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

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

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

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

Comparisons of regional white matter diffusion in healthy neonates and adults performed with a 3.0-T head-only MR imaging unit

PURPOSE: To evaluate the normal brains of adults and neonates for regional and age-related differences in apparent diffusion coefficient (ADC) and fractional anisotropy (FA). MATERIALS AND METHODS: Eight healthy adults and 20 healthy neonates were examined with a 3.0-T head-only magnetic resonance (MR) imaging unit by using a single-shot diffusion-tensor sequence. Trace ADC maps, FA maps, directional maps of the putative directions of white matter (WM) tracts, and fiber-tracking maps were obtained. Regions of interest-eight in WM and one in gray matter (GM)-were predefined for the ADC and FA measurements. The Student t test was used to compare FA and ADC between adults and neonates, whereas the Tukey multiple-comparison test was used to compare FA and ADC in different brain regions in the adult and neonate groups. RESULTS: A global elevation in ADC (P <.001) in both GM and WM and a reduction in FA (P <.001) in WM were observed in neonates as compared with these values in adults. In addition, significant regional variations in FA and ADC were observed in both groups. Regional variations in FA and ADC were less remarkable in adults, whereas neonates had consistently higher FA values and lower ADC values in the central WM as compared with these values in the peripheral WM. Fiber tracking revealed only major WM tracts in the neonates but fibers extending to the peripheral WM in the adults. CONCLUSION: There were regional differences in FA and ADC values in the neonates; such variations were less remarkable in the adults.     

Peritumoral brain regions in gliomas and meningiomas: investigation with isotropic diffusion-weighted MR imaging and diffusion-tensor MR imaging

PURPOSE: To retrospectively measure the diffusion-weighted (DW) imaging characteristics of peritumoral hyperintense white matter (WM) and peritumoral normal-appearing WM, as seen on T2-weighted magnetic resonance (MR) images of infiltrative high-grade gliomas and meningiomas. MATERIALS AND METHODS: Seventeen patients with biopsy-proved glioma and nine patients with imaging findings consistent with meningioma and an adjacent hyperintense region on T2-weighted MR images were examined with DW and diffusion-tensor MR imaging. Apparent diffusion coefficients (ADCs) were measured on maps generated from isotropic DW images of enhancing tumor, hyperintense regions adjacent to enhancing tumor, normal-appearing WM adjacent to hyperintense regions, and analogous locations in the contralateral WM corresponding to these areas. Fractional anisotropy (FA) was measured in similar locations on maps generated from diffusion-tensor imaging data. Changes in ADC and FA in each type of tissue were compared across tumor types by using a two-sample t test. P <.05 indicated statistical significance. RESULTS: Mean ADCs in peritumoral hyperintense regions were 1.309 x 10(-3) mm2/sec (mean percentage of 181% of normal WM) for gliomas and 1.427 x 10(-3) mm2/sec (192% of normal value) for meningiomas (no significant difference). Mean ADCs in peritumoral normal-appearing WM were 0.723 x 10(-3) mm2/sec (106% of normal value) for gliomas and 0.743 x 10(-3) mm2/sec (102% of normal value) for meningiomas (no significant difference). Mean FA values in peritumoral hyperintense regions were 0.178 (43% of normal WM value) for gliomas and 0.224 (65% of normal value) for meningiomas (P =.05). Mean FA values for peritumoral normal-appearing WM were 0.375 (83% of normal value) for gliomas and 0.404 (100% of normal value) for meningiomas (P =.01). CONCLUSION: The difference in FA decreases in peritumoral normal-appearing WM between gliomas and meningiomas was significant, and the difference in FA decreases in peritumoral hyperintense regions between these tumors approached but did not reach significance. These findings may indicate a role for diffusion MR imaging in the detection of tumoral infiltration that is not visible on conventional MR images.     

A comparison of images generated from diffusion-weighted and diffusion-tensor imaging data in hyper-acute stroke

