Effect of magnetization transfer on the measurement of cerebral blood flow using steady-state arterial spin tagging approaches: A theoretical investigation

A simple four-compartment model for magnetization transfer was used to obtain theoretical expressions for the relationship between regional cerebral blood flow and ΔM, the change in longitudinal magnetization of brain water spins when arterial water spins are perturbed. The theoretical relationship can be written in two forms, depending on the approach used to normalize ΔM. Using the first approach, the calculation of cerebral blood flow requires a knowledge of R₁ (ω₁, Δω), the longitudinal relaxation rate observed in the presence of continuous off-resonance RF irradiation. Using the second approach, the calculation of cerebral blood flow requires a knowledge of ?₁(ω₁, Δω), where ?₁(ω₁, Δω) is given by the product of R₁(ω₁, Δω) and the fractional steady-state longitudinal water magnetization in the presence of off-resonance RF irradiation. If the off-resonance RF irradiation used for arterial tagging does not produce appreciable magnetization transfer effects, ?₁, (ω₁, Δω) can be approximated by the longitudinal relaxation rate measured in the absence of offresonance RF irradiation, R_1obs. Theoretical expressions obtained by using the four-component model for magnetization transfer are compared with equivalent expressions obtained by using two-compartment models.     

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。     

Regional pulmonary blood flow: Comparison of dynamic contrast‐enhanced MR perfusion and phase‐contrast MR

Regional pulmonary blood flow can be assessed using both dynamic contrast‐enhanced (DCE) MR and phase‐contrast (PC) MR. These methods provide somewhat complementary information: DCE MR can assess flow over the entire lung while PC MR can detect rapid changes in flow to a targeted region. Although both methods are considered accurate, one may be more feasible than the other depending on pathology, patient condition, and availability of an intravenous route. The objective of this study was to establish a consensus between the two methods by comparing paired DCE MR and PC MR measurements of relative blood flow in Yorkshire piglets (N = 5, age = 7 days, weight = 3.3 ± 0.6 kg) under various physiological states including regional lung collapse. A strong correlation (R² = 0.71, P < 0.01) was observed between the methods. In conclusion, DCE MR and PC MR provide a consistent measure of changes in regional pulmonary blood flow. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.     

Three‐dimensional flow‐independent balanced steady‐state free precession vessel wall MRI of the popliteal artery: Preliminary experience and comparison with flow‐dependent black‐blood techniques

Purpose:

To examine the feasibility of flow‐independent T2‐prepared inversion recovery (T2IR) black‐blood (BB) magnetization preparation for three‐dimensional (3D) balanced steady‐state free precession (SSFP) vessel wall MRI of the popliteal artery, and to evaluate its performance relative to flow‐dependent double inversion recovery (DIR), spatial presaturation (SPSAT), and motion‐sensitizing magnetization preparation (MSPREP) BB techniques in healthy volunteers.

Materials and Methods:

Eleven subjects underwent 3D MRI at 1.5 Tesla with four techniques performed in a randomized order. Wall and lumen signal‐to‐noise ratio (SNR), wall‐to‐lumen contrast‐to‐noise ratio (CNR), vessel wall area, and lumen area were measured at proximal, middle, and distal locations of the imaged popliteal artery. Image quality scores based on wall visualization and degree of intraluminal artifacts were also obtained.

Results:

In the proximal region, DIR and SPSAT had higher wall SNR and wall‐to‐lumen CNR than both MSPREP and T2IR. In the middle and distal regions, DIR and SPSAT failed to provide effective blood suppression, whereas MSPREP and T2IR provided adequate black blood contrast with comparable wall‐to‐lumen CNR and image quality.

Conclusion:

The feasibility of 3D SSFP imaging of the popliteal vessel wall using flow‐independent T2IR was demonstrated with effective blood suppression and good vessel wall visualization. Although DIR and SPSAT are effective for thin slab imaging, MSPREP and T2IR are better suited for 3D thick slab imaging. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

Quantification of myocardial blood flow using model based analysis of first‐pass perfusion MRI: Extraction fraction of Gd‐DTPA varies with myocardial blood flow in human myocardium

