Effective Transverse Relaxation Rate Research Articles

High-Resolution MR Imaging of the Human Brainstem In vivo at 7 Tesla

The human brainstem, which comprises a multitude of axonal nerve fibers and nuclei, plays an important functional role in the human brain. Depicting its anatomy non-invasively with high spatial resolution may thus in turn help to better relate normal and pathological anatomical variations to medical conditions as well as neurological and peripheral functions. We explored the potential of high-resolution magnetic resonance imaging (MRI) at 7 T for depicting the intricate anatomy of the human brainstem in vivo by acquiring and generating images with multiple contrasts: T2-weighted images, quantitative maps of longitudinal relaxation rate (R1 maps) and effective transverse relaxation rate ( maps), magnetic susceptibility maps, and direction-encoded track-density images. Images and quantitative maps were compared with histological stains and anatomical atlases to identify nerve nuclei and nerve fibers. Among the investigated contrasts, susceptibility maps displayed the largest number of brainstem structures. Contrary to R1 maps and T2-weighted images, which showed rather homogeneous contrast, maps, magnetic susceptibility maps, and track-density images clearly displayed a multitude of smaller and larger fiber bundles. Several brainstem nuclei were identifiable in sections covering the pons and medulla oblongata, including the spinal trigeminal nucleus and the reticulotegmental nucleus on magnetic susceptibility maps as well as the inferior olive on R1, , and susceptibility maps. The substantia nigra and red nuclei were visible in all contrasts. In conclusion, high-resolution, multi-contrast MR imaging at 7 T is a versatile tool to non-invasively assess the individual anatomy and tissue composition of the human brainstem.

Quantitative multi-parameter mapping of R1, PD*, MT, and R2* at 3T: a multi-center validation

Multi-center studies using magnetic resonance imaging facilitate studying small effect sizes, global population variance and rare diseases. The reliability and sensitivity of these multi-center studies crucially depend on the comparability of the data generated at different sites and time points. The level of inter-site comparability is still controversial for conventional anatomical T1-weighted MRI data. Quantitative multi-parameter mapping (MPM) was designed to provide MR parameter measures that are comparable across sites and time points, i.e., 1 mm high-resolution maps of the longitudinal relaxation rate (R1 = 1/T1), effective proton density (PD*), magnetization transfer saturation (MT) and effective transverse relaxation rate (R2* = 1/T2*). MPM was validated at 3T for use in multi-center studies by scanning five volunteers at three different sites. We determined the inter-site bias, inter-site and intra-site coefficient of variation (CoV) for typical morphometric measures [i.e., gray matter (GM) probability maps used in voxel-based morphometry] and the four quantitative parameters. The inter-site bias and CoV were smaller than 3.1 and 8%, respectively, except for the inter-site CoV of R2* (<20%). The GM probability maps based on the MT parameter maps had a 14% higher inter-site reproducibility than maps based on conventional T1-weighted images. The low inter-site bias and variance in the parameters and derived GM probability maps confirm the high comparability of the quantitative maps across sites and time points. The reliability, short acquisition time, high resolution and the detailed insights into the brain microstructure provided by MPM makes it an efficient tool for multi-center imaging studies.

Voxel spread function method for correction of magnetic field inhomogeneity effects in quantitative gradient-echo-based MRI.

Macroscopic magnetic field inhomogeneities adversely affect different aspects of MRI images. In quantitative MRI when the goal is to quantify biological tissue parameters, they bias and often corrupt such measurements. The goal of this article is to develop a method for correction of macroscopic field inhomogeneities that can be applied to a variety of quantitative gradient-echo-based MRI techniques. We have reanalyzed a basic theory of gradient echo MRI signal formation in the presence of background field inhomogeneities and derived equations that allow for correction of magnetic field inhomogeneity effects based on the phase and magnitude of gradient echo data. We verified our theory by mapping effective transverse relaxation rate in computer simulated, phantom, and in vivo human data collected with multi-gradient echo sequences. The proposed technique takes into account voxel spread function effects and allowed obtaining virtually free from artifacts effective transverse relaxation rate maps for all simulated, phantom and in vivo data except of the edge areas with very steep field gradients. The voxel spread function method, allowing quantification of tissue specific effective transverse relaxation rate-related tissue properties, has a potential to breed new MRI biomarkers serving as surrogates for tissue biological properties similar to longitudinal and transverse relaxation rate constants widely used in clinical and research MRI.

