Progressive multifocal leukoencephalopathy and human immunodeficiency virus-associated white matter lesions in AIDS: magnetization transfer MR imaging

PURPOSE: To determine the magnetization transfer features of progressive multifocal leukoencephalopathy (PML) and human immunodeficiency virus (HIV)-associated white matter lesions (WML) (hereafter, HIV-WML) on magnetic resonance (MR) images obtained in patients with acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: Conventional MR imaging and magnetization transfer MR imaging were performed in 21 AIDS patients with 42 areas of white matter hyperintensity on MR images (13 patients had 25 PML lesions, eight patients had 17 WML). The magnetization transfer ratio was calculated for each lesion. RESULTS: Compared with normal-appearing white matter (magnetization transfer ratio = 47.9%), both PML and HIV-WML showed reduced magnetization transfer ratio. The magnetization transfer ratio was significantly lower in PML lesions (magnetization transfer ratio = 26.1%) than in HIV-WML (magnetization transfer ratio = 38.0%, P < .0001), and there was no overlap in the magnetization transfer ratio between PML lesions and HIV-WML. The separation in magnetization transfer ratio between the two lesion types was valid for lesion as small as 0.5 cm2. CONCLUSION: The larger reduction in magnetization transfer ratio for PML lesions is most likely due to demyelination, whereas the reduction in HIV-WML may be associated primarily with gliosis. PML lesions appear to cause strong reductions in magnetization transfer ratio early in the course of disease. Magnetization transfer MR imaging is a noninvasive tool that improves the differentiation between PML and HIV-WML in patients with AIDS.     

A transcranial Doppler method in the evaluation of cerebrovascular spasm

Summary An ultrasonic Doppler method was used to monitor flow velocities in basal cerebral arteries in 21 patients with spontaneous subarachnoid hemorhage (SAH). The time course of vasospasm as evaluated by this technique was similar to that reported in angiographic studies. In 82% of the patients an increase in intracranial velocities to 120 cm/s or more was found during the second or third week after hemorrhage. (Normal value 62 cm/s). Arterial narrowing giving rise to velocities above 200 cm/s was classified as servere spasm. This occurred in 42% of the cases, and a significant decrease in flow velocity in the extracranial carotid artery was found in this group.     

Optimization of on‐resonant magnetization transfer contrast in coronary vein MRI

Magnetization transfer contrast has been used commonly for endogenous tissue contrast improvements in angiography, brain, body, and cardiac imaging. Both off‐resonant and on‐resonant RF pulses can be used to generate magnetization transfer based contrast. In this study, on‐resonant magnetization transfer preparation using binomial pulses were optimized and compared with off‐resonant magnetization transfer for imaging of coronary veins. Three parameters were studied with simulations and in vivo measurements: flip angle, pulse repetitions, and binomial pulse order. Subsequently, first or second order binomial on‐resonant magnetization transfer pulses with eight repetitions of 720° and 240° flip angle were used for coronary vein MRI. Flip angles of 720° yielded contrast enhancement of 115% (P < 0.0006) for first order on‐resonant and 95% (P < 0.0006) for off‐resonant magnetization transfer. There was no statistically significance difference between off‐resonant and on‐resonant first order binomial Magnetization transfer at 720°. However, for off‐resonance pulses, much more preparation time is needed when compared with the binomials but with considerably reduced specific absorption rate. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

Angle-corrected imaging transcranial doppler sonography versus imaging and nonimaging transcranial doppler sonography in children with sickle cell disease

