Frederik Wenz

Functional magnetic resonance imaging at 1.5 T: Activation pattern in schizophrenic patients receiving neuroleptic medication

Activation of the cerebral cortex during motor task performance can be visualised with functional MRI. A modified FLASH sequence (TR/TE/alpha 100/60/40 degrees, first order flow rephased, fat suppression, reduced bandwidth 28 Hz/pixel, 120 repetitions, three cycles of rest and finger movement for each hand) on a standard 1.5 T clinical imager was used to investigate 10 schizophrenic patients receiving clozapine and 10 healthy volunteers. All subjects were right-handed. Color-coded statistical parametric maps (SPM) based on the Students t-test were calculated. A grid overlay was used for global and regional quantification. Activation strength was defined as the mean t-value of the respective region. All patients and volunteers showed a significant activation in the contralateral and ipsilateral sensorimotor cortex during motor task performance. The schizophrenic patients showed a significantly reduced global activation strength compared with healthy volunteers (p < .005). Selective evaluation of left-hand compared to right-hand movement demonstrated an increase in global activation strength in volunteers in contrast to a decrease in patients. Furthermore a reduced coactivation in the dominant left hemisphere was found in patients compared to volunteers during movement of the ipsilateral (left) hand. We conclude that alterations of the right and left hemispheric balance can be detected in schizophrenic patients using functional MRI at 1.5 T. These changes may indicate a disturbed interhemispheric interaction in schizophrenia. The reduction in cortical activation may result from several causes, however, taken together with previous studies and the underlying physiological effects, the most likely explanation is a combined effect of the disease and the neuroleptic medication.

Cerebral arteriovenous malformations: Improved nidus demarcation by means of dynamic tagging MR-angiography

Our purpose was to further improve the target volume definition for radiosurgical treatment of cerebral arteriovenous malformations (AVMs) by means of dynamic MRA (dMRA) using a blood bolus tagging sequence. We therefore compare this technique with 3D-TOF-MRA and transfemoral high resolution angiography in plain film technique. Twenty patients with angiographically proven cerebral AVMs were investigated by dMRA, TOF-MRA, and conventional angiography during the MR-assisted radiosurgical planning protocol. The patients head was fixed in an MR-compatible stereotactic device. The different angiography techniques were evaluated by consensus of two radiologists. AVMs were characterized by the number and origin of feeding arteries, the maximum diameter of the AVM nidus, and the venous drainage pattern. Dynamic MRA was able to demonstrate the complete AVM characteristics and hemodynamics in 12 out of 20 patients. In three patients with an AVM nidus smaller than 1 cm in diameter the technique could not reliably depict the malformation. Technical problems due to steel screws and pins in the initially used stereotactic frame occurred in five patients. Due to reduced vessel overlap and the lack of disturbances caused by formations with short T1 time, dMRA was superior to TOF-MRA in the detection and the exact localization of the AVM nidus in four patients. We conclude that dMRA is able to demonstrate reliably AVM characteristics and hemodynamics in AVMs with a nidus larger than 1 cm in diameter. Because of the improved demarcation of the AVM nidus, this technique may be a valuable adjunct to radiosurgery planning of cerebral AVMs.

Monitoring of task performance during functional magnetic resonance imaging of sensorimotor cortex at 1.5 T

Functional magnetic resonance imaging (fMRI) has found widespread clinical interest. Difficulties in clinical use of the fMRI technique arise, considering the lack of knowledge about activation task performance. This accounts especially for sensorimotor activation studies, in which performance of the sensorimotor activation task is-if at all-usually rated visually by subjective or semiquantitative methods (i.e., defining categories of performance such as neurological soft signs scales). Recently, instrumental methods for the measurement and analysis of motor performance have been developed. Pronation/supination (hand rotation) movement was shown to be an easily measurable and promising motor task. We have adapted a mechanic device (pronation/supination device, PSD) to monitor motor performance during the fMRI experiment. In a feasibility study, an investigation of fMRI activation strength dependence of sensorimotor cortices and supplementary motor area upon task frequency (25, 50, and 75 cycles/min) was carried out on 10 right-handed healthy volunteers. Furthermore, the authors report the observation of stimulus-induced activation changes in the cerebellum during pronation/supination movement.