Susceptibility induced gray-white matter MRI contrast in the human brain.

MR phase images have shown significantly improved contrast between cortical gray and white matter regions compared to magnitude images obtained with gradient echo sequences. A variety of underlying biophysical mechanisms (including iron, blood, myelin content, macromolecular chemical exchange, and fiber orientation) have been suggested to account for this observation but assessing the individual contribution of these factors is limited in vivo.For a closer investigation of iron and myelin induced susceptibility changes, postmortem MRI of six human corpses (age range at death: 56–80 years) was acquired in situ. Following autopsy, the iron concentrations in the frontal and occipital cortex as well as in white matter regions were chemically determined. The magnetization transfer ratio (MTR) was used as an indirect measure for myelin content. Susceptibility effects were assessed separately by determining R2* relaxation rates and quantitative phase shifts. Contributions of myelin and iron to local variations of the susceptibility were assessed by univariate and multivariate linear regression analysis.Mean iron concentration was lower in the frontal cortex than in frontal white matter (26 ± 6 vs. 45 ± 6 mg/kg wet tissue) while an inverse relation was found in the occipital lobe (cortical gray matter: 41 ± 10 vs. white matter: 34 ± 10 mg/kg wet tissue). Multiple regression analysis revealed iron and MTR as independent predictors of the effective transverse relaxation rate R2* but solely MTR was identified as source of MR phase contrast. R2* was correlated with iron concentrations in cortical gray matter only (r = 0.42, p < 0.05).In conclusion, MR phase contrast between cortical gray and white matter can be mainly attributed to variations in myelin content, but not to iron concentration. Both, myelin and iron impact the effective transverse relaxation rate R2* significantly. Magnitude contrast is limited because it only reflects the extent but not the direction of the susceptibility shift.

Respiratory self-gated multiple gradient recalled echo sequence for free-breathing abdominal R 2 * mapping

Abdominal effective transverse relaxation rate (R(2)*) mapping is critical for a wide range of applications. However, respiratory motion can lead to significant image quality deterioration and R(2)* overestimation. For this work, we explored the feasibility of combining respiratory self-gating techniques with a multiple gradient-recalled echo sequence for free-breathing abdominal R(2)* measurements. In a series of eight normal volunteers, respiratory self-gated-multiple gradient-recalled echo methods effectively avoided motion artifacts to produce quantitative R(2)* measurements in liver, spleen, and kidneys that were comparable to R(2)* measurements produced while breath-holding. Respiratory self-gated-multiple gradient-recalled echo methods demonstrated the potential to avoid the need for breath-holding during abdominal R(2)* mapping. For clinical application, respiratory self-gated-multiple gradient-recalled echo approaches could be particularly useful for R(2)* measurements in those patients unable or unwilling to sustain sufficiently long breath-holds to avoid motion artifacts.

