Jay S. Tsuruda

Analysis of partial volume effects in diffusion-tensor MRI.

The diffusion tensor is currently the accepted model of diffusion in biological tissues. The measured diffusion behavior may be more complex when two or more distinct tissues with different diffusion tensors occupy the same voxel. In this study, a partial volume model of MRI signal behavior for two diffusion‐tensor compartments is presented. Simulations using this model demonstrate that the conventional single diffusion tensor model could lead to highly variable and inaccurate measurements of diffusion behavior. The differences between the single and two‐tensor models depend on the orientations, fractions, and exchange between the two diffusion tensor compartments, as well as the diffusion‐tensor encoding technique and diffusion‐weighting that is used in the measurements. The current single compartment models inaccuracies could cause diffusion‐based characterization of cerebral ischemia and white matter connectivity to be incorrect. A diffusion‐tensor MRI imaging experiment on a normal human brain revealed significant partial volume effects between oblique white matter regions when using very large voxels and large diffusion‐weighting (b ∼ 2.69 × 103 sec/mm2). However, the apparent partial volume effects in white matter decreased significantly when smaller voxel dimensions were used. For diffusion tensor studies obtained using typical diffusion‐weighting values (b ∼ 1 × 103 sec/mm2) partial volume effects are much more difficult to detect and resolve. More accurate measurements of multiple diffusion compartments may lead to improved confidence in diffusion measurements for clinical applications. Magn Reson Med 45:770–780, 2001.

White matter tractography using diffusion tensor deflection

Diffusion tensor MRI provides unique directional diffusion information that can be used to estimate the patterns of white matter connectivity in the human brain. In this study, the behavior of an algorithm for white matter tractography is examined. The algorithm, called TEND, uses the entire diffusion tensor to deflect the estimated fiber trajectory. Simulations and imaging experiments on in vivo human brains were performed to investigate the behavior of the tractography algorithm. The simulations show that the deflection term is less sensitive than the major eigenvector to image noise. In the human brain imaging experiments, estimated tracts were generated in corpus callosum, corticospinal tract, internal capsule, corona radiata, superior longitudinal fasciculus, inferior longitudinal fasciculus, fronto‐occipital fasciculus, and uncinate fasciculus. This approach is promising for mapping the organizational patterns of white matter in the human brain as well as mapping the relationship between major fiber trajectories and the location and extent of brain lesions. Hum. Brain Mapping 18:306–321, 2003.

A geometric analysis of diffusion tensor measurements of the human brain

The degree of diffusion tensor anisotropy is often associated with the organization of structural tissues such as white matter. Numerous measures of diffusion anisotropy have been proposed, which could lead to confusion in interpreting and comparing results from different studies. In this study, a new method for representing the diffusion tensor shape, called the three‐phase (3P) plot, is described. This is a graphical technique based upon a barycentric coordinate system, which weights the tensor shape by a combination of linear, cylindrical, and spherical shape factors. This coordinate system can be used to map and potentially segment different tissues based upon the tensor shape. In addition, the 3P plot can be used to examine the shape properties of existing measures of diffusion anisotropy. In this paper, the 3P plot is used to compare four well‐known anisotropy measures: the anisotropy index, the fractional anisotropy, the relative anisotropy, and the volume fraction. Computer simulations and diffusion tensor images of normal brains were obtained to study the properties of this new mapping technique. Magn Reson Med 44:283–291, 2000.

Magnetic Resonance Imaging Signal Changes in Denervated Muscles after Peripheral Nerve Injury