BACKGROUND AND PURPOSE: Nonimaging transcranial Doppler sonography (TCD) and imaging TCD (TCDI) are used for determination of the risk of stroke in children with sickle cell disease (SCD). The purpose was to compare angle-corrected, uncorrected TCDI, and TCD blood flow velocities in children with SCD. MATERIALS AND METHODS: A total of 37 children (mean age, 7.8 +/- 3.0 years) without intracranial arterial narrowing determined with MR angiography, were studied with use of TCD and TCDI at the same session. Depth of insonation and TCDI mean velocities with and without correction for the angle of insonation in the terminal internal carotid artery (ICA) and middle (MCA), anterior (ACA), and posterior (PCA) cerebral arteries were compared with TCD velocities with use of a paired t test. RESULTS: Two arteries were not found on TCDI compared with 15 not found on TCD. Average angle of insonation in the MCA, ACA, ICA, and PCA was 31 degrees , 44 degrees , 25 degrees , and 29 degrees , respectively. TCDI and TCD mean depth of insonation for all arteries did not differ significantly; however, individual differences varied substantially. TCDI velocities were significantly lower than TCD velocities, respectively, for the right and left sides (mean +/- SD): MCA, 106 +/- 22 cm/s and 111 +/- 33 cm/s versus 130 +/- 19 cm/s and 134 +/- 26 cm/s; ICA, 90 +/- 14 cm/s and 98 +/- 27 cm/s versus 117 +/- 18 cm/s and 119 +/- 23 cm/s; ACA, 74 +/- 24 cm/s and 88 +/- 25 cm/s versus 105 +/- 23 cm/s and 105 +/- 31 cm/s; and PCA, 84 +/- 27 cm/s and 82 +/- 21 cm/s versus 95 +/- 23 cm/s and 94 +/- 20 cm/s. TCD and angle-corrected TCDI velocities were not statistically different except for higher angle-corrected TCDI values in the left ACA and right PCA. CONCLUSION: TCD velocities are significantly higher than TCDI velocities but are not different from the angle-corrected TCDI velocities. TCDI identifies the major intracranial arteries more effectively than TCD.     

Breath-hold MR measurements of blood flow velocity in internal mammary arteries and coronary artery bypass grafts

Breath-hold velocity-encoded cine MR (VENC-MR) imaging is a feasible method for measuring phasic blood flow velocity in small vessels that move during respiration. The purposes of the current study are to compare breathhold VENC-MR measurements of flow velocities in the internal mammary arteries (IMA) with nonbreath-hold measurements and to characterize the systolic and diastolic flow velocity curves in a cardiac cycle in native IMA and IMA grafts. Flow velocity in 30 native IMA and 8 IMA grafts were evaluated with a breath-hold VENC-MR sequence with K-space segmentation and view-sharing reconstruction(TR/TE=16/9 msec, VENC=100 cm/s). In 10 native IMA, nonbreathhold VENC-MR images were acquired as well for comparison. Breath-hold VENC-MR imaging showed significantly higher systolic and diastolic peak velocities in native IMA (43.1 cm/second ± 15.0 and 10.0 cm/second ± 4.8), in comparison to those of nonbreath-hold VENC-MR imaging (27.6 cm/second ± 10.2 and 7.3 cm/second ± 3.9, P<.05). The diastolic/systolic peak velocity ratio in the IMA grafts (.88 ± .41) was significantly higher than that in native IMA (.24 ± .08, P<.01). Interobserver variability in the flow velocity measurement was less than 4%. Breath-hold VENC-MR imaging demonstrated higher peak flow velocity in the IMA than nonbreath-hold VENC-MR imaging. This technique is a rapid and effective method for the noninvasive assessment of blood flow velocity in IMA grafts.     

Transfer insensitive labeling technique (TILT): application to multislice functional perfusion imaging

Cerebral blood flow can be studied in a multislice mode with a recently proposed perfusion sequence using inversion of water spins as an endogenous tracer without magnetization transfer artifacts. The magnetization transfer insensitive labeling technique (TILT) has been used for mapping blood flow changes at a microvascular level under motor activation in a multislice mode. In TILT, perfusion mapping is achieved by subtraction of a perfusion-sensitized image from a control image. Perfusion weighting is accomplished by proximal blood labeling using two 90 degrees radiofrequency excitation pulses. For control preparation the labeling pulses are modified such that they have no net effect on blood water magnetization. The percentage of blood flow change, as well as its spatial extent, has been studied in single and multislice modes with varying delays between labeling and imaging. The average perfusion signal change due to activation was 36.9 +/- 9.1% in the single-slice experiments and 38.1 +/- 7.9% in the multislice experiments. The volume of activated brain areas amounted to 1.51 +/- 0.95 cm3 in the contralateral primary motor (M1) area, 0.90 +/- 0.72 cc in the ipsilateral M1 area, 1.27 +/- 0.39 cm3 in the contralateral and 1.42 +/- 0.75 cm3 in the ipsilateral premotor areas, and 0.71 +/- 0.19 cm3 in the supplementary motor area.     