Rapid monitoring of iron‐chelating therapy in thalassemia major by a new cardiovascular MR measure: the reduced transverse relaxation rate

In iron overload, almost all the excess iron is stored intracellularly as rapidly mobilizable ferritin iron and slowly exchangeable hemosiderin iron. Increases in cytosolic iron may produce oxidative damage that ultimately results in cardiomyocyte dysfunction. Because intracellular ferritin iron is evidently in equilibrium with the low-molecular-weight cytosolic iron pool, measurements of ferritin iron potentially provide a clinically useful indicator of changes in cytosolic iron. The cardiovascular magnetic resonance (CMR) index of cardiac iron used clinically, the effective transverse relaxation rate (R(2)*), is principally influenced by hemosiderin iron and changes only slowly over several months, even with intensive iron-chelating therapy. Another conventional CMR index of cardiac iron, the transverse relaxation rate (R(2)), is sensitive to both hemosiderin iron and ferritin iron. We have developed a new MRI measure, the 'reduced transverse relaxation rate' (RR(2)), and have proposed in previous studies that this measure is primarily sensitive to ferritin iron and largely independent of hemosiderin iron in phantoms mimicking ferritin iron and human liver explants. We hypothesized that RR(2) could detect changes produced by 1 week of iron-chelating therapy in patients with transfusion-dependent thalassemia. We imaged 10 patients with thalassemia major at 1.5 T in mid-ventricular short-axis planes of the heart, initially after suspending iron-chelating therapy for 1 week and subsequently after resuming oral deferasirox. After resuming iron-chelating therapy, significant decreases were observed in the mean myocardial RR(2) (7.8%, p < 0.01) and R(2) (5.5%, p < 0.05), but not in R(2)* (1.7%, p > 0.90). Although the difference between changes in RR(2) and R(2) was not significant (p > 0.3), RR(2) was consistently more sensitive than R(2) (and R(2)*) to the resumption of iron-chelating therapy, as judged by the effect sizes of relaxation rate differences detected. Although further studies are needed, myocardial RR(2) may be a promising investigational method for the rapid assessment of the effects of iron-chelating therapy in the heart.

Relaxivity‐iron calibration in hepatic iron overload: Probing underlying biophysical mechanisms using a Monte Carlo model

Iron overload is a serious condition for patients with β-thalassemia, transfusion-dependent sickle cell anemia, and inherited disorders of iron metabolism. MRI is becoming increasingly important in noninvasive quantification of tissue iron, overcoming the drawbacks of traditional techniques (liver biopsy). Effective transverse relaxation rate (1/effective transverse relaxation time) rises linearly with iron while transverse relaxation rate (1/T2) has a curvilinear relationship in human liver. Although recent work has demonstrated clinically valid estimates of human liver iron, the calibration varies with MRI sequence, field strength, iron chelation therapy, and organ imaged, forcing recalibration in patients. To understand and correct these limitations, a thorough understanding of the underlying biophysics is of critical importance. Toward this end, a Monte Carlo-based approach, using human liver as a "model" tissue system, was used to determine the contribution of particle size and distribution on MRI signal relaxation. Relaxivities were determined for hepatic iron concentrations ranging from 0.5 to 40 mg iron per gram dry tissue weight. Model predictions captured the linear and curvilinear relationship of effective transverse relaxation rate and transverse relaxation rate with hepatic iron concentrations, respectively, and were within in vivo confidence bounds; contact or chemical exchange mechanisms were not necessary. A validated and optimized model will aid understanding and quantification of iron-mediated relaxivity in tissues where biopsy is not feasible (heart and spleen).

Postprocessing correction for distortions in T2* decay caused by quadratic cross‐slice B0 inhomogeneity

Relaxometric measurement of the effective transverse relaxation rate R2* plays an important role in the quantitative evaluation of brain function, perfusion, and tissue iron content. However, accurate measurement of R2* is prone to macroscopic background field inhomogeneity. In clinical applications and systems, postprocessing correction techniques are more flexible in implementation than unsupported protocol or hardware modifications. The current postprocessing correction approach assumes the cross-slice background field inhomogeneity can be approximated by a linear gradient and corrects for a sinc modulation function. The importance of the high-order terms in background field inhomogeneity has increased with the fast development of high- and ultrahigh-field scanners in recent years. In this study, we derived an analytical expression of the free induction decay signal modulation in the presence of a quadratic cross-slice background field inhomogeneity. The proposed quadratic correction method was applied to phantom and volunteer studies and demonstrated to be superior to the classic monoexponential model, monoexponential-plus-constant model, and the linear sinc correction method in recovering background field inhomogeneity-induced. R2* overestimations with visual inspection of R2* parametric maps and a statistical model selection technique. We also tabulated 7-T T2*/R2* measurements of several human brain structures and MnCl(2) solutions with various concentrations for fellow researchers' reference.