POSTPROCESSING OF FUNCTIONAL MRI DATA OF MOTOR CORTEX STIMULATION MEASURED WITH A STANDARD 1.5 T IMAGER

Functional magnetic resonance imaging (fMRI) is usually based on acquisition of alternating series of images under rest and an activation task (stimulus). Brain activation maps can be generated from fMRI data sets by applying several mathematical methods. Two methods of image postprocessing have been compared: (i) simple difference of mean values between rest and stimulation, and (ii) Students t-test. The comparison shows that the difference method is very sensitive to arbitrary signal fluctuations as seen mainly in large vessels (e.g., in the sagittal sinus), leading to insignificantly activated spots in brain activation maps. In contrary, Students t-test maps show strongly reduced sensitivity for fluctuations and have the advantage of giving activation thresholds by setting significance levels. This allows the comparison of activation strength between patient collectives by using a grid overlay technique leading to an observer independent quantification of the stimulation effects. The method was able to reproduce previous findings of activation differences between healthy volunteers and schizophrenic patients. Moreover, a simple algorithm for the correction of slight head movements during the functional imaging task is presented. The algorithm is based on shifting the fMRI data set relative to a reference image by maximizing the linear correlation coefficients. This leads to a further reduction of insignificant brain activation and to an improvement in brain activation map quality.

Radiosurgical treatment planning of brain metastases based on a fast, three-dimensional MR imaging technique

A fast, three-dimensional (3D) sequence for magnetic resonance (MR) imaging of the brain and its application in radiosurgical treatment planning of brain metastases is reported. The measuring sequence (MPRAGE) requires magnetization-prepared 180 degrees inversion pulses followed by rapid low angle excitation pulses and gradient-echoes for image generation. The resulting T1-weighted MPRAGE images were compared with two-dimensional (2D) T1-weighted spin-echo (SE) images after administration of 0.1 mmol/kg b.w. Gd-DTPA in 10 patients with known brain metastases. Original or multiplanar reformatted images obtained from a 128 partition data set of the 3D MPRAGE sequence offered comparable diagnostic quality to that of 2D SE imaging. Gd-DTPA enhancement and lesion targeting was similar in most of the patients in SE as well as MPRAGE imaging. During imaging and therapy the patients head was fixed in a stereotactic localization system which is usable at the MR and the linear accelerator installations. The dose calculation of the radiosurgery planning was based on 3D MR imaging data assuming a homogenous attenuation value inside the head which was sufficient for an accurate dose calculation since tissue inhomogeneities do not significantly influence the shape of the relative dose distribution especially for radiosurgery of the brain. Under this circumstance the dose calculation can be based only on the 3D geometric conformation of the patients head. A simple algorithm for treatment planning can be used if the MR data are free of geometric distortion.(ABSTRACT TRUNCATED AT 250 WORDS)

3D MPRAGE evaluation of lesions in the posterior cranial fossa

Standard spin-echo images of the posterior cranial fossa are usually impaired by pulsation artifacts. We evaluated a heavily T1 weighted MPRAGE sequence (TR/TE/alpha/TI = 10/4/10-15 degrees/200-350) for detection of intracerebral lesions in the posterior fossa in 11 patients. Overall quality of the MPRAGE images was superior due to the lack of pulsation artifacts, high S/N and excellent gray-white matter contrast. Lesion detection was better in one patient, equal in six and inferior in four patients compared to SE technique. A cerebellar metastasis (8 mm) in one patient was completely blurred from pulsation artifacts on the SE images. Whereas multiple small lesions (< or = 4 mm) with discrete contrast enhancement were missed on the MPRAGE images in three patients. We conclude, that the MPRAGE sequence yields high quality images with isotropic spatial resolution in a reasonable time. But MPRAGE with these parameters can not replace standard SE images in screening the posterior fossa, because of a decreased sensitivity in the detection of small contrast-enhancing lesions.

