BOLD Imaging Research Articles

Free-water and BOLD imaging changes in Parkinson's disease patients chronically treated with a MAO-B inhibitor.

Rasagiline is a monoamine oxidase type B inhibitor that possesses no amphetamine-like properties, and provides symptomatic relief in early and late stages of Parkinson's disease (PD). Data in animal models of PD suggest that chronic administration of rasagiline is associated with structural changes in the substantia nigra, and raise the question whether the structure and function of the basal ganglia could be different in PD patients treated chronically with rasagiline as compared with PD patients not treated with rasagiline. Here, we performed a retrospective cross-sectional magnetic resonance imaging (MRI) study at 3 T that investigated nigrostriatal function and structure in PD patients who had taken rasagiline before testing (∼8 months), PD who had not taken rasagiline before testing, and age-matched controls. The two PD groups were selected a priori to not differ significantly in age, sex, disease duration, severity of symptoms, cognitive status, and total levodopa equivalent daily dose of medication. We evaluated percent signal change in the posterior putamen during force production using functional MRI, free-water in the posterior substantia nigra using diffusion MRI, and performance on a bimanual coordination task using a pegboard test. All patients were tested after overnight withdrawal from antiparkinsonian medication. The rasagiline group had greater percent signal change in the posterior putamen, less free-water in the posterior substantia nigra, and better performance on the coordination task than the group not taking rasagiline. These findings point to a possible chronic effect of rasagiline on the structure and function of the basal ganglia in PD. Hum Brain Mapp 37:2894-2903, 2016. © 2016 Wiley Periodicals, Inc.

Psychopaths Show Enhanced Amygdala Activation during Fear Conditioning.

Psychopathy is a personality disorder characterized by emotional deficits and a failure to inhibit impulsive behavior and is often subdivided into “primary” and “secondary” psychopathic subtypes. The maladaptive behavior related to primary psychopathy is thought to reflect constitutional “fearlessness,” while the problematic behavior related to secondary psychopathy is motivated by other factors. The fearlessness observed in psychopathy has often been interpreted as reflecting a fundamental deficit in amygdala function, and previous studies have provided support for a low-fear model of psychopathy. However, many of these studies fail to use appropriate screening procedures, use liberal inclusion criteria, or have used unconventional approaches to assay amygdala function. We measured brain activity with BOLD imaging in primary and secondary psychopaths and non-psychopathic control subjects during Pavlovian fear conditioning. In contrast to the low-fear model, we observed normal fear expression in primary psychopaths. Psychopaths also displayed greater differential BOLD activity in the amygdala relative to matched controls. Inverse patterns of activity were observed in the anterior cingulate cortex (ACC) for primary versus secondary psychopaths. Primary psychopaths exhibited a pattern of activity in the dorsal and ventral ACC consistent with enhanced fear expression, while secondary psychopaths exhibited a pattern of activity in these regions consistent with fear inhibition. These results contradict the low-fear model of psychopathy and suggest that the low fear observed for psychopaths in previous studies may be specific to secondary psychopaths.

Role of 3T multiparametric-MRI with BOLD hypoxia imaging for diagnosis and post therapy response evaluation of postoperative recurrent cervical cancers

