Changes In T2 Research Articles

Oxygen-induced MRI T1 changes in head and neck anatomical structures

Oxygen-induced MRI T1 changes in head and neck anatomical structures

Magnetization transfer weighted laminar fMRI with multi-echo FLASH

Laminar functional magnetic resonance imaging (fMRI) using the gradient echo (GRE) blood oxygenation level dependent (BOLD) contrast is prone to signal changes arising from large unspecific venous vessels. Alternatives based on changes of cerebral blood volume (CBV) become more popular since it is expected that this hemodynamic response is dominant in microvasculature. One approach to sensitize the signal toward changes in CBV, and to simultaneously reduce unwanted extravascular (EV) BOLD blurring, is to selectively reduce gray matter (GM) signal via magnetization transfer (MT). In this work, we use off-resonant MT-pulses with a 3D FLASH readout to perform MT-prepared (MT-prep) laminar fMRI of the primary visual cortex (V1) at multiple echo times at 7 T. With a GRE-BOLD contrast without additional MT-weighting as reference, we investigated the influence of the MT-preparation on the shape and the echo time dependency of laminar profiles. Through numerical simulations, we optimized the sequence parameters to increase the sensitivity toward signal changes induced by changes in arterial CBV and to delineate the contributions of different compartments to the signal. We show that at 7 T, GM signals can be reduced by 30 %. Our laminar fMRI responses exhibit an increased signal change in the parenchyma at very short TE compared to a BOLD-only reference as a result of reduced EV signal intensity. By varying echo times, we could show that MT-prep results in less sensitivity toward unwanted signal changes based on changes in T2*. We conclude that when accounting for nuclear overhauser enhancement effects in blood, off-resonant MT-prep combined with efficient short TE readouts can become a promising method to reduce unwanted EV venous contributions in GRE-BOLD and/or to allow scanning at much shorter echo times without incurring a sensitivity penalty in laminar fMRI.

MRI of radiation chemistry: First images and investigation of potential mechanisms.

Paramagnetic species such as O2 and free radicals can enhance T1 and T2 relaxation times. If the change in relaxation time is sufficiently large, the contrast will be generated in magnetic resonance images. Since radiation is known to be capable of altering the concentration of O2 and free radicals during water radiolysis, it may be possible for radiation to induce MR signal change. We present the first reported instance of x-ray-induced MR signal changes in water phantoms and investigate potential paramagnetic relaxation enhancement mechanisms associated with radiation chemistry changes in oxygen and free radical concentrations. Images of water and 10 mM coumarin phantoms were acquired on a 0.35 T MR-linac before, during, and after a dose delivery of 80Gy using an inversion-recovery dual-echo sequence with water nullified. Radiation chemistry simulations of these conditions were performed to calculate changes in oxygen and free radical concentrations. Published relaxivity values were then applied to calculate the resulting T1 change, and analytical MR signal equations were used to calculate the associated signal change. Compared to pre-irradiation reference images, water phantom images taken during and after irradiation showed little to no change, while coumarin phantom images showed a small signal loss in the irradiated region with a contrast-to-noise ratio (CNR) of 1.0-2.5. Radiation chemistry simulations found oxygen depletion of -11µM in water and -31µM in coumarin, resulting in a T1 lengthening of 24ms and 68ms respectively, and a simulated CNR of 1.0 and 2.8 respectively. This change was consistent with observations in both direction and magnitude. Steady-state superoxide, hydroxyl, hydroperoxyl, and hydrogen radical concentrations were found to contribute less than 1ms of T1 change. Observed radiation-induced MR signal changes were dominated by an oxygen depletion mechanism. Free radicals were concluded to play a minor secondary role under steady-state conditions. Future applications may include in vivo FLASH treatment verification but would require an MR sequence with a better signal-to-noise ratio and higher temporal resolution than the one used in this study.

Glioblastoma Response during Chemoradiation by Daily Quantitative Multiparametric MRI