Functional 2D and 3D magnetic resonance imaging of motor cortex stimulation at high spatial resolution using standard 1.5 T imager.

This paper reports the effects of motor cortex stimulation of normal volunteers using conventional MR imaging techniques on standard 1.5 T clinical scanner. Improvement in signal-to-noise (S/N) ratio has been achieved by using a commercially available eye/ear surface coil with a loop of 8.5 cm in diameter. Magnet shimming with all first order coils was performed to the volunteers head resulting in a magnetic field homogeneity of about 0.1-0.2 ppm. The imaging technique used was an optimized conventional 2D and 3D, first order flow rephased, gradient-echo sequence (FLASH) with fat-suppression and reduced bandwidth (16-28 Hz/pixel) and TR = 80-120 ms, TE = 60 ms, flip angle = 40 degrees, matrix = 128 x 128, FOV = 150-250 mm, slice-thickness = 2-5 mm, NEX = 1, and a total single scan time for one image of about 12-16 s. In the 3D FLASH measurements, a slab of 32 mm thickness with 16 partitions was evaluated. The motor cortex stimulation was achieved by touching each finger to thumb in a sequential, self-paced, and repetitive manner. During stimulation, an increase in signal of order 10-20% was detected in the motor and sensory cortex due to reduced partial volume effects and optimized S/N for the measurements at small voxel size. 3D FLASH imaging at high spatial resolution shows good anatomical correlation of signal increase with gray matter of the motor and sensory cortex. The reported data demonstrate the technical feasibility of functional 2D and 3D MR imaging at high spatial resolution using optimized conventional sequences and equipment.

Functional neuroimaging in the assessment of CNS neoplasms

Abstract. Assessment of CNS neoplasms has focused traditionally on morphological analysis. Recent developments in MR sequence design now enable functional assessments. T1-weighted, as well as T2*-weighted, dynamic, gadolinium-enhanced, imaging can be used for assessment of vascularisation, permeability, and microcirculation of CNS neoplasms. Characterisation of cerebrovascular blood flow is possible using dynamic MR angiography, while neurofunctional imaging enables visualisation of local alterations in neuronal activity in stimulated cortical areas. Diffusion-weighted imaging can be used for improved delineation of neoplasms, while chemical shift imaging allows metabolic mapping of lesions and surrounding tissues. Implementation of these techniques can improve characterisation, information for therapy, planning and prognosis in clinical imaging of CNS neoplasms.

Fluid-attenuated-inversion-recovery-(FLAIR-) Bildgebung in der Diagnostik zerebraler Gliome und Metastasen