PURPOSE: To compare isotropic (combined diffusion-weighted image [CMB], apparent diffusion coefficient [ADC], TRACE, exponential ADC [eADC], and isotropically-weighted diffusion image [isoDWI]) and anisotropic (relative anisotropy [RA], fractional anisotropy [FA], and volume ratio [VR]) diffusion images collected with fast magnetic resonance (MR) diffusion-weighted (DWI) and diffusion-tensor (DTI) acquisition strategies (each less than one minute) in hyper-acute stroke. MATERIALS AND METHODS: Twenty-one patients suffering from ischemic stroke-imaged within six hours of symptom onset using both DWI and DTI-were analyzed. Regions of interest were placed in the ischemic lesion and in normal contralateral tissue and the percent difference in image intensity was calculated for all nine generated images. RESULTS: The average absolute percent changes for the isotropic strategies were all > 38%, with isoDWI found to have a difference of 50.7% +/- 7.9% (mean +/- standard error, P < 0.001). The ADC maps had the most significant difference (-42.4% +/- 2.0%, P < 0.001, coefficient of variation = 0.22). No anisotropic images had significant differences. CONCLUSION: Anisotropic maps do not consistently show changes in the first six hours of ischemic stroke; therefore, isotropic maps, such as those obtained using DWI, are more appropriate for detecting hyper-acute stroke. Anisotropic images, however, may be useful to differentiate hyper-acute stroke from acute and sub-acute stroke.     

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

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

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

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

Water diffusion compartmentation at high b values in ischemic human brain

BACKGROUND AND PURPOSE: We studied the evolution of brain water compartments during the early stage of ischemic stroke. METHODS: Diffusion-weighted imaging was performed at 1.5 T in 10 volunteers and 14 patients with stroke. We used a single-shot echo-planar technique with 11 b values of 0-5000 s/mm(2). Regions of interest were selected in the white matter (WM) and striatum of the volunteers and in the ischemic core of the patients. Measurements were fitted on the basis of a biexponential decay with the b factor as follows: S(b) = S(0)[(f(slow) x exp(-b x ADC(slow)) + (f(fast) x exp(-b x ADC(fast))] where S(b) is the signal intensity in the presence of a diffusion gradient, S(0) is the signal intensity without diffusion sensitization, ADC(slow) and ADC(fast) are the respective apparent diffusion coefficients (ADCs) of slow diffusing compartments (SDCs) and fast diffusing compartments (FDCs), and f(slow) and f(fast) the respective contributions to the signal intensity of SDC and FDC. RESULTS: In healthy subjects, FDC represents 74.3 +/- 3.1% of brain water, with ADC(fast) = (124.6 +/- 12.0) x 10(-5) mm(2)/s and ADC(slow) = (15.5 +/- 3.9) x 10(-5) mm(2)/s. In stroke, decreased FDC (49.1% +/- 10.9%; P = 1.05 x10(-5)) and increased ADC(slow) ([22.4 +/- 8.1] x 10(-5) mm(2)/s; P = 8.07 x 10(-3)) were observed, but ADC(fast) was not significantly changed ([135.6 +/- 25.7] x 10 (-5) mm(2)/s; P =.151). CONCLUSION: The restricted diffusion observed in the early stroke is mainly related to a redistribution of water from the FDC to the SDC.     

Diffusion-weighted imaging of normal and malignant prostate tissue at 3.0T

PURPOSE: To measure the apparent diffusion coefficient (ADC) of normal and malignant prostate tissue at 3.0T using a phased-array coil and parallel imaging, and determine the utility of ADC values in differentiating tumor from normal peripheral zone (PZ). MATERIALS AND METHODS: ADC values were calculated for 49 patients (tumor and PZ) with evidence of prostate cancer. Additionally, for nine asymptomatic volunteers, ADC values were determined for apparently normal central gland and PZ. A single-shot EPI diffusion-weighted imaging (DWI) technique with b = 0 and 500 seconds/mm2 was employed. RESULTS: ADC values were significantly lower for tumor (1.38 +/- 0.32 x 10(-3) mm2/second) than for patient PZ (1.95 +/- 0.50 x 10(-3) mm2/second, P < 0.001) and volunteer PZ (1.60 +/- 0.25 x 10(-3) mm2/second, P = 0.031). A considerable overlap of ADC values was noted between patient tissue types. CONCLUSION: DWI of the prostate at 3.0T in conjunction with a phased-array coil and parallel imaging allows ADC calculation of the prostate. ADC values were lower for tumors compared to normal-appearing PZ; however, there was considerable intersubject variability.     