ObjectivesTo assess the diagnostic value of multiparametric-MRI (MPMRI) with hypoxia imaging as a functional marker for characterizing and detecting vaginal vault/local recurrence following primary surgery for cervical cancer. MethodsWith institutional review board approval and written informed consent 30 women (median age: 45 years) from October 2009 to March 2010 with previous operated carcinoma cervix and suspected clinical vaginal vault/local recurrence were examined with 3.0T-MRI. MRI imaging included conventional and MPMRI sequences [dynamic contrast enhanced (DCE), diffusion weighted (DW), 1H-MR spectroscopy (1HMRS), blood oxygen level dependent hypoxia imaging (BOLD)]. Two radiologists, blinded to pathologic findings, independently assessed the pretherapy MRI findings and then correlated it with histopathology findings. Sensitivity, specificity, positive predictive value, negative predictive value and their confidence intervals were calculated. The pre and post therapy conventional and MPMRI parameters were analyzed and correlated with response to therapy. ResultsOf the 30 patients, there were 24 recurrent tumors and 6 benign lesions. The accuracy of diagnosing recurrent vault lesions was highest at combined MPMRI and conventional MRI (100%) than at conventional-MRI (70%) or MPMRI (96.7%) alone. Significant correlation was seen between percentage tumor regression and pre-treatment parameters such as negative enhancement integral (NEI) (p=0.02), the maximum slope (p=0.04), mADC value (p=0.001) and amount of hypoxic fraction on the pretherapy MRI (p=0.01). ConclusionConventional-MR with MPMRI significantly increases the diagnostic accuracy for suspected vaginal vault/local recurrence. Post therapy serial MPMRI with hypoxia imaging follow-up objectively documents the response. MPMRI and BOLD hypoxia imaging provide information regarding tumor biology at the molecular, subcellular, cellular and tissue levels and this information may be used as an appropriate and reliable biologic target for radiation dose painting to optimize therapy in future.

Induction of Gradual Changes in Blood Oxygen Levels in Post Lumpectomy Breast Tissue With Breath Holding: Results of a Pilot Study

Our pilot study investigates whether changes in breast tissue oxygenation, as measured by BOLD MRI contrast, occur with breath holding schedules typically utilized during adjuvant left breast radiation therapy. Ten women status post lumpectomy for breast cancer and undergoing treatment planning for whole breast radiation therapy were enrolled. Each subject underwent an imaging session on a 1.5T GE MRI, immobilized in the prone position on a custom board with a 4 channel breast coil. BOLD contrast MRI imaging was performed using two MRI sequences: T2* based Gradient Echo EPI (TR/TE = 500/41ms, flip angle = 60°) and T2 based Single Shot Fast Spin Echo (SSFSE) (TR/TE = 3000/60ms). For each imaging sequence 1-3 planes of the breast were imaged continuously. After a 1 minute background measurement the subject was asked to hold their breath at inspiration for 20-40 seconds, with 3-5 breath holds total per imaging sequence. We quantified changes in oxygenation as the correlation between the breath holding signal and per-pixel intensity changes from each MRI image sequence. We also investigated the rate of oxygenation response to breath holding using various hemodynamic functions convolved with the breath hold schedule. Statistical significance for BOLD contrast was set at p<0.001. On T2* sequences, all subjects had mixed BOLD contrast signal with areas of increasing and decreasing oxygenation occurring in localized adjacent areas. On T2 sequences, three subjects had consistent oxygen decreases throughout the breast and three subjects had consistent oxygen increases throughout the breast. Compared to a fast hemodynamic function (5s), a slow function (180s) showed increased BOLD contrast within the breast; suggesting that breast oxygenation changes are generally slow hemodynamic effects and are additive over multiple breath holds. We observed correlation between breath holding and blood oxygenation as quantified by BOLD contrast MRI for 6/10 whole breast radiation therapy candidates; however the pattern and magnitude varied considerably between subjects. Changes in breast oxygenation appear to occur slowly and are additive over multiple breath holds. Further study in a larger sample is needed to better understand the effect of breath hold technique on breast tissue oxygenation.

Neural signatures of experimentally induced flow experiences identified in a typical fMRI block design with BOLD imaging.

Previously, experimentally induced flow experiences have been demonstrated with perfusion imaging during activation blocks of 3 min length to accommodate with the putatively slowly evolving "mood" characteristics of flow. Here, we used functional magnetic resonance imaging (fMRI) in a sample of 23 healthy, male participants to investigate flow in the context of a typical fMRI block design with block lengths as short as 30 s. To induce flow, demands of arithmetic tasks were automatically and continuously adjusted to the individual skill level. Compared against conditions of boredom and overload, experience of flow was evident from individuals' reported subjective experiences and changes in electrodermal activity. Neural activation was relatively increased during flow, particularly in the anterior insula, inferior frontal gyri, basal ganglia and midbrain. Relative activation decreases during flow were observed in medial prefrontal and posterior cingulate cortex, and in the medial temporal lobe including the amygdala. Present findings suggest that even in the context of comparably short activation blocks flow can be reliably experienced and is associated with changes in neural activation of brain regions previously described. Possible mechanisms of interacting brain regions are outlined, awaiting further investigation which should now be possible given the greater temporal resolution compared with previous perfusion imaging.