<h3>Purpose/Objective(s)</h3> Quantitative Multiparametric MRI (qMP-MRI) is a fast and robust technique for providing relaxometry information such as T1, R2 and R2* maps. This information is correlated to glioblastoma (GBM) cellular density and may be useful to predict sites of tumor progression. For example, T1 has longer and R2 and R2* have shorter relaxation times for voxels adjacent to gadolinium enhancing tumor. The availability of MRI-Linac systems provides the opportunity to detect qMP-MRI changes daily through the course of radiation therapy (RT) and to adapt plans during RT. We hypothesize that qMP-MRI can detect tumor changes during a course of MRI-Linac treatment and correlates with patient outcomes. <h3>Materials/Methods</h3> We analyzed an IRB-approved prospective cohort of 21 consecutive GBM patients treated on a 0.35T MRI-Linac system with 30 fractions to 60 Gy and temozolomide. Daily qMP-MRI data were obtained with multi-TE and the Strategically Acquired Gradient Echo (STAGE) on alternating treatment days (15 qMP-MRI acquisitions during RT). For STAGE, 36 slices of 1.5 × 1.5 × 5 mm³ resolution were acquired using varying TEs and flip angles. A multi-TE sequence with 18 slices of 1.6 × 1.6 × 6 mm³ were also acquired. Quantitative T1 and R2* (1/T2*) maps were obtained from STAGE acquisitions and R2 (1/T2) maps from the multi-TE acquisition. Image changes related to tumor area and resection cavity were contoured on the T2 weighted images from daily patient setup using a standard contouring software. A ROI (Peri-tumor) was created based on a 10 mm expansion around the tumor or resection cavity. Changes of T1, R2* and R2 from each voxel within the Peri-tumor were analyzed by parametric response mapping comparing the images from each fraction to those obtained during pre-RT simulation. <h3>Results</h3> Of the 21 GBM patients, 10 had no tumor growth on first post-RT diagnostic MRI (48%), 4 (19%) were determined to have pseudoprogression based on regression or long-term stability of findings, and 7 (33%) had true progression due to continued progression of disease past 6 months, rapid patient death from disease, or tissue sampling showing active malignancy. The analysis of qMP-MRI obtained during RT showed that true progressors presented increases of T1 and decreases of R2* and R2 values for at least 10, 20 and 15%, respectively, of the voxels within the Peri-tumor when compared to patients with no change (Fisher's exact test, p<0.05 for each metric). All true progressors showed such changes before the 15^th fraction (3^rd week) of treatment. <h3>Conclusion</h3> Changes of qMP-MRI based parameters obtained during RT, such as increases in T1 and decreases in R2 and R2* within the Peri-tumor, were found to correlate with true progression. These changes were observed in images obtained before the third week of treatment, suggesting that adaptive RT or other therapies may be useful to intervene early for patients with GBM unresponsive to conventional therapy.

CMR Findings in COVID-19 Recovered Patients: A Review on Parametric Mapping, Feature-Tracking, and LGE.

On March 11, 2020, the World Health Organization raised the coronavirus disease 2019 (COVID-19) status to a pandemic level. The disease caused a global outbreak with devastating consequences, and a fair percentage of patients who have recovered from it continue experiencing persistent sequelae. Hence, identifying the medium and long-term effects of the COVID-19 disease is crucial for its future management. In particular, cardiac complications, from affected function to myocardial injuries, have been reported in these patients. Considering that cardiovascular magnetic resonance (CMR) imaging is the gold standard in diagnosing myocardial involvement and has more advantages than other medical imaging modalities, assessing the outcomes of patients who recovered from COVID-19 with CMR could prove beneficial. This review compiles common findings in CMR in patients from the general population who recovered from COVID-19. The CMR-based techniques comprised parametric mapping for analyzing myocardial composition, feature tracking for studying regional heart deformation, and late gadolinium enhancement for detecting compromised areas in the cardiac muscle. A total of 19 studies were included. The evidence suggests that it is more likely to find signs of myocardial injury in patients who recovered from COVID-19 than in healthy controls, including changes in T1 and T2 mapping relaxation times, affected strain, or the presence of late gadolinium enhancement (LGE) lesions. However, more than two years after the outbreak, there is still a lack of consensus about how these parameters may indicate cardiac involvement in patients who recovered from the disease, as limited and contradictory data is available.

Cyclic changes in T2* relaxometry of human uterus during the menstrual cycle using BOLD MR imaging

