Kieran O'Brien

Measuring brain perfusion with intravoxel incoherent motion (IVIM): Initial clinical experience

To evaluate the feasibility of intravoxel incoherent motion (IVIM) perfusion measurements in the brain with currently available imaging systems.

MRI phase contrast velocity and flow errors in turbulent stenotic jets

To clarify the use of MRI phase contrast (PC), as an alternative to Doppler echocardiography, when measuring high‐velocity turbulent jets associated with stenotic valvular disease.

Assessing white matter microstructure of the newborn with multi-shell diffusion MRI and biophysical compartment models

Brain white matter connections have become a focus of major interest with important maturational processes occurring in newborns. To study the complex microstructural developmental changes in-vivo, it is imperative that non-invasive neuroimaging approaches are developed for this age-group. Multi-b-value diffusion weighted imaging data were acquired in 13 newborns, and the biophysical compartment diffusion models CHARMED-light and NODDI, providing new microstructural parameters such as intra-neurite volume fraction (νin) and neurite orientation dispersion index (ODI), were developed for newborn data. Comparative analysis was performed and twenty ROIs in the white matter were investigated. Diffusion tensor imaging and both biophysical compartment models highlighted the compact and oriented structure of the corpus-callosum with the highest FA and νin values and the smallest ODI values. We could clearly differentiate, using the FA, νin and ODI, the posterior and anterior internal capsule representing similar cellular structure but with different maturation (i.e. partially myelinated and absence of myelin, respectively). Late maturing regions (external capsule and periventricular crossroads of pathways) had lower νin values, but displayed significant differences in ODI. The compartmented models CHARMED-light and NODDI bring new indices corroborating the cellular architectures, with the lowest νin, reflecting the late maturation of areas with thin non-myelinated fibers, and with highest ODI indicating the presence of fiber crossings and fanning. The application of biophysical compartment diffusion models adds new insights to the brain white matter development in vivo.

Perfusion Measurement in Brain Gliomas with Intravoxel Incoherent Motion MRI

BACKGROUND AND PURPOSE: Intravoxel incoherent motion MRI has been proposed as an alternative method to measure brain perfusion. Our aim was to evaluate the utility of intravoxel incoherent motion perfusion parameters (the perfusion fraction, the pseudodiffusion coefficient, and the flow-related parameter) to differentiate high- and low-grade brain gliomas. MATERIALS AND METHODS: The intravoxel incoherent motion perfusion parameters were assessed in 21 brain gliomas (16 high-grade, 5 low-grade). Images were acquired by using a Stejskal-Tanner diffusion pulse sequence, with 16 values of b (0–900 s/mm2) in 3 orthogonal directions on 3T systems equipped with 32 multichannel receiver head coils. The intravoxel incoherent motion perfusion parameters were derived by fitting the intravoxel incoherent motion biexponential model. Regions of interest were drawn in regions of maximum intravoxel incoherent motion perfusion fraction and contralateral control regions. Statistical significance was assessed by using the Student t test. In addition, regions of interest were drawn around all whole tumors and were evaluated with the help of histograms. RESULTS: In the regions of maximum perfusion fraction, perfusion fraction was significantly higher in the high-grade group (0.127 ± 0.031) than in the low-grade group (0.084 ± 0.016, P < .001) and in the contralateral control region (0.061 ± 0.011, P < .001). No statistically significant difference was observed for the pseudodiffusion coefficient. The perfusion fraction correlated moderately with dynamic susceptibility contrast relative CBV (r = 0.59). The histograms of the perfusion fraction showed a “heavy-tailed” distribution for high-grade but not low-grade gliomas. CONCLUSIONS: The intravoxel incoherent motion perfusion fraction is helpful for differentiating high- from low-grade brain gliomas.

Are glutamate and lactate increases ubiquitous to physiological activation? A 1H functional MR spectroscopy study during motor activation in human brain at 7Tesla

Recent studies at high field (7Tesla) have reported small metabolite changes, in particular lactate and glutamate (below 0.3μmol/g) during visual stimulation. These studies have been limited to the visual cortex because of its high energy metabolism and good magnetic resonance spectroscopy (MRS) sensitivity using surface coil. The aim of this study was to extend functional MRS (fMRS) to investigate for the first time the metabolite changes during motor activation at 7T. Small but sustained increases in lactate (0.17μmol/g±0.05μmol/g, p<0.001) and glutamate (0.17μmol/g±0.09μmol/g, p<0.005) were detected during motor activation followed by a return to the baseline after the end of activation. The present study demonstrates that increases in lactate and glutamate during motor stimulation are small, but similar to those observed during visual stimulation. From the observed glutamate and lactate increase, we inferred that these metabolite changes may be a general manifestation of the increased neuronal activity. In addition, we propose that the measured metabolite concentration increases imply an increase in ΔCMRO2 that is transiently below that of ΔCMRGlc during the first 1 to 2min of the stimulation.

Phase contrast ultrashort TE: A more reliable technique for measurement of high‐velocity turbulent stenotic jets

Accurate measurement of peak velocity is critical to the assessment of patients with stenotic valvular disease. Conventional phase contrast (PC) methods for imaging high‐velocity jets in aortic stenosis are susceptible to intravoxel dephasing signal loss, which can result in unreliable measurements. The most effective method for reducing intravoxel dephasing is to shorten the echo time (TE); however, the amount that TE can be shortened in conventional sequences is limited. A new sequence incorporating velocity‐dependent slice excitation and ultrashort TE (UTE) centric radial readout trajectories is proposed that reduces TE from 2.85 to 0.65 ms. In a high‐velocity stenotic jet phantom, a conventional sequence had >5% flow error at a flow rate of only 400 mL/s (velocity >358 cm/s), whereas the PC‐UTE showed excellent agreement (<5% error) at much higher flow rates (1080 mL/s, 965 cm/s). In vivo feasibility studies demonstrated that by measuring velocity over a shorter time the PC‐UTE approach is more robust to intravoxel dephasing signal loss. It also has less inherent higher‐order motion encoding. This sequence therefore demonstrates potential as a more robust method for measuring peak velocity and flow in high‐velocity turbulent stenotic jets. Magn Reson Med, 2009.