Functional Magnetic Resonance Study of Non-conventional Morphological Brains: malnourished rats

Abstract Malnutrition during brain development can cause serious problems that can be irreversible. Dysfunctional patterns of brain activity can be detected with functional MRI. We used BOLD functional Magnetic Resonance Imaging (fMRI) to investigate region differences of brain activity between control and malnourished rats. The food-competition method was applied to a rat model to induce malnutrition during lactation. A 7T magnet was used to detect changes of the BOLD signal associated with changes in brain activity caused by the trigeminal nerve stimulation in malnourished and control rats. Major neuronal activation was observed in malnourished rats in several brain regions, including cerebellum, somatosensory cortex, hippocampus, and hypothalamus. Statistical analysis of the BOLD signals from various brain areas revealed significant differences in somatosensory cortex between the control and experimental groups, as well as a significant difference between the cerebellum and other structures in the experimental group. This study, particularly in malnourished rats, demonstrates increased BOLD activation in the cerebellum.

The cumulative influence of hyperoxia and hypercapnia on blood oxygenation and R*₂.

Cerebrovascular reactivity (CVR)-weighted blood-oxygenation-level-dependent magnetic resonance imaging (BOLD-MRI) experiments are frequently used in conjunction with hyperoxia. Owing to complex interactions between hyperoxia and hypercapnia, quantitative effects of these gas mixtures on BOLD responses, blood and tissue R2*, and blood oxygenation are incompletely understood. Here we performed BOLD imaging (3 T; TE/TR=35/2,000 ms; spatial resolution=3 × 3 × 3.5 mm(3)) in healthy volunteers (n=12; age=29±4.1 years) breathing (i) room air (RA), (ii) normocapnic-hyperoxia (95% O2/5% N2, HO), (iii) hypercapnic-normoxia (5% CO2/21% O2/74% N2, HC-NO), and (iv) hypercapnic-hyperoxia (5% CO2/95% O2, HC-HO). For HC-HO, experiments were performed with separate RA and HO baselines to control for changes in O2. T2-relaxation-under-spin-tagging MRI was used to calculate basal venous oxygenation. Signal changes were quantified and established hemodynamic models were applied to quantify vasoactive blood oxygenation, blood-water R2*, and tissue-water R2*. In the cortex, fractional BOLD changes (stimulus/baseline) were HO/RA=0.011±0.007; HC-NO/RA=0.014±0.004; HC-HO/HO=0.020±0.008; and HC-HO/RA=0.035±0.010; for the measured basal venous oxygenation level of 0.632, this led to venous blood oxygenation levels of 0.660 (HO), 0.665 (HC-NO), and 0.712 (HC-HO). Interleaving a HC-HO stimulus with HO baseline provided a smaller but significantly elevated BOLD response compared with a HC-NO stimulus. Results provide an outline for how blood oxygenation differs for several gas stimuli and provides quantitative information on how hypercapnic BOLD CVR and R2* are altered during hyperoxia.

Simultaneous functional imaging using fPET and fMRI.

