Magnetization-prepared Rapid Gradient-echo Imaging Research Articles

Quantitative evaluation of Scout Accelerated Motion Estimation and Reduction (SAMER) MPRAGE for morphometric analysis of brain tissue in patients undergoing evaluation for memory loss

BackgroundThree-dimensional (3D) T1-weighted MRI sequences such as the magnetization prepared rapid gradient echo (MPRAGE) sequence are important for assessing regional cortical atrophy in the clinical evaluation of dementia but have long acquisition times and are prone to motion artifact. The recently developed Scout Accelerated Motion Estimation and Reduction (SAMER) retrospective motion correction method addresses motion artifact within clinically-acceptable computation times and has been validated through qualitative evaluation in inpatient and emergency settings. MethodsWe evaluated the quantitative accuracy of morphometric analysis of SAMER motion-corrected compared to non-motion-corrected MPRAGE images by estimating cortical volume and thickness across neuroanatomical regions in two subject groups: (1) healthy volunteers and (2) patients undergoing evaluation for dementia. In part (1), we used a set of 108 MPRAGE reconstructed images derived from 12 healthy volunteers to systematically assess the effectiveness of SAMER in correcting varying degrees of motion corruption, ranging from mild to severe. In part (2), 29 patients who were scheduled for brain MRI with memory loss protocol and had motion corruption on their clinical MPRAGE scans were prospectively enrolled. ResultsIn part (1), SAMER resulted in effective correction of motion-induced cortical volume and thickness reductions. We observed systematic increases in the estimated cortical volume and thickness across all neuroanatomical regions and a relative reduction in percent error values compared to reference standard scans of up to 66 % for the cerebral white matter volume. In part (2), SAMER resulted in statistically significant volume increases across anatomical regions, with the most pronounced increases seen in the parietal and temporal lobes, and general reductions in percent error relative to reference standard clinical scans. ConclusionSAMER improves the accuracy of morphometry through systematic increases and recovery of the estimated cortical volume and cortical thickness following motion correction, which may affect the evaluation of regional cortical atrophy in patients undergoing evaluation for dementia.

A - 5 Longitudinal Analysis of Protective Factors on Cognition Following Total Knee Arthroplasty

Abstract Objective To examine cognitive and brain resilience factors on older adult cognition following total knee arthroplasty (TKA). Methods Participants were recruited through orthopedic clinics and screened for eligibility (i.e., age > 60 years, English as first language, diagnosis of knee osteoarthritis, intact activities of daily living). Data were collected before surgery, three weeks, three months, and one-year post-TKA (N = 67; mean(SD) age = 69.49(7.09) years; mean(SD) education = 15.62(2.83) years; 51% female; 90% non-Hispanic White (NHW), 10% non-Hispanic Black. Participants received baseline magnetic resonance imaging (3 T Siemens Verio). Magnetization-prepared rapid gradient-echo images were preprocessed. Machine learning predicted brain age (DeepBrainNet) was calculated for each participant. Linear mixed effects models examined longitudinal effects of word reading (Wide Range Achievement Test-III (WRAT-III)), brain age gap (predicted brain age minus chronological age), sex, ethnicity/race, pain interference (Brief Pain Inventory), and depression (Beck Depression Inventory-II) on cognitive composites (i.e., memory, working memory/inhibition, reasoning, processing speed, language). Results Memory, working memory/inhibition, reasoning, and processing speed had curvilinear trajectories (p’s < 0.05), declining post-TKA and subsequently returning to baseline. Word reading positively associated with memory (β = 0.065, SE = 0.016, p < 0.001), working memory/inhibition (β = 0.069, SE = 0.016, p < 0.001), reasoning (β = 0.099, SE = 0.021, p < 0.001), and processing speed (β = 0.050, SE = 0.015, p < 0.01). Language negatively associated with BAG (β = −0.041, SE = 0.017, p < 0.05). Women had higher processing speed (β = −0.285, SE = 0.135, p < 0.05), and NHW participants had higher memory (β = 0.479, SE = 0.224, p < 0.05). When pain interference was higher, processing speed (β = −0.003, SE = 0.002, p < 0.05) and language (β = −0.007, SE = 0.002, p < 0.01) were lower. Conclusions Cognitive and brain resilience measures may identify individuals protected against cognitive dysfunction post-surgically. Future research increasing representation in underrepresented groups is warranted.

