Petros Martirosian

Relaxivity of Gadopentetate Dimeglumine (Magnevist), Gadobutrol (Gadovist), and Gadobenate Dimeglumine (MultiHance) in human blood plasma at 0.2, 1.5, and 3 Tesla.

Objectives:We sought to determine the relaxivity and accurate relaxation rates of Gd-DTPA, Gd-BT-DO3A, and Gd-BOPTA at 0.2, 1.5, and 3 T in human blood plasma. Materials and Methods:Contrast media concentrations between 0.01 and 16 mM in human plasma were used for relaxation measurements. The R1 and R2 relaxation rates and r1 and r2 relaxivities were determined. Results:Gd-BOPTA produced the highest relaxation rates and relaxivities at all field strengths. The r1 and r2 values for Gd-BOPTA were 107–131% and 91–244% higher than for Gd-DTPA, respectively, and 72–98% and 82–166% higher than for Gd-BT-DO3A. Higher field strengths resulted in lower values of R1, R2, and r1 for all contrast agents tested and of r2 for Gd-DTPA and Gd-BT-DO3A. A linear dependence of R1 and R2 on concentration was found for Gd-DTPA and Gd-BT-DO3A and a nonlinear dependence for Gd-BOPTA for concentrations larger than 1 mM. The r1 and r2 relaxivity of Gd-BOPTA increased with decreasing concentration. Conclusions:Gd-BOPTA demonstrates the highest longitudinal r1 at all field strengths, which is ascribable to weak protein interaction. The R2/R1 ratio increases at higher field strength only for Gd-BOPTA, hence very short echo times are required for Gd-BOPTA to benefit from the higher longitudinal relaxivity.

FAIR True-FISP perfusion imaging of the kidneys

Most arterial spin labeling (ASL) techniques apply echoplanar imaging (EPI) because this strategy provides relatively high SNR in short measuring times. Unfortunately, those techniques are very susceptible to static magnetic field inhomogeneities and perfusion signals from organs with fast transverse relaxation might decrease due to the exchange of water molecules in capillaries and organ tissue combined with relatively long echo times of EPI sequences. To overcome these problems a novel imaging technique, FAIR True‐FISP, was developed. It combines a FAIR (flow‐sensitive alternating inversion recovery) perfusion preparation and a true fast imaging with steady precession (True‐FISP) data acquisition strategy. True‐FISP was chosen since this sequence type does not show the mentioned disadvantages of EPI, but provides a similar SNR per measuring time. An important problem of this approach is that True‐FISP sequences usually work in a steady state which is independent of a previous preparation of magnetization. For this reason a sequence structure had to be developed which keeps the advantages of True‐FISP and makes the signal intensity sensitive to the FAIR preparation. Breathhold and nonbreathhold examinations of kidneys are presented and possible strategies to quantitative flow measurements are reported. It is shown that correction of spatially inhomogeneous receiver coil characteristics is easily feasible and leads to clinically valuable perfusion examinations of kidneys without application of potentially nephrotoxic contrast media. Magn Reson Med 51:353–361, 2004.

Respiratory Motion Correction in Oncologic PET Using T1-Weighted MR Imaging on a Simultaneous Whole-Body PET/MR System

