Elise Bannier

Arterial spin labeling (ASL) perfusion: Techniques and clinical use

Arterial spin labeling (ASL) perfusion is a MRI technique to quantify tissue blood flow. ASL is a non-invasive technique that labels the protons in the arterial blood by radiofrequency pulses, without the exogenous injection of contrast media. This article has three goals: 1) present the principles of ASL perfusion, the types of labeling and the ways to obtain the mapping; 2) specify and the quality criteria for the mapping obtained, while emphasizing the artifacts; and 3) describe the main encephalic and renal applications.

Arterial spin labeling for motor activation mapping at 3T with a 32-channel coil: reproducibility and spatial accuracy in comparison with BOLD fMRI.

Functional arterial spin labeling (fASL) is an innovative biomarker of neuronal activation that allows direct and absolute quantification of activation-related CBF and is less sensitive to venous contamination than BOLD fMRI. This study evaluated fASL for motor activation mapping in comparison with BOLD fMRI in terms of involved anatomical area localization, intra-individual reproducibility of location, quantification of neuronal activation, and spatial accuracy. Imaging was performed at 3T with a 32-channel coil and dedicated post-processing tools were used. Twelve healthy right-handed subjects underwent fASL and BOLD fMRI while performing a right hand motor activation task. Three sessions were performed 7days apart in similar physiological conditions. Our results showed an activation in the left primary hand motor area for all 36 sessions in both fASL and BOLD fMRI. The individual functional maps for fASL demonstrated activation in ipsilateral secondary motor areas more often than the BOLD fMRI maps. This finding was corroborated by the group maps. In terms of activation location, fASL reproducibility was comparable to BOLD fMRI, with a distance between activated volumes of 2.1mm and an overlap ratio for activated volumes of 0.76, over the 3 sessions. In terms of activation quantification, fASL reproducibility was higher, although not significantly, with a CVintra of 11.6% and an ICC value of 0.75. Functional ASL detected smaller activation volumes than BOLD fMRI but the areas had a high degree of co-localization. In terms of spatial accuracy in detecting activation in the hand motor area, fASL had a higher specificity (43.5%) and a higher positive predictive value (69.8%) than BOLD fMRI while maintaining high sensitivity (90.7%). The high intra-individual reproducibility and spatial accuracy of fASL revealed in the present study will subsequently be applied to pathological subjects.

Improving quality of arterial spin labeling MR imaging at 3 Tesla with a 32-channel coil and parallel imaging.

To compare 12‐channel and 32‐channel phased‐array coils and to determine the optimal parallel imaging (PI) technique and factor for brain perfusion imaging using Pulsed Arterial Spin labeling (PASL) at 3 Tesla (T).

Hemodynamic Quantification in Brain Arteriovenous Malformations With Time-Resolved Spin-Labeled Magnetic Resonance Angiography

Background and Purpose— Unenhanced time-resolved spin-labeled magnetic resonance angiography enables hemodynamic quantification in arteriovenous malformations (AVMs). Our purpose was to identify quantitative parameters that discriminate among different AVM components and to relate hemodynamic patterns with rupture risk. Methods— Sixteen patients presenting with AVMs (7 women, 9 men; mean age 37.1±15.9 years) were assigned to the high rupture risk or low rupture risk group according to anatomic AVM characteristics and rupture history. High temporal resolution (<70 ms) unenhanced time-resolved spin-labeled magnetic resonance angiography was performed on a 3-T MR system. After dedicated image processing, hemodynamic quantitative parameters were computed. T tests were used to compare quantitative parameters among AVM components, between the high rupture risk and low rupture risk groups, and between the hemorrhagic and nonhemorrhagic groups. Results— Among the quantitative parameters, time-to-peak (P<0.001) and maximum outflow gradient (P=0.01) allowed discriminating various intranidal flow patterns with significantly different values between feeding arteries and draining veins. With 9 AVMs classified into the high rupture risk group (whose 6 were hemorrhagic) and 7 into the low rupture risk group, the observed venous-to-arterial time-to-peak ratio was significantly lower in the high rupture risk (P=0.003) and hemorrhagic (P=0.001) groups. Conclusions— Unenhanced time-resolved spin-labeled magnetic resonance angiography allows AVM-specific combined anatomic and quantitative analysis of AVM hemodynamics.

