Hirohito Kan

Idiopathic Normal-Pressure Hydrocephalus: Temporal Changes in ADC during Cardiac Cycle

PURPOSE To determine whether temporal changes in apparent diffusion coefficient (ADC) over the cardiac cycle are different in patients with idiopathic normal-pressure hydrocephalus (INPH) as compared with patients with ex vacuo ventricular dilatation and healthy control subjects. MATERIALS AND METHODS This prospective study was approved by the institutional review board and was performed only after informed consent was obtained from each patient. At 1.5 T, electrocardiographically triggered single-shot diffusion echo-planar magnetic resonance imaging (b = 0 and 1000 sec/mm(2)) was performed with sensitivity encoding and half-scan techniques to minimize bulk motion. ΔADC was defined as the difference between maximum and minimum ADC on a pixel-by-pixel basis over 20 phases of the cardiac cycle. Mean ADC during the diastolic phase and ΔADC in the frontal white matter were determined in patients with INPH (n = 13), patients with ex vacuo ventricular dilatation (n = 8), and healthy volunteers (n = 10). Kruskal-Wallis tests were used to determine significance between groups. RESULTS Mean ΔADC in the INPH group was significantly higher than that in the ex vacuo ventricular dilatation and control groups (P < .01 for both). There was no significant difference in ΔADC between the ex vacuo ventricular dilatation and control groups (P = .86). There was no significant difference in mean ADC during the diastolic phase among groups (P > .05 for all). There was no significant correlation between ΔADC and mean ADC during the diastolic phase in any group. CONCLUSION Determination of fluctuation of ADC over the cardiac cycle may render it possible to noninvasively obtain new and more detailed information than that provided by standard ADC measurement in suspected INPH, potentially facilitating the diagnosis of this disease.

Feasibility of time-resolved MR angiography for detecting recanalization of pulmonary arteriovenous malformations treated with embolization with platinum coils.

PURPOSE To assess the feasibility of time-resolved magnetic resonance (MR) angiography as a follow-up method after embolization for pulmonary arteriovenous malformations (PAVMs). MATERIALS AND METHODS Evaluation of 28 PAVMs in 10 patients previously treated with embolization with platinum coils was performed. The mean observation period after embolization was 49 months. All patients underwent unenhanced chest computed tomography (CT) and time-resolved MR angiography followed by transcatheter digital subtraction angiography within 5 weeks for a definite diagnosis. Two radiologists reviewed the CT and time-resolved MR angiography findings using a blinded method. On CT, the draining veins of the PAVMs were measured before and after embolization, and shrinkage rates were calculated. On time-resolved MR angiography, recanalization was diagnosed when the draining vein or aneurysmal sac or both were enhanced in the pulmonary arterial phase. Correlations between recanalization, the shrinkage rate of the draining vein, and the diagnostic accuracies of CT and time-resolved MR angiography were assessed and compared with digital subtraction angiography. RESULTS Five lesions could not be measured on CT because of metallic artifacts. The mean shrinkage rates of the draining vein for recanalized and occluded PAVMs were 23% ± 19 (SD) for recanalized PAVMs and 47% ± 21 for occluded PAVMs (P = .001). The sensitivity and specificity were 93% and 53%, respectively, when the shrinkage rate threshold was set to 50%. On time-resolved MR angiography, the sensitivity and specificity were 93% and 100%, respectively, for Reader 1 and 100% and 93%, respectively, for Reader 2. The κ coefficient was 0.86. CONCLUSIONS Time-resolved MR angiography appears to be a feasible method for PAVM follow-up examinations and to provide a more accurate diagnosis of recanalization compared with unenhanced CT.

Insular Volume Reduction in Patients with Social Anxiety Disorder.

Despite the fact that social anxiety disorder (SAD) is highly prevalent, there have been only a few structural imaging studies. Moreover, most of them reported about a volume reduction in amygdale, which plays a key role in the neural function of SAD. Insula is another region of interest. Its hyperactivity in regard to processing negative emotional information or interoceptive awareness has been detected in patients with SAD. Referring to these studies, we hypothesized that insular volumes might reduce in patients with SAD and made a comparison of insular volumes between 13 patients with SAD and 18 healthy controls with matched age and gender using voxel-based morphometry. As a result, we found a significant volume reduction in insula in the SAD group. Our results suggest that the patients with SAD might have an insular volume reduction apart from amygdala. Since insula plays a critical role in the pathology of SAD, more attention should be paid not only to functional study but also morphometrical study of insula.

