Lothar R. Schad

Pharmacokinetic Parameters in Cns Gd-dtpa Enhanced Mr Imaging

Dynamic MR imaging can be used to study tissue perfusion and vascular permeability. In the present article a procedure for dynamic MR is presented, which (a) accurately resolves the fast kinetics of tissue response during and after intravenous infusion of the paramagnetic contrast medium Gd-DTPA and (b) yields a linear relationship between the measured MR signal and the Gd-DTPA concentration in the tissue. According to these features, the measured signal-time curves can be analyzed within the framework of pharmacokinetic modeling. Tissue response has been parameterized using a linear two-compartment open model, with only negligible effects of the peripheral compartment on the central compartment. The three model parameters were fitted to the signal-time data pixel by pixel, based on a set of 64 rapid SE images (SE 100/10 ms, image scan time 13 s, interscan intervals 11 s). This makes it possible to construct parameter images, whereby structures become visible that cannot be distinguished in conventional Gd-DTPA enhanced MR. As a clinical example, the approach is discussed in a case of glioblastoma.

Prospective acquisition correction for head motion with image-based tracking for real-time fMRI.

In functional magnetic resonance imaging (fMRI) head motion can corrupt the signal changes induced by brain activation. This paper describes a novel technique called Prospective Acquisition CorrEction (PACE) for reducing motion‐induced effects on magnetization history. Full three‐dimensional rigid body estimation of head movement is obtained by image‐based motion detection to a high level of accuracy. Adjustment of slice position and orientation, as well as regridding of residual volume to volume motion, is performed in real‐time during data acquisition. Phantom experiments demonstrate a high level of consistency (translation < 40μm; rotation < 0.05°) for detected motion parameters. In vivo experiments were carried out and they showed a significant decrease of variance between successively acquired datasets compared to retrospective correction algorithms. Magn Reson Med 44:457–465, 2000.

Diffusion tensor imaging of cingulum fibers in mild cognitive impairment and Alzheimer disease

Background: Neuroimaging in mild cognitive impairment (MCI) and Alzheimer disease (AD) generally shows medial temporal lobe atrophy and diminished glucose metabolism and cerebral blood flow in the posterior cingulate gyrus. However, it is unclear whether these abnormalities also impact the cingulum fibers, which connect the medial temporal lobe and the posterior cingulate regions. Objective: To use diffusion tensor imaging (DTI), by measuring fractional anisotropy (FA), to test 1) if MCI and AD are associated with DTI abnormalities in the parahippocampal and posterior cingulate regions of the cingulum fibers; 2) if white matter abnormalities extend to the neocortical fiber connections in the corpus callosum (CC); 3) if DTI improves accuracy to separate AD and MCI from healthy aging vs structural MRI. Methods: DTI and structural MRI were preformed on 17 patients with AD, 17 with MCI, and 18 cognitively normal (CN) subjects. Results: FA of the cingulum fibers was significantly reduced in MCI, and even more in AD. FA was also significantly reduced in the splenium of the CC in AD, but not in MCI. Adding DTI to hippocampal volume significantly improved the accuracy to separate MCI and AD from CN. Conclusion: Assessment of the cingulum fibers using diffusion tensor imaging may aid early diagnosis of Alzheimer disease.

Stereotactic fractionated radiotherapy for chordomas and chondrosarcomas of the skull base

PURPOSE To investigate the treatment outcome of patients suffering from skull base chordoma or chondrosarcoma after fractionated stereotactic radiotherapy. METHODS AND MATERIALS We report 45 patients treated for chordoma or chondrosarcoma with postoperative fractionated stereotactic radiotherapy between 1990 and 1997. Patients had CT and MRI for 3D treatment planning performed under stereotactic guidance. Median dose at isocenter was 66.6 Gy for chordomas and 64.9 Gy for chondrosarcomas. MRI imaging was obtained in intervals after therapy to evaluate local relapse. Survival was calculated according to the Kaplan-Meier method. RESULTS All chondrosarcomas had achieved and maintained local control and recurrence-free status at follow-up of 5 years. Local control rate of chordomas was 82% at 2 years and 50% at 5 years. Survival was 97% at 2 years and 82% at 5 years. At maximum follow-up of 8 years local control and survival rate of chordomas was 40% (82%). Clinically significant late toxicity developed in one patient. CONCLUSIONS Our results demonstrate the feasibility of fractionated photon beam therapy and its success in the treatment of skull base tumors. Modern 3D treatment techniques provide superior results compared to conventional techniques. The role of high-precision radiotherapy compared to particle beam therapy in the treatment of these tumors is not yet fully clear and further research is needed.