Hybrid PET/MR combines the exceptional molecular sensitivity of PET with the high resolution and versatility of MR imaging. Simultaneous data acquisition additionally promises the use of MR to enhance the quality of PET images, for example, by respiratory motion correction. This advantage is especially relevant in thoracic and abdominal areas to improve the visibility of small lesions with low radiotracer uptake and to enhance uptake quantification. In this work, the applicability and performance of an MR-based method of respiratory motion correction for PET tumor imaging was evaluated in phantom and patient studies. Methods: PET list-mode data from a motion phantom with 22Na point sources and 5 patients with tumor manifestations in the thorax and upper abdomen were acquired on a simultaneous hybrid PET/MR system. During the first 3 min of a 5-min PET scan, the respiration-induced tissue deformation in the PET field of view was recorded using a sagittal 2-dimensional multislice gradient echo MR sequence. MR navigator data to measure the location of the diaphragm were acquired throughout the PET scan. Respiration-gated PET data were coregistered using the MR-derived motion fields to obtain a single motion-corrected PET dataset. The effect of motion correction on tumor visibility, delineation, and radiotracer uptake quantification was analyzed with respect to uncorrected and gated images. Results: Image quality in terms of lesion delineation and uptake quantification was significantly improved compared with uncorrected images for both phantom and patient data. In patients, in head–feet line profiles of 14 manifestations, the slope became steeper by 66.7% (P = 0.001) and full width at half maximum was reduced by 20.6% (P = 0.001). The mean increase in maximum standardized uptake value, lesion-to-background ratio (contrast), and signal-to-noise ratio was 28.1% (P = 0.001), 24.7% (P = 0.001), and 27.3% (P = 0.003), respectively. Lesion volume was reduced by an average of 26.5% (P = 0.002). As opposed to the gated images, no increase in background noise was observed. However, motion correction performed worse than gating in terms of contrast (−11.3%, P = 0.002), maximum standardized uptake value (−10.7%, P = 0.003), and slope steepness (−19.3%, P = 0.001). Conclusion: The proposed method for MR-based respiratory motion correction of PET data proved feasible and effective. The short examination time and convenience (no additional equipment required) of the method allow for easy integration into clinical routine imaging. Performance compared with gating procedures can be further improved using list-mode–based motion correction.

Simultaneous PET-MRI reveals brain function in activated and resting state on metabolic, hemodynamic and multiple temporal scales

Combined positron emission tomography (PET) and magnetic resonance imaging (MRI) is a new tool to study functional processes in the brain. Here we study brain function in response to a barrel-field stimulus simultaneously using PET, which traces changes in glucose metabolism on a slow time scale, and functional MRI (fMRI), which assesses fast vascular and oxygenation changes during activation. We found spatial and quantitative discrepancies between the PET and the fMRI activation data. The functional connectivity of the rat brain was assessed by both modalities: the fMRI approach determined a total of nine known neural networks, whereas the PET method identified seven glucose metabolism–related networks. These results demonstrate the feasibility of combined PET-MRI for the simultaneous study of the brain at activation and rest, revealing comprehensive and complementary information to further decode brain function and brain networks.

Quantification of pancreatic lipomatosis and liver steatosis by MRI: comparison of in/opposed-phase and spectral-spatial excitation techniques.

Objectives:The goal of the present study was the assessment of pancreatic and hepatic fat content applying 2 established magnetic resonance (MR) imaging techniques: in-phase/opposed-phase gradient-echo MR imaging and fat-selective spectral-spatial gradient-echo imaging. Results of both approaches were compared, and influences of T1- and T2*-related corrections were assessed. The possibility of a correlation between pancreatic lipomatosis and liver steatosis was investigated. Materials and Methods:Seventeen volunteers at risk for type 2 diabetes (6 male, 11 female; age, 26–70 years; body mass index, 19.4–41.3 kg/m2; mean, 31.7 kg/m2) were examined. Liver and pancreas fat content were quantified with 2 different gradient-echo techniques: one uses a spectral-spatial excitation technique with 6 binomial radio frequency pulses, which combines chemical shift selectivity with simultaneous slice-selective excitation. The other technique based on double-echo chemical shift gradient-echo MR provides in- and opposed-phase images simultaneously. Influences of T1 and individual T2* effects on results using in-phase/opposed-phase imaging were estimated and corrected for, based on additional T2* measurements. Results:The fat content calculated from images recorded with the fat-selective spectral-spatial gradient-echo sequence correlated well with the fat fraction determined with in-phase/opposed-phase imaging and following correction for T1/T2* effects: pancreas r = 0.93 (P < 0.0001) and liver r = 0.96 (P < 0.0001). In-phase/opposed-phase imaging revealed a pancreatic fat content between 1.6% and 22.2% (mean, 8.8% ± 5.7%) and a hepatic fat fraction between 0.6% and 33.3% (mean, 7.9% ± 9.1%). The fat-selective spectral-spatial gradient-echo sequence revealed a pancreatic lipid content between 3.4% and 16.1% (mean, 9.8% ± 4.0%) and a hepatic fat content between 0% and 28.5% (mean, 8.8% ± 8.3%). With neither technique was a substantial correlation between pancreatic and hepatic fat content found. Conclusion:The presented results suggest that both methods are reliable tools for pancreatic and hepatic fat quantification. However, for reliable assessment of quantitative fat by the in-phase/opposed-phase technique, an additional measurement of T2* seems crucial.