Cortical and subcortical structural changes in pediatric patients with infratentorial tumors.

This study aimed to detect supratentorial cortical and subcortical morphological changes in pediatric patients with infratentorial tumors. The study included 24 patients aged 4-18 years who were diagnosed with primary infratentorial tumors and 41 age- and gender-matched healthy controls. Synthetic magnetization-prepared rapid gradient echo images of brain magnetic resonance imaging were generated using deep learning algorithms applied to T2-axial images. The cortical thickness, surface area, volume, and local gyrification index (LGI), as well as subcortical gray matter volumes, were automatically calculated. Surface-based morphometry parameters for the patient and control groups were compared using the general linear model, and volumes between subcortical structures were compared using the t-test and Mann-Whitney U test. In the patient group, cortical thinning was observed in the left supramarginal, and cortical thickening was observed in the left caudal middle frontal (CMF), left fusiform, left lateral orbitofrontal, left lingual gyrus, right CMF, right posterior cingulate, and right superior frontal (P < 0.050). The patient group showed a volume reduction in the pars triangularis, paracentral, precentral, and supramarginal gyri of the left hemisphere (P < 0.05). A decreased surface area was observed in the bilateral superior frontal and cingulate gyri (P < 0.05). The patient group exhibited a decreased LGI in the right precentral and superior temporal gyri, left supramarginal, and posterior cingulate gyri and showed an increased volume in the bilateral caudate nucleus and hippocampus, while a volume reduction was observed in the bilateral putamen, pallidum, and amygdala (P < 0.05). The ventricular volume and tumor volume showed a positive correlation with the cortical thickness in the bilateral CMF while demonstrating a negative correlation with areas exhibiting a decreased LGI (P < 0.05). Posterior fossa tumors lead to widespread morphological changes in cortical structures, with the most prominent pattern being hypogyria. This study illuminates the neurological impacts of infratentorial tumors in children, providing a foundation for future therapeutic strategies aimed at mitigating these adverse cortical and subcortical changes and improving patient outcomes.

Cortical Microhemorrhage Presentation of Small Vessel Primary Angiitis of the Central Nervous System.

Primary angiitis of the central nervous system (PACNS) is a rare vasculitis restricted to the brain, spinal cord, and leptomeninges. This study aimed to describe the imaging characteristics of patients with small vessel PACNS (SV-PACNS) using 7 T magnetic resonance imaging (MRI). This ongoing prospective observational cohort study included patients who met the Calabrese and Mallek criteria and underwent 7 T MRI scan. The MRI protocol includes T1-weighted magnetization-prepared rapid gradient echo imaging, T2 star weighted imaging, and susceptibility-weighted imaging. Two experienced readers independently reviewed the neuroimages. Clinical data were extracted from the electronic patient records. The findings were then applied to a cohort of patients with large vessel central nervous system (CNS) vasculitis. We included 21 patients with SV-PACNS from December 2021 to November 2023. Of these, 12 (57.14%) had cerebral cortical microhemorrhages with atrophy. The pattern with microhemorrhages was described in detail based on the gradient echo sequence, leading to the identification of what we have termed the "coral-like sign." The onset age of patients with coral-like sign (33.83 ± 9.93 years) appeared younger than that of patients without coral-like sign (42.11 ± 14.18 years) (P = 0.131). Furthermore, the cerebral lesions in patients with cortical microhemorrhagic SV-PACNS showed greater propensity toward bilateral lesions (P = 0.03). The coral-like sign was not observed in patients with large vessel CNS vasculitis. The key characteristics of the coral-like sign represent cerebral cortical diffuse microhemorrhages with atrophy, which may be an important MRI pattern of SV-PACNS. ANN NEUROL 2024;96:194-203.