MR of intracranial tumors: combined use of gadolinium and magnetization transfer.

PURPOSETo study the potential combined application of gadolinium and magnetization transfer in the MR imaging of intracranial tumors.METHODSTwenty-two patients were imaged at low field strength (0.1 T). Corresponding gradient-echo partial saturation images without and with magnetization transfer pulse were produced. Images with intermediate repetition times were obtained in 18 cases; five different sequences were produced in 4 cases. Gadopentetate dimeglumine was used at a dose of 0.1 mmol/kg.RESULTSMagnetization transfer effect increased the contrast between enhancing lesion and normal brain and the contrast between edema and normal brain; the contrast between enhancing lesion and edema was not significantly changed. On intermediate-repetition-time magnetization transfer images the contrast between enhancing tumor and normal brain and the contrast between edema and normal brain were superior to short-repetition-time magnetization transfer images, but the differentiation between enhancing tumor and edema was poorer.CONCLUSIONMagnetization transfer can be used to improve contrast in Gd-enhanced MR imaging. Combining magnetization transfer with an intermediate-repetition-time image provides the possibility for displaying both enhancing and nonenhancing lesions on a single MR image.     

Improved detection of enhancing and nonenhancing lesions of multiple sclerosis with magnetization transfer.

PURPOSETo determine whether magnetization transfer imaging can improve visibility of contrast enhancement of multiple sclerosis plaques.METHODSFifty-nine enhancing and 63 nonenhancing lesions in 10 patients with multiple sclerosis were evaluated to calculate contrast-to-noise ratios on conventional T1-weighted and T1-weighted magnetization transfer images. The signal intensity of the lesion and the background (white matter) were measured on precontrast T1-weighted and T1-weighted magnetization transfer images (800/20/1 [repetition time/echo time/excitations]) and on postcontrast T1-weighted and T1-weighted magnetization transfer images. Mean contrast-to-noise ratios was calculated for all lesions.RESULTSThe contrast-to-noise ratio was significantly higher for enhancing and nonenhancing lesions on T1-weighted magnetization transfer images than on conventional T1-weighted images. For enhancing lesions, the contrast-to-noise ratio was significantly higher on postcontrast T1-weighted magnetization transfer images, 32 +/- 2 compared with 21 +/- 2 on conventional T1-weighted images. Fifty of the 59 enhancing lesions were seen on both the T1-weighted and the T1-weighted magnetization transfer images. Nine enhancing lesions were seen only on the postcontrast T1-weighted magnetization transfer images. In addition, of 63 nonenhancing lesions seen on proton-density, T2-weighted, and T1-weighted magnetization transfer images, 16 were not seen on the conventional T1-weighted images. Seven of the 63 nonenhancing lesions and 7 of the 59 enhancing lesions had high signal intensity on the precontrast T1-weighted magnetization transfer images suggestive of lipid signal, a finding not seen on the conventional precontrast T1-weighted images.CONCLUSIONMagnetization transfer improves the visibility of enhancing multiple sclerosis lesions, because they have a higher contrast-to-noise ratio than conventional postcontrast T1-weighted images. High signal intensity on both nonenhancing and enhancing lesions noted only on precontrast T1-weighted magnetization transfer suggests a lipid signal was unmasked. If magnetization transfer is used in multiple sclerosis patients, a precontrast magnetization transfer image is necessary.     

Peak systolic and diastolic CSF velocity in the foramen magnum in adult patients with Chiari I malformations and in normal control participants