Distributions of transverse relaxation times for soft-solids measured in strongly inhomogeneous magnetic fields

The single-sided NMR-MOUSE sensor that operates in highly inhomogeneous magnetic fields is used to record a CPMG 1H transverse relaxation decay by CPMG echo trains for a series of cross-linked natural rubber samples. Effective transverse relaxation rates 1/ T 2,short and 1/ T 2,long were determined by a bi-exponential fit. A linear dependence of transverse relaxation rates on cross-link density is observed for medium to large values of cross-link density. As an alternative to multi-exponential fits the possibility to analyze the dynamics of soft polymer network in terms of multi-exponential decays via the inverse Laplace transformation was studied. The transient regime and the effect of the T 1/ T 2 ratio in inhomogeneous static and radiofrequency magnetic fields on the CPMG decays were studied numerically using a dedicated C++ program to simulate the temporal and spatial dependence of the CPMG response. A correction factor T 2/ T 2,eff is derived as a function of the T 1/ T 2 ratio from numerical simulations and compared with earlier results from two different well logging devices. High-resolution T 1– T 2 correlations maps are obtained by two-dimensional Laplace inversion of CPMG detected saturation recovery curves. The T 1– T 2 experimental correlations maps were corrected for the T 1/ T 2 effect using the derived T 2/ T 2,eff correction factor.

K-Space spatial low-pass filters can increase signal loss artifacts in echo-planar imaging

Effective transverse relaxation rate ( T 2 * )-weighted echo-planar imaging (EPI) is extensively used for functional magnetic resonance imaging (fMRI), because of its high speed and good sensitivity to the blood oxygenation level-dependent (BOLD) signal. Nevertheless, its use is limited in areas with severe static magnetic field inhomogeneities that cause frequency shifts and T 2 * relaxation-related distortions of the MR signal along the time-domain ( k-space) trajectory, resulting in disperse time-domain signals and generating susceptibility-induced signal losses. Echo planar images are commonly smoothed with k-space spatial low-pass filters to improve the signal-to-noise ratio (SNR) and reduce reconstruction artifacts. Here, we show that when such filters are applied to the dispersed echo-signals (not perfectly centered in k-space), part of the image information from the object is removed, thereby enhancing signal-loss artifacts in the images. To avoid this artifact, the dispersed echo signal has to be refocused before k-space filtering.

Correlation of MRI Biomarkers with Tumor Necrosis in Hras5 Tumor Xenograft in Athymic Rats

Magnetic resonance imaging (MRI) can measure the effects of therapies targeting the tumor vasculature and has demonstrated that vascular-damaging agents (VDA) induce acute vascular shutdown in tumors in human and animal models. However, at subtherapeutic doses, blood flow may recover before the induction of significant levels of necrosis. We present the relationship between changes in MRI biomarkers and tumor necrosis. Multiple MRI measurements were taken at 4.7 T in athymic rats (n = 24) bearing 1.94 ± 0.2-cm3 subcutaneous Hras5 tumors (ATCC 41000) before and 24 hours after clinically relevant doses of the VDA, ZD6126 (0-10 mg/kg, i.v.). We measured effective transverse relaxation rate (R2*), initial area under the gadolinium concentration-time curve (IAUGC60/150), equivalent enhancing fractions (EHF60/150), time constant (Ktrans), proportion of hypoperfused voxels as estimated from fit failures in Ktrans analysis, and signal intensity (SI) in T2-weighted MRI (T2W). ZD6126 treatment induced < 90% dose-dependent tumor necrosis at 10 mg/kg; correspondingly, SI changes were evident from T2W MRI. Although R2* did not correlate, other MRI biomarkers significantly correlated with necrosis at doses of ≥ 5 mg/kg ZD6126. These data on Hras5 tumors suggest that the quantification of hypoperfused voxels might provide a useful biomarker of tumor necrosis.