Dynamic contrast-enhanced MRI: Study of inter-software accuracy and reproducibility using simulated and clinical data.

To test the reproducibility and accuracy of pharmacokinetic parameter measurements on five analysis software packages (SPs) for dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI), using simulated and clinical data.

Time-resolved Spin-labeled MR Angiography for the Depiction of Cerebral Arteriovenous Malformations: A Comparison of Techniques

PURPOSE To assess time-resolved spin-labeled (SL) magnetic resonance (MR) angiographic imaging with a large acquisition time window over two cardiac cycles for characterization of cerebral arteriovenous malformations (AVMs). MATERIALS AND METHODS This study was institutional review board-approved. Sixteen patients presented with an AVM, provided informed consent, and were prospectively included. Time-resolved SL MR angiographic images with acquisition window that covered two cardiac cycles (acquisition time, 10-12 min; temporal resolution, 60 msec) or one cardiac cycle and time-of-flight (TOF) MR angiographic images were acquired with a 3-T MR imager. A diagnostic confidence index was used for image quality evaluation; scores were 0, no diagnosis, to 3, high image quality. AVM characterization consisted of arterial feeder, nidus size, and venous drainage type identification compared with those at digital subtraction angiography (DSA). κ coefficients were computed to determine interobserver and intermodality agreement. RESULTS Time-resolved SL MR angiographic imaging over two cardiac cycles provided a median diagnostic confidence index of 2.5 for arterial feeders, 3.0 for nidus, and 3.0 for venous drainage. Venous drainage depiction quality was higher with time-resolved SL MR angiography over two cardiac cycles than with time-resolved SL MR angiography over one cardiac cycle (P < .001) and TOF MR angiography (P < .001). For AVM characterization, interobserver agreement was very good to excellent, and agreement with DSA showed κ of 0.85 for arterial feeders, κ of 1.00 for nidus size, and κ of 0.82 for venous drainage. CONCLUSION Time-resolved SL MR angiographic imaging over two cardiac cycles is a reliable clinical tool for cerebral AVM characterization, which showed very good to excellent agreement with DSA.

Predictive Value of Imaging Markers at Multiple Sclerosis Disease Onset Based on Gadolinium- and USPIO-Enhanced MRI and Machine Learning

Objectives A novel characterization of Clinically Isolated Syndrome (CIS) patients according to lesion patterns is proposed. More specifically, patients are classified according to the nature of inflammatory lesions patterns. It is expected that this characterization can infer new prospective figures from the earliest imaging signs of Multiple Sclerosis (MS), since it can provide a classification of different types of lesions across patients. Methods The method is based on a two-tiered classification. Initially, the spatio-temporal lesion patterns are classified. The discovered lesion patterns are then used to characterize groups of patients. The patient groups are validated using statistical measures and by correlations at 24-month follow-up with hypointense lesion loads. Results The methodology identified 3 statistically significantly different clusters of lesion patterns showing p-values smaller than 0.01. Moreover, these patterns defined at baseline correlated with chronic hypointense lesion volumes by follow-up with an score of . Conclusions The proposed methodology is capable of identifying three major different lesion patterns that are heterogeneously present in patients, allowing a patient classification using only two MRI scans. This finding may lead to more accurate prognosis and thus to more suitable treatments at early stage of MS.