BACKGROUND AND PURPOSE: Abnormal flow of CSF through the foramen magnum has been implicated in the pathogenesis of clinical deficits in association with Chiari I malformation. The purpose of this study was to test the hypothesis that peak CSF velocities in the foramen magnum are increased in patients with Chiari I malformations. METHODS: Eight adult patients with symptomatic Chiari I malformations and 10 adult volunteers were studied with cardiac gated, phase-contrast MR imaging in the axial plane at the foramen magnum. The spatial uniformity of flow velocity in the foramen magnum was assessed at 14 time frames within the R-R interval. The velocity in each of the voxels at each of the time frames was calculated, and the peak systolic and diastolic velocities were tabulated for the patients and controls. RESULTS: For the normal volunteers, the CSF velocities in the subarachnoid space were relatively uniform throughout the subarachnoid space at each of the time frames. Peak systolic velocity ranged from 1.2 to 3.3 cm/s, and peak diastolic velocity ranged from 1.6 to 4.5 cm/s. In symptomatic patients with Chiari I, velocities in the foramen magnum did not appear as uniform throughout the subarachnoid space in the phase-contrast images. Peak systolic velocities ranged from 1.8 to 4.8 cm/s, and peak diastolic velocities ranged from 2.5 to 5.3 cm/s. Peak systolic velocity was significantly higher (P =.01) in the patients than in the control volunteers. CONCLUSION: Patients with Chiari I malformations have significant elevations of peak systolic velocity in the CSF in the foramen magnum.     

Analysis of water-macromolecule proton magnetization transfer in articular cartilage

These studies were designed to establish which structural elements of cartilage are responsible for proton magnetization transfer between water (Hf) and macromolecules (Hr) observed in MRI studies on articular cartilage. Saturation transfer techniques were used to monitor magnetization transfer in vitro on samples of the two major constituents of cartilage: collagen and proteoglycan. Articular cartilage samples were also evaluated in vitro before and after the removal of the proteoglycan fraction. Isolated hydrated collagen exhibited a significant proton magnetization transfer rate with water. In contrast, proteoglycans exhibited no proton magnetization transfer. Articular cartilage, in vitro, exhibited a high degree of magnetization transfer with water protons consistent with previous MRI studies in vivo. Enzymatic removal of proteoglycan from the cartilage did not alter the magnetization transfer rate between Hr and Hf. These data demonstrate that the structure and concentration of the collagen matrix are the predominant determinants of the magnetization transfer process in articular cartilage with little or no contribution from proteoglycans. This specificity of the magnetization transfer effect may prove useful in the noninvasive evaluation of cartilage composition and structure in vivo.     

Rapid average-flow velocity measurement by NMR

We describe an NMR method to make a quick determination of average fluid velocity by monitoring the change in phase of the magnetization during a transient signal. We give an example utilizing the second Carr-Purcell-Meiboom-Gill echo in which we measured the velocity of water up to 54 cm/s where each velocity was determined by data taken over 2.5 ms.     

Flow velocity quantification in human coronary arteries with fast,breath-hold MR angiography

Measurement of coronary artery flow velocities has, until now, largely required the use of invasive technologies. The authors have implemented a breath-hold magnetic resonance (MR) angiography technique for depicting the coronary arteries and for quantifying flow velocities. The method was tested in flow phantoms and then applied to a series of subjects: 11 subjects were studied at rest, and four were studied before and during pharmacologic stress induced by intravenous adenosine. Flow velocities at rest in the midportion of the right coronary artery were 9.9 cm/sec ± 3.5 (n = 12); in the proximal left anterior descending coronary artery, they were significantly higher, measuring 20.5 cm/sec ± 5.2 (n = 6). With adenosine, flow velocities typically increased at least fourfold. The authors conclude that noninvasive measurement of coronary artery flow velocities is feasible with MR angiography; this method may prove useful for determining the physiologic significance of coronary artery stenosis.     

Dispersion in magnetization transfer contrast at a given specific absorption rate due to variations of RF pulse parameters in the magnetization transfer preparation

The effects of RF pulse parameters on magnetization transfer contrast (MTC) were investigated using a magnetization prepared segmented fast gradient echo sequence. MTC was found not to be uniquely determined by the specific absorption rate (SAR). RF pulse parameters (RF amplitude, number of RF pulses and RF duration) also affect MTC. There can be 40% variation in MTC due to differences in RF parameters at SAR = 1 W/kg for a 70-kg subject. Increasing the number of RF pulses is a more efficient way to increase MTC than increasing RF amplitude. This phenomenon is likely caused by the fact that the time scale for magnetization transfer between the free and restricted proton pools is on the same order or longer than the duration of the MT pulse. Accordingly, increase in the MT pulse duration by increasing the number of RF pulses in the MT pulse allows more effective magnetization transfer. Such information can be used as a guide to select RF pulse parameters for a magnetization transfer (MT) pulse. An off-resonance MT pulse designed under this guide for coronary MR angiography improved the depiction of distal vessels.     

