Echo-planar Diffusion-weighted Magnetic Resonance Imaging Research Articles

Imaging therapeutic response in human bone marrow using rapid whole‐body MRI

Whole-body imaging of therapeutic response in human bone marrow was achieved without introduced contrast agents using diffusion-weighted echo-planar magnetic resonance imaging of physiologic water. Bone marrow disease was identified relative to the strong overlying signals from water and lipids in other anatomy through selective excitation of the water resonance and generation of image contrast that was dependent upon differential nuclear relaxation times and self-diffusion coefficients. Three-dimensional displays were generated to aid image interpretation. The geometric distortion inherent in echo-planar imaging techniques was minimized through the acquisition of multiple axial slices at up to 12 anatomic stations over the entire body. Examples presented include the evaluation of therapeutic response in bone marrow during cytotoxic therapy for leukemia and metastatic prostate cancer and during cytokine administration for marrow mobilization prior to stem cell harvest.

Detection of Postoperative Relapsing/Residual Cholesteatomas With Diffusion-Weighted Echo-Planar Magnetic Resonance Imaging

To assess the capability of echo-planar diffusion-weighted magnetic resonance imaging (MRI) (EPI-DWI) in diagnosing relapsing/residual cholesteatomas after canal wall-up mastoidectomy. In a blinded study design, we investigated with MRI, including standard spin-echo sequences, 18 patients evaluated with clinical examination and computed tomography (CT) suspected for relapsing/residual cholesteatoma 7 to 19 months after a canal wall-up mastoidectomy. Images were evaluated by two radiologists blinded to patients' identities, CT findings, and clinical data set, who decided in a consensus agreement whether there was a pathologic signal increase in the petrous bone in a single-shot EPI-DWI sequence. All the patients underwent a second tympanoplasty or revision surgery of the mastoidectomy cavity within 15 days after magnetic resonance investigation.Sensitivity, specificity, and predictive values were evaluated separately for standard sequences and EPI-DWI. In EPI-DWI, five of six patients with cholesteatoma showed a bright signal, whereas those patients with a noncholesteatomatous tissue showed no anomalies. The only misdiagnosed cholesteatoma was a pearl 2 mm in diameter. Sensitivity, specificity, and positive predictive values, and negative predictive values of EPI-DWI in diagnosing relapsing/residual cholesteatomas were 86, 100, 100, and 92%, respectively. EPI-DWI may be a useful tool in differentiating between cholesteatomatous and noncholesteatomatous tissues after closed cavity mastoidectomy. Further investigations are, however, required to establish the practical utility of EPI-DWI on larger series as a screening modality in the follow-up after closed cavity mastoidectomies.

Measurement of the apparent diffusion coefficient in intraductal mucin-producing tumor of the pancreas by diffusion-weighted echo-planar MR imaging.

We investigated whether diffusion-weighted echo-planar magnetic resonance (MR) imaging can help differentiate intraductal mucin-producing tumors of the pancreas from other cystic lesions. Diffusion-weighted echo-planar MR imaging was performed in patients with mucin-producing tumors (n = 19), pseudocysts (n = 9), chronic pancreatitis with diffuse main pancreatic dilatation (n = 5), and serous cystadenomas (n = 2). Images were obtained with diffusion sensitizing gradients of 30, 300, and 900 s/mm2. The apparent diffusion coefficient (ADC) was calculated. The mean (+/- standard deviation) ADCs of mucin-producing tumors (2.8 x 10(-3) mm2/s +/- 1.0 x 10(-3)), pseudocysts (2.9 x 10(-3) mm2/s +/- 1.2 x 10(-3)), dilated main pancreatic duct in chronic pancreatitis (3.3 x 10(-3) mm2/s +/- 1.2 x 10(-3)), serous cystadenomas (2.9 x 10(-3) and 2.6 x 10(-3) mm2/s), and cerebrospinal fluid (3.5 x 10A(-3) mm2/s +/- 1.1 x 10(-3)) were not statistically different. It is difficult to differentiate between mucin-producing tumors and other cystic lesions by ADC measurements when using diffusion-weighted echo-planar MR imaging.

Salivary glands and lesions: evaluation of apparent diffusion coefficients with split-echo diffusion-weighted MR imaging--initial results.

The authors investigated the feasibility of performing diffusion-weighted (DW) magnetic resonance (MR) imaging with split acquisition of fast spin-echo signals (hereafter, split echo) for the assessment of salivary glands and salivary lesions. Eighteen patients without salivary disease and 10 patients with Sjögren syndrome, chronic parotitis, or focal salivary masses underwent split-echo and echo-planar DW MR imaging. DW MR images and apparent diffusion coefficient maps of the salivary gland had higher quality with split-echo rather than with echo-planar DW MR imaging.