Rich Club Reorganization in Nurses Before and After the Onset of Occupational Burnout: A Longitudinal MRI Study.

Studies on potential disruptions in rich club structure in nursing staff with occupational burnout are lacking. Moreover, existing studies on nurses with burnout are limited by their cross-sectional design. To investigate rich club reorganization in nursing staff before and after the onset of burnout and the underlying impact of anatomical distance on such reconfiguration. Prospective, longitudinal. Thirty-nine hospital nurses ( years old at baseline, years old at a follow-up within 1.5 years, 38 female). Magnetization-prepared rapid gradient-echo and gradient-echo echo-planar imaging sequences at 3.0 T. The Maslach Burnout Inventory and Symptom Check-List 90 testing were acquired at each MRI scan. Rich club structure was assessed at baseline and follow-up to determine whether longitudinal changes were related to burnout and to changes in connectivities with different anatomical distances (short-, mid-, and long range). Chi-square, paired-samples t, two-sample t, Mann-Whitney U tests, network-based statistic, Spearman correlation analysis, and partial least squares regression analysis. Significance level: Bonferroni-corrected . In nurses who developed burnout: 1) Strengths of rich club, feeder, local, short-, mid-, and long-range connectivities were significantly decreased at follow-up compared with baseline. 2) At follow-up, strengths of above connectivities and that between A5m.R and dlPu.L were significantly correlated with emotional exhaustion (r ranges from -0.57 to -0.73) and anxiety scores (r = -0.56), respectively. 3) Longitudinal change (follow-up minus baseline) in connectivity strength between A5m.R and dlPu.L reflected change in emotional exhaustion score (r = 0.87). Longitudinal changes in strength of connectivities mainly involving parietal lobe were significantly decreased in nurses who developed burnout compared with those who did not. In nurses after the onset of burnout, rich club reorganization corresponded to significant reductions in strength of connectivities with different anatomical distances. 1 TECHNICAL EFFICACY: Stage 2.

Hippocampal volume and recovery profile following propofol sedation in children undergoing magnetic resonance imaging: An exploratory study.

Reduction in the hippocampal volume may contribute to agitated and delayed emergence after anesthesia in epilepsy surgery. We hypothesized that hippocampal volume and the duration of various recovery parameters after a short duration of sedation may be correlated. The primary objective was to evaluate the correlation between hippocampal volumes with time to recovery after the stoppage of propofol infusion. After obtaining Institute Ethical Clearance, we included all children of the age group 5-17 years, who needed sedation for brain magnetic resonance imaging (MRI) for at least 20-60 minutes for the evaluation of epilepsy. The hippocampal volume was estimated bilaterally in the pre-contrast volumetric magnetization-prepared rapid gradient-echo (MPRAGE) brain imaging by the radiologist using statistical parametric mapping. The correlation of hippocampal volume with recovery and time to discharge (assessed by the modified Aldrete score (MAS)) was obtained using Spearman's correlation coefficient (rho). A rho > ± 0.5 was considered a good correlation between the variables. Data on a total of 18 children (10 males and 8 females) who required sedation for an MRI were studied over a period of six months. The correlation coefficients of right and left corrected hippocampal volumes with time to spontaneous eye opening were -0.052 and -0.195, respectively. The correlation coefficients of right and left corrected hippocampal volumes with time to respond to oral commands were -0.017 and -0.219, respectively. There was a weak negative correlation between hippocampal volumes and recovery parameters after a short duration of sedation with propofol in children.

