Gray-white Matter Contrast Research Articles

The use and promise of nuclear magnetic resonance imaging in epilepsy.

The revolutionary influence of X-ray computerized tomography (CT) on neurodiagnosis will be considerably extended by a newer imaging probe using magnetic fields. This form of imaging uses nuclear magnetic resonance (NMR) as the probe-tissue interaction to make many regional measurements of tissue in a short time, thus allowing an image to be computer-reconstructed. The nuclei of about 100 nuclides have significant magnetic properties, behaving like small permanent bar magnets. The most interesting of these in brain tissue are ordinary hydrogen, sodium, and phosphorus. Placed in a strong magnetic field, they partially align themselves with the field. They can then absorb energy which will subsequently be reradiated. Since the resonant frequency of each nucleus is proportional to the magnetic field in which it finds itself, producing fields which change predictably in strength with position, it becomes possible to localize the activated nuclei. Images of hydrogen density and relaxation times can be made and offer considerable tissue characterization. Bone is nearly invisible and considerable gray-white matter contrast is seen. Factors altering water-binding in tissues affect the image. Malignant tissue usually is seen in contrast to adjacent healthy tissue. Movement of blood is visible. By measuring energy-rich phosphorus, energy stores can be determined. There is no tissue ionization, no injected contrast materials are needed, and there are no radioactive materials involved. NMR scanners probably will replace CT within the next decade for most brain scanning purposes and will offer considerably greater tissue characterization which surely will influence studies of human epilepsy.

THE NMR DIAGNOSIS OF CEREBRAL TUMORS

The results of NMR examinations in 52 patients with histological or clinical diagnoses of cerebral tumor are reviewed. An increase in relaxation time was recognized in all tumors but problems were experienced in distinguishing the margin of tumors from surrounding edema. Mass effects were well demonstrated as a result of the high level of gray-white matter contrast available with inversion-recovery sequences and the use of coronal and sagittal imaging planes. In general repeated FID sequences were less sensitive in detecting tumors than inversion-recovery or spin-echo squences. Periventricular edema was well demonstrated with spin-echo sequences and was of importance in recognizing acute or subacute hydrocephalus. Radiation therapy was associated with increased relaxation times particularly within white matter. Problems in the recognition of tumor recurrence following treatment are outlined. The opportunities and challenges that NMR imaging is now providing for physicists and radiologists are discussed. Contents. Introduction. Patients and methods. Results Normal appearances. Benign tumors. Malignant tumors. Diagnostic features of tumors. The appearance of the tumor. Peritumoral edema. Mass effects and displacements. Hydrocephalus. The comparative sensitivity of different pulse sequences. Differentiation of tumor types. Differential diagnosis between tumors and other conditions. Effects of treatment. Comparison with X-ray CT. Discussion. The physical basis for increased relaxation times. Volume scanning. Multislice imaging. Paramagnetic contrast agents. Tissue characterization. Particular aspects of childhood tumors. Epilepsy. Response to therapy and detection of recurrence. Summary.

The NMR diagnosis of cerebral tumors.

The results of NMR examinations in 52 patients with histological or clinical diagnoses of cerebral tumor are reviewed. An increase in relaxation time was recognized in all tumors but problems were experienced in distinguishing the margin of tumors from surrounding edema. Mass effects were well demonstrated as a result of the high level of gray-white matter contrast available with inversion-recovery sequences and the use of coronal and sagittal imaging planes. In general repeated FID sequences were less sensitive in detecting tumors than inversion-recovery or spin-echo sequences. Periventricular edema was well demonstrated with spin-echo sequences and was of importance in recognizing acute or subacute hydrocephalus. Radiation therapy was associated with increased relaxation times particularly within white matter. Problems in the recognition of tumor recurrence following treatment are outlined. The opportunities and challenges that NMR imaging is now providing for physicists and radiologists are discussed.