Head and Neck Lesions: Characterization with Diffusion-weighted Echo-planar MR Imaging

To evaluate whether apparent diffusion coefficients (ADCs) calculated from diffusion-weighted echo-planar magnetic resonance (MR) images can be used to characterize head and neck lesions. Diffusion-weighted echo-planar MR imaging was performed with a 1.5-T MR unit in 97 head and neck lesions in 97 patients. Images were obtained with a diffusion-weighted factor, factor b, of 0, 500, and 1,000 sec/mm(2), and an ADC map was constructed. The ADCs of lesions, cerebrospinal fluid, and spinal cord were calculated. Acceptable images for ADC measurement were obtained in 81 (84%) patients. The mean ADC of malignant lymphomas, (0.66 +/- 0.17[SD]) x 10(-3) mm(2)/sec (n = 13), was significantly smaller (P <.001) than that of carcinomas. The mean ADC of carcinomas, (1.13 +/- 0.43) x 10(-3) mm(2)/sec (n = 36), was significantly smaller (P =.002) than that of benign solid tumors. The mean ADC of benign solid tumors, (1.56 +/- 0.51) x 10(-3) mm(2)/sec (n = 22), was significantly smaller (P =.035) than that of benign cystic lesions, (2.05 +/- 0.62) x 10(-3) mm(2)/sec (n = 10). No significant differences were seen in the mean ADC of cerebrospinal fluid and of spinal cord among four groups of lesions. When an ADC smaller than 1.22 x 10(-3) mm(2)/sec was used for predicting malignancy, the highest accuracy of 86%, with 84% sensitivity and 91% specificity, was obtained. Measurement of ADCs may be used to characterize head and neck lesions.

Use of exponential diffusion imaging to determine the age of ischemic infarcts.

Diffusion-weighted magnetic resonance imaging (DWI) detects acute ischemic infarcts with high lesion conspicuity. Determination of infarct age is difficult on DWI alone because infarct signal intensity (SIinfarct) on DWI is influenced by T2 properties ("T2 shine-through"). Maps of the apparent diffusion coefficient (ADC) reflect pure diffusion characteristics without T2 effects but have low lesion conspicuity. Thus, in clinical practice, combined use of DWI and ADC maps is required. Exponential DWI (eDWI) is an innovative means of MRI-diffusion data analysis that merges the advantages of DWI and ADC maps. The authors hypothesized that SIinfarct on eDWI would correlate with infarct age. The authors studied 114 consecutive patients who had 120 ischemic strokes with clearly determined onset times and who underwent echo-planar DWI. The eDWI were generated by dividing the signal intensity on DWI by that on the corresponding T2 image on a pixel-by-pixel basis. SIinfarct on eDWI was measured in the lesion core and expressed as a percentage of contralateral control tissue. On eDWI, relative SIinfarct changed significantly with infarct age (P < .0001). When patients were sorted in infarct-age groups, no significant differences were found within the first 120 hours. However, for patients studied within 5 days, the mean relative SIinfarct was significantly higher compared with patients studied > or = 8 days after stroke (P < .05). For all infarcts up to 5 days old, the eDWI signal intensity was higher than control tissue (hyperintense appearance). All infarcts > 10 days old had an eDWI signal intensity lower than control tissue (hypointense appearance). The authors concluded that the use of eDWI, as a single set of images, reliably differentiates acute infarcts (< or = 5 days old) from infarcts > 10 days old. This feature would be expected to be helpful when the distinction between acute and nonacute infarction cannot be determined on clinical grounds.

Mild hypothermia decreases the incidence of transient ADC reduction detected with diffusion MRI and expression of c-fos and hsp70 mRNA during acute focal ischemia in rats

The effects of mild hypothermia on the apparent diffusion coefficient of water (ADC) and expression of c-fos and hsp70 mRNA were examined during acute focal cerebral ischemia. Young adult rats were subjected to 60-min middle cerebral artery occlusion under either normothermia (37.5°C) or hypothermia (33°C). Diffusion-weighted echo-planar magnetic resonance imaging was used to monitor changes in ADC throughout the ischemic period. Perfusion MRI with dysprosium contrast was used at the end of the ischemic period to verify that the occlusion was successful. C-fos and hsp70 mRNA expression were examined with in situ hybridization at the end of the ischemic period. The results indicate that the size of the region that exhibited reduced ADC was smaller during hypothermia than during normothermia. Hypothermia also decreased the frequency of occurrence of transient ADC reductions, especially in dorsal aspects of cortex. Expression of both c-fos and hsp70 mRNA were markedly reduced by hypothermia. Transient ADC reduction and c-fos expression are associated with spreading depression, which is believed to contribute to lesion expansion during acute focal ischemia. The results suggest that part of the neuroprotective effect of hypothermia may be due to a reduced incidence of spreading depression.