In vivo quantitative three-dimensional motion mapping of the murine myocardium with PC-MRI at 17.6 T.

This work presents a method that allows for the assessment of 3D murine myocardial motion in vivo at microscopic resolution. Phase-contrast (PC) magnetic resonance imaging (MRI) at 17.6 T was applied to map myocardial motion in healthy mice along three gradient directions. High-resolution velocity maps were acquired at three different levels in the murine myocardium with an in-plane resolution of 98 mum, a slice thickness of 0.6 mm, and a temporal resolution of 6 ms. The applied PC-MRI method was validated with phantom experiments that confirmed the correctness of the method with deviations of <1.7%. Myocardial in-plane velocities between 0.5 cm/s and 2.2 cm/s were determined for the healthy murine myocardium. Through-plane velocities of 0.1-0.83 cm/s were measured. Velocity data was also used to calculate the myocardial twist angle during systole at different slices in the short-axis view.     

Characterization of experimental spinal cord injury with magnetization transfer ratio histograms

This study was designed to characterize the severity of tissue damage in experimental spinal cord injury using magnetization transfer (MT) histogram analysis. Seven Sprague-Dawley rats were subjected to laminectomy and standard weight-drop injury to the spinal cord (four rats at 15 cm drop-height and three rats at 2.5 cm). Three control animals underwent laminectomy without weight-drop. After sacrifice, the animals were scanned at 1.9 T with a pulsed off-resonance MT technique. Following magnetic resonance (MR) imaging, the cords were embedded in paraffin and sectioned into 5-microm sections for semiquantitative histopathological analysis. Composite histograms were generated using data spanning an axial distance of 3 cm centered on the injury site. MT histogram parameters, such as the amount of tissue with statistical correspondence to normal white matter, were highly predictive of histopathological results, including myelination state and neurofilament damage. Less correlation with edema was observed, suggesting that the technique was most sensitive to true tissue alteration.     

Determination of proton magnetization transfer rate constants in heterogeneous biological systems

Two procedures are currently in use for the determination of proton magnetization transfer rate constants between macro-molecular tissue components and water. The first method assumes that there are only two spin baths (macromolecular plus solvent) and that during off-resonance irradiation complete saturation of the “immobile” proton spin bath occurs (S. H. Koenig, R. D. Brown, 111, R. Ugolini, Magn. Reson. Med. 29, 311 (1993)). This approach neglects the possibility of incomplete saturation and polydispersity, and yields an apparent magnetization transfer rate constant, K_app. The second approach utilizes a formalism which can account for polydispersity and incomplete saturation of the immobile spin bath (K. Kuwata, D. Brooks, H. Yang, T. Schleich, J. Magn. Reson., in press). In this work magnetization transfer rate constants derived by the use of both methods for two systems, ocular lens tissue and cross-linked bovine serum albumin (BSA) were compared. For both samples K_app was dependent on B², off-resonance irradiation frequency and power when the first method was used. The second method provided values of the magnetization transfer rate constant that were similar to the values obtained by the first method, as the limit of complete saturation was approached.     

Nonenhanced methods for lower-extremity MRA: a phantom study examining the effects of stenosis and pathologic flow waveforms at 1.5T

Purpose

To evaluate the signal properties of 2D time of flight (TOF), quiescent‐interval single‐shot (QISS), ECG‐gated 3D fast spin‐echo (FBI), and ungated 3D fast spin‐echo ghost (Ghost) magnetic resonance angiography (MRA) over a range of flow velocities in a pulsatile flow phantom with a 50% diameter stenosis at 1.5T.

Materials and Methods

Blood‐mimicking fluid was pumped at eight peak flow velocities through a stenotic region in triphasic and monophasic waveforms. Vascular signal proximal, within, and distal to the stenosis was measured from the source images of the four MRA methods. Coronal maximum intensity projection images were used to compare image quality.

Results

TOF and QISS signal trends were similar, but QISS exhibited the most consistent signal across velocities. At high velocities (≥42.4 cm/s), TOF showed poststenotic signal loss that was not observed with QISS. FBI and Ghost signals peaked at low velocities (3.9–9.7 cm/s) without flow compensation and at high velocities (≥64.6 cm/s) with flow compensation.