Brain mapping of task-associated changes in metabolism with PET has been accomplished by subtracting scans acquired during two distinct static states. We have demonstrated that PET can provide truly dynamic information on cerebral energy metabolism using constant infusion of FDG and multiple stimuli in a single experiment. We demonstrate here that the functional PET (fPET-FDG) method accomplished simultaneously with fMRI, can enable the first direct comparisons in time, space and magnitude of hemodynamics and oxygen and glucose consumption. The imaging studies were performed on a 3T Tim-Trio MR scanner modified to support an MR-compatible BrainPET insert. Ten healthy subjects were included. The total PET acquisition and infusion time was 90 minutes. We did 3 blocks of right hand fingers tapping for 10 minutes at 30, 50 and 70 minutes after the beginning of the PET acquisition. ASL and BOLD imaging were acquired simultaneously during the motor paradigm. Changes in glucose utilization are easily observed as changes in the TAC slope of the PET data (FDG utilization rate) and in the derivative signal during motor stimuli in the activated voxels. PET and MRI (ASL, and BOLD) activations are largely colocalized but with very different statistical significance and temporal dynamic, especially in the ipsilateral side of the stimuli. This study demonstrated that motor activation can be measured dynamically during a single FDG PET scan. The complementary nature of fPET-FDG to fMRI capitalizes on the emerging technology of hybrid MR-PET scanners. fPET-FDG, combined with quantitative fMRI methods, allow us to simultaneously measure dynamic changes in glucose utilization and hemodynamic, addressing vital questions about neurovascular coupling.

Functional imaging of the musculoskeletal system.

Functional imaging, which provides information of how tissues function rather than structural information, is well established in neuro- and cardiac imaging. Many musculoskeletal structures, such as ligaments, fascia and mineralized bone, have by definition a mainly structural role and clearly don't have the same functional capacity as the brain, heart, liver or kidney. The main functionally responsive musculoskeletal tissues are the bone marrow, muscle and nerve and, as such, magnetic resonance (MR) functional imaging has primarily addressed these areas. Proton or phosphorus spectroscopy, other fat quantification techniques, perfusion imaging, BOLD imaging, diffusion and diffusion tensor imaging (DTI) are the main functional techniques applied. The application of these techniques in the musculoskeletal system has mainly been research orientated where they have already greatly enhanced our understanding of marrow physiology, muscle physiology and neural function. Going forwards, they will have a greater clinical impact helping to bridge the disconnect often seen between structural appearances and clinical symptoms, allowing a greater understanding of disease processes and earlier recognition of disease, improving prognostic prediction and optimizing the monitoring of treatment effect.

Comparison of muscle BOLD responses to arterial occlusion at 3 and 7 Tesla

The purpose of this study was to determine the feasibility of muscle BOLD (mBOLD) imaging at 7 Tesla (T) by comparing the changes in R2* of muscle at 3 and 7T in response to a brief period of tourniquet-induced ischemia. Eight subjects (three male), aged 29.5 ± 6.1 years (mean ± standard deviation, SD), 167.0 ± 10.6 cm tall with a body mass of 62.0 ± 18.0 kg, participated in the study. Subjects reported to the lab on four separate occasions including a habituation session, two MRI scans, and in a subset of subjects, a session during which changes in blood flow and blood oxygenation were quantified using Doppler ultrasound (U/S) and near-infrared spectroscopy (NIRS) respectively. For statistical comparisons between 3 and 7T, R2* rate constants were calculated as R2* = 1/T2*. The mean preocclusion R2* value was greater at 7T than at 3T (60.16 ± 2.95 vs. 35.17 ± 0.35 s(-1), respectively, P < 0.001). Also, the mean ΔR2 *END and ΔR2*POST values were greater for 7T than for 3T (-2.36 ± 0.25 vs. -1.24 ± 0.39 s(-1), respectively, Table 1). Muscle BOLD contrast at 7T is as much as six-fold greater than at 3T. In addition to providing greater SNR and CNR, 7T mBOLD studies may offer further advantages in the form of greater sensitivity to pathological changes in the muscle microcirculation.