The evaluation of peripheral nerve disorders has traditionally relied on a clinical history, physical examination, and electrodiagnostic studies. Recent studies have used magnetic resonance imaging (MRI) to evaluate a variety of both nerve and muscle disorders. In this article, we describe the use of MRI, using short-tau inversion recovery (STIR) sequences, to evaluate muscle signal characteristics in a variety of peripheral nerve disorders. A total of 32 patients were studied, and 12 representative cases are discussed in detail. Increased STIR signal in muscle was seen in cases of severe axonotmetic injuries involving the transection of axons producing severe denervation changes on electromyography. The increased STIR signal in denervated muscles was seen as early as 4 days after the onset of clinical symptoms, which is significantly earlier than changes detected on electromyography. The MRI signal changes were reversible when the recovery of motor function occurred as a result of further muscle innervation. In cases of neurapraxic nerve injuries, characterized by conduction block without axonal loss, the STIR signal in muscle was normal. These findings show that MRI using STIR sequences provides a panoramic visual representation of denervated muscles useful in localizing and grading the severity of peripheral nerve injury secondary to either disease or trauma. MRI using STIR sequences may therefore play an important role in the prediction of clinical outcome and the formulation of appropriate therapy early after peripheral nerve injury.

Magnetic resonance neurography of peripheral nerve lesions in the lower extremity

OBJECTIVE We describe the clinical application and utility of high-resolution magnetic resonance neurography (MRN) techniques to image the normal fascicular structure of peripheral nerves and its distortion by mass lesions or trauma in the lower extremity. METHODS MRN images were obtained using a standard 1.5 Tesla magnet and custom built phased-array coils. Patients were imaged using T1-weighted spin echo without and with gadolinium, T2-weighted fast spin echo with fat peripheral nerve tumors (three neurofibromas and one schwannoma), two with intraneural cysts, and three with traumatic peripheral nerve lesions. Six patients with peripheral nerve mass lesions underwent surgery, thereby allowing MRN images to be correlated with intraoperative and pathological findings. RESULTS Preoperative MRN accurately imaged the normal fascicular anatomy of peripheral nerves and precisely depicted its relation to tumor and cystic lesions. Increased signal on T2-weighted fast spin-echo and short tau inversion recovery fast spin-echo pulse sequences was seen in the peripheral nerve fascicles of patients with clinical and electrodiagnostic evidence of nerve injury. CONCLUSION MRN proved useful in the preoperative evaluation and planning of surgery in patients with peripheral nerve lesions.

Three-dimensional time-of-flight MR angiography in the evaluation of cerebral aneurysms.

We review our preliminary experience with the use of three-dimensional (3D) time-of-flight (TOF) magnetic resonance (MR) angiography (MRA) in the assessment of intra- and extracranial aneurysms. Six patients were examined: Five had intracranial aneurysms and one had a cervical carotid pseudoaneurysm. A 3D rephased gradient recalled echo pulse sequence and maximum intensity projection (MIP) reconstruction algorithm were used. Magnetic resonance angiography, spin echo MR, and conventional angiography were retrospectively reviewed with specific regard to individual vessel visualization, aneurysm depiction, and presence of artifact related to acquisition techniques or MIP reconstruction. All aneurysms were detected on MRA, and anatomical correlation with conventional angiography was excellent. Significant problems included loss of visualization of small vessels, intraluminal signal loss in large vessels, subacute thrombus simulating flow on MIP reconstructions, and limited projections obtainable with MIP techniques. Adequate MRA assessment of aneurysms can be obtained using a combination of T1-weighted spin echo images and 3D TOF MRA. Review of all components of the MRA is required. MRA may be useful in screening asymptomatic patients for intracranial aneurysms as well as in the follow-up of patients treated with balloon occlusion.

Elevated Lactate and Alkalosis in Chronic Human Brain Infarction Observed by 1H and 31P MR Spectroscopic Imaging

The goal of this study was to investigate lactate and pH distributions in subacutely and chronically infarcted human brains. Magnetic resonance spectroscopic imaging (MRSI) was used to map spatial distributions of 1H and 31P metabolites in 11 nonhemorrhagic subacute to chronic cerebral infarction patients and 11 controls. All six infarcts containing lactate were alkalotic (pHi = 7.20 ± 0.04 vs. 7.05 ± 0.01 contralateral, p < 0.01). This finding of elevated lactate and alkalosis in chronic infarctions does not support the presence of chronic ischemia; however, it is consistent with the presence of phagocytic cells, gliosis, altered buffering mechanisms, and/or luxury perfusion. Total 1H and 31P metabolites were markedly reduced (about 50% on average) in subacute and chronic brain infarctions (p < 0.01), and N-acetyl aspartate (NAA) was reduced more (∼75%) than other metabolites (p < 0.01). Because NAA is localized in neurons, selective NAA reduction is consistent with pathological findings of a greater loss of neurons than glial cells in chronic infarctions.