PurposeTo evaluate dynamic changes of T2* values within the endometrium, junctional zone and myometrium during the menstrual cycle using blood oxygen level-dependent (BOLD) magnetic resonance imaging. MethodVolunteers underwent MRI scans on menstrual phase, ovulatory phase and luteal phase, including T2-weighted imaging and BOLD MR imaging. Multi-gradient-recalled echo (MGRE) sequence was used to obtain BOLD MR images. T2* values of different uterine layers, including endometrium, junctional zone and myometrium, on sagittal images were analyzed quantitatively. ResultsTwenty-four subjects calculated T2* values successfully. The T2* values of each zonal structure during menstruation were significantly lower than those during ovulatory phase (P < 0.05) and luteal phase (P < 0.001). The T2* value of junctional zone was significantly lower than that of the myometrium over all three menstrual phases (P = 0.000, menstrual; P = 0.000, ovulatory; P = 0.001, luteal). The mean T2* value in endometrium during the ovulatory phase was the highest of the uterine zones over menstrual cycle. During menstrual phase, there was no statistical difference between endometrium and junctional zone (P > 0.05). Conversely, the comparison of the T2* values between endometrium and myometrium, junctional zone and myometrium both showed significant difference (P = 0.000). The mean T2* values within endometrium during ovulatory phase and luteal phase were significantly higher than those within junctional zone and myometrium (P < 0.05). ConclusionsCyclic changes of T2* values in each zonal structure of the uterus were revealed during the menstrual cycle by means of BOLD technique, which may be potentially beneficial in investigating dysmenorrhea, guiding assisted reproductive technologies and monitoring hypoxia in gynecological tumors.

Low-field time-domain NMR relaxometry for studying polymer hydration and mobilization in sodium alginate matrix tablets

Sodium alginate is used in various industries, including food, pharmaceutical, and agriculture. Matrix systems, e.g., tablets, and granules, are macro samples with incorporated active substances. During hydration, they are neither equilibrated nor homogenous. Phenomena occurring during hydration of such systems are complex, determine their functional properties and hence require multimodal analysis. Still, there's a lack of comprehensive view. The study aimed to obtain unique characteristics of the sodium alginate matrix during hydration, particularly considering polymer mobilization phenomena using low-field time-domain NMR relaxometry in H2O and D2O.An increase in total signal during 4 h of hydration in D2O of ca. 30 μV resulted from polymer/water mobilization. Modes in T1–T2 maps and changes in their amplitudes reflected physicochemical state of the polymer/water system: e.g. air-dry polymer mode (T1/T2 ~ 600) and two mobilized polymer/water modes (at T1/T2 ~ 40 and T1/T2 ~ 20).The study describes the approach to evaluating the hydration of the sodium alginate matrix in terms of the temporal evolution of proton pools: those existing in the matrix before hydration and those entering the matrix from the bulk water. It provides data complementary to spatially resolved methods like MRI and microCT.

Associations between Bone Mineral Density and Longitudinal Changes of Vertebral Bone Marrow and Paraspinal Muscle Composition Assessed Using MR-Based Proton Density Fat Fraction and T2* Maps in Patients with and without Osteoporosis.

Background: Proton-density fat fraction (PDFF) and T2* of the vertebrae, as well as the cross-sectional area (CSA) of the paraspinal musculature (PSM), have been suggested as biomarkers for bone fragility. The aim of this study was to longitudinally assess changes in PDFF, T2* and CSA of the PSM over 6 months in patients with and without osteoporosis. Methods: Opportunistic bone mineral density (BMD) measurements (BMD < 120 mg/cm3) were obtained from a CT acquired during the clinical routine work up in osteoporotic/osteopenic patients (n = 29, mean age 72.37 ± 10.12 years, 16 women). These patients were frequency-matched for age and sex to subjects with normal BMD values (n = 29). All study patients underwent 3T MR imaging at baseline and 6-month follow up, including spoiled gradient echo sequences for chemical shift encoding-based water-fat separation, from which T2* and PDFF values of the lumbar spine and the PSM were obtained. Moreover, the CSA of the PSM was assessed longitudinally. Changes in T2*, PDFF and CSA over 6 months were calculated for the vertebrae and PSM and associations with baseline BMD values were assessed. Results: The change in CSA of the PSM over 6 months was significantly lower in the osteoporotic/osteopenic group (−91.5 ± 311.7 mm2), compared to the non-osteoporotic group, in which the CSA increased (29.9 ± 164.0 mm2, p = 0.03). In a further analysis, patients with higher vertebral PDFF at baseline showed a significantly stronger increase in vertebral T2*, compared to those patients with lower vertebral PDFF at baseline (0.9 ± 1.6 ms vs. 0.0 ± 1.8 ms, p = 0.04). Moreover, patients with higher PSM PDFF at baseline showed a significantly stronger increase in vertebral T2*, compared to those patients with lower PSM PDFF at baseline (0.9 ± 2.0 ms vs. 0.0 ± 1.3 ms, p = 0.03). Conclusion: The PSM CSA decreased significantly longitudinally in patients with osteoporosis/osteopenia, compared to those without. Additionally, higher vertebral and PSM PDFF at baseline were associated with stronger changes in vertebral bone marrow T2*. Therefore, longitudinal PDFF and T2* mapping may be useful quantitative radiation-free tools for the assessment and prediction of muscle and bone health in patients with suspected osteoporosis/osteopenia.