Segmental orientation of thermoplastic polyurethanes investigated by 1H double-quantum NMR. Correlation with thermodynamic and mechanical properties

The segmental orientation of a series of thermoplastic polyurethane (TPU) samples with different content in hard segments and different number average molecular weights of soft segments was investigated by 1H double-quantum (DQ) NMR. The residual dipolar couplings of the hard segments were measured via the residual second van Vleck moments. A simple theoretical approach based on Rouse modes was developed to explain the orientation dependence of the hard segments on the number average molecular weight of the soft segments. The effective transverse relaxation rates of the hard segments were correlated to the 1H residual dipolar couplings. Moreover, the correlation between the segmental orientation of the hard segments and the thermodynamic and mechanical properties of the TPU samples is investigated. The glass transition temperatures of the soft segments represent the relevant thermodynamic quantities. The mechanical parameters used for discussing the correlations are Young's modulus, yield stress, and rebound resilience angles from tensile testing and rebound resilience measurements.

Quantitative study of changes in oxidative metabolism during visual stimulation using absolute relaxation rates

In the context of quantitative functional MRI (fMRI), deoxyhemoglobin (dHb) content is the essential physiological parameter for calibrating the blood oxygenation level-dependent (BOLD) signal. In studies on humans, the baseline dHb content or its equivalent has been evaluated indirectly by means of carbon dioxide breathing as a physiological reference condition. In this study with normal volunteers, quantitative mapping of baseline dHb content was performed in a direct manner by measuring the reversible contribution of the effective transverse relaxation rate. The BOLD signal change in the visual cortex during 8 Hz flicker visual stimulation was calibrated based on the quantitative map of baseline dHb content. The calibrated relaxation rate change that represents the stimulation-induced fractional change of dHb content decreased by 14% within the activated visual cortex. Simultaneous measurement of cerebral blood flow (CBF) with BOLD showed an increase of 59%. From the calibrated relaxation rate and CBF changes, the cerebral metabolic rate of oxygen (CMRO2) was calculated to increase by 19-28% within the activated visual cortex. The ratio of the CBF increase to the CMRO2 increase was 2-3:1, which agreed well with results of similar quantitative fMRI studies for humans. The method proposed here for quantitative evaluation of the BOLD signal may be applicable not only to fMRI for normal human subjects, but also to physiologically altered or diseased states, because it requires no physiological perturbation.

Investigation of soft segments of thermoplastic polyurethane by NMR, differential scanning calorimetry and rebound resilience

The microscopic and macroscopic properties of a series of thermoplastic polyurethane (TPU) samples with different content in the hard segments and different molecular weight of the soft segments were investigated. Proton NMR transverse magnetization relaxation, DSC and rebound resilience techniques were used to characterize their molecular chain mobility, phase composition, glass transition temperature and angle of rebound. The increase of the hard segments content at the same molecular weight soft segments leads to an increase of the glass transition temperature as determined by DSC and to a decrease of the angle of rebound as determined by rebound resilience. These quantities can be correlated to the decrease in the effective transverse relaxation rates of the soft segments and to the increase of the relative fraction of the hard segments as determined by NMR. By increasing the molecular weight of the soft segments at the same content of the hard segments, the glass transition temperature and the angle of rebound decrease and the effective transverse relaxation time of the soft phase increases.