Visualization of small brain nuclei with a high-spatial resolution, clinically available whole-body PET scanner

ObjectiveTo verify the visibility of physiological 18F-fluorodeoxyglucose (18F-FDG) uptake in nuclei in and around the brainstem by a whole-body (WB) silicon photomultiplier positron emission tomography (SiPM-PET) scanner with point-spread function (PSF) reconstruction using various iteration numbers.MethodsTen healthy subjects (5 men, 5 women; mean age, 56.0 ± 5.0 years) who underwent 18F-FDG PET/CT using a WB SiPM-PET scanner and magnetic resonance imaging (MRI) of the brain including a spin-echo three-dimensional sampling perfection with application-optimized contrasts using different flip angle evolutions fluid-attenuated inversion recovery (3D-FLAIR) and a 3D-T1 magnetization-prepared rapid gradient-echo (T1-MPRAGE) images were enrolled. Each acquired PET image was reconstructed using ordered-subset expectation maximization (OSEM) with iteration numbers of 4, 16, 64, and 256 (subset 5 fixed) + time-of-flight (TOF) + PSF. The reconstructed PET images and 3D-FLAIR images for each subject were registered to individual T1-MPRAGE volumes using normalized mutual information criteria. For each MR-coregistered individual PET image, the pattern of FDG uptake in the inferior olivary nuclei (ION), dentate nuclei (DN), midbrain raphe nuclei (MRN), inferior colliculi (IC), mammillary bodies (MB), red nuclei (RN), subthalamic nuclei (STN), lateral geniculate nuclei (LGN), medial geniculate nuclei (MGN), and superior colliculi (SC) was visually classified into the following three categories: good, clearly distinguishable FDG accumulation; fair, obscure contour of FDG accumulation; poor, FDG accumulation indistinguishable from surrounding uptake.ResultsAmong individual 18F-FDG PET images with OSEM iterations of 4, 16, 64, and 256 + TOF + PSF, the iteration numbers that showed the best visibility in each structure were as follows: ION, MRN, LGN, MGN, and SC, iteration 64; DN, iteration 16; IC, iterations 16, 64, and 256; MB, iterations 64 and 256; and RN and STN, iterations 16 and 64, respectively. Of the four iterations, the 18F-FDG PET image of iteration 64 visualized FDG accumulation in small structures in and around the brainstem most clearly (good, 98 structures; fair, 2 structures).ConclusionsA clinically available WB SiPM-PET scanner is useful for visualizing physiological FDG uptake in small brain nuclei, using a sufficiently high number of iterations for OSEM with TOF and PSF reconstructions.

Radiomics features from 3D-MPRAGE imaging can differentiate temporal-plus epilepsy from temporal lobe epilepsy.

This study aimed to differentiate temporal-plus epilepsy (TPE) from temporal lobe epilepsy (TLE) using extraction of radiomics features from three-dimensional magnetization-prepared rapid acquisition gradient echo (3D-MPRAGE) imaging data. Data from patients with TLE or TPE who underwent epilepsy surgery between January 2019 and January 2021 were retrospectively analyzed. Thirty-three regions of interest in the affected hemisphere of each patient were defined on 3D-MPRAGE images. A total of 3531 image features were extracted from each patient. Four feature selection methods and 10 machine learning algorithms were used to build 40 differentiation models. Model performance was evaluated using receiver operating characteristic analysis. Eighty-two patients were included for analysis, 47 with TLE and 35 with TPE. The model combining logistic regression and the relief selection method had the best performance (area under the receiver operating characteristic curve, .779; accuracy, .875; sensitivity, .800; specificity, .929; positive predictive value, .889; negative predictive value, .867). Radiomics analysis can differentiate TPE from TLE. The logistic regression classifier trained with radiomics features extracted from 3D-MPRAGE images had the highest accuracy and best performance.