ZusammenfassungDie diagnostische Wertigkeit einer schnellen Fluid-attenuated-inversion-recovery-(FLAIR-) Sequenz wurde an 35 Patienten mit zerebralen Gliomen und 12 Patienten mit insgesamt 39 zerebralen Metastasen überprüft. Es wurden FLAIR vor und nach Kontrastmittel, T2/PD gewichtete schnelle SE (FSE) und kontrastmittelunterstützte T1-gewichtete SE-Sequenzen anhand quantitativer und qualitativer Kriterien verglichen. Die quantitative Auswertung umfaßte Tumor-zu-Marklager- und Tumor-zu-Liquor-Kontrast- und Kontrast-zu-Rausch-Bestimmungen. In der qualitativen Auswertung wurde die Tumordetektion und Abgrenzung anhand einer Multireaderanalyse (4 Leser) beurteilt.In der qualitativen Auswertung fanden alle Leser die FLAIR-Aufnahmen den konventionellen Sequenzen in der exakten Abgrenzung des Gesamttumors und der Abgrenzung von anreichernden von den nicht anreichernden Tumoranteilen überlegen. In der Detektion von zerebralen Metastasen hingegen zeigte sich die FLAIR-Technik den T1-SE-Sequenzen deutlich unterlegen.In der qualitativen Analyse stieg das Signal nach Kontrastmittelgabe bei anreichernden Tumoren auf den FLAIR-Bildern um 37%, wodurch der Tumor-zu-Marklager-Kontrast deutlich über den der konventionellen Aufnahmen stieg. Durch die Kontrastmittelgabe wurde durch die Abgrenzung der infiltrativen Tumoranteile signifikant verbessert. Es wird daher empfohlen, FLAIR-Aufnahmen nach Kontrastmittelgabe durchzuführen.Artefakte nahe der Liquorräume sind auf FLAIR-Bildern häufig, sie störten die Bildinterpretation jedoch nicht wesentlich. Signalhyperintensitäten aufgrund physiologischer Gliosezonen an den Ventrikelrändern sind ebenfalls häufig zu beobachten und müssen in die Bildinterpretation einbezogen werden.SummaryThis study demonstrates the value of a fast fluid-attenuated inversion-recovery (FLAIR) technique in the assessment of cerebral gliomas and metastases. Thirty-five patients with cerebral gliomas and 12 patients with a total of 39 cerebral metastases were examined by T2/proton density-weighted fast spin echo, fast FLAIR with and without contrast medium and contrast-enhanced T1-weighted spin echo using identical slice parameters. The images were evaluated using quantitative and qualitative criteria. Quantitative criteria were tumor-to-background and tumor-to-cerebrospinal fluid contrast and contrast-to-noise. The qualitative evaluation was performed as a multireader analysis concerning lesion detection, lesion delineation and image artifacts. In the qualitative evaluation, all readers found fast FLAIR to be superior to fast spin echo in the exact delineation of cerebral tumors (P<0.001) and the delineation of enhancing and nonenhancing tumor parts. Fast FLAIR was superior in the delineation of cortically located and small lesions but was limited in lesions adjacent to the ventricles. Fast FLAIR provided a significantly better tumor-to-CSF contrast and tumor-to-CSF contrast-to-noise (P<0.001). The tumor-to-background contrast and tumor-to-background contrast-to-noise of the fast FLAIR images were lower than that of T2-weighted spin-echo images but were significantly increased after the application of contrast medium. FLAIR images had a more image artifacts, but these influenced the image interpretation in only two patients. Signal hyperintensities at the ventricular border were present in 92% of the patients. These are common findings in fast FLAIR and should be included in image interpretation.

A 3D T1-weighted gradient-echo sequence for routine use in 3D radiosurgical treatment planning of brain metastases: first clinical results

The authors report on a 3D sequence for MRI of the brain and its application in radiosurgical treatment planning of 35 brain metastases. The measuring sequence, called magnetization — prepared rapid gradient echo (MPRAGE), was compared with 2D T1-weighted spin-echo (SE) sequences following intravenous contrast-medium application in 19 patients with brain metastases. The average diameter of all lesions was similar in both sequences, with 16.8 and 17.0 mm for SE and MPRAGE, respectively. Target point definition was equal in 29 metastases, and in 6 cases superior on MPRAGE, due to better gray-white matter contrast and increased contrast enhancement. In cases of bleeding metastases there was improved depiction of internal structures in 3D MRI. Postprocessing of 3D MPRAGE data created multi-planar reconstruction along any chosen plane with isotropic spatial resolution, which helped to improve radiosurgical isodose distribution in 4 cases when compared to 2D SE. However, sensitivity of 3D MPRAGE to detect small lesions (< 3 mm) was decreased in one patient with more than 50 metastases. We conclude that 3D gradient-echo (GE) imaging might be of great value for radiosurgical treatment planning, but does not replace 2D SE with its current parameters.