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

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

Diffusion tensor imaging in evaluation of human skeletal muscle injury

PURPOSE: To explore the capability and reliability of diffusion tensor magnetic resonance imaging (DTI) in the evaluation of human skeletal muscle injury. MATERIALS AND METHODS: DTI of four patients with gastrocnemius and soleus muscles injuries was compared to eight healthy controls. Imaging was performed using a GE 3.0T short-bore scanner. A diffusion-weighted 2D spin echo echo-planar imaging (EPI) pulse sequence optimized for skeletal muscle was used. From a series of axially acquired diffusion tensor images the diffusion tensor eigenparameters (eigenvalues and eigenvectors), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were calculated and compared for injured and healthy calf muscles. Two dimensional (2D) projection maps of the principal eigenvectors were plotted to visualize the healthy and pathologic muscle fiber architectures. RESULTS: Clear differences in FA and ADC were observed in injured skeletal muscle, compared to healthy controls. Mean control FA was 0.23 +/- 0.02 for medial and lateral gastrocnemius (mg and lg) muscles, and 0.20 +/- 0.02 for soleus (sol) muscles. In all patients FA values were reduced compared to controls, to as low as 0.08 +/- 0.02. The ADC in controls ranged from 1.41 to 1.31 x 10(-9) m(2)/second, while in patients this was consistently higher. The 2D projection maps revealed muscle fiber disorder in injured calves, while in healthy controls the 2D projection maps show a well organized (ordered) fiber structure. CONCLUSION: DTI is a suitable method to assess human calf muscle injury.     

Cerebral spinal fluid contamination of the measurement of the apparent diffusion coefficient of water in acute stroke.

The measurement of the apparent diffusion coefficient (ADC) of water in brains of stroke patients is used in models developed to help distinguish reversible from irreversible ischemic injury. The ADC by conventional methods may be overestimated by the presence of cerebral spinal fluid (CSF) in sulci and perivascular spaces. In this study the hypothesis that DWI with CSF suppression (FLAIR-DWI) would result in different ADC values than those obtained with the conventional DWI technique was investigated. Thirty-one patients with stroke onset of less than 6 hr and an acute lesion on conventional DWI were studied. Both conventional isotropic DWI and FLAIR-DWI were performed using a single-shot echo-planar technique. In all 31 patients, CSF-suppressed ADC was lower than conventional ADC. The mean (SD) of the 31 patients' lesion ADC was 0.64 (0.08) x 10(-3) mm(2) s(-1) with FLAIR-DWI and 0.72 (0.09) x 10(-3) mm(2) s(-1) with conventional DWI (P < 0.001). The overestimation of ADC in conventional DWI corresponded to the percentage of the voxel that contained CSF. Suppression of CSF leads to lesion ADC values that are more homogeneous and more than 15% lower than those obtained with conventional DWI techniques. This suggests that FLAIR-DWI ADC measurements are more accurate than conventional ADC maps.     

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

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

MRI measurements of water diffusion: impact of region of interest selection on ischemic quantification

OBJECTIVE: To investigate the effect of ADC heterogeneity on region of interest (ROI) measurement of isotropic and anisotropic water diffusion in acute (< 12 h) cerebral infarctions. METHODS AND MATERIALS: Full diffusion tensor images were retrospectively analyzed in 32 patients with acute cerebral infarction. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were measured in ischemic lesions and in the corresponding contralateral, normal appearing brain by using four ROIs for each patient. The 2 x 2 pixel square ROIs were placed in the center, the lateral rim and the medial rim of the infarction. In addition, the whole volume of the infarction was measured using a free hand method. Each ROI value obtained from the ischemic lesion was normalized using contralateral normal ROI values. RESULTS: The localization of the ROIs in relation to the ischemic lesion significantly affected ADC measurement (P < 0.01, using Friedman test), but not FA measurement (P = 0.25). Significant differences were found between ADC values of the center of the infarction versus whole volume (P < 0.01), and medial rim versus whole volume of infarction (P < 0.001) with variation of relative ADC values up to 11%. The differences of absolute ADC for these groups were 22 and 23%, respectively. The lowest ADC was found in the center, followed by medial rim, lateral rim and whole volume of infarction. CONCLUSION: ADC quantification may provide variable results depending on ROI method. The ADC and FA values, obtained from the center of infarction tend to be lower compared to the periphery. The researchers who try to compare studies or work on ischemic quantification should be aware of these differences and effects.     

不同弥散强度对脑组织ADC值及FA值测定的影响

探讨不同弥散强度对弥散张量成像中表观弥散系数值及部分各向异性指数值测定的影响.材料和方法:使用七个不同的弥散梯度(b值分别为b0=0、b1=500s/mm2、b2=1000s/mm2、b3=1500s/mm2、b4=2000s/mm2、b5=2500s/mm2和b6=3000s/mm2)对20名正常成人脑组织进行弥散张量成像,对7个不同的b值分别进行组合(组合方式为b0b1、b0b2、b0b3、b0b5、b0b6和b0b6)及后处理,分别获得其ADC图和FA图,然后在ADC图和FA图上分别测定尾状核头、内囊后肢、丘脑、半卵圆中心、侧脑室体部及胼胝体膝部和压部的数值并进行统计学分析.结果:脑内各个解剖部位的ADC值均随着弥散强度的增加而显著降低(P＜0.05);FA值不随弥散强度的改变而改变(P＞0.05).结论:FA值不随弥散强度的改变而发生改变;随着弥散强度的改变,ADC值也发生改变,在进行临床研究时要充分考虑弥散强度对ADC值测定的影响.     