Effects of pendulum appliance versus clear aligners in the vertical dimension during Class II malocclusion treatment: a randomized prospective clinical trial

BackgroundThe aim of the present study was to compare the effects on vertical dentoskeletal dimension produced by Pendulum appliance and Clear Aligners in patients with Class II malocclusion.Trial designThis is a prospective two-arm parallel group randomized clinical trial with 1:1 allocation ratio.MethodsThe Pendulum Group (PG) consisted of 20 patients (15F, 5 M) with a mean age of 17.2 ± 4.3 years. The Clear Aligners Group (CAG) comprised 20 patients (13F, 7 M) with a mean age of 17.2 ± 3.2 years. Distalization’s protocol in PG involved the activation of TMA wires till the achievement of Class I molar relationship. A protocol of sequential distalization was applied in the CAG. For each subject lateral cephalograms have been analyzed before treatment (T1) and at the end of the therapy (T2). Descriptive statistics and statistical between-group comparisons (PG vs CAG) were calculated for the craniofacial starting forms at T1 and for the T2–T1 changes. Statistical between-group comparisons for the T2–T1 changes were performed with independent samples t-tests (P < 0.05).ResultsThe PG showed significantly greater increases in SN^GoGn° when compared with CAG (+ 2.1 and − 0.3 degrees, respectively). Clockwise rotation of the occlusal plane with significantly greater increase of SN^POccl angle was observed in PG (+ 2.8 degrees) when compared with CAG (− 4.2 degrees).The PG revealed a significant increase in the N-Me variable with a mean change of + 4.4 mm compared to the CAG with mean values of − 1.2 mm. The PG showed an increase in the ArGo^GoMe angle (+ 0.7° degrees) compared to the CAG (− 3.4° degrees). The PG showed significantly greater increases in both maxillary and mandibular first molar to palatal plane (+ 1.3 and + 2.1 mm, respectively) when compared with CAG (− 0.9 and − 0.2 mm, respectively).ConclusionsUpper molar distalization with clear aligners represents a valid alternative to non-extraction treatment of Class II malocclusion, reducing the extrusion of maxillary first molars and improving the management of the occlusal plane and vertical dimension.Trial registration: ClinicalTrials.gov, NCT05298280. Registered 28 March 2022—Retrospectively registered, https://clinicaltrials.gov.

Age-Dependent Changes in Knee Cartilage T1 , T2 , and T1p Simultaneously Measured Using MRI Fingerprinting.

Magnetic resonance fingerprinting (MRF) techniques have been recently described for simultaneous multiparameter cartilage mapping of the knee although investigation of their ability to detect early cartilage degeneration remains limited. To investigate age-dependent changes in knee cartilage T1 , T2 , and T1p relaxation times measured using a three-dimensional (3D) MRF sequence in healthy volunteers. Prospective. The study group consisted of 24 healthy asymptomatic human volunteers (15 males with mean age 34.9 ± 14.4 years and 9 females with mean age 44.5 ± 13.1 years). A 3.0 T gradient-echo-based 3D-MRF sequence was used to simultaneously create proton density-weighted images and T1 , T2 , and T1p maps of knee cartilage. Mean global cartilage and regional cartilage (lateral femur, lateral tibia, medial femur, medial tibia, and patella) T1 , T2 , and T1ρ relaxation times of the knee were measured. Kruskal-Wallis tests were used to compared cartilage T1 , T2 , and T1ρ relaxation times between different age groups, while Spearman correlation coefficients was used to determine the association between age and cartilage T1 , T2 , and T1ρ relaxation times. The value of P < 0.05 was considered statistically significant. Higher age groups showed higher global and regional cartilage T1 , T2 , and T1ρ . There was a significant difference between age groups in global cartilage T2 and T1ρ but no significant difference (P=0.13) in global cartilage T1. Significant difference was also present between age groups in cartilage T2 and T1ρ for medial femur cartilage and medial tibia cartilage. There were significant moderate correlations between age and T2 and T1ρ for global cartilage (R2 =0.63-0.64), medial femur cartilage (R2 =0.50-0.56), and medial tibia cartilage (R2 =0.54-0.66). Cartilage T2 and T1p relaxation times simultaneously measured using a 3D-MRF sequence in healthy volunteers showed age-dependent changes in knee cartilage, primarily within the medial compartment.