Diffusion-Weighted MRI of Advanced Hepatocellular Carcinoma During Sorafenib Treatment: Initial Results

OBJECTIVE The objective of our study was to evaluate signal changes of advanced hepatocellular carcinoma in diffusion-weighted MRI in the early-response monitoring of oral therapy with the multikinase inhibitor sorafenib. CONCLUSION Hepatocellular carcinoma lesions exhibit characteristic but unusual apparent diffusion coefficient (ADC) changes during sorafenib therapy, consisting of early decrease in ADC after therapy onset followed by a reincrease. The ADC changes seem to reflect the underlying pathophysiologic mechanisms in tumor necrosis (most probably hemorrhagic) induced by this novel targeted agent early after therapy onset and may indicate tumor reactivation in the later follow-up period.

Correlation of Simultaneously Acquired Diffusion-Weighted Imaging and 2-Deoxy-[18F] fluoro-2-D-glucose Positron Emission Tomography of Pulmonary Lesions in a Dedicated Whole-Body Magnetic Resonance/Positron Emission Tomography System

ObjectiveHybrid whole-body magnetic resonance/positron emission tomography (MR/PET) systems are a new diagnostic tool enabling the simultaneous acquisition of morphologic and multiple functional data and thus allowing for a diversified characterization of oncological diseases.The aim of this study was to investigate the image and alignment quality of MR/PET in patients with pulmonary lesions and to compare the congruency of the 2 functional measurements of diffusion-weighted imaging (DWI) in MR imaging and 2-deoxy-[18F] fluoro-2-D-glucose (FDG) uptake in PET. Materials and MethodsA total of 15 patients were examined with a routine positron emission tomography/computer tomography (PET/CT) protocol and, subsequently, in a whole-body MR/PET scanner allowing for simultaneous PET and MR data acquisition. The PET and MR image quality was assessed visually using a 4-point score (1, insufficient; 4, excellent). The alignment quality of the rigidly registered PET/CT and MR/PET data sets was investigated on the basis of multiple anatomic landmarks of the lung using a scoring system from 1 (no alignment) to 4 (very good alignment). In addition, the alignment quality of the tumor lesions in PET/CT and MR/PET as well as for retrospective fusion of PET from PET/CT and MR images was assessed quantitatively and was compared between lesions strongly or less influenced by respiratory motion. The correlation of the simultaneously acquired DWI and FDG uptake in the pulmonary masses was analyzed using the minimum and mean apparent diffusion coefficient (ADCmin and ADCmean) as well as the maximum and mean standardized uptake value (SUVmax and SUVmean), respectively. In addition, the correlation of SUVmax from PET/CT data was investigated as well. On lesions 3 cm or greater, a voxelwise analysis of ADC and SUV was performed. ResultsThe visual evaluation revealed excellent image quality of the PET images (mean [SD] score, 3.6 [0.5]) and overall good image quality of DWI (mean [SD] score of 2.5 [0.5] for ADC maps and 2.7 [0.5] for diffusion-weighted images, respectively). The alignment quality of the data sets was very good in both MR/PET and PET/CT without significant differences (overall mean [SD] score of MR/PET, 3.8 [0.4]; PET/CT 3.6 [0.5]). Also, the alignment quality of the tumor lesions showed no significant differences between PET/CT and MR/PET (mean cumulative misalignment of MR/PET, 7.7 mm; PET/CT, 7.0 mm; P = 0.705) but between both modalities and a retrospective fusion (mean cumulative misalignment, 17.1 mm; P = 0.002 and P = 0.008 for PET/CT and MR/PET, respectively). Also, the comparison of the lesions strongly or less influenced by respiratory motion showed significant differences only for the retrospective fusion (21.3 mm vs 11.5 mm, respectively; P = 0.043). The ADCmin and SUVmax as measures of the cell density and glucose metabolism showed a significant reverse correlation (r = −0.80; P = 0.0006). No significant correlation was found between ADCmean and SUVmean (r = −0.42; P = 0.1392). Also, SUVmax from the PET/CT data showed significant reverse correlation to ADCmin (r = −0.62; P = 0.019). The voxelwise analysis of 5 pulmonary lesions each showed weak but significant negative correlation between ADC and SUV. ConclusionsExaminations of pulmonary lesions in a simultaneous whole-body MR/PET system provide diagnostic image quality in both modalities. Although DWI and FDG-PET reflect different tissue properties, there may very well be an association between the measures of both methods most probably because of increased cellularity and glucose metabolism of FDG-avid pulmonary lesions. A voxelwise DWI and FDG-PET correlation might provide a more sophisticated spatial characterization of pulmonary lesions.