Arterial spin labeling in combination with a look‐locker sampling strategy: Inflow turbo‐sampling EPI‐FAIR (ITS‐FAIR)

Arterial spin labeling (ASL) permits quantification of tissue perfusion without the use of MR contrast agents. With standard ASL techniques such as flow‐sensitive alternating inversion recovery (FAIR) the signal from arterial blood is measured at a fixed inversion delay after magnetic labeling. As no image information is sampled during this delay, FAIR measurements are inefficient and time‐consuming. In this work the FAIR preparation was combined with a Look‐Locker acquisition to sample not one but a series of images after each labeling pulse. This new method allows monitoring of the temporal dynamics of blood inflow. To quantify perfusion, a theoretical model for the signal dynamics during the Look‐Locker readout was developed and applied. Also, the imaging parameters of the new ITS‐FAIR technique were optimized using an expression for the variance of the calculated perfusion. For the given scanner hardware the parameters were: temporal resolution 100 ms, 23 images, flip‐angle 25.4°. In a normal volunteer experiment with these parameters an average perfusion value of 48.2 ± 12.1 ml/100 g/min was measured in the brain. With the ability to obtain ITS‐FAIR time series with high temporal resolution arterial transit times in the range of −138 − 1054 ms were measured, where nonphysical negative values were found in voxels containing large vessels. Magn Reson Med 46:974–984, 2001.

Differentiation of Pancreas Carcinoma From Healthy Pancreatic Tissue Using Multiple b-Values: Comparison of Apparent Diffusion Coefficient and Intravoxel Incoherent Motion Derived Parameters

Objectives:To evaluate in detail the diagnostic performance of diffusion-weighted imaging (DWI) to differentiate pancreas carcinoma from healthy pancreas using the apparent diffusion coefficient (ADC) and parameters derived from the intravoxel incoherent motion (IVIM) theory. Materials and Methods:Twenty-three patients with pancreas carcinoma and 14 volunteers with healthy pancreas were examined at 1.5 Tesla using a single-shot echo-planar imaging DWI pulse sequence. Eleven b-values ranging from 0 to 800 s/mm2 were used. The acquisition was separated into blocks (b0, b25), (b0, b50),...(b0, b800) and each block was acquired in a single expirational breath-hold (TA = 26 seconds) to avoid motion artifacts. The ADC was calculated for all b-values using linear regression yielding ADCtot. By applying the IVIM model, which allows for the estimation of perfusion effects in DWI, the perfusion fraction f and the perfusion free diffusion parameter D were calculated. The diagnostic performance of ADC, f and D as a measure for the differentiation between healthy pancreas and pancreatic carcinoma was evaluated with receiver operating characteristics analysis. Results:In the healthy control group, the ADCtot ranged from 1.53 to 2.01 &mgr;m2/ms with a mean value of 1.71 ± 0.19 &mgr;m2/ms, the perfusion fraction f ranged from 18.5% to 40.4% with a mean value of 25.0 ± 6.2%, and the diffusion coefficient D from 0.94 to 1.28 &mgr;m2/ms with a mean value of 1.13 ± 0.15 &mgr;m2/ms. In patients with pancreas carcinoma, the ADCtot ranged from 0.98 to 1.81 &mgr;m2/ms with a mean value of 1.31 ± 0.24 &mgr;m2/ms, the perfusion fraction f ranged from 0% to 20.4% with a mean value of 8.59 ± 4.6% and the diffusion coefficient D from 0.74 to 1.60 &mgr;m2/ms with a mean value of 1.15 ± 0.22 &mgr;m2/ms. In comparison to healthy pancreatic tissue, a significant reduction of the perfusion fraction f and of ADCtot was found in pancreatic carcinoma (P < 0.00001, 0.0002, respectively). The f value showed more than a 10-fold higher significance level in distinguishing cancerous from normal tissue when compared with the ADCtot value. No significant difference in the diffusion coefficient D was observed between the 2 groups (P > 0.5). In the receiver operating characteristic-analyses, the area under curve for f was 0.991 and significantly larger than ADCtot (P < 0.05). f had the highest sensitivity, specificity, negative predictive value, and positive predictive value with 95.7%, 100%, 93.3%, and 100%, respectively. Conclusions:Using the IVIM-approach, the f value proved to be the best parameter for the differentiation between healthy pancreas and pancreatic cancer. The acquisition of several b-values strongly improved the stability of the parameter estimation thus increasing the sensitivity and specificity to 95.7% and 100% respectively. The proposed method may hold great promise for the non invasive, noncontrast-enhanced imaging of pancreas lesions and may eventually become a screening tool for pancreatic cancer.