Background field removal technique using regularization enabled sophisticated harmonic artifact reduction for phase data with varying kernel sizes

An effective background field removal technique is desired for more accurate quantitative susceptibility mapping (QSM) prior to dipole inversion. The aim of this study was to evaluate the accuracy of regularization enabled sophisticated harmonic artifact reduction for phase data with varying spherical kernel sizes (REV-SHARP) method using a three-dimensional head phantom and human brain data. The proposed REV-SHARP method used the spherical mean value operation and Tikhonov regularization in the deconvolution process, with varying 2-14mm kernel sizes. The kernel sizes were gradually reduced, similar to the SHARP with varying spherical kernel (VSHARP) method. We determined the relative errors and relationships between the true local field and estimated local field in REV-SHARP, VSHARP, projection onto dipole fields (PDF), and regularization enabled SHARP (RESHARP). Human experiment was also conducted using REV-SHARP, VSHARP, PDF, and RESHARP. The relative errors in the numerical phantom study were 0.386, 0.448, 0.838, and 0.452 for REV-SHARP, VSHARP, PDF, and RESHARP. REV-SHARP result exhibited the highest correlation between the true local field and estimated local field. The linear regression slopes were 1.005, 1.124, 0.988, and 0.536 for REV-SHARP, VSHARP, PDF, and RESHARP in regions of interest on the three-dimensional head phantom. In human experiments, no obvious errors due to artifacts were present in REV-SHARP. The proposed REV-SHARP is a new method combined with variable spherical kernel size and Tikhonov regularization. This technique might make it possible to be more accurate backgroud field removal and help to achive better accuracy of QSM.

Delta-ADC (apparent diffusion coefficient) analysis in patients with idiopathic normal pressure hydrocephalus.

We have developed the delta-apparent diffusion coefficient (ADC), a new parameter of the water dynamics of brain tissue using MRI. Delta-ADC is the changes in regional ADC values of the brain during the cardiac cycle. The study included 6 idiopathic normal pressure hydrocephalus (iNPH) patients (iNPH group) and 12 healthy volunteers (control group). ECG-triggered single-shot diffusion echo planar imaging (b = 0 and 1,000 s/mm(2)) was used on a 1.5-T MRI. The delta-ADC image was calculated from the maximum minus the minimum ADC value of all cardiac phase images (20 phases) on a pixel-by-pixel basis. Delta-ADC values in the white matter of the frontal, temporal, and occipital lobe were obtained. Delta-ADC values in the iNPH group were significantly higher than those in the control group in all regions. ADC values in the iNPH were also significantly higher than those in the control group, but the differences in the ADC between the groups in each region were much lower than those for the delta-ADC. Although the changes in the delta-ADC and ADC values were similar, there was no significant correlation between the delta-ADC and the ADC. These results suggest that the ADC and the delta-ADC may reflect different kinds of water dynamics. The ADC depends on the water content in brain tissue. On the other hand, delta-ADC depends on not only the water content, but also on the degree of the fluctuation of the water molecules. Delta-ADC analysis makes it possible to obtain non-invasively new and more detailed information on the regional brain condition in iNPH.

Dynamic state of water molecular displacement of the brain during the cardiac cycle in idiopathic normal pressure hydrocephalus

The predictive accuracy of iNPH diagnoses could be increased using a combination of supplemental tests for iNPH. To evaluate the dynamic state of water displacement during the cardiac cycle in idiopathic normal pressure hydrocephalus (iNPH), we determined the change in water displacement using q-space analysis of diffusion magnetic resonance image. ECG-triggered single-shot diffusion echo planar imaging was used. Water displacement was obtained from the displacement probability profile calculated by Fourier transform of the signal decay fitted as a function of the reciprocal spatial vector q. Then maximum minus minimum displacement (delta-displacement), of all cardiac phase images was calculated. We assessed the delta-displacement in white matter in patients with iNPH and atrophic ventricular dilation (atrophic VD), and in healthy volunteers (control group). Delta-displacement in iNPH was significantly higher than those in the atrophic VD and control. This shows that water molecules of the white matter in iNPH are easily fluctuated by volume loading of the cranium during the cardiac cycle, due to the decrease in intracranial compliance. There was no significant correlation between delta-displacement and displacement. The delta-displacement and the displacement do not necessarily yield the same kind of information. Delta-displacement demonstrated to obtain biophysical information about fluctuation. This analysis may be helpful in the understanding physiology and pathological condition in iNPH and the assisting in the diagnosis.

A method for assessing metabolic information on liver and bone marrow by use of double gradient-echo with spectral fat suppression

Abstract Our aim in this study was to create a noninvasive and practical method for evaluating metabolic information on the liver (iron content and lipid infiltration) and spine (bone mineral density and marrow fat degeneration) using double gradient-echo with and without the spectral fat suppression technique (double-GRE–FS). We arranged phantoms made of various concentrations of superparamagnetic iron oxide solution adjacent to neutral fat to obtain slice planes with various fat fractions using the partial volume effect. We obtained double-GRE–FS images and calculated the T2* values. The fat fraction was calculated from signal intensities of double-GRE–FS images after T2* decay, baseline, and slope corrections. We assessed the fat fraction and the relationship between R2* of the water component and the iron concentration. In addition, we evaluated those values in human bone marrow and liver, including a patient with liver steatosis. The actual fat fraction value was consistent with the fat fraction obtained with the double-GRE–FS method, and the calculated fat fraction was unaffected by the iron concentration. There was a strong positive correlation between R2* of the water component and the iron concentration. There was a negative correlation between the fat fraction and the bone mineral density, and the R2* was correlated with the bone mineral density. The calculated fat fraction in the liver steatosis patient was significantly higher than that in healthy volunteers. The double-GRE–FS makes it possible to assess the fat fraction and R2* simultaneously, and to obtain metabolic information on the liver and bone marrow.