Optimized flow compensation for contrast-enhanced T1-weighted Wave-CAIPI 3D MPRAGE imaging of the brain

Flow-related artifacts have been observed in highly accelerated T1-weighted contrast-enhanced wave-controlled aliasing in parallel imaging (CAIPI) magnetization-prepared rapid gradient-echo (MPRAGE) imaging and can lead to diagnostic uncertainty. We developed an optimized flow-mitigated Wave-CAIPI MPRAGE acquisition protocol to reduce these artifacts through testing in a custom-built flow phantom. In the phantom experiment, maximal flow artifact reduction was achieved with the combination of flow compensation gradients and radial reordered k-space acquisition and was included in the optimized sequence. Clinical evaluation of the optimized MPRAGE sequence was performed in 64 adult patients, who all underwent contrast-enhanced Wave-CAIPI MPRAGE imaging without flow-compensation and with optimized flow-compensation parameters. All images were evaluated for the presence of flow-related artifacts, signal-to-noise ratio (SNR), gray-white matter contrast, enhancing lesion contrast, and image sharpness on a 3-point Likert scale. In the 64 cases, the optimized flow mitigation protocol reduced flow-related artifacts in 89% and 94% of the cases for raters 1 and 2, respectively. SNR, gray-white matter contrast, enhancing lesion contrast, and image sharpness were rated as equivalent for standard and flow-mitigated Wave-CAIPI MPRAGE in all subjects. The optimized flow mitigation protocol successfully reduced the presence of flow-related artifacts in the majority of cases.Relevance statementAs accelerated MRI using novel encoding schemes become increasingly adopted in clinical practice, our work highlights the need to recognize and develop strategies to minimize the presence of unexpected artifacts and reduction in image quality as potential compromises to achieving short scan times.Key points• Flow-mitigation technique led to an 89–94% decrease in flow-related artifacts.• Image quality, signal-to-noise ratio, enhancing lesion conspicuity, and image sharpness were preserved with the flow mitigation technique.• Flow mitigation reduced diagnostic uncertainty in cases where flow-related artifacts mimicked enhancing lesions.Graphical

Diaschisis Profiles in the Cerebellar Response to Hemodynamic Stimuli: Insights From Dynamic Measurement of Cerebrovascular Reactivity to Identify Occult and Transient Maxima.

Crossed cerebellar diaschisis (CCD) refers to depressions in perfusion and metabolism within the cerebellar hemisphere contralateral to supratentorial disease. Prior investigation into CCD in cerebrovascular reactivity (CVR) has been limited to terminal CVR estimations (CVRend ). We recently have demonstrated the presence of unsustained CVR maxima (CVRmax ) using dynamic CVR analysis, offering a fully dynamic characterization of CVR to hemodynamic stimuli. To investigate CCD in CVRmax from dynamic blood oxygen level-dependent (BOLD) MRI, by comparison with conventional CVRend estimation. Retrospective. A total of 23 patients (median age: 51 years, 10 females) with unilateral chronic steno-occlusive cerebrovascular disease, without prior knowledge of CCD status. A 3-T, T1-weighted magnetization-prepared rapid gradient-echo (MPRAGE) and acetazolamide-augmented BOLD imaging performed with a gradient-echo echo-planar imaging (EPI) sequence. A custom denoising pipeline was used to generate BOLD-CVR time signals. CVRend was established using the last minute of the BOLD response relative to the first-minute baseline. Following classification of healthy versus diseased cerebral hemispheres, CVRmax and CVRend were calculated for bilateral cerebral and cerebellar hemispheres. Three independent observers evaluated all data for the presence of CCD. Pearson correlations for comparing CVR across hemispheres, two-proportion Z-tests for comparing CCD prevalence, and Wilcoxon signed-rank tests for comparing median CVR. The level of statistical significance was set at P≤ 0.05. CCD-related changes were observed on both CVRend and CVRmax maps, with all CCD+ cases identifiable by inspection of either map. Diseased cerebral and contralateral cerebellar hemispheric CVR correlations in CCD+ patients were stronger when using CVRend (r=0.728) as compared to CVRmax (r=0.676). CVR correlations between healthy cerebral hemispheres and contralateral cerebellar hemispheres were stronger for CVRmax (r=0.739) than for CVRend (r=0.705). CCD-related alterations could be observed in CVR examinations. Conventional CVRend may underestimate CVR and could exaggerate CCD. 4. Stage 3.