Clinical NMR imaging of the brain in children: Normal and neurologic disease

The results of initial clinical nuclear magnetic resonance imaging of the brain in eight normal and 52 children with a wide variety of neurologic diseases were reviewed. The high level of gray-white matter contrast available with inversion-recovery sequences provided a basis for visualizing normal myelination as well as delays or deficits in this process. The appearances seen In cases of parenchymal hemorrhage, cerebral infarction, and porencephalic cysts are described. Ventricular enlargement was readily identified and mareginal edema was demonstrated with spin-echo sequeces. Abnormalities were sleen in cerebral palsy, congenital malformations, Hallervorden-Spatz disease, aminoaciduria, and meningitis. Space-occupying lesions were identified by virtue of their increased relaxation times and mass effects. Nuclear magnetic resonance imaging has considerable potential in pediatric neuroradiologic practice, in some conditions supplying information not available by computed tomography or sonography.

Nuclear magnetic resonance (NMR) tomography of the central nervous system: Comparison of two imaging sequences

Abstract A brief description of a nuclear magnetic resonance (NMR) imaging system and preliminary results from its clinical evaluation in the study of various central nervous system diseases are presented. Particular attention is paid to NMR capabilities for soft tissue discrimination, topographical demarcation, and specificity of diagnosis. Two imaging sequences were used: (a) Spin echo measurements with four sets of imaging parameters revealed the different appearances of normal and pathological structures, (b) Inversion recovery images showed marked gray-white matter contrast and clear depiction of pathological lesions. Finally, a number of measurements of longitudinal (T1) and transverse (T2) relaxation times of normal and pathological tissues were carried out.

NMR anatomy of the brain using inversion-recovery sequences.

The use of NMR inversion-recovery (IR) sequences to demonstrate brain anatomy is illustrated. The high level of grey-white matter contrast is of value in localising anatomical structures and demonstrating myelination during childhood. While the resemblance of IR scans to gross anatomical sections in different planes is close, it is limited by the spatial resolution of the NMR scanner, artefacts and partial volume effects.

Nuclear magnetic resonance (NMR) imaging in white matter disease of the brain using spin-echo sequences.

Attention is drawn to the use of nuclear magnetic resonance (NMR) spin-echo sequences in the recognition of white matter disease of the brain. In 5 patients with multiple sclerosis, 8 lesions were seen with postcontrast x-ray computed tomography (CT) (37.5 g of iodine), 33 with inversion-recovery (IR) scans, and 47 with spin-echo (SE) scans. Partial volume effects were less of a diagnostic difficulty with SE scans than with IR scans. Extensive areas of abnormal white matter were seen with CT, IR, and SE scans in a patient with leucodystrophy associated with congenital muscular dystrophy. In a patient with adrenoleucodystrophy focal lesions were seen with CT, IR, and SE scans. In addition, loss of gray-white matter contrast was seen in both occipital lobes with IR scans. Extensive areas of white matter involvement were also seen in a case of Binswangers disease.

NMR imaging of the brain using spin-echo sequences

Eight normal volunteers and 32 patients with a variety of neurological disease were studied with a nuclear magnetic resonance (NMR) scanner using repeated free induction decay (RFID), inversion-recovery (IR) and spin-echo (SE) sequences. The results were compared with X-ray computed tomography (CT). RFID sequences which produce images that reflect changes in proton density displayed very little grey-white matter contrast and relatively small changes in disease. IR sequences which produce images that are dependent on T1 showed a high level of grey-white matter contrast and demonstrated changes in a variety of pathological processes. Although SE scans, which have a strong T2 dependence, had shown no abnormality in previous studies of patients with neurological disease, sequences of this type with longer values of tau displayed abnormalities in cerebral infarction, haemorrhage, herpes encephalitis, multiple sclerosis, cerebral oedema, hydrocephalus, tumours and Wilson's disease. All of these conditions were associated with an increase in T2. Abnormalities were demonstrated in cases of multiple sclerosis and brainstem infarction with NMR scans where no abnormality was seen with CT. More extensive changes were seen with NMR in cases of hemisphere infarction, systemic lupus erythematosis, herpes encephalitis, hydrocephalus (periventricular oedema) and Sturge-Weber disease. The margin between malignant tumour and surrounding oedema was better defined with contrast enhanced CT in four of eight malignant tumours, equally well defined in one, and better defined with NMR in three cases. NMR spin-echo sequences provide a sensitive technique for detecting abnormalities in a variety of neurological disease.