Understanding the dynamic relationship between cerebral blood flow and the BOLD signal: Implications for quantitative functional MRI

Calibrated BOLD imaging, in which traditional measurements of the BOLD signal are combined with measurements of cerebral blood flow (CBF) within a BOLD biophysical model to estimate changes in oxygen metabolism (CMRO2), has been a valuable tool for untangling the physiological processes associated with neural stimulus-induced BOLD activation. However, to date this technique has largely been applied to the study of essentially steady-state physiological changes (baseline to activation) associated with block-design stimuli, and it is unclear whether this approach may be directly extended to the study of more dynamic, naturalistic experimental designs. In this study we tested an assumption underlying this technique whose validity is critical to the application of calibrated BOLD to the study of more dynamic stimuli, that information about fluctuations in venous cerebral blood volume (CBVv) can be captured indirectly by measuring fluctuations in CBF, making the independent measurement of CBVv unnecessary. To accomplish this, simultaneous arterial spin labeling and BOLD imaging were used to measure the CBF and BOLD responses to flickering checkerboards with contrasts that oscillated continuously with frequencies of ~0.02–0.16Hz. The measurements were then fit to a dynamic physiological model of the BOLD response in order to explore the range of consistent CMRO2 and CBVv responses. We found that the BOLD and CBF responses were most consistent with relatively tight dynamic coupling between CBF and CMRO2 and a CBVv response that was an order of magnitude slower than either CBF or CMRO2. This finding suggests that the assumption of tight flow–volume coupling may not be strictly valid, complicating the extension of calibrated BOLD to more naturalistic experimental designs.

Sentential influences on acoustic-phonetic processing: a Granger causality analysis of multimodal imaging data

ABSTRACTSentential context influences the way that listeners identify phonetically ambiguous or perceptual degraded speech sounds. Unfortunately, inherent inferential limitations on the interpretation of behavioural or BOLD imaging results make it unclear whether context influences perceptual processing directly, or acts at a post-perceptual decision stage. In this paper, we use Kalman-filter enabled Granger causation analysis of MRI-constrained MEG/EEG data to distinguish between these possibilities. Using a retrospective probe verification task, we found that sentential context strongly affected the interpretation of words with ambiguous initial voicing (e.g. DUSK-TUSK). This behavioural context effect coincided with increased influence by brain regions associated with lexical representation on regions associated with acoustic-phonetic processing. These results support an interactive view of sentence context effects on speech perception.

The effects of hearing loss on neural processing and plasticity.

The effects of hearing loss on neural processing and plasticity.

Identifying the integrated neural networks involved in capsaicin-induced pain using fMRI in awake TRPV1 knockout and wild-type rats.

In the present study, we used functional MRI in awake rats to investigate the pain response that accompanies intradermal injection of capsaicin into the hindpaw. To this end, we used BOLD imaging together with a 3D segmented, annotated rat atlas and computational analysis to identify the integrated neural circuits involved in capsaicin-induced pain. The specificity of the pain response to capsaicin was tested in a transgenic model that contains a biallelic deletion of the gene encoding for the transient receptor potential cation channel subfamily V member 1 (TRPV1). Capsaicin is an exogenous ligand for the TRPV1 receptor, and in wild-type rats, activated the putative pain neural circuit. In addition, capsaicin-treated wild-type rats exhibited activation in brain regions comprising the Papez circuit and habenular system, systems that play important roles in the integration of emotional information, and learning and memory of aversive information, respectively. As expected, capsaicin administration to TRPV1-KO rats failed to elicit the robust BOLD activation pattern observed in wild-type controls. However, the intradermal injection of formalin elicited a significant activation of the putative pain pathway as represented by such areas as the anterior cingulate, somatosensory cortex, parabrachial nucleus, and periaqueductal gray. Notably, comparison of neural responses to capsaicin in wild-type vs. knock-out rats uncovered evidence that capsaicin may function in an antinociceptive capacity independent of TRPV1 signaling. Our data suggest that neuroimaging of pain in awake, conscious animals has the potential to inform the neurobiological basis of full and integrated perceptions of pain.

Brain MRI CO2 stress testing: a pilot study in patients with concussion.