Anisotropic diffusion in kidney: apparent diffusion coefficient measurements for clinical use.

The purpose of this study was to evaluate anisotropy of the kidney by measurements of the apparent diffusion coefficient (ADC) using commercially available magnetic resonance (MR) imaging. Fifty-one consecutive patients underwent diffusion-weighted echoplanar MR imaging of the upper abdomen with five different strengths of motion probing gradients (b = 1.51, 55.3, 36.6, 317, and 932 sec/mm2) applied along the z-axis. Four ADC values for the upper pole and central portion of the kidney were calculated from four different b-value ranges and compared. The ADCs for the kidney calculated in the lower b-value ranges were significantly higher than those in the higher ranges. The ADCs for the upper pole portion were significantly higher than those for the central portion except for one in the highest b-value range. Diffusion in the kidney is anisotropic, probably due to the kidney's radially oriented structures such as renal vessels and tubules.

Imaging the microcirculatory proton fraction of muscle with diffusion-weighted echo-planar imaging

The diagnosis of exertional compartment syndrome is challenging. In this feasibility study, diffusion-weighted echo-planar magnetic resonance imaging was performed in human subjects to determine whether alterations in the circulating blood volume of muscle secondary to exercise or changes in compartment pressure could be visualized. The calf muscles of six subjects were studied before and after exercise and also during the application of external pressure to the calf. Gated, single-shot, diffusion-weighted echo-planar imaging (1.5 T) was implemented with signal averaging. Parametric images of the "perfusion" fraction (f) were generated, and regions of interest from anatomic compartments were analyzed. The precision of f was estimated by using propagation of error analysis. Parametric images depicted visible increases in the microcirculatory proton fraction (f) of calf muscle after exercise (mean change, +0.016) and visible decreases in f on the application of 40 mm Hg to the calf after exercise (mean change, -0.023). Mean changes in f were only significantly different from zero for the group, however, under conditions of applied pressure to the calf after exercise. Changes in f were not significantly different across muscle compartments. The error variance in f was approximately 0.01. Parametric images of f generated by diffusion-weighted echo-planar imaging may depict alterations in the circulating blood volume of muscle induced by exercise and changes in compartment pressure. The inherent imprecision of this technique, however, appears to limit its clinical utility.

Mapping eddy current induced fields for the correction of diffusion-weighted echo planar images

Diffusion-weighted echo-planar magnetic resonance imaging is potentially of great importance as a diagnostic imaging tool; however, the technique currently suffers a number of limitations, including the image distortion caused by the eddy current induced fields when the diffusion-weighting magnetic field gradient pulses are applied. The distortions cause mis-registration between images with different diffusion-weighting, that then results in artifacts in quantitative diffusion images. A method is presented to measure the magnetic fields generated from the eddy currents for each of three orthogonal gradient pulse vectors, and then to use these to ascertain the image distortion that occurs in subsequent diffusion-weighted images with arbitrary gradient pulse vector amplitude and direction, and image plane orientation. The image distortion can then be reversed. Both temporal and spatial dependence of the residual eddy current induced fields are included in the analysis. Image distortion was substantially reduced by the correction scheme, for arbitrary slice position and angulation. This method of correction is unaffected by the changes in image contrast that occur due to diffusion weighting, and does not need any additional scanning time during the patient scan. It is particularly suitable for use with single-shot echo planar imaging.

Echo-planar diffusion-weighted MRI in the diagnosis of acute ischemic stroke: characterisation of tissue abnormalities and limitations in the interpretation of imaging findings

An accurate diagnosis is frequently difficult in early stroke. Diffusion-weighted (DW) magnetic resonance imaging (MRI) allows visualization of ischemic parenchyma and quantitative assessment of tissue changes before unequivocal abnormalities appear on T(2)-weighted MRI. We analyzed 105 MRI examinations of patients with acute stroke (<24 h) with regard to patterns of abnormalities in T(2)-weighted and DW MRI. Furthermore we assessed the influence of artifacts related to DW echo-planar single-shot MRI on image interpretation. Depending on the time of patient assessment there were three partly overlapping T(2)/DW patterns: (1) in the very early phase (</=1.5 h after symptom onset) there was no T(2) abnormality and no definite abnormality of diffusion; (2) no T(2) abnormality and restricted diffusion (1.5-4 h); (3) T(2) hyperintensity and restricted diffusion (>/=3 h). Typical artifacts (susceptibility distortions, N/2 artifact, chemical shift artifact and eddy currents artifact) had to be considered when interpreting images. Provided typical artifacts are taken into consideration, echo-planar DW MRI allows a more precise diagnostic assessment in acute stroke.