For the absolute quantification of myocardial blood flow (MBF), Patlak plot‐derived K1 need to be converted to MBF by using the relation between the extraction fraction of gadolinium contrast agent and MBF. This study was conducted to determine the relation between extraction fraction of Gd‐DTPA and MBF in human heart at rest and during stress. Thirty‐four patients (19 men, mean age of 66.5 ± 11.0 years) with normal coronary arteries and no myocardial infarction were retrospectively evaluated. First‐pass myocardial perfusion MRI during adenosine triphosphate stress and at rest was performed using a dual bolus approach to correct for saturation of the blood signal. Myocardial K1 was quantified by Patlak plot method. Mean MBF was determined from coronary sinus flow measured by phase contrast cine MRI and left ventricle mass measured by cine MRI. The extraction fraction of Gd‐DTPA was calculated as the K1 divided by the mean MBF. The extraction fraction of Gd‐DTPA was 0.46 ± 0.22 at rest and 0.32 ± 0.13 during stress (P < 0.001). The relationship between extraction fraction (E) and MBF in human myocardium can be approximated as E = 1 ? exp(?(0.14 × MBF + 0.56)/MBF). The current results indicate that MBF can be accurately quantified by Patlak plot method of first‐pass myocardial perfusion MRI by performing a correction of extraction fraction. Magn Reson Med, 2011. © 2011 Wiley Periodicals, Inc.     

Differentiation of malignant and benign breast lesions using magnetization transfer imaging and dynamic contrast‐enhanced MRI

Purpose:

To evaluate feasibility of using magnetization transfer ratio (MTR) in conjunction with dynamic contrast‐enhanced MRI (DCE‐MRI) for differentiation of benign and malignant breast lesions at 3 Tesla.

Materials and Methods:

This prospective study was IRB and HIPAA compliant. DCE‐MRI scans followed by MT imaging were performed on 41 patients. Regions of interest (ROIs) were drawn on co‐registered MTR and DCE postcontrast images for breast structures, including benign lesions (BL) and malignant lesions (ML). Initial enhancement ratio (IER) and delayed enhancement ratio (DER) were calculated, as were normalized MTR, DER, and IER (NMTR, NDER, NIER) values. Diagnostic accuracy analysis was performed.

Results:

Mean MTR in ML was lower than in BL (P < 0.05); mean DER and mean IER in ML were significantly higher than in BL (P < 0.01, P < 0.001). NMTR, NDER, and NIER were significantly lower in ML versus BL (P < 0.007, P < 0.001, P < 0.001). IER had highest diagnostic accuracy (77.6%), sensitivity (86.2%), and area under the ROC curve (.879). MTR specificity was 100%. Logistic regression modeling with NMTR and NIER yielded best results for BL versus ML (sensitivity 93.1%, specificity 80%, AUC 0.884, accuracy 83.7%).

Conclusion:

Isolated quantitative DCE analysis may increase specificity of breast MR for differentiating BL and ML. DCE‐MRI with NMTR may produce a robust means of evaluating breast lesions. J. Magn. Reson. Imaging 2013;37:138–145. © 2012 Wiley Periodicals, Inc.     

Quantification of cerebral arterial blood volume and cerebral blood flow using MRI with modulation of tissue and vessel (MOTIVE) signals.

Regional cerebral arterial blood volume (CBVa) and blood flow (CBF) can be quantitatively measured by modulation of tissue and vessel (MOTIVE) signals, enabling separation of tissue signal from blood. Tissue signal is selectively modulated using magnetization transfer (MT) effects. Blood signal is changed either by injection of a contrast agent or by arterial spin labeling (ASL). The measured blood volume represents CBVa because the contribution from venous blood was insignificant in our measurements. Both CBVa and CBF were quantified in isoflurane-anesthetized rats at 9.4T. CBVa obtained using a contrast agent was 1.1 +/- 0.5 and 1.3 +/- 0.6 ml/100 g tissue (N = 10) in the cortex and caudate putamen, respectively. The CBVa values determined from ASL data were 1.0 +/- 0.3 ml/100 g (N = 10) in both the cortex and the caudate putamen. The match between CBVa values determined by both methods validates the MOTIVE approach. In ASL measurements, the overestimation in calculated CBF values increased with MT saturation levels due to the decreasing contribution from tissue signals, which was confirmed by the elimination of blood with a contrast agent. Using the MOTIVE approach, accurate CBF values can also be obtained.     

Quantitative analysis of first‐pass contrast‐enhanced myocardial perfusion MRI using a patlak plot method and blood saturation correction

The objectives of this study were to develop a method for quantifying myocardial K₁ and blood flow (MBF) with minimal operator interaction by using a Patlak plot method and to compare the MBF obtained by perfusion MRI with that from coronary sinus blood flow in the resting state. A method that can correct for the nonlinearity of the blood time–signal intensity curve on perfusion MR images was developed. Myocardial perfusion MR images were acquired with a saturation‐recovery balanced turbo field‐echo sequence in 10 patients. Coronary sinus blood flow was determined by phase‐contrast cine MRI, and the average MBF was calculated as coronary sinus blood flow divided by left ventricular (LV) mass obtained by cine MRI. Patlak plot analysis was performed using the saturation‐corrected blood time–signal intensity curve as an input function and the regional myocardial time–signal intensity curve as an output function. The mean MBF obtained by perfusion MRI was 86 ± 25 ml/min/100 g, showing good agreement with MBF calculated from coronary sinus blood flow (89 ± 30 ml/min/100 g, r = 0.74). The mean coefficient of variation for measuring regional MBF in 16 LV myocardial segments was 0.11. The current method using Patlak plot permits quantification of MBF with operator interaction limited to tracing the LV wall contours, registration, and time delays. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.     