BackgroundThere is a real need for quantifiable neuro-imaging biomarkers in concussion. Here we outline a brain BOLD-MRI CO2 stress test to assess the condition.MethodsThis study was approved by the REB at the University of Manitoba. A group of volunteers without prior concussion were compared to post-concussion syndrome (PCS) patients – both symptomatic and recovered asymptomatic. Five 3-minute periods of BOLD imaging at 3.0 T were studied – baseline 1 (BL1– at basal CO2 tension), hypocapnia (CO2 decreased ∼5 mmHg), BL2, hypercapnia (CO2 increased ∼10 mmHg) and BL3. Data were processed using statistical parametric mapping (SPM) for 1st level analysis to compare each subject’s response to the CO2 stress at the p = 0.001 level. A 2nd level analysis compared each PCS patient’s response to the mean response of the control subjects at the p = 0.05 level.ResultsWe report on 5 control subjects, 8 symptomatic and 4 asymptomatic PCS patients. Both increased and decreased response to CO2 was seen in all PCS patients in the 2nd level analysis. The responses were quantified as reactive voxel counts: whole brain voxel counts (2.0±1.6%, p = 0.012 for symptomatic patients for CO2 response < controls and 3.0±5.1%, p = 0.139 for CO2 response > controls: 0.49±0.31%, p = 0.053 for asymptomatic patients for CO2 response < controls and 4.4±6.8%, p = 0.281 for CO2 response > controls).ConclusionsQuantifiable alterations in regional cerebrovascular responsiveness are present in concussion patients during provocative CO2 challenge and BOLD MRI and not in healthy controls. Future longitudinal studies must aim to clarify the relationship between CO2 responsiveness and individual patient symptoms and outcomes.

Cerebral, subcortical, and cerebellar activation evoked by selective stimulation of muscle and cutaneous afferents: an fMRI study.

We compared the brain areas that showed significant flow changes induced by selective stimulation of muscle and cutaneous afferents using fMRI BOLD imaging. Afferents arising from the right hand were studied in eight volunteers with electrical stimulation of the digital nerve of the index finger and over the motor point of the FDI muscle. Both methods evoked areas of significant activation cortically, subcortically, and in the cerebellum. Selective muscle afferent stimulation caused significant activation in motor‐related areas. It also caused significantly greater activation within the contralateral precentral gyrus, insula, and within the ipsilateral cerebellum as well as greater areas of reduced blood flow when compared to the cutaneous stimuli. We demonstrated separate precentral and postcentral foci of excitation with muscle afferent stimulation. We conclude, contrary to the findings with evoked potentials, that muscle afferents evoke more widespread cortical, subcortical, and cerebellar activation than do cutaneous afferents. This emphasizes the importance, for studies of movement, of matching the kinematic aspects in order to avoid the results being confounded by alterations in muscle afferent activation. The findings are consistent with clinical observations of the movement consequences of sensory loss and may also be the basis for the contribution of disturbed sensorimotor processing to disorders of movement.

New applications of disease genetics and pharmacogenetics to drug development

TOMMORROW is a Phase III delay of onset clinical trial to determine whether low doses of pioglitazone, a molecule that induces mitochondrial doubling, delays the onset of MCI-AD in normal subjects treated with low dose compared to placebo. BOLD imaging studies in rodents and man were used to find the dose that increases oxygen consumption at central regions of the brain in higher proportion than activation of large corticol regions. The trial is made practical by the use of a pharmacogenetic algorithm based on TOMM40 and APOE genotypes and age to identify normal subjects at high risk of MCI-AD between the ages of 65-83 years within a five year follow-up period.