Altered Functional Connectivity Strength in Distinct Brain Networks of Children With Early-Onset Schizophrenia.

Schizophrenia is regarded as a brain network or connectome disorder that is associated with neurodevelopment. Children with early-onset schizophrenia (EOS) provide an opportunity to evaluate the neuropathology of schizophrenia at a very early stage without potential confounding factors. But dysfunction in brain networks of schizophrenia is inconsistent. To identify abnormal functional connectivity (FC) in EOS patients and relationships with clinical symptoms, we aimed to reveal neuroimaging phenotypes of EOS. Prospective, cross-sectional. Twenty-six female/22 male patients (age:14.3 ± 3.45 years) with first-episode EOS, 27 female/22 male age- and gender-matched healthy controls (HC) (age:14.1 ± 4.32). 3-T, resting-state (rs) gradient-echo echo-planar imaging and three-dimensional magnetization-prepared rapid gradient-echo imaging. Intelligence quotient (IQ) was measured by the Wechsler Intelligence Scale-Fourth edition for Children (WISC-IV). The clinical symptoms were evaluated by the Positive and Negative Syndrome Scale (PANSS). FC strength (FCS) from rs functional MRI (rsfMRI) was used to investigate functional integrity of global brain regions. In addition, associations between regionally altered FCS and clinical symptoms in EOS patients were examined. Two-sample t-test controlling for sample size, diagnostic method, brain volume algorithm, and age of the subjects, Bonferroni correction, Pearson's correlation analysis. A P-value <0.05 with a minimum cluster size of 50 voxels was considered statistically significant. Compared with HC, EOS patients had significantly lower total IQ scores (IQ:91.5 ± 16.1), increased FCS in the bilateral precuneus, left dorsolateral prefrontal cortex, left thalamus, and left parahippocampus (paraHIP), and decreased FCS in the right cerebellum posterior lobe and right superior temporal gyrus. The PANSS total score of EOS patients (PANSS total score:74.30 ± 7.23) was found to be positively correlated to FCS in the left paraHIP (r=0.45). Our study revealed that disrupted FC of brain hubs illustrate multiple abnormalities in brain networks in EOS patients. 1 TECHNICAL EFFICACY STAGE: 2.

Brain imaging of sequential acquisition using a flexible PET scanner and 3-T MRI: quantitative and qualitative assessment.

A mobile PET scanner termed flexible PET (fxPET) has been designed to fit existing MRI systems. The purpose of this study was to assess brain imaging with fxPET combined with 3-T MRI in comparison with conventional PET (cPET)/CT. In this prospective study, 29 subjects with no visible lesions except for mild leukoaraiosis on whole brain imaging underwent 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) cPET/CT followed by fxPET and MRI. The registration differences between fxPET and MRI and between cPET and CT were compared by measuring spatial coordinates. Three-dimensional magnetization-prepared rapid acquisition gradient-echo T1-weighted imaging (T1WI) was acquired. We applied two methods of attenuation correction to the fxPET images: MR-based attenuation correction, which yielded fxPETMRAC; and CT-based attenuation correction, which yielded fxPETCTAC. The three PET datasets were co-registered to the T1WI. Following subcortical segmentation and cortical parcellation, volumes of interest were placed in each PET image to assess physiological accumulation in the brain. SUVmean was obtained and compared between the three datasets. We also visually evaluated image distortion and clarity of fxPETMRAC. Mean misregistration of fxPET/MRI was < 3mm for each margin. Mean registration differences were significantly larger for fxPET/MRI than for cPET/CT except for the superior margin. There were high correlations between the three PET datasets regarding SUVmean. On visual evaluation of image quality, the grade of distortion was comparable between fxPETMRAC and cPET, and the grade of clarity was acceptable but inferior for fxPETMRAC compared with cPET. fxPET could successfully determine physiological [18F]FDG uptake; however, improved image clarity is desirable. In this study, fxPET/MRI at 3-T was feasible for brain imaging.