Conclusion

FBI and Ghost demonstrated dependence on blood flow velocity and flow compensation. TOF was sensitive to flow artifacts at high velocities. QISS proved most robust for accurately depicting the normal lumen and stenosis under a wide range of flow conditions. Monophasic and triphasic flow did not appreciably affect the signal performance of any method. J. Magn. Reson. Imaging 2011;33:401–408. © 2011 Wiley‐Liss, Inc.     

Middle cerebral artery: determination of flow velocities with MR angiography

A magnetic resonance (MR) angiographic technique for noninvasive measurement of flow velocities in the intracranial cerebral arteries was studied. Velocity measurements were made in a phantom and in the middle cerebral artery of six volunteers. Velocities were assessed in the volunteers before, during, and after finger movement. Average values for mean maximal velocities determined with MR angiography were 69.8 cm/sec before, 77.2 cm/sec during, and 69.6 cm/sec after finger movement. Correlations between values obtained with MR angiography and transcranial Doppler (TCD) sonography were r = .86 and P = .0001 for values obtained at rest and r = .84 and P = .0001 for values obtained during finger movement. The velocity increase during finger movement compared with that at rest was 11% for MR angiography and 11.3% for TCD sonography. Values measured with TCD sonography, however, were less than those measured with MR angiography (P = .001). The results show the feasibility of measuring flow velocities in intracranial arteries with MR angiography.     

Dyke Award paper. MR of wallerian degeneration in the feline visual system: characterization by magnetization transfer rate with histopathologic correlation.

PURPOSETo examine the utility of measuring magnetization transfer ratio for for delineating the dynamic changes of wallerian degeneration which occur after controlled injury in a feline model in which anatomic pathways are well understood.METHODSUsing standard neurosurgical techniques, discrete lesions were made to ablate the visual cortex. Gradient imaging was performed serially at 1.5 T, with and without a saturation pulse to create a magnetization transfer effect. At varying intervals, the animals were killed for histologic analysis.RESULTSWithin the first 2 weeks there is a statistically significant increase in magnetization transfer ratio relative to the control hemisphere within the white matter connections between the lateral geniculate nucleus and the visual cortex at a time when no effects are visually detectable on spin-echo images. Between 16 and 28 days, this reverses to a decrease in magnetization transfer ratio in both the lateral geniculate nucleus itself and the adjacent superolateral white matter. More remote white matter tracts remained stable, without significant change.CONCLUSIONSMagnetization transfer ratio seems to be more sensitive for early detection of degeneration than conventional spin-echo imaging. Moreover, temporal changes in magnetization transfer ratio seem to correspond well with known histologic phases of wallerian degeneration.     

Effect of craniocervical decompression on peak CSF velocities in symptomatic patients with Chiari I malformation

BACKGROUND AND PURPOSE: Peak CSF velocities detected in individual voxels in the subarachnoid space in patients with Chiari I malformations exceed those in similar locations in the subarachnoid space in healthy subjects. The purpose of this study was to test the hypothesis that the peak voxel velocities are decreased by craniocervical decompression. METHODS: A consecutive series of patients with symptomatic Chiari I malformations was studied before and after craniocervical decompression with cardiac-gated, phase contrast MR imaging. Velocities were calculated for each voxel within the foramen magnum at 14 time points throughout the cardiac cycle. The greatest velocities measured in a voxel during the cephalad and caudad phases of CSF flow through the foramen magnum were tabulated for each patient before and after surgery. The differences in these velocities between the preoperative and postoperative studies were tested for statistical significance by using a single-tailed Student's t test of paired samples. RESULTS: Eight patients with a Chiari I malformation, including four with a syrinx, were studied. Peak caudad velocity diminished after craniocervical decompression in six of the eight patients, and the average diminished significantly from 3.4 cm/s preoperatively to 2.4 cm/s postoperatively (P =.01). Peak cephalad velocity diminished in six of the eight cases. The average diminished from 6.9 cm/s preoperatively to 3.9 cm/s postoperatively, a change that nearly reached the significance level of.05 (P =.055). CONCLUSION: Craniocervical decompression in patients with Chiari I malformations decreases peak CSF velocities in the foramen magnum. The study supports the hypothesis that successful treatment of the Chiari I malformation is associated with improvement in CSF flow patterns.