Myocardial oxygenation in hibernating myocardium: insights from blood oxygen level dependent imaging pre and post revascularization

Background The mechanisms underlying hibernating myocardium are controversial. Whether de-oxygenation occurs at rest and/or stress in severely dysfunctional viable (i.e. hibernating) myocardium is currently unknown. By utlising the paramagnetic properties of deoxy-haemoglobin, blood oxygen level dependent magnetic resonance imaging (BOLD-MRI) can detect oxygenation and myocardial ischemia. We applied BOLD imaging to examine the pathophysiological relationship between coronary stenosis, regional wall motion abnormalities, ventricular scar and myocardial oxygenation in hibernating myocardium. Methods BOLD imaging was acquired at rest and stress after 5 minutes of administration of adenosine (140 μg/kg/min) and assessed quantitatively (using a BOLD signal intensity index [stress/resting signal intensity] in 11 patients pre and median of 8 months (207, 299 days) post revascularisation. Late gadolinium (LGE) images were acquired using a T1 weighted segmented inversion recovery sequence and regional wall motion abnormalities (RWM) were scored pre and post revascularization using standard criteria. All segments were matched for BOLD, RWM and LGE analysis. Significant stenosis were classed as >50% by QCA. Results

Frameless Stereotactic Functional Neuronavigation Combined with Intraoperative Magnetic Resonance Imaging as a Strategy in Highly Eloquent Located Tumors Causing Epilepsy

Background: Intractable epilepsy due to tumors located in highly eloquent brain regions is often considered surgically inaccessible because of a high risk of postoperative neurological deterioration. Intraoperative MRI and functional navigation contribute to overcome this problem. Objectives: To retrospectively investigate the long-term results and impact of functional neuronavigation and 1.5-tesla intraoperative MRI on patients who underwent surgery of tumors associated with epilepsy located close to or within eloquent brain areas. Methods: Nineteen patients (9 female, 10 male, mean age 41.4 ± 13.4 years, 11 low-grade and 8 high-grade glial tumors) were evaluated preoperatively using BOLD imaging, diffusion-tensor imaging tractography and magnetoencephalography. Functional data were implemented into neuronavigation in this multimodal approach. Results: In 14 of 19 patients (74%), complete resection was achieved, and in 5 patients significant tumor volume reduction was accomplished. Eight of 14 (57%) complete resections were achieved only by performing an intraoperative image update. Neurological deterioration was found permanently in 2 patients. After a mean follow-up of 43.8 ± 23.8 months, 15 patients (79%) became seizure free (Engel class Ia). Conclusions: Despite the highly eloquent location of tumors causing intractable epilepsy, our multimodal approach led to complete resection in more than two-thirds of patients with an acceptable neurological morbidity and excellent long-term seizure control.

Monitoring of tumor oxygenation status in uterine cervical carcinoma using hypoxia related blood oxygen level dependent MR imaging

Objective To investigate the application of MR BOLD imaging in uterine cervical cancer and the value of hypoxia related MR parameters R2*andΔR2*in monitoring treatment response and predicting prognosis. Methods Twenty eight female patients with locally advanced uterine cervical cancer were studied prospectively.MR BOLD imaging was performed in 3.0 T MR scanner with the air and Carbogen gas mixture (95% O2+ 5% CO2) inhalation alternately,14 patients were accomplished with the same protocol before and after the treatment.The hypoxia related parameters:tumor baseline R2* (air) and dynamicΔR2* (R2*changed values before and after carbogen gas inhalation) were obtained.Independent t test was used to compare the baseline R2*values between cervical cancer tissue and uterine myometrium.Paired t test and Wilcoxon signed rank test were used to compare the hypoxia related parameters changes after carbogen gas mixture inhalation as well as after treatment.Mann-Whitney U test was used to compare the difference between the good and poor response subgroups. Results The scan was convenient and the imaging was good with significant contrast between tumor and the uterine myometrium[cervical cancer (15.92 ±2.71) /s,uterine myometrium (22.76±3.79) /s,t=6.474,P 0.05) andΔR2* (good response median:2.06/s,poor response median: 2.31/s,Z=-1.670,P>0.05) of the pretreatment scan. Conclusions The evaluation of tumor hypoxia status is essential for radiation therapy.The hypoxia related parameters R2*andΔR2*derived of MR BOLD imaging can indirectly reflect the tumor oxygenation status,particularly the changes caused by the treatment. Key words: Uterine cervical neoplasms; Magnetic resonance imaging