Sleep apnea and temporal changes in cardiac repolarization in patients undergoing coronary artery bypass grafting

Abstract Background In coronary artery bypass grafting (CABG), despite re-establishing coronary reperfusion, myocardial recovery and restoration of contractility often occur later, and the risk of adverse cardiovascular events persists during the post-CABG period. The occurrence of adverse cardiovascular events is linked to abnorm-al cardiac repolarisation that can be measured by surface electrocardiograms (ECGs). Sleep apnoea is an emerging cardiovascular risk factor. The relationship between sleep apnoea, abnorm-al cardiac repolarisation, and the occurrence of adverse cardiovascular events is not well studied. Purpose We investigated the impact of sleep apnoea on the change in repolarisation after CABG, and if the change in repolarisation is associated with the occurrence of major adverse cardiac and cerebrovascular events (MACCE). Methods Between November 2013 and December 2018, 1007 patients from 4 hospitals underwent an overnight sleep study prior to a non-emergent CABG. ECGs were acquired prospectively within 48h before the CABG (T1), and within 24h after the CABG (T2). QTc intervals were measured in three consecutive heart beats in one lead - the preferential lead measurements were lead II, followed by lead V5. QTc intervals were measured using the BRAVO algorithm by Analysing Medical Parameters for Solutions (AMPS) LLC. The change of T2 from T1 for QTc (ΔQTc) was derived. The mean follow-up duration was 2.1 years. MACCE was a composite of cardiovascular death, myocardial infarction, stroke, and unplanned revascularisation. Results A total of 954 patients (median age: 62 years; male: 86%) survived the initial 24 hours and had quality ECGs for analysis. Lead II and V5 were measured in 72% and 25% of the cohort, respectively. A total of 115 patients developed MACCE (MACCE group). Compared with the non-MACCE group, the MACCE group was older, had (a) a higher prevalence of smoking, hypertension, diabetes mellitus, and chronic kidney disease, (b) higher apnoea-hypopnoea index (AHI) and oxygen desaturation index (ODI), and (c) a smaller ΔQTc (Table). In Cox regression analysis, a smaller ΔQTc was independently associated with occurrence of MACCE (HR: 1.003; 95% CI: 1.000–1.006; p=0.032). Older age, history of previous stroke, chronic kidney disease, more severe sleep apnoea (higher AHI, ODI, and severe oxygen desaturation) were associated with smaller ΔQTc. After adjusting for the effects of confounding variables, a higher ODI was independently associated with a smaller ΔQTc (correlation coefficient: −0.58; p&amp;lt;0.001). Conclusions In patients undergoing a non-emergent CABG, a smaller ΔQTc during the first 24 hours after the CABG is associated with a higher incidence of MACCE. A higher pre-operative ODI based on a sleep study is an independent predictor of a smaller ΔQTc. This suggests that change in QTc within 24 hours after CABG could be due to sleep apnoea, and it is a novel predictor of occurrence of MACCE at medium term follow-up. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Transition Award and Clinician Scientist Award from the National Medical Research Council of Singapore (award numbers: NMRC/TA/012/2012; NMRC/CSA-INV/002/2015)

P.69 Minimum clinically important difference in magnetic resonance biomarkers in DMD

Magnetic resonance (MR) biomarkers that quantify increases in intramuscular fat are highly sensitive to disease progression and predictive of meaningful functional milestones in DMD. However, the minimum clinically important difference (MCID), defined as "the smallest change that is important to patients" has not been established. The purpose of this investigation was to estimate the MCID for both muscle fat fraction measured using MR spectroscopy and bulk muscle T2 measured using MRI. As part of the multicenter ImagingDMD study, localized 1H-MR spectra (TE=108 ms; TR=3000 ms) and multi-echo T2 weighted images were collected longitudinally in 180 males with DMD, with 0-8 annual follow up visits. Spectra from the vastus lateralis and soleus muscles were integrated and relaxation-corrected then used to estimate fat fraction (fat:(fat+water)). Spin-echo images were used to calculate T2 maps, which were manually segmented to obtain T2 measurements for 7 leg muscles. Ambulatory function groups were defined as: able to rise from the floor - Group I; able to walk - Group II; nonambulatory - Group III. MCID was estimated using 1) the standard error of measurement method, incorporating the group variance and day-to-day reproducibility of the measurement from 111 study participants, 2) the 1/3 standard deviation method, and 3) a survey of experts. Combining results from the three estimation methods, ranges for MCID for fat fraction were 0.02-0.05 in the vastus lateralis and 0.01-0.05 in the soleus. For MRI T2, MCID ranged between 1.9 and 3.0 ms for the vastus lateralis and 0.9 and 2.4 ms for the soleus. The average annual change in fat fraction or T2 exceeds the MCID in Groups I, II, and III for vastus lateralis fat fraction, Groups I and II for vastus lateralis T2, Groups II and III for soleus fat fraction, and Group II for soleus T2. Expected change, expected variability, and estimated MCID in the target population should all be considered when selecting a primary MR measure to use in clinical trials.