The effect of small rotations on R2* measured with echo planar imaging

Several modern MRI techniques, such as functional MRI (fMRI), rely on the detection of microscopic changes in magnetic susceptibility. However, differences in magnetic susceptibility between brain tissue, bone, and air also produce local magnetic field gradients that may interfere with the contrast of interest, particularly at high field strengths. Since the magnetic field distribution depends on the orientation of the human head in the MRI scanner, head rotations can change the effective transverse relaxation rate ( R 2*) and confound fMRI studies. The size of the R 2* changes produced by small head rotations was estimated from a brain-shaped gel-phantom at 4 T, by measuring the signal decay at 96 different echo times. Similar measurements were carried out in a human study. Rotations larger than 2° changed R 2* more than 1.5 Hz in the phantom, and indicate that even small rotations may compromise fMRI results.

Slow dynamics in folded and unfolded states of an SH3 domain.

(15)N relaxation dispersion experiments were applied to the isolated N-terminal SH3 domain of the Drosophila protein drk (drkN SH3) to study microsecond to second time scale exchange processes. The drkN SH3 domain exists in equilibrium between folded (F(exch)) and unfolded (U(exch)) states under nondenaturing conditions in a ratio of 2:1 at 20 degrees C, with an average exchange rate constant, k(ex), of 2.2 s(-1) (slow exchange on the NMR chemical shift time scale). Consequently a discrete set of resonances is observed for each state in NMR spectra. Within the U(exch) ensemble there is a contiguous stretch of residues undergoing conformational exchange on a micros/ms time scale, likely due to local, non-native hydrophobic collapse. For these residues both the F(exch) <--> U(exch) conformational exchange process and the micros/ms exchange event within the U(exch) state contribute to the (15)N line width and can be analyzed using CPMG-based (15)N relaxation dispersion measurements. The contribution of both processes to the apparent relaxation rate can be deconvoluted numerically by combining the experimental (15)N relaxation dispersion data with results from an (15)N longitudinal relaxation experiment that accurately quantifies exchange rates in slow exchanging systems (Farrow, N. A.; Zhang, O.; Forman-Kay, J. D.; Kay, L. E. J. Biomol. NMR 1994, 4, 727-734). A simple, generally applicable analytical expression for the dependence of the effective transverse relaxation rate constant on the pulse spacing in CPMG experiments has been derived for a two-state exchange process in the slow exchange limit, which can be used to fit the experimental data on the global folding/unfolding transition. The results illustrate that relaxation dispersion experiments provide an extremely sensitive tool to probe conformational exchange processes in unfolded states and to obtain information on the free energy landscape of such systems.

Measurement of slow (micros-ms) time scale dynamics in protein side chains by (15)N relaxation dispersion NMR spectroscopy: application to Asn and Gln residues in a cavity mutant of T4 lysozyme.

A new NMR experiment is presented for the measurement of micros-ms time scale dynamics of Asn and Gln side chains in proteins. Exchange contributions to the (15)N line widths of side chain residues are determined via a relaxation dispersion experiment in which the effective nitrogen transverse relaxation rate is measured as a function of the number of refocusing pulses in constant-time, variable spacing CPMG intervals. The evolution of magnetization from scalar couplings and dipole-dipole cross-correlations, which has limited studies of exchange in multi-spin systems in the past, does not affect the extraction of accurate exchange parameters from relaxation profiles of NH(2) groups obtained in the present experiment. The utility of the method is demonstrated with an application to a Leu --> Ala cavity mutant of T4 lysozyme, L99A. It is shown that many of the side chain amide groups of Asn and Gln residues in the C-terminal domain of the protein are affected by a chemical exchange process which may be important in facilitating the rapid binding of hydrophobic ligands to the cavity.

Parametric mapping of scaled fitting error in dynamic susceptibility contrast enhanced MR perfusion imaging.