Quantitative susceptibility mapping using principles of echo shifting with a train of observations sequence on 1.5 T MRI

PURPOSE To evaluate the accuracy of susceptibility estimated from the principles of echo shifting with a train of observations (PRESTO) sequence using a 1.5T MRI system, we conducted experiments on the human brain using the PRESTO sequence and compared our results with the susceptibility obtained from spoiled gradient-recalled echo (GRE) sequence with flow compensation using quantitative susceptibility mapping (QSM) reconstruction. MATERIALS AND METHODS Experiments on the human brain were conducted on 12 healthy volunteers (27±4years) using PRESTO and spoiled GRE sequences on a 1.5T scanner. The PRESTO sequence is an echo-shifted gradient echo sequence that allows high susceptibility sensitivity and rapid acquisition because of TE>TR compared with the spoiled GRE sequence. QSM analysis was performed on the obtained phase images using the iLSQR method. Estimated susceptibility maps were used for region of interest analyses and estimation of line profiles through iron-rich tissue and major vessels. RESULTS Our results demonstrated that susceptibility maps were accurately estimated, without error, by QSM analysis of PRESTO and spoiled GRE sequences. Acquisition time in the PRESTO sequence was reduced by 43% compared with that in the spoiled GRE sequence. Differences did exist between susceptibility maps in PRESTO and spoiled GRE sequences for visualization and quantitative values of major blood vessels and the areas around them CONCLUSION: The PRESTO sequence enables correct estimation of tissue susceptibility with rapid acquisition and may be useful for QSM analysis of clinical use of 1.5T scanners.

Transfer characteristics of arterial pulsatile force in regional intracranial tissue using dynamic diffusion MRI: A phantom study

INTRODUCTION To clarify the mechanism underlying apparent diffusion coefficient (ADC) changes in regional intracranial tissue during the cardiac cycle, we investigated relationships among ADC changes, volume loading, and intracranial pressure using a hemodialyzer phantom in magnetic resonance imaging (MRI). MATERIALS AND METHODS The hemodialyzer phantom consisted of hollow fibers (HF), the external space of HFs (ES), and a gateway of dialysis solution, filled with syrup solution and air. The high-volume and low-volume loadings were periodically applied to HFs by a to-and-fro flow pump, and syrup solution was permitted to enter or leave HFs during the volume loading cycles. ADC maps at each volume loading phase were obtained using ECG-triggered single-shot diffusion echo-planar imaging. Dynamic phase contrast MRI was also used to measure volume loading to the phantom. We compared the ADC changes, volume loading, and intracranial pressure in the phantom during the cardiac cycle. RESULTS ADC changes synchronized significantly with absolute volumetric flow rate change. The maximum ADC change was higher in high-volume loading cycles than in low-volume loading cycles. Results showed that the water molecules in ES fluctuated according to the force transferred from HF to ES. ADC changes were dependent upon the volumetric flow rate during the cardiac cycle. CONCLUSIONS Our original phantom allowed us to clarify the mechanism underlying water fluctuations in intracranial tissues. Measurement of maximum changes in ADC is an effective method to define the transfer characteristics of the arterial pulsatile force in regional intracranial tissue.

Water and lipid diffusion MRI using chemical shift displacement-based separation of lipid tissue (SPLIT)

PURPOSE To obtain water and lipid diffusion-weighted images (DWIs) simultaneously, we devised a novel method utilizing chemical shift displacement-based separation of lipid tissue (SPLIT) imaging. MATERIALS AND METHODS Single-shot diffusion echo-planar imaging without fat suppression was used and the imaging parameters were optimized to separate water and lipid DWIs by chemical shift displacement of the lipid signals along the phase-encoding direction. Using the optimized conditions, transverse DWIs at the maximum diameter of the right calf were scanned with multiple b-values in five healthy subjects. Then, apparent diffusion coefficients (ADCs) were calculated in the tibialis anterior muscle (TA), tibialis bone marrow (TB), and subcutaneous fat (SF), as well as restricted and perfusion-related diffusion coefficients (D and D*, respectively) and the fraction of the perfusion-related diffusion component (F) for TA. RESULTS Water and lipid DWIs were separated adequately. The mean ADCs of the TA, TB, and SF were 1.56±0.03mm2/s, 0.01±0.01mm2/s, and 0.06±0.02mm2/s, respectively. The mean D*, D, and F of the TA were 13.7±4.3mm2/s, 1.48±0.05mm2/s, and 4.3±1.6%, respectively. CONCLUSION SPLIT imaging makes it possible to simply and simultaneously obtain water and lipid DWIs without special pulse sequence and increases the amount of diffusion information of water and lipid tissue.