VIII. MR image texture analysis—An approach to tissue characterization

The role and value of texture analysis in the quantification of medical images is reviewed and the various methods described. The promise in magnetic resonance imaging is discussed and the coordinated research programme being carried out within the framework of the European Economic Community Concerted Action on Tissue Characterization by MRS and MRI is outlined. Tissue characterization of the human brain has been performed by texture analysis of proton relaxation time images using a standard MR whole body imager operating at 1.5 T and the results are presented.

Three dimensional image correlation of CT, MR, and PET studies in radiotherapy treatment planning of brain tumors

Abstract A treatment planning system for stereotactic convergent beam irradiation of deeply localized brain tumors is reported. The treatment technique consists of several moving field irradiations in noncoplanar planes at a linear accelerator facility. Using collimated narrow beams, a high concentration of dose within small volumes with a dose gradient of 10-15%/mm was obtained. The dose calculation was based on geometrical information of multiplanar CT or magnetic resonance (MR) imaging data. The patients head was fixed in a stereotactic localization system, which is usable at CT, MR, and positron emission tomography (PET) installations. Special computer programs for correction of the geometrical MR distortions allowed a precise correlation of the different imaging modalities. The therapist can use combinations of CT, MR, and PET data for defining target volume. For instance, the superior soft tissue contrast of MR coupled with the metabolic features of PET may be a useful addition in the radiation treatment planning process. Furthermore, other features such as calculated dose distribution to critical structures can also be transferred from one set of imaging data to another and can be displayed as three-dimensional shaded structures.

Toward an optimal distribution of b values for intravoxel incoherent motion imaging

The intravoxel incoherent motion (IVIM) theory provides a framework for the separation of perfusion and diffusion effects in diffusion-weighted imaging (DWI). To measure the three free IVIM parameters, DWIs with several diffusion weightings b must be acquired. To date, the used b value distributions are chosen heuristically and vary greatly among researchers. In this work, optimal b value distributions for the three parameter fit are determined using Monte-Carlo simulations for the measurement of a low, medium and high IVIM perfusion regime. The first 16 b values of a b value distribution, which was optimized to be appropriate for all three regimes, are {0, 40, 1000, 240, 10, 750, 90, 390, 170, 10, 620, 210, 100, 0, 530 and 970} in units of seconds per square meter. This distribution performed well for all organs and outperformed a distribution frequently used in the literature. In case of limited acquisition time, the b values should be chosen in the given order, but at least 10 b values should be used for current clinical settings. The overall parameter estimation quality depends strongly and nonlinearly on the signal-to-noise ratio (SNR): it is essential that the SNR is considerably higher than a critical SNR. This critical SNR is about 8 for medium and high IVIM perfusion and 50 for the low IVIM perfusion regime. Initial in vivo IVIM measurements were performed in the abdomen and were in keeping with the numerically simulated results.

Fast and precise T1 imaging using a TOMROP sequence

Proton spin-lattice (T1) relaxation time images were computed from a data set of 32 gradient-echo images acquired with a fast TOMROP (T One by Multiple Read Out Pulses) sequence using a standard whole-body MR imager operating at 64 MHz. The data acquisition and analysis method which permits accurate pixel-by-pixel estimation of T1 relaxation times is described. As an example, the T1 parameter image of a human brain is shown demonstrating an excellent image quality. For white and gray brain matter, the measured longitudinal relaxation processes are adequately described by a single-component least-squares fit, while more than one proton component has to be considered for fatty tissue. A quantitative analysis yielded T1 values of 547 +/- 36 msec and 944 +/- 73 msec for white and gray matter, respectively.