Aortic valve stenotic area calculation from phase contrast cardiovascular magnetic resonance: the importance of short echo time

BackgroundCardiovascular magnetic resonance (CMR) can potentially quantify aortic valve area (AVA) in aortic stenosis (AS) using a single-slice phase contrast (PC) acquisition at valve level: AVA = aortic flow/aortic velocity-time integral (VTI). However, CMR has been shown to underestimate aortic flow in turbulent high velocity jets, due to intra-voxel dephasing. This study investigated the effect of decreasing intra-voxel dephasing by reducing the echo time (TE) on AVA estimates in patients with AS.Method15 patients with moderate or severe AS, were studied with three different TEs (2.8 ms/2.0 ms/1.5 ms), in the main pulmonary artery (MPA), left ventricular outflow tract (LVOT) and 0 cm/1 cm/2.5 cm above the aortic valve (AoV). PC estimates of stroke volume (SV) were compared with CMR left ventricular SV measurements and PC peak velocity, VTI and AVA were compared with Doppler echocardiography. CMR estimates of AVA obtained by direct planimetry from cine acquisitions were also compared with the echoAVA.ResultsWith a TE of 2.8 ms, the mean PC SV was similar to the ventricular SV at the MPA, LVOT and AoV0 cm (by Bland-Altman analysis bias ± 1.96 SD, 1.3 ± 20.2 mL/-6.8 ± 21.9 mL/6.5 ± 50.7 mL respectively), but was significantly lower at AoV1 and AoV2.5 (-29.3 ± 31.2 mL/-21.1 ± 35.7 mL). PC peak velocity and VTI underestimated Doppler echo estimates by approximately 10% with only moderate agreement. Shortening the TE from 2.8 to 1.5 msec improved the agreement between ventricular SV and PC SV at AoV0 cm (6.5 ± 50.7 mL vs 1.5 ± 37.9 mL respectively) but did not satisfactorily improve the PC SV estimate at AoV1 cm and AoV2.5 cm. Agreement of CMR AVA with echoAVA was improved at TE 1.5 ms (0.00 ± 0.39 cm2) versus TE 2.8 (0.11 ± 0.81 cm2). The CMR method which agreed best with echoAVA was direct planimetry (-0.03 cm2 ± 0.24 cm2).ConclusionAgreement of CMR AVA at the aortic valve level with echo AVA improves with a reduced TE of 1.5 ms. However, flow measurements in the aorta (AoV 1 and 2.5) are underestimated and 95% limits of agreement remain large. Further improvements or novel, more robust techniques are needed in the CMR PC technique in the assessment of AS severity in patients with moderate to severe aortic stenosis.

Dielectric pads and low- B1+ adiabatic pulses: Complementary techniques to optimize structural T1w whole-brain MP2RAGE scans at 7 tesla

To evaluate the combination of low‐B1+ adiabatic pulses and high permittivity (εr ≈ 165) dielectric pads effectiveness to reproducibly improve the inversion efficiency for whole‐brain MP2RAGE scans, at ultra‐high field.

Improving T2 -weighted imaging at high field through the use of kT -points

At high magnetic field strengths (B0 ≥ 3 T), the shorter radiofrequency wavelength produces an inhomogeneous distribution of the transmit magnetic field. This can lead to variable contrast across the brain which is particularly pronounced in T2‐weighted imaging that requires multiple radiofrequency pulses. To obtain T2‐weighted images with uniform contrast throughout the whole brain at 7 T, short (2–3 ms) 3D tailored radiofrequency pulses (kT‐points) were integrated into a 3D variable flip angle turbo spin echo sequence.

Robust T1-weighted structural brain imaging and morphometry at 7T using MP2RAGE.

Purpose To suppress the noise, by sacrificing some of the signal homogeneity for numerical stability, in uniform T1 weighted (T1w) images obtained with the magnetization prepared 2 rapid gradient echoes sequence (MP2RAGE) and to compare the clinical utility of these robust T1w images against the uniform T1w images. Materials and Methods 8 healthy subjects (29.0±4.1 years; 6 Male), who provided written consent, underwent two scan sessions within a 24 hour period on a 7T head-only scanner. The uniform and robust T1w image volumes were calculated inline on the scanner. Two experienced radiologists qualitatively rated the images for: general image quality; 7T specific artefacts; and, local structure definition. Voxel-based and volume-based morphometry packages were used to compare the segmentation quality between the uniform and robust images. Statistical differences were evaluated by using a positive sided Wilcoxon rank test. Results The robust image suppresses background noise inside and outside the skull. The inhomogeneity introduced was ranked as mild. The robust image was significantly ranked higher than the uniform image for both observers (observer 1/2, p-value = 0.0006/0.0004). In particular, an improved delineation of the pituitary gland, cerebellar lobes was observed in the robust versus uniform T1w image. The reproducibility of the segmentation results between repeat scans improved (p-value = 0.0004) from an average volumetric difference across structures of ≈6.6% to ≈2.4% for the uniform image and robust T1w image respectively. Conclusions The robust T1w image enables MP2RAGE to produce, clinically familiar T1w images, in addition to T1 maps, which can be readily used in uniform morphometry packages.