The purpose of this study was to examine the benefits of routine generation of a parametric image of scaled curve fitting errors in the analysis of dynamic susceptibility contrast enhanced MR perfusion imaging. We describe the scaled fitting error (SFE), which reflects the magnitude of potential errors in the estimation of perfusion parameters from dynamic susceptibility contrast enhanced studies. The SFE is the root-mean-square error between the observed values in the time course of change of effective transverse relaxation rate (delta R2* (t)) in tissue and the theoretical values derived by gamma variate curve fitting, scaled with a simple function related to the area under the fitted gamma variate curve. The SFE was tested using Monte Carlo simulation and by observations in normal volunteers and patients. This demonstrated that the SFE was linearly related to uncertainties in calculation of the values of relative cerebral blood volume (rCBV) and relative mean transit time (rMTT). High spatial resolution SFE maps were obtained in all volunteers and patients. In normal brain, SFE was consistently higher in white matter than in grey matter. In 54/85 patients with neurodegenerative or vascular brain disease, SFE maps showed focal areas with high values owing to poor signal to noise ratio in delta R2*(t). Increased SFE was also found in 11/54 brain tumours owing to loss of conformance of delta R2*(t) to the gamma variate function. SFE mapping is simple to implement and the computational overhead is negligible. It is concluded that parametric maps of SFE allow visual and quantitative comparison of fitting errors with the theoretical gamma variate model between anatomical regions and provide a quality control device to rapidly assess the reliability of the associated rCBV and rMTT estimations.

Postprocessing technique to correct for background gradients in image-based R*(2) measurements.

Background static magnetic field gradients are a source of signal loss in gradient-echo imaging, as they typically result from discontinuity in the magnetic susceptibility at air-tissue boundaries. Moreover, these induced gradients severely compromise the measurement of R*(2), the effective transverse relaxation rate, which is of interest in many biomedical applications of MRI. Since the slice thickness is usually larger than the in-plane pixel dimensions, gradients parallel to the slice-select direction are of particular concern. In this work, a post-processing technique is introduced which attempts to correct the signal on the assumption that the background gradients are approximately linear across the voxel and the signal decay in the absence of these gradients is exponential. In this case, the time-domain signal is weighted by a sinc function characterized by the amplitude G(b) of the background gradient, which is typically not known a priori. The algorithm searches for the estimate of G(b) which yields the optimum fit of the corrected experimental data to an exponential. It is shown to be effective as long as this gradient is below a critical threshold. Evaluation in a phantom and in the human brain at 1.5 and 4 T demonstrates that this method can restore R(2)* in spite of the apparent rate constant exceeding the true value by up to 100%. Contrary to prospective correction techniques, the approach presented in this study does not prolong scan time.

Moyamoya disease: evaluation with diffusion-weighted and perfusion echo-planar MR imaging.

To determine the clinical efficacy of diffusion-weighted and perfusion echo-planar magnetic resonance (MR) imaging in the evaluation of moyamoya disease. Seventeen patients with moyamoya disease were examined prospectively with diffusion-weighted and perfusion echo-planar MR imaging and conventional angiography. The change in the effective transverse relaxation rate (delta R2*) peak value, delta R2* peak time, and delta R2* integral were calculated to assess regional cerebral perfusion. The MR images were compared with angiographic images. Of the 34 posterior cerebral arteries (PCAs) of the 17 patients, 14 PCAs (41%) in 11 patients showed stenosis or occlusion. The delta R2* peak value ratio in the cerebral hemispheres decreased significantly, and the delta R2* peak time ratio increased significantly, with PCA stenosis and occlusion. However, no correlation was apparent between perfusion and extent of the stenotic or occlusive lesions of the internal carotid artery bifurcation. The frequency of cerebral infarctions was significantly increased in patients with stenotic or occlusive PCA lesions. For three acute infarctions, a decrease in the apparent diffusion coefficient was significantly correlated with a decrease in the delta R2* peak value, an increase in the delta R2* peak time, and a decrease in the delta R2* integral. Regional cerebral perfusion in moyamoya disease is decreased and delayed with PCA stenosis, with greater decrease and delay with PCA occlusion. Diffusion-weighted and perfusion imaging are useful for evaluating cerebral ischemia in moyamoya disease.