Measurement of the apparent diffusion coefficient in diffuse renal disease by diffusion-weighted echo-planar MR imaging.

The purpose of this study was to determine the relationship between the apparent diffusion coefficient (ADC) and diffuse renal disease by diffusion-weighted echolanar magnetic resonance (MR) imaging (EPI). Thirty-four patients were examined with diffusion-weighted EPI. The average ADC values were 2.55 x 10(-3) mm2/sec for the cortex and 2.84 x 10(-3) mm2/sec for the medulla in the normal kidneys. The ADC values in both the cortex and medulla in chronic renal failure (CRF) kidneys and in acute renal failure (ARF) kidneys were significantly lower than those of the normal kidneys. In renal artery stenosis kidneys, the ADC values in the cortex were significantly lower than those of the normal and the contralateral kidneys. In the cortex, ADC values were above 1.8 x 10(-3) mm2/sec in all 32 normal kidneys, ranging from 1.6 to 2.0 x 10(-3) mm2/sec in all 8 ARF kidneys, and below 1.5 x 10(-3) mm2/sec in 14 of 15 CRF kidneys. In the medulla, there was considerable overlap in the ADC values of the normal and diseased kidneys. There was a linear correlation between ADC value and sCr level in the cortex (r = 0.75) and a weak linear correlation in the medulla (r = 0.60). Our results show that diffusion-weighted MR imaging may be useful to identify renal dysfunction.

Imaging the pyramidal tract in patients with brain tumors

The clinical usefulness of diffusion-weighted magnetic resonance imaging (DWI) of the pyramidal tract was evaluated in patients with brain tumors. Five normal volunteers and seven patients with glioma ( n=4) or meningioma ( n=3) near the pyramidal tract underwent coronal echo planar DWI. Greyscale DWIs in each of the three orthogonal diffusion gradients were transformed into graduations, color-coded as red, green or blue, respectively, and then composited to form a combined color image. The entire pyramidal tract was visualized on a single fiber mapping image by combining the upper half of the image slice including the primary motor cortex, the corona radiata and the internal capsule with the lower half of the image slice including the internal capsule, the cerebral peduncle and the ventral brain stem. Fiber mapping images demonstrated the pyramidal tract as a distinct band indicating nerve fiber integrity in all volunteers. The entire pyramidal tract from the primary motor subcortex to the ventral brain stem could be traced. Fiber mapping images showed the ipsilateral pyramidal tract as either discontinuous due to impaired anisotropy or compressed due to mass effect in patients with brain tumors. These findings corresponded well with the pre- and postoperative motor functions. Fiber mapping images are useful for evaluating the white matter neuronal tracts and can provide indications for determining surgical strategy.

Acute stroke: Imaging and intervention

“Stroke” is defined as sudden-onset nonconvulsive neurologic deficit of a cerebrovascular origin. Each year, in the United States, 350,000 people experience a first stroke, and another 100,000 have a recurrent attack. A total of 400,000 to 500,000 new strokes occur annually, and there are 3 million stroke survivors. Stroke is the #3 cause of death and the #1 cause of disability (1992 Heart and Stroke Facts. Dallas: American Heart Association, 1991;1–48). This article will review recent advances in echoplanar diffusion-weighted magnetic resonance imaging and intravenous thrombolytic therapy of acute stroke.

Focal liver masses: characterization with diffusion-weighted echo-planar MR imaging.

To evaluate diffusion-weighted echo-planar magnetic resonance (MR) imaging for improving the specificity of characterization of liver tumors. Diffusion-weighted echo-planar imaging was performed with a 1.5-T whole-body imager with use of a body phased-array coil in 51 patients with 59 hepatic masses (41 malignant tumors, nine hemangiomas, and nine cysts). Apparent diffusion coefficient (ADC) values were obtained with two motion-probing gradients (b = 30 and 1,200 sec/mm2) during each of the breath-hold periods, and an ADC map was constructed. The T2 was derived from spin-echo echo-planar images with echo times of 47 and 99 msec. The ADC value of malignant masses (1.04 x 10(-3) mm2/sec) was significantly lower (P < .01) than that of benign masses (hemangiomas [1.95 x 10(-3) mm2/sec] and cysts [3.05 x 10(-3) mm2/sec]), although the T2s showed considerable overlap. A small amount of overlap in ADC values occurred among malignant tumors, hemangiomas, and cysts. ADC values of two cystic masses from ovarian carcinomas were within the range of those of hemangiomas. These preliminary results indicate that diffusion-weighted MR imaging can be useful in characterizing focal liver masses. With the exception of cystic metastatic tumors, the technique may be especially useful in tumors that appear markedly hyperintense on T2-weighted images due to a long T2.