T2- and diffusion-maps reveal diurnal changes of intervertebral disc composition: an in vivo MRI study at 1.5 Tesla.

To investigate the lumbar intervertebral discs (IVDs) by MRI in the morning and evening after a diurnal load cycle. Changes in MR characteristics (T2‐weighted imaging, T2‐ and apparent diffusion coefficient [ADC] ‐mapping) during the course of the day were visualized and analyzed visually and quantitatively. The length of the lumbar spine was measured in between the lower anterior edge of Th12 and the upper anterior edge of S1. T2 changes and diffusion characteristics of the vertebral disc tissue were investigated with a higher spatial resolution than in former studies.

Measurement of kidney perfusion by magnetic resonance imaging: comparison of MRI with arterial spin labeling to para-aminohippuric acid plasma clearance in male subjects with metabolic syndrome

BACKGROUND Magnetic resonance imaging with arterial spin labeling (MRI-ASL) is a non-invasive approach to measure organ perfusion. We aimed to examine whether MRI-ASL kidney perfusion measurements are related to measurements of renal plasma flow (RPF) by para-aminohippuric acid (PAH) plasma clearance and whether changes of kidney perfusion in response to treatment with telmisartan can be detected by MRI-ASL. METHODS Twenty-four patients with metabolic syndrome and an estimated creatinine clearance according to Cockroft and Gault of > or =60 ml/min were included in the study. Kidney perfusion was assessed by MRI-ASL measurements of a single coronal kidney slice (with flow-sensitive alternating inversion recovery and true fast imaging with steady-state processing sequence) and by measurements of RPF using PAH plasma clearance before and after 2 weeks of treatment with the angiotensin receptor blocker telmisartan. All MRI-ASL examinations were performed on a 1.5 T scanner. RESULTS Two weeks of therapy with telmisartan led to a significant increase of RPF (from 313 +/- 47 to 348 +/- 69 ml/min/m, P = 0.007) and MRI-ASL kidney perfusion measurements (from 253 +/- 20 to 268 +/- 25 ml/min/100 g, P = 0.020). RPF measurements were related with MRI-ASL kidney perfusion measurements (r = 0.575, P < 0.001). Changes of RPF measurements and changes of MRI-ASL kidney perfusion measurements in response to treatment with telmisartan revealed a close relationship when expressed in absolute terms (r = 0.548, P = 0.015) and in percentage changes (r = 0.514, P = 0.025). CONCLUSIONS Perfusion measurement of a single coronal kidney slice by MRI-ASL is able to approximate kidney perfusion and to approximate changes in kidney perfusion due to pharmacological intervention.

Diffusion tensor imaging of the human calf muscle: distinct changes in fractional anisotropy and mean diffusion due to passive muscle shortening and stretching

The influence of passive shortening and stretching of the calf muscles on diffusion characteristics was investigated. The diffusion tensor was measured in transverse slices through the lower leg of eight healthy volunteers (29 ± 7 years) on a 3 T whole‐body MR unit in three different positions of the foot (40° plantarflexion, neutral ankle position (0°), and −10° dorsiflexion in the ankle). Maps of the mean diffusivity, the three eigenvalues of the tensor and fractional anisotropy (FA) were calculated. Results revealed a distinct dependence of the mean diffusivity and FA on the foot position and the related shortening and stretching of the muscle groups. The tibialis anterior muscle showed a significant increase of 19% in FA with increasing dorsiflexion, while the FA of the antagonists significantly decreased (∼20%). Regarding the mean diffusivity of the diffusion tensor, the muscle groups showed an opposed response to muscle elongation and shortening. Regarding the eigenvalues of the diffusion tensor, λ2 and λ3 showed significant changes in relation to muscle length. In contrast, no change in λ1 could be found. This work reveals significant changes in diffusional characteristics induced by passive muscle shortening and stretching. Copyright