MR-self Noise2Noise: self-supervised deep learning-based image quality improvement of submillimeter resolution 3D MR images.

The study aimed to develop a deep neural network (DNN)-based noise reduction and image quality improvement by only using routine clinical scans and evaluate its performance in 3D high-resolution MRI. This retrospective study included T1-weighted magnetization-prepared rapid gradient-echo (MP-RAGE) images from 185 clinical scans: 135 for DNN training, 11 for DNN validation, 20 for qualitative evaluation, and 19 for quantitative evaluation. Additionally, 18 vessel wall imaging (VWI) data were included to evaluate generalization. In each scan of the DNN training set, two noise-independent images were generated from the k-space data, resulting in an input-label pair. 2.5D U-net architecture was utilized for the DNN model. Qualitative evaluation between conventional MP-RAGE and DNN-based MP-RAGE was performed by two radiologists in image quality, fine structure delineation, and lesion conspicuity. Quantitative evaluation was performed with full sampled data as a reference by measuring quantitative error metrics and volumetry at 7 different simulated noise levels. DNN application on VWI was evaluated by two radiologists in image quality. Our DNN-based MP-RAGE outperformed conventional MP-RAGE in all image quality parameters (average scores = 3.7 vs. 4.9, p < 0.001). In the quantitative evaluation, DNN showed better error metrics (p < 0.001) and comparable (p > 0.09) or better (p < 0.02) volumetry results than conventional MP-RAGE. DNN application to VWI also revealed improved image quality (3.5 vs. 4.6, p < 0.001). The proposed DNN model successfully denoises 3D MR image and improves its image quality by using routine clinical scans only. • Our deep learning framework successfully improved conventional 3D high-resolution MRI in all image quality parameters, fine structure delineation, and lesion conspicuity. • Compared to conventional MRI, the proposed deep neural network-based MRI revealed better quantitative error metrics and comparable or better volumetry results. • Deep neural network application to 3D MRI whose pulse sequences and parameters were different from the training data showed improvement in image quality, revealing the potential to generalize on various clinical MRI.

Stereotactic radiotherapy of brain metastases: clinical impact of three-dimensional SPACE imaging for 3T-MRI-based treatment planning

PurposeFor planning CyberKnife stereotactic radiosurgery (CK SRS) of brain metastases (BM), it is essential to precisely determine the exact number and location of BM in MRI. Recent MR studies suggest the superiority of contrast-enhanced 3D fast spin echo SPACE (sampling perfection with application-optimized contrast by using different flip angle evolutions) images over 3D gradient echo (GE) T1-weighted MPRAGE (magnetization-prepared rapid gradient echo) images for detecting small BM. The aim of this study is to test the usability of the SPACE sequence for MRI-based radiation treatment planning and its impact on changing treatment.MethodsFor MRI-based radiation treatment planning using 3T MRI in 199 patients with cerebral oligometastases, we compared the detectability of BM in post-gadolinium SPACE images, post-gadolinium MPRAGE images, and post-gadolinium late-phase MPRAGE images.ResultsWhen SPACE images were used for MRI-based radiation treatment planning, 29.8% and 16.9% more BM, respectively, were detected and included in treatment planning than in the post-gadolinium MPRAGE images and the post-gadolinium late-phase MPRAGE images (post-gadolinium MPRAGE imaging: ntotal = 681, mean ± SD 3.4 ± 4.2; post-gadolinium SPACE imaging: ntotal = 884, mean ± SD 4.4 ± 6.0; post-gadolinium late-phase MPRAGE imaging: ntotal = 796, mean ± SD 4.0 ± 5.3; Ppost-gadolinium SPACE imaging versus post-gadolinium MPRAGE imaging < 0.0001, Ppost-gadolinium SPACE imaging versus post-gadolinium late-phase MPRAGE imaging< 0.0001).ConclusionFor 3T MRI-based treatment planning of stereotactic radiosurgery of BM, we recommend the use of post-gadolinium SPACE imaging rather than post-gadolinium MPRAGE imaging.