Unimodal Versus Bimodal EEG-fMRI Neurofeedback of a Motor Imagery Task

Neurofeedback is a promising tool for brain rehabilitation and peak performance training. Neurofeedback approaches usually rely on a single brain imaging modality such as EEG or fMRI. Combining these modalities for neurofeedback training could allow to provide richer information to the subject and could thus enable him/her to achieve faster and more specific self-regulation. Yet unimodal and multimodal neurofeedback have never been compared before. In the present work, we introduce a simultaneous EEG-fMRI experimental protocol in which participants performed a motor-imagery task in unimodal and bimodal NF conditions. With this protocol we were able to compare for the first time the effects of unimodal EEG-neurofeedback and fMRI-neurofeedback versus bimodal EEG-fMRI-neurofeedback by looking both at EEG and fMRI activations. We also propose a new feedback metaphor for bimodal EEG-fMRI-neurofeedback that integrates both EEG and fMRI signal in a single bi-dimensional feedback (a ball moving in 2D). Such a feedback is intended to relieve the cognitive load of the subject by presenting the bimodal neurofeedback task as a single regulation task instead of two. Additionally, this integrated feedback metaphor gives flexibility on defining a bimodal neurofeedback target. Participants were able to regulate activity in their motor regions in all NF conditions. Moreover, motor activations as revealed by offline fMRI analysis were stronger during EEG-fMRI-neurofeedback than during EEG-neurofeedback. This result suggests that EEG-fMRI-neurofeedback could be more specific or more engaging than EEG-neurofeedback. Our results also suggest that during EEG-fMRI-neurofeedback, participants tended to regulate more the modality that was harder to control. Taken together our results shed first light on the specific mechanisms of bimodal EEG-fMRI-neurofeedback and on its added-value as compared to unimodal EEG-neurofeedback and fMRI-neurofeedback.

Ultra-small superparamagnetic iron oxide enhancement is associated with higher loss of brain tissue structure in clinically isolated syndrome

Background: Macrophages are important components of inflammatory processes in multiple sclerosis, closely linked to axonal loss, and can now be observed in vivo using ultra-small superparamagnetic iron oxide (USPIO). In the present 1-year longitudinal study, we aimed to determine the prevalence and the impact on tissue injury of macrophage infiltration in patients after the first clinical event of multiple sclerosis. Methods: Thirty-five patients, 32 years mean age, were imaged in a mean of 66 days after their first event using conventional magnetic resonance imaging, gadolinium (Gd) to probe blood–brain barrier integrity, USPIO to study macrophage infiltration and magnetization transfer ratio (MTR) to assess tissue structure integrity. Statistics were performed using two-group repeated-measures ANOVA. Any patient received treatment at baseline. Results: At baseline, patients showed 17 USPIO-positive lesions reflecting infiltration of macrophages present from the onset. This infiltration was associated with local higher loss of tissue structure as emphasized by significant lower MTRnorm values (p<0.03) in USPIO+/Gd+ lesions (n=16; MTRnormUSPIO+/Gd+=0.78 at baseline, MTRnormUSPIO+/Gd+=0.81 at M12) relative to USPIO-/Gd+ lesions (n=67; MTRnormUSPIO-/Gd+=0.82 at baseline, MTRnormUSPIO–/Gd+=0.85 at M12). No interaction in MTR values was observed during the 12 months follow-up (lesion type × time). Conclusion: Infiltration of activated macrophages evidenced by USPIO enhancement, is present at the onset of multiple sclerosis and is associated with higher and persistent local loss of tissue structure. Macrophage infiltration affects more tissue structure while tissue recovery during the following year has a similar pattern for USPIO and Gd-enhanced lesions, leading to relative higher persistent local loss of tissue structure in lesions showing USPIO enhancement at baseline.

Template-based approach for detecting motor task activation-related hyperperfusion in pulsed ASL data.

Arterial spin labeling (ASL) permits the noninvasive measurement of quantitative values of cerebral blood flow (CBF) and is thus well adapted to study inter‐ and intrasubject perfusion variations whether at rest or during an fMRI task. In this study, a template approach to detect brain activation as a CBF difference between resting and activated groups was compared with a standard generalized linear model (GLM) analysis. A basal perfusion template of PICORE‐Q2TIPS ASL images acquired at 3T from a group of 25 healthy subjects (mean age 31.6 ± 8.3 years) was created. The second group of 12 healthy subjects (mean age 28.6 ± 2.7 years) performed a block‐design motor task. The template was compared with the mean activated image of the second group both at the individual and at the group level to extract activation maps. The results obtained using a GLM analysis of the whole sequence was used as ground truth for comparison. The influences of spatial normalization using DARTEL registration and of correction of partial volume effects (PVE) in the construction of the template were assessed. Results showed that a basal perfusion template can detect activation‐related hyperperfusion in motor areas. The true positive ratio was increased by 2.5% using PVE‐correction and by 3.2% using PVE‐correction with DARTEL registration. On average, the group comparison presented a 2.2% higher true positive ratio than the one‐to‐many comparison. Hum Brain Mapp 35:1179–1189, 2014.