Gary P. Zientara

Microstructural development of human newborn cerebral white matter assessed in vivo by diffusion tensor magnetic resonance imaging.

Alterations of the architecture of cerebral white matter in the developing human brain can affect cortical development and result in functional disabilities. A line scan diffusion-weighted magnetic resonance imaging (MRI) sequence with diffusion tensor analysis was applied to measure the apparent diffusion coefficient, to calculate relative anisotropy, and to delineate three-dimensional fiber architecture in cerebral white matter in preterm (n = 17) and full-term infants (n = 7). To assess effects of prematurity on cerebral white matter development, early gestation preterm infants (n = 10) were studied a second time at term. In the central white matter the mean apparent diffusion coefficient at 28 wk was high, 1.8 µm2/ms, and decreased toward term to 1.2 µm2/ms. In the posterior limb of the internal capsule, the mean apparent diffusion coefficients at both times were similar (1.2 versus 1.1 µm2/ms). Relative anisotropy was higher the closer birth was to term with greater absolute values in the internal capsule than in the central white matter. Preterm infants at term showed higher mean diffusion coefficients in the central white matter (1.4 ± 0.24 versus 1.15 ± 0.09 µm2/ms, p = 0.016) and lower relative anisotropy in both areas compared with full-term infants (white matter, 10.9 ± 0.6 versus 22.9 ± 3.0%, p = 0.001; internal capsule, 24.0 ± 4.44 versus 33.1 ± 0.6% p = 0.006). Nonmyelinated fibers in the corpus callosum were visible by diffusion tensor MRI as early as 28 wk; full-term and preterm infants at term showed marked differences in white matter fiber organization. The data indicate that quantitative assessment of water diffusion by diffusion tensor MRI provides insight into microstructural development in cerebral white matter in living infants.

Periventricular white matter injury in the premature infant is followed by reduced cerebral cortical gray matter volume at term

Periventricular white matter injury, that is, periventricular leukomalacia (PVL), the dominant form of brain injury in the premature infant, is the major neuropathological substrate associated with the motor and cognitive deficits observed later in such infants. The nature of the relationship of this lesion to the subsequent cognitive deficits is unclear, but such deficits raise the possibility of cerebral cortical neuronal dysfunction. Although cortical neuronal necrosis is not a prominent feature of brain injury in premature infants, the possibility of a deleterious effect of PVL on subsequent cerebral cortical development has not been investigated. An advanced quantitative volumetric three‐dimensional magnetic resonance imaging technique was used to measure brain tissue volumes at term in premature infants with earlier ultrasonographic and magnetic resonance imaging evidence of PVL (mean gestational age at birth, 28.7 ± 2.0 weeks; n = 10), in premature infants with normal imaging studies (mean gestational age at birth, 29.0 ± 2.1 weeks; n = 10), and in control term infants (n = 14). Premature infants with PVL had a marked reduction in cerebral cortical gray matter at term compared with either premature infants without PVL or normal term infants (mean ± SD: PVL, 157.5 ± 41.5 ml; no PVL, 211.7 ± 25.4 ml; normal term, 218.8 ± 21.3 ml). As expected, a reduction in the volume of total brain myelinated white matter was also noted (mean ± SD: PVL, 14.5 ± 4.6 ml; no PVL, 23.1 ± 6.9 ml; normal term, 27.6 ± 10.3 ml). An apparent compensatory increase in total cerebrospinal fluid volume also was found (mean ± SD: PVL, 64.5 ± 15.2 ml; no PVL, 52.0 ± 24.1 ml; normal term, 32.9 ± 13.5 ml). PVL in the premature infant is shown for the first time to be followed by impaired cerebral cortical development. These findings may provide insight into the anatomical correlate for the intellectual deficits associated with PVL in the premature infant.

Early detection of periventricular leukomalacia by diffusion-weighted magnetic resonance imaging techniques.

Periventricular leukomalacia (PVL), the principal form of brain injury in the premature infant, is characterized by overt focal necrotic lesions in periventricular white matter and less prominent, more diffuse cerebral white matter injury. The early detection of the latter, diffuse component of PVL is not consistently possible with conventional brain imaging techniques. We demonstrate the early detection of the diffuse component of PVL by diffusion-weighted magnetic resonance imaging (DWI). In a premature infant with no definite cerebral abnormality detectable by cranial ultrasonography or conventional magnetic resonance imaging, DWI showed a striking bilateral decrease in water diffusion in cerebral white matter. The DWI abnormality (ie, decreased apparent diffusion coefficient) was similar to that observed with acute cerebral ischemic lesions in adults. At 10 weeks of age, conventional magnetic resonance imaging and ultrasonography showed striking changes consistent with PVL, including the presence of small cysts. The observations indicate the importance of DWI in the early identification of the diffuse component of PVL and also perhaps the role of ischemia in the pathogenesis of the lesion.

Volumetric Quantification of Brain Swelling after Hypobaric Hypoxia Exposure

We applied a novel MR imaging technique to investigate the effect of acute mountain sickness on cerebral tissue water. Nine volunteers were exposed to hypobaric hypoxia corresponding to 4572 m altitude for 32 h. Such an exposure may cause acute mountain sickness. We imaged the brains of the volunteers before and at 32 h of hypobaric exposure with two different MRI techniques with subsequent data processing. (1) Brain volumes were calculated from 3D MRI data sets by applying a computerized brain segmentation algorithm. For this specific purpose a novel adaptive 3D segmentation program was used with an automatic correction algorithm for RF field inhomogeneity. (2) T(2) decay rates were analyzed in the white matter. The results demonstrated that a significant brain swelling of 36.2 +/- 19.6 ml (2.77 +/- 1.47%, n = 9, P < 0.001) developed after the 32-h hypobaric hypoxia exposure with a maximal observed volume increase of 5.8% (71.3 ml). These volume changes were significant only for the gray matter structures in contrast to the unremarkable changes seen in the white matter. The same study repeated 3 weeks later in 6 of 9 original subjects demonstrated that the brains recovered and returned approximately to the initially determined sea-level brain volume while hypobaric hypoxia exposure once again led to a significant new brain swelling (24.1 +/- 12.1 ml, 1.92 +/- 0.96%, n = 6, P < 0.005). On the contrary, the T(2) mapping technique did not reveal any significant effect of hypobaria on white matter. We present here a technique which is able to detect reversible brain volume changes as they may occur in patients with diffuse brain edema or increased cerebral blood volume, and which may represent a useful noninvasive tool for future evaluations of antiedematous drugs.