Single-shot multi-parametric mapping based on multiple overlapping-echo detachment (MOLED) imaging

Multi-parametric quantitative magnetic resonance imaging (mqMRI) allows the characterization of multiple tissue properties non-invasively and has shown great potential to enhance the sensitivity of MRI measurements. However, real-time mqMRI during dynamic physiological processes or general motions remains challenging. To overcome this bottleneck, we propose a novel mqMRI technique based on multiple overlapping-echo detachment (MOLED) imaging, termed MQMOLED, to enable mqMRI in a single shot. In the data acquisition of MQMOLED, multiple MR echo signals with different multi-parametric weightings and phase modulations are generated and acquired in the same k-space. The k-space data is Fourier transformed and fed into a well-trained neural network for the reconstruction of multi-parametric maps. We demonstrated the accuracy and repeatability of MQMOLED in simultaneous mapping apparent proton density (APD) and any two parameters among T2, T2*, and apparent diffusion coefficient (ADC) in 130–170 ms. The abundant information delivered by the multiple overlapping-echo signals in MQMOLED makes the technique potentially robust to system imperfections, such as inhomogeneity of static magnetic field or radiofrequency field. Benefitting from the single-shot feature, MQMOLED exhibits a strong motion tolerance to the continuous movements of subjects. For the first time, it captured the synchronous changes of ADC, T2, and T1-weighted APD in contrast-enhanced perfusion imaging on patients with brain tumors, providing additional information about vascular density to the hemodynamic parametric maps. We expect that MQMOLED would promote the development of mqMRI technology and greatly benefit the applications of mqMRI, including therapeutics and analysis of metabolic/functional processes.

Treatment of class II malocclusion with Invisalign®: A pilot study using digital model-integrated maxillofacial cone beam computed tomography

Background/purposeThe treatment effects of Invisalign® are still obscure due to methodological limitations of previous studies. We introduced a method to comprehensively evaluate the dental and skeletal changes of Class II malocclusion treated non-extraction with Invisalign® and compare with the virtual simulation of ClinCheck® using digital models integrated into maxillofacial cone-beam computed tomography (CBCT). Materials and methodsThe pretreatment (T1) and posttreatment (T2) scanned digital images of actual dentitions were integrated into maxillofacial CBCT images. To evaluate three-dimensional movement of maxillary teeth and change of mandible position, T1 and T2 digital model-integrated maxillofacial CBCT images were superimposed using voxel-based registrations of stable cranial base structures. To evaluate movement of mandibular teeth, model-integrated mandibular CBCT superimposition was registered on mandibular basal bone. To compare achieved and predicted tooth movements, the actual dental images and the virtual digital models created by ClinCheck® were registered on the T1 dentitions. ResultsFor simulated upper first molar (U6) distalization of more than 1 mm, treatment accuracy ranged from 31.1% to 40.1%, which was significantly less than virtual planning and previous reports. In unilateral Class II subjects, the amount of U6 distalization on the Class II side was not significantly different from contralateral side, indicating efficacy of sequential distalization was questionable. Those with favorable overjet correction showed evidence of condylar distraction. ConclusionDigital model-integrated CBCT superimpositions reflected the actual treatment changes in comparison with the virtual simulation, and showed that ideal occlusion was not achieved in mild to moderate Class II adult patients treated non-extraction with Invisalign®.

Monitoring kidney size to interpret MRI-based assessment of renal oxygenation in acute pathophysiological scenarios.