Magnetic resonance neurography of peripheral nerve degeneration and regeneration

1To date, no study has shown that this technique can visualise the process of peripheral nerve degeneration and regeneration over time. We show how MRN signal changes during degeneration and regeneration of an injured peripheral nerve correlated with clinical and electrodiagnostic findings. A 29-year-old man had a traumatic laceration of the right sciatic nerve in the lower thigh resulting in an inability to dorsiflex and evert his right foot. Emergency surgery documented complete transection of the peroneal nerve which was surgically anastomosed. On referral 2 months later, clinical and electrodiagnostic examinations confirmed complete denervation of all muscles supplied by this nerve. Follow-up examinations 4 and 6 months after the injury showed no reinnervation of these muscles. MRN images were obtained on a 1·5-Tesla scanner (Signa; General Electric, Milwaukee, WI) with custom-designed phasedarray coils and imaging protocols previously described: 1

Congenital muscular dystrophy with rigid spine syndrome: a clinical, pathological, radiological, and genetic study.

Rigid spine syndrome is a term first proposed by Dubowitz to describe a subset of patients affected by myopathy with early spinal contractures as a prominent feature. While spinal rigidity is a nonspecific feature, found in Emery‐Dreifuss muscular dystrophy and in some congenital myopathies, it is also a prominent feature in a group of patients with merosin‐positive congenital muscular dystrophy, where it is generally associated with stable or only slowly progressive weakness and early respiratory insufficiency. Recently, the first locus for congenital muscular dystrophy in association with rigid spine syndrome was mapped to chromosome 1p35‐p36 in consanguineous Moroccan, Turkish, and Iranian families. We present here a detailed phenotypic description of the familial syndrome linked to this locus, describing 4 siblings (3 boys and 1 girl) of Northern European‐American heritage who are the offspring of a nonconsanguineous marriage. All 4 siblings were affected by hypotonia and prominent neck weakness in infancy, early spinal rigidity, and early scoliosis. After initial improvement, muscle strength stabilizes or slowly declines, and skeletal deformities and respiratory insufficiency supervene. Muscle biopsy in an affected child at age 9 months revealed minimal, nonspecific myopathic changes, leading to a diagnosis of “minimal change myopathy.” Muscle biopsy in his sibling, at the age of 14 years, revealed chronic and severe myopathic (dystrophic) changes, with normal staining for laminin‐2 and for proteins of the dystrophin–glycoprotein complex. A possible explanation for these biopsy findings is that magnetic resonance imaging of the thighs reveals stereotyped selective muscle involvement, with the selectivity more pronounced early in the disease course followed by widespread muscular signal abnormalities in the late stages of the disease. In this family, linkage to the chromosome 1p rigid spine syndrome locus (RSMD1) is supported by maximum LOD scores for several markers of 1.81 at θ = 0, representing the maximum statistical power possible for this family. In combination with the previous report, this syndrome is linked to the RSMD1 locus with a summated maximum LOD score of 6.29, and analysis of recombination events in our family narrows the previously reported RSMD1 locus to 3 centiMorgans. Ann Neurol 2000;47:152–161.

Improved efficiency in double-inversion fast spin-echo imaging

Double‐inversion fast spin‐echo (FSE) pulse sequences can be designed to provide excellent suppression of blood signal in black‐blood MRI. However, because a nonselective inversion is used, these sequences typically have been highly inefficient. In this work it is demonstrated that the efficiency of double‐inversion sequences can be greatly improved by a form of interleaving in which all of the slices to be imaged in a single pass are reinverted each time a signal is obtained from any single slice. To date, several studies have demonstrated a high level of blood suppression with these more efficient techniques. Magn Reson Med 47:1017– 1021, 2002.