Clinical NMR imaging of the brain: 140 cases

Cranial nuclear magnetic resonance (NMR) scans were performed on 13 healthy volunteers and 140 patients with a broad spectrum of neurologic disease and compared with x-ray computed tomography (CT) scans. The NMR scans included a variety of sequences reflecting proton density, blood flow, T1, and T2 as well as transverse, sagittal, and coronal images. White matter, gray matter, and cerebrospinal fluid were clearly distinguished in the normal brain with inversion-recovery (IR) sequences, and normal progressive myelination was demonstrated in infants and children. Acute hemorrhages displayed short T1 values, but other pathologic processes such as infarction, infection, demyelination, edema, and malignancy were associated with long T1 values. Cysts had very long T1 values (about that of cerebrospinal fluid). Spinecho (SE) sequences showed increased values of T2 in a variety of conditions and highlighted lesions against the relatively featureless background of the remaining brain. With inversion-recovery scans, different stages of infarction were recognized in the hemispheres. NMR was more useful than CT in demonstrating brainstem infarction. The white matter lesions in demyelinating diseases were well demonstrated with NMR scans. Many more lesions were observed in multiple sclerosis with NMR than with CT. Benign tumors were well seen and usually had shorter T1 values than malignant tumors. Mass effects from tumors were generally better demonstrated with NMR than with CT, including more subtle mass effects such as displacement of the external capsule. Abnormalities were seen in diseases of the basal ganglia, including marked atrophy of the head of the caudate nucleus in Huntington chorea. Advantages of NMR imaging include the high level of gray–white matter contrast, lack of bone artifact, variety of possible sequences, transverse, sagittal, and coronal imaging, sensitivity to pathologic change, and lack of known hazard. Disadvantages include lack of bone detail, limited spatial resolution, lack of contrast agent s, and cost. Promising directions for future clinical research include developmental neurology, tissue characterization with T1 and T2, assessment of blood flow, and the development of contrast agents. Much more detailed evaluation will be required, but NMR seems to be a potentially important addition to existing techniques of neurologic diagnosis.

The principles of shop manipulation for engineering apprentices

We aimed to determine whether 80 kVp conventional nonenhanced head CT scans have better gray–white matter contrast than standard 120 kVp scans performed on the same patients. Thirty head CT scans acquired at 80 kVp (CT dose index [CTDI]vol 46) were compared to prior studies in the same patients performed at 120 kVp (CTDIvol 59). Signal (Hounsfield units [HU]), noise (sd HU), and contrast-to-noise ratio per dose (CNRD) were assessed in multiple cerebral gray and white matter regions of interest. A noise correction factor was used to compensate for scanning at different CTDIvol values. Average gray matter signal at 80 kVp and 120 kVP was 33.9 ± 3.5 HU and 29 ± 4.6 HU, respectively (p < 0.0001); the averages for white matter were 22.5 ± 3.1 HU and 21.6 ± 4.6 HU, respectively (p = 0.11). Corrected noise was 3 ± 0.6 and 2.7 ± 0.6, respectively, for gray matter (p = 0.0001), and 2.8 ± 0.6 and 2.6 ± 0.5, respectively, for white matter (p = 0.00001). The gray–white matter CNRD was 4.0 ± 1.2 at 80 kVp and 2.8 ± 1 at 120 kVp (p < 0.00001). Cerebral gray–white matter CNRD is increased by 40% at 80 kVp compared to conventional 120 kVp CT scans. These findings justify further clinical evaluation in the acute stroke setting.