Tissue hypoxia is an early key feature of acute kidney injury. Assessment of renal oxygenation using magnetic resonance imaging (MRI) markers T2 and T2 * enables insights into renal pathophysiology. This assessment can be confounded by changes in the blood and tubular volume fractions, occurring upon pathological insults. These changes are mirrored by changes in kidney size (KS). Here, we used dynamic MRI to monitor KS for physiological interpretation of T2 * and T2 changes in acute pathophysiological scenarios. KS was determined from T2 *, T2 mapping in rats. Six interventions that acutely alter renal tissue oxygenation were performed directly within the scanner, including interventions that change the blood and/or tubular volume. A biophysical model was used to estimate changes in O2 saturation of hemoglobin from changes in T2 * and KS. Upon aortic occlusion KS decreased; this correlated with a decrease in T2 *, T2 . Upon renal vein occlusion KS increased; this negatively correlated with a decrease in T2 *, T2 . Upon simultaneous occlusion of both vessels KS remained unchanged; there was no correlation with decreased T2 *, T2 . Hypoxemia induced mild reductions in KS and T2 *, T2 . Administration of an X-ray contrast medium induced sustained KS increase, with an initial increase in T2 *, T2 followed by a decrease. Furosemide caused T2 *, T2 elevation and a minor increase in KS. Model calculations yielded physiologically plausible calibration ratios for T2 *. Monitoring KS allows physiological interpretation of acute renal oxygenation changes obtained by T2 *, T2 . KS monitoring should accompany MRI-oximetry, for new insights into renal pathophysiology and swift translation into human studies.

Oxygen Challenge Imaging Reveals Differences in Metabolic Activity Between Kurtosis Lesion and Diffusion/Kurtosis Lesion Mismatch in a Rodent Model of Acute Stroke.

Accurate identification of potentially salvageable tissues is critical for improving acute stroke treatment. A previous study showed that the kurtosis lesion exhibited insignificant response after prompt reperfusion treatment, while the diffusion/kurtosis lesion mismatch could recover after reperfusion. We hypothesized that these 2 regions are in different metabolic states. Transient oxygen challenge (OC) is a procedure that uses oxygen as a metabolic bio-tracer and has been performed to explore metabolic activity in tissues. We combined OC with multiparameter magnetic resonance imaging (including diffusion kurtosis imaging and T2* mapping sequences) to study metabolic activity in the ischemic brain of Sprague Dawley rats. Oxygen challenge image analysis revealed changes in T2* values, most significantly in the mean diffusivity (MD)/mean kurtosis (MK) lesion mismatch (22.3 ± 1.6%) and least significantly in the MK lesions (6.6 ± 0.6%). The MD images acquired within 138 ± 9 minutes after ischemia showed a larger ischemic lesion (45.5 ± 3.0% of the total area) than the MK images (33.2 ± 4.2% of the total area). The change rate of the MK value (53.0 ± 4.4%) was higher than that of the MD value (37.5 ± 3.2%). The present study shows that MK lesion and MD/MK lesion mismatch exhibited different metabolic activity states. The MK lesion presented metabolic-related values close to the ischemic core, while at least part of the MD/MK mismatch area was comparable with ischemic penumbra metabolic activity. These findings are important to support image-guided individualized stroke therapies.

Improving the understanding and performance of clinical MRI using tissue property filters and the central contrast theorem, MASDIR pulse sequences and synergistic contrast MRI.

This paper updates and extends three previous papers on tissue property filters (TP-filters), Multiplied, Added, Divided and/or Subtracted Inversion Recovery (MASTIR) pulse sequences and synergistic contrast MRI (scMRI). It does this by firstly adding the central contrast theorem (CCT) to TP-filters, secondly including division with MASTIR sequences to make them Multiplied, Added, Subtracted and/or Divided IR (MASDIR) sequences, and thirdly incorporating division into the image processing needed for scMR to increase synergistic T1 contrast. These updated concepts are then used to explain and improve contrast at tissue boundaries, as well as to develop imaging regimes to detect and monitor small changes to the brain over time and quantify T1. The CCT is in two parts: the first part states that contrast produced by each TP is the product of the change in TP multiplied by the TP sequence weighting which is the first partial derivative of the TP-filter. The second part states that the overall fractional contrast is the algebraic sum of the fractional contrasts produced by each of the TPs. Subtraction of two IR sequences alone about doubles contrast relative to a conventional single IR sequence. Division of this subtraction can amplify contrast 5–15 times compared with conventional IR sequences. Dividing sequences can be problematic in areas where the signal is zero but this is avoided by dividing the difference in signal of two magnitude reconstructed IR sequences by the sum of their signals. The basis for the production of high contrast, high spatial resolution boundaries at white-gray matter junctions, between cerebral cortex and cerebrospinal fluid (CSF) and at other sites with subtracted IR (SIR) and divided subtracted IR (dSIR) sequences is explained and examples are shown. A key concept is the tissue fraction f, which is the proportion of a tissue in a mixture of two tissues within a voxel. Contrast at boundaries is a function of the partial derivative of the TP-filter, the partial derivative of the relevant TP with respect to f, and the partial derivative of f with respect to distance, x. Location of tissue boundaries is important for segmentation and is helpful in determining if inversion times have been chosen correctly. In small change regimes, the high sensitivity to small changes in T1 provided by dSIR images, together with the high definition boundaries, afford mechanisms for detecting small changes due to contrast agents, disease, perfusion and other causes. 3D isotropic rigid body registration provides a technique for following these changes over time in serial studies. Images showing high lesion contrast, high definition tissue and fluid boundaries, and the detection of small changes are included. T1 maps can be created by linearly scaling dSIR images.