Noncontrast‐enhanced peripheral MRA: Technical optimization of flow‐spoiled fresh blood imaging for screening peripheral arterial diseases

Flow‐spoiled fresh blood imaging, a noncontrast peripheral MR angiography technique, allows the depiction of the entire tree of peripheral arteries by utilizing the signal difference between systolic‐ and diastolic‐triggered data. The image quality of the technique relies on selecting the right triggering delay times and flow‐dependent read‐out spoiler gradient pulses. ECG triggering delays were verified using manual subtraction and automated software. The read‐out spoiler gradients pulses were optimized on volunteers before utilizing the flow‐spoiled fresh blood imaging technique to screen for peripheral arterial disease. Thirteen consecutive patients with suspected peripheral arterial disease underwent both flow‐spoiled fresh blood imaging and 16‐detector‐row computed tomography angiography examinations. A total of 23 segments were evaluated in the arterial vascular system. Using computed tomography angiography as the reference standard, 56 diseased segments were detected with 22 nonsignificant stenoses (<50%) and 34 significant stenoses, 15 of which were totally occluded. Flow‐spoiled fresh blood imaging had a sensitivity of 97%, a specificity of 96%, an accuracy of 96%, a positive predictive value of 88%, and a negative predictive value of 99%. With such a high negative predictive value, flow‐spoiled fresh blood imaging has the potential to become the safest noninvasive screening tool for peripheral arterial disease, especially for patients with impaired renal function. Magn Reson Med, 2011. © 2010 Wiley‐Liss, Inc.     

Continuous flow‐driven inversion for arterial spin labeling using pulsed radio frequency and gradient fields

Continuous labeling by flow‐driven adiabatic inversion is advantageous for arterial spin labeling (ASL) perfusion studies, but details of the implementation, including inefficiency, magnetization transfer, and limited support for continuous‐mode operation on clinical scanners, have restricted the benefits of this approach. Here a new approach to continuous labeling that employs rapidly repeated gradient and radio frequency (RF) pulses to achieve continuous labeling with high efficiency is characterized. The theoretical underpinnings, numerical simulations, and in vivo implementation of this pulsed continuous ASL (PCASL) method are described. In vivo PCASL labeling efficiency of 96% relative to continuous labeling with comparable labeling parameters far exceeded the 33% duty cycle of the PCASL RF pulses. Imaging at 3T with body coil transmission was readily achieved. This technique should help to realize the benefits of continuous labeling in clinical imagers. Magn Reson Med 60:1488–1497, 2008. © 2008 Wiley‐Liss, Inc.     

Post‐processing correction of magnetization transfer effects in FENSI perfusion MRI data

Magnetization transfer effects induced by repetitive saturation pulses employed in flow enhancement of signal intensity imaging sequences currently prevent quantitative, in vivo, cerebral perfusion studies. This study investigates the magnitude of these effects and introduces a post‐processing correction protocol. The study shows that the magnetization transfer effect is consistent across individuals, which enables the derivation of a correction factor to be applied in post‐acquisition. Our results, obtained for cerebral flux in white and gray matter in rodent brains, are in agreement with cerebral blood flow measurements previously reported in the literature. Magn Reson Med, 2011. © 2010 Wiley‐Liss, Inc.     

Estimation of water extraction fractions in rat brain using magnetic resonance measurement of perfusion with arterial spin labeling

The model used for calculating perfusion by MRI techniques that use endogenous water as a tracer assumes that arterial water is a freely diffusible tracer. Evidence shows that this assumption is not valid in the brain at high blood flow rates, at which movement of water into and out of the microvasculature becomes limited by diffusion across the blood-brain barrier. In this work, the arterial spin-labeling technique is used to show that fraction of arterial water that is dependent on blood flow rate remains in the vasculature and does not exchange with brain tissue water. By using perfusion measurements without and with magnetization transfer (MT) effects, one can distinguish arterial label that exchanges into tissue because blood has much smaller MT than brain tissue. Using this technique, the extraction fraction for water is measured in the rat brain at various cerebral blood flow rates. At high flow rates (-5 ml/g/min), the extraction fraction for water is found to be about 45% in rat brain. Disruption of the blood-brain barrier with D-mannitol caused an increase in the extraction fraction for water. It was possible to form an image related to the extraction fraction for water. The ability to estimate the amount of vascular water exchanging with tissue water by MRI may represent a noninvasive approach to detect the integrity of the blood-brain barrier.     

