and 41%, respectively, permitting resolution of significant differences between any combination of stimulated digits, except two versus three (P < .05). CONCLUSION: Although functional MR imaging and magnetoencephalography show measurable evoked responses with somatosensory stimulation, in this study, functional MR imaging did not permit robust quantification of increasing cortical areas of activation.     

Impact of lung volume on MR signal intensity changes of the lung parenchyma

PURPOSE: To test the hypothesis that, in magnetic resonance (MR) imaging of healthy individuals, equal relative changes in lung volume cause equal relative changes in MR signal intensity of the lung parenchyma. MATERIALS AND METHODS: In two experimental runs, 10 volunteers underwent spirometrically monitored MR imaging of the lungs, with MR images acquired at 10 incremental lung volumes ranging from total lung capacity to 10% above residual volume. Average signal intensity, signal variability, and signal intensity integrals were calculated for each volunteer and for each lung volume. The effect of lung volume on signal intensity was quantified using linear regression analysis complemented by the runs test. Slopes and intercepts of regression lines were compared with an analysis of covariance. Slopes of the lines of best fit for lung volumes and signal intensities from the two runs were compared to the slope of the line of identity. Comparisons between the two runs were visualized using Bland and Altman plots. RESULTS: The slopes of the 10 individual regression lines yielded no significant differences (F = 1.703, P = 0.101; F = 1.321, P = 0.239). The common slopes were -0.556 +/- 0.027 (P = 0.0001) for the first and -0.597 +/- 0.0031 (P = 0.0001) for the second experimental run. Both slopes displayed no significant nonlinearity (P = 0.419 and P = 0.067). There was a strong association between changes in lung volumes (rs = 0.991, P = 0.0001) and changes in signal intensity (rs = 0.889, P = 0.0001) in the two experimental runs. Lines of best fit for lung volume and signal intensities were not significantly different from the slope of the line of identity (P = 0.321 and P = 0.212, respectively). CONCLUSION: Equal changes in lung volume cause equal changes in MR signal intensity of the lung parenchyma. This linear and reproducible phenomenon could be helpful in comparing pulmonary MR signal intensity between individuals.