The Relationship Between Magnetic Resonance Imaging and Electrodiagnostic Studies in Patients with Ulnar Neuropathy at the Elbow

Objective: This study investigated the correlations between magnetic resonance imaging (MRI) and nerve conduction studies (NCS) in patients with ulnar neuropathy at the elbow (UNE).Methods:In total, 46 patients who underwent elbow MRI and NCS at a single center from 2014 to 2018 were included. Motor studies, including segmental and inching tests, and sensory NCS were performed. The 5-point severity score was evaluated based on the signal change and swelling in the fat-suppressed T2 weighted sequence. The findings of MRI and NCS were grouped into 3 categories. The Spearman rank test was used to evaluate correlations between the severity score on MRI and electrodiagnostic parameters.Results:The locations of the lesions on MRI and NCS were correlated in 20 of the 46 patients with UNE, while the other 20 patients had no correlations. Six patients who could not be categorized according to the location showed various findings. The severity score based on MRI showed significant negative correlations with amplitude on the segmental study (r = -0.423, p = 0.002) and the inching study (r = -0.456, p = 0.002), and with conduction velocity in the segmental study (r = -0.526, p &lt; 0.001) and the inching study (r = -0.548, p &lt; 0.001).Conclusion Electrodiagnostic outcomes had negative correlations with the severity score, reflecting the structural changes seen on MRI. Combining electrodiagnostic studies and MRI could make the diagnosis and localization more precise.

Change in T2* measurements of placenta and fetal organs during Braxton Hicks contractions

Maternal-placental perfusion can be temporarily compromised by Braxton Hicks (BH) uterine contractions. Although prior studies have employed T2* changes to investigate the effect of BH contractions on placental oxygen, the effect of these contractions on the fetus has not been fully characterized. We investigated the effect of BH contractions on quantitative fetal organ T2* across gestation together with the birth information. We observed a slight but significant decrease in fetal brain and liver T2* during contractions.

Comparison of meniscal T1rho- and T2*-relaxation times in professional female volleyball players and healthy controls using 3T MRI: A pilot study

PurposeComparison of meniscal T1rho- and T2*-relaxation times in professional female volleyball players and healthy controls to determine if relaxation times are prolonged in athletes due to compositional meniscal alterations based on extensive and repetitive joint loading. MethodsThe right knee of 20 asymptomatic professional female volleyball players and 20 female controls were examined at 3T MRI. T1rho- and T2*-measurements were performed in sagittal orientation. For quantitative measurements, two readers independently defined two consecutive central slices with the greatest area of the anterior and posterior horn of the lateral (AHLAT; PHLAT) and medial meniscus (AHMED; PHMED). Both readers repeated measurements after a six-week interval on the original MR images. Statistical analysis included intraclass correlation coefficient (ICC), Wilcoxon signed-rank-, Shapiro-Wilk- & Kolmogorov-Smirnov- and Mann-Whitney U-tests. ResultsMean T1rho-relaxation times in the PHMED were significantly prolonged in professional female volleyball players when compared to controls (24.2 ± 4.0 vs 21.1 ± 2.6 ms; p < 0.005). There were no significant differences for the remaining three meniscal horns. T2*-relaxation times revealed no significant differences between athletes and controls. Prolonged T1rho-relaxation times in the PHMED of female volleyball players did not correlate with significant change in T2*-relaxation times within all meniscal subregions. Reproducibility levels were excellent in all segments (Interobserver-ICC: 0.93–0.97 and intraobserver-ICC: 0.97–0.99). ConclusionT1rho-relaxation times were significantly increased in the PHMED of female volleyball players, potentially indicating a predilection to early degenerative meniscal changes. T1rho may serve as a sensitive biomarker at detecting early compositional meniscal alterations in athletes.