Diffusion tensor imaging (DTI) of rodent brains in vivo using a 1.5T clinical MR scanner

PURPOSE: To evaluate the feasibility of using a clinical 1.5T MR scanner to perform magnetic resonance (MR) diffusion tensor imaging (DTI) on in vivo rodent brains and to trace major rodent neuronal bundles with anatomical correlation. MATERIALS AND METHODS: Two normal adult Sprague Dawley (SD) rats were anesthetized and imaged in a 1.5T MR scanner with a microscopic coil. DTI was performed at a resolution of 0.94 mm x 0.94 mm x 0.5 mm (reconstructed to 0.47 mm x 0.47 mm x 0.5 mm, with b-factors of 600 seconds/mm2 and 1000 seconds/mm2) and a higher resolution of 0.63 mm x 0.63 mm x 0.5 mm (reconstructed to 0.235 mm x 0.235 mm x 0.5 mm, with a b-factor of 1500 seconds/mm2). The fiber-tracking results were correlated with corresponding anatomical sections stained to visualize neuronal fibers. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of the neuronal fibers were measured and compared with results in published reports. RESULTS: Several major neuronal fiber tracts, including the corticospinal cord, corpus callosum, and anterior commissure, were identified in all DTI data sets. Stained anatomical sections obtained from the rats confirmed the location of these fibers. The ADC values (0.6-0.8 +/- 10(-3) mm2/second) of the fibers were similar to published figures. However, the FA values (0.3-0.35) were lower than those obtained in previous studies of white matter in rodent spinal cord. CONCLUSION: We have demonstrated the feasibility of using a 1.5T clinical MR scanner for neuronal fiber tracking in rodent brains. The technique will be useful in rodent neuroanatomy studies. Further investigation is encouraged to verify the FA values generated by DTI with such techniques.     

Diffusion anisotropy in subcortical white matter and cortical gray matter: changes with aging and the role of CSF-suppression

PURPOSE: To determine the relevance of cerebrospinal fluid (CSF)-suppression for the measurement of diffusion anisotropy in well-localized areas of the brain, particularly the subcortical white matter (WM) within the gyri and cortical gray matter (GM), in young and elderly subjects, and to assess the changes of water diffusivity in the brain with normal aging. MATERIALS AND METHODS: Quantitative measures of anisotropy in 26 regions, including subcortical WM (i.e., in the gyri), cortical GM, major deep WM, and deep GM regions of young (21-25 years, N = 8) and elderly (61-74 years, N = 10) normal volunteers, were assessed with CSF-suppressed diffusion tensor imaging (DTI) relative to standard DTI. RESULTS: CSF-suppressed DTI demonstrated significant increases in fractional anisotropy (FA) of 3-12% in the young and 2-14% in the elderly groups with the largest changes being in the subcortical WM of the gyri. Furthermore, FA decreased by 10-19% in the subcortical WM of the gyri of the elderly subjects relative to the young, primarily due to increases in the perpendicular diffusivity, lambda(3), with age. CONCLUSION: CSF-suppressed DTI yields more accurate measures of quantitative anisotropy in cortical and subcortical brain regions. Reductions of anisotropy with aging were predominantly observed in subcortical WM of the gyri.     