The effect of pulmonary blood flow changes on oxygen‐enhanced lung magnetic resonance imaging

In this study, we investigated the effects of changes in pulmonary blood flow on oxygen‐enhanced lung magnetic resonance imaging. Increased pulmonary blood flow was produced by intravenous infusion of sildenafil (0.2 mg/kg) in 10 New Zealand white rabbits. Decreased pulmonary blood flow was produced by single subcutaneous injection of monocrotaline (60 mg/kg). A velocity‐encoded cine magnetic resonance imaging for pulmonary blood flow and an oxygen‐enhanced lung magnetic resonance imaging were performed at baseline, during sildenafil infusion, and after monocrotaline injection. We compared the baseline data to those obtained during sildenafil infusion and after monocrotaline injection for pulmonary blood flow changes and signal intensity enhancement ratios of oxygen‐enhanced lung magnetic resonance imaging. Wilcoxon's signed rank test was used for statistical analysis. There was a significant difference between pulmonary blood flow at baseline (418.6 ± 108.9 mL/min) and after sildenafil (491.9 ± 118.0 mL/min; P = 0.005) or between pulmonary blood flow at baseline and after monocrotaline administration (356.3 ± 85.8 mL/min; P = 0.017). However, there was no significant difference between the signal intensity enhancement ratios at baseline (23.8 ± 11.4%) and after sildenafil (24.0 ± 7.9%; P = 0.953) or the signal intensity enhancement ratios at baseline and after monocrotaline administration (22.7 ± 10.3%; P = 0.374). Changes in pulmonary blood flow had little effect on the signal intensity enhancement ratio of oxygen‐enhanced lung magnetic resonance imaging. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.     

Rapid quantification of oxygen tension in blood flow with a fluorine nanoparticle reporter and a novel blood flow‐enhanced‐saturation‐recovery sequence

We present a novel blood flow‐enhanced‐saturation‐recovery (BESR) sequence, which allows rapid in vivo T₁ measurement of blood for both ¹H and ¹⁹F nuclei. BESR sequence is achieved by combining homogeneous spin preparation and time‐of‐flight image acquisition and therefore preserves high time efficiency and signal‐to‐noise ratio for ¹⁹F imaging of circulating perfluorocarbon nanoparticles comprising a perfluoro‐15‐crown‐5‐ether core and a lipid monolayer (nominal size = 250 nm). The consistency and accuracy of the BESR sequence for measuring T₁ of blood was validated experimentally. With a confirmed linear response feature of ¹⁹F R₁ with oxygen tension in both salt solution and blood sample, we demonstrated the feasibility of the BESR sequence to quantitatively determine the oxygen tension within mouse left and right ventricles under both normoxia and hyperoxia conditions. Thus, ¹⁹F BESR MRI of circulating perfluorocarbon nanoparticles represents a new approach to noninvasively evaluate intravascular oxygen tension. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.     

Magnetization transfer enhanced vascular‐space‐occupancy (MT‐VASO) functional MRI

Vascular‐space‐occupancy (VASO) MRI is a novel technique that uses blood signal nulling to detect blood volume alterations through changes in tissue signal. VASO has relatively low signal to noise ratio (SNR) because only 10–20% of tissue signal remain at the time of blood nulling. Here, it is shown that by adding a magnetization transfer (MT) prepulse it is possible to increase SNR either by attenuating the initial tissue magnetization when the MT pulse is placed before inversion, or, accelerating the recovery process when the pulse is applied after the inversion. To test whether the MT pulse would affect the blood nulling time in VASO, MT effects in blood were measured both ex vivo in a bovine blood phantom and in vivo in human brain. Such effects were found to be sufficiently small (< 2.5%) under a saturation power ≤ 3 μT, length = 500 ms, and frequency offset ≥40 ppm to allow use of the same nulling time. Subsequently, functional MRI experiments using MT‐VASO were performed in human visual cortex at 3 Tesla. The relative signal changes in MT‐VASO were of the same magnitude as in VASO, while the contrast to noise ratio (CNR) was enhanced by 44 ± 12% and 36 ± 11% respectively. Therefore, MT‐VASO should provide a means for increasing inherently low CNR in VASO experiments while preserving the CBV sensitivity. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.