In Vivo Visualization of White Matter Fiber Tracts of Preterm- and Term-Infant Brains With Diffusion Tensor Magnetic Resonance Imaging

Objective:The goal of this study was to test the feasibility of visualizing a 3-dimensional structure of cerebral white matter fiber tracts in preterm infants, postconceptional age (PCA) 28 weeks to term, by using volumetric diffusion tensor magnetic resonance imaging (DTI) data. Materials and Method:We combined tractography algorithms and visualization methods, currently available for adult DTI data, to trace the pixelated principal direction of a diffusion tensor originating from regions-of-interest with high fractional anisotropy. Consequently, white matter fiber bundles from the genu and the splenium of corpus callosum, the corticospinal tracts, the inferior fronto-occipital fasciculi, and optic radiations were visualized. Results:Our results suggest that major white matter tracts of preterm infant brains, with PCAs ranging from 28 weeks to term (40 weeks old), can be successfully visualized despite the small brain volume and low anisotropy. Conclusion:The feasibility of fiber tractography in preterm neonates with DTI may add a new dimension in detection and characterization of white matter injuries of preterm infants.

Noise Cancellation Signal Processing Method and Computer System for Improved Real-Time Electrocardiogram Artifact Correction During MRI Data Acquisition

A system was developed for real-time electrocardiogram (ECG) analysis and artifact correction during magnetic resonance (MR) scanning, to improve patient monitoring and triggering of MR data acquisitions. Based on the assumption that artifact production by magnetic field gradient switching represents a linear time invariant process, a noise cancellation (NC) method is applied to ECG artifact linear prediction. This linear prediction is performed using a digital finite impulse response (FIR) matrix, that is computed employing ECG and gradient waveforms recorded during a training scan. The FIR filters are used during further scanning to predict artifacts by convolution of the gradient waveforms. Subtracting the artifacts from the raw ECG signal produces the correction with minimal delay. Validation of the system was performed both off-line, using prerecorded signals, and under actual examination conditions. The method is implemented using a specially designed Signal Analyzer and Event Controller (SAEC) computer and electronics. Real-time operation was demonstrated at 1 kHz with a delay of only 1 ms introduced by the processing. The system opens the possibility of automatic monitoring algorithms for electrophysiological signals in the MR environment

Spin-echoes for diffusion in bounded, heterogeneous media: A numerical study

The diffusive behavior of spin‐bearing species in a bounded heterogeneous medium is analyzed in a manner appropriate for spin echo experiments in the presence of field gradients. A numerical method based upon the stochastic Liouville equation (SLE) is discussed that includes the discontinuities in transport and solubility properties due to the different spatial regions. The double step computational algorithm, which takes advantage of the different time scales of diffusive and spin‐quantum phenomena, is then introduced as a general approximate solution of the time dependent SLE. This method is applied to the calculation of the decay of spin echo amplitudes, and it suggests a new approach for analyzing such experiments in terms of the microscopic details and chemical properties of heterogeneous systems.

A Binary Entropy Measure to Assess Nonrigid Registration Algorithms

Assessment of normal and abnormal anatomical variability requires a coordinate system enabling inter-subject comparison. We present a binary minimum entropy criterion to assess affine and nonrigid transformations bringing a group of subject scans into alignment. This measure is a data-driven measure allowing the identification of an intrinsic coordinate system of a particular group of subjects. We assessed two statistical atlases derived from magnetic resonance imaging of newborn infants with gestational age ranging from 24 to 40 weeks. Over this age range major structural changes occur in the human brain and existing atlases are inadequate to capture the resulting anatomical variability. The binary entropy measure we propose allows an objective choice between competing registration algorithms to be made.

Line Scan Diffusion Tensor MRI of the Cervical Spinal Cord in Preterm Infants

Line scan diffusion tensor magenetic resonance imaging (DT‐MRI) of the cervical spinal cord was demonstrated in vivo for unsedated preterm (gestational age 24–30 weeks at birth), very low birthweight (birthweight 620–1300 g) infants at postmenstrual ages from 29–40 weeks. Scalar invariant measures of diffusion [apparent diffusion coefficient (ADC) and relative anisotropy (RA)] determined from a cervical cord region of interest in each case are reported, characterizing the maturational status of the normal third trimester and newborn spinal cord. Mean ADC of 11 infants was 1.2 ± 0.1 μm2/msec and the mean RA was 24.3 ± 4.9%. Normal infant cord neural fiber tract morphology was visualized using a mapping of the predominant diffusion tensor eigenvector. Potential clinical applications of line scan DT‐MRI of the spinal cord of preterm and term newborns for assessment of spinal cord injury are discussed. J. Magn. Reson. Imaging 2001;13:949–953.

Periventricular White Matter Injury in the Premature Infant Is Associated with a Reduction in Cerebral Cortical Gray Matter Volume at Term

Periventricular White Matter Injury in the Premature Infant Is Associated with a Reduction in Cerebral Cortical Gray Matter Volume at Term