Quantitative diffusion imaging in breast cancer: a clinical prospective study

PURPOSE: To study the correlation between apparent diffusion coefficient (ADC) and pathology in patients with undefined breast lesion, to validate how accurately ADC is related to histology, and to define a threshold value of ADC to distinguish malignant from benign lesions. MATERIALS AND METHODS: Seventy-eight patients (110 lesions) were referred for positive or dubious findings. Three-dimensional fast low-angle shot (3D-FLASH) with contrast injection was applied. EPI diffusion-weighted imaging (DWI) with fat saturation was performed, and ROIs were selected on subtraction 3D-FLASH images before and after contrast injection, and copied on an ADC map. Inter- and intraobserver analyses were performed. RESULTS: At pathology 22 lesions were benign, 65 were malignant, and 23 were excluded. The ADCs of malignant and benign lesions were statistically different. In malignant tumors the ADC was (mean +/- SEM) 0.95 +/- 0.027 x 10(-3)mm(2)/second, and in benign tumors it was 1.51 +/- 0.068 x 10(-3)mm(2)/second. According to receiver operating characteristic (ROC) curves, we found a threshold between malignant and benign lesions for highest sensitivity and specificity (both 86%) around 1.13 +/- 0.10 x 10(-3)mm(2)/second. For a threshold of 0.95 +/- 0.10 x 10(-3)mm(2)/second, specificity was 100% but sensitivity was very low. Inter- and intraobserver studies showed good reproducibility. CONCLUSION: The ADC may help to differentiate benign and malignant lesions with good specificity, and may increase the overall specificity of breast MRI.     

In vivo measurement of the apparent diffusion coefficient in normal and malignant prostatic tissues using echo-planar imaging

PURPOSE: To measure for the first time the apparent diffusion coefficient (ADC) values in anatomical regions of the prostate for normal and patient groups, and to investigate its use as a differentiating parameter between healthy and malignant tissue within the patient group. MATERIALS AND METHODS: Single-shot diffusion-weighted echo-planar imaging (DW-EPI) was used to measure the ADC in the prostate in normal (N = 7) and patient (N = 19) groups. The spin-echo images comprised 96 x 96 pixels (field of view of 16 cm, TR/TE = 4000/120 msec) with six b-factor values ranging from 64 to 786 seconds/mm(2). RESULTS: The ADC values averaged over all patients in non-cancerous and malignant peripheral zone (PZ) tissues were 1.82 +/- 0.53 x 10(-3) (mean +/- SD) and 1.38 +/- 0.52 x 10(-3) mm(2)/second, respectively (P = 0.00045, N = 17, paired t-test). The ADC values were found to be higher in the non-cancerous PZ (1.88 +/- 0.48 x 10(-3)) than in healthy or benign prostatic hyperplasia central gland (BPH-CG) region (1.62 +/- 0.41 x 10(-3)). For the normal group, the mean values were 1.91 +/- 0.46 x 10(-3) and 1.63 +/- 0.30 x 10(-3) mm(2)/second for the PZ and CG, respectively (P = 0.011, N = 7). Significant overlap exists between individual values among all tissue types. Furthermore, ADC values for the same tissue type showed no statistically significant difference between the two subject groups. CONCLUSION: ADC is quantified in the prostate using DW-EPI. Values are lower in cancerous than in healthy PZ in patients, and in BPH-CG than PZ in volunteers.     

Vascular occlusion sites determine differences in lesion growth from early apparent diffusion coefficient lesion to final infarct

BACKGROUND AND PURPOSE: Occlusion of major cerebral arteries is the primary source of tissue damage in ischemic stroke and the target of thrombolytic therapy. We hypothesized that large infarcts in more proximal vascular occlusions correspond with substantially increased ischemic lesions shown on initial apparent diffusion coefficient (ADC) maps. METHODS: Initial ADC lesions in 120 patients with acute ischemic stroke were analyzed within 6 hours of stroke onset. Patients were categorized on the basis of vascular occlusion, as shown on MR angiography. Lesion volumes were determined by using manual delineation (ADC(man)) and a threshold method for ADC values (<550 x 10(-9) mm(2)/s(-1), ADC(<550)). Infarct volumes were analyzed by using T2-weighted (n = 109) or CT (n = 11) images obtained on days 5-8. RESULTS: Median lesion volumes for ADC(<550), ADC(man), and infarcts, respectively, were as follows: proximal internal carotid artery (ICA)/middle cerebral artery (MCA) occlusions, 10, 23, and 32 cm(3); carotid-T occlusions, 11, 37, and 138 cm(3); MCA trunk occlusions, 11, 27, and 44 cm(3)); and MCA branch occlusions 8, 27, and 21 cm(3). Initial ADC lesion volumes were different only between the carotid T and the MCA branch (P < .05). On days 5-8, infarct volumes decreased from proximal to distal sites (P < .05), with the exception of MCA trunk versus proximal ICA/MCA occlusions. Recanalization rate in carotid-T occlusion was significantly lower than those of all other occlusion types. CONCLUSION: Initial ADC lesions can be small, even in patients with proximal vascular occlusions. These patients develop considerably large infarctions, suggesting a high potential for infarct growth. This growth might be averted with improved early recanalization of proximal vascular occlusions.