Loss of hippocampal dentation in hippocampal sclerosis and its relationship to memory dysfunction.

Hippocampal dentation (HD) is a "toothlike" morphological feature observed on the inferior aspect of the human hippocampus. It has been found that HD varies dramatically in healthy adults and is positively associated with verbal and visual memory. In this work, we evaluate the loss of HD and its association with memory dysfunction in patients with temporal lobe epilepsy (TLE) who have hippocampal sclerosis (HS). Fifty-eight unilateral HS patients with neuropsychological data were identified from a retrospective database. T1-weighted magnetization-prepared rapid acquisition gradient echo images (~1mm resolution) were upsampled to .25mm and were processed using ASHS software to obtain ultra-high-resolution segmentations and three-dimensional renderings. Dentes were counted on the epileptic and contralateral sides, and associations were tested between dentation on the epileptic versus contralateral sides and measures of verbal and visuospatial memory with respect to the dominant versus nondominant hemisphere. The median number of dentes in epileptic hippocampi was significantly lower than in contralateral hippocampi (p<.0001). Among cases with HS in the dominant hemisphere, verbal memory was significantly correlated with contralateral nondominant hemisphere dentation (r=.43, p=.04). Similarly, among cases of HS in the nondominant hemisphere, visual memory was significantly correlated with contralateral dominant hemisphere dentation (r=.48, p=.04). All other analyses were not significant. This is the first study characterizing dentation in TLE patients with HS and its memory correlates. There is marked loss of dentation in sclerotic hippocampi compared to the unaffected contralateral hippocampi. Material-specific measures of memory performance are paradoxically correlated with dentation contralateral to the side with HS, suggesting that contralateral functional capacity explains some of the variation in memory across TLE patients. HD is an important variable to consider in understanding memory loss in TLE.

Hippocampal Subfields and White Matter Connectivity in Patients with Subclinical Geriatric Depression.

Despite an abundance of research related to the functional and structural changes of the brain in patients with geriatric depression, knowledge related to early alterations such as decreased white matter connectivity and their association with cognitive decline remains lacking. We aimed to investigate early alterations in hippocampal microstructure and identify their associations with memory function in geriatric patients with subclinical depression. Nineteen participants with subclinical geriatric depression and 19 healthy controls aged ≥65 years exhibiting general cognitive function within the normal range were included in the study and underwent assessments of verbal memory. Hippocampal subfield volumes were determined based on T1-weighted magnetization-prepared rapid gradient echo (T1-MPRAGE) images, while group tractography and connectometry analyses were conducted using diffusion tensor images. Our findings indicated that the volumes of whole bilateral hippocampus, cornus ammonis (CA) 1, molecular layer, left subiculum, CA3, hippocampal tail, right CA4, and granule cell/molecular layers of the dentate gyrus (GC-ML-DG) were significantly smaller in the subclinical depression group than in the control group. In the subclinical depression group, verbal learning was positively correlated with the volumes of the CA1, GC-ML-DG, molecular layer, and whole hippocampus in the right hemisphere. The fractional anisotropy of the bilateral fornix was also significantly lower in the subclinical depression group and exhibited a positive correlation with verbal learning and recall in both groups. Our results suggest that hippocampal microstructure is disrupted and associated with memory in patients with subclinical depression.

Altered Resting-State Intranetwork and Internetwork Functional Connectivity in Patients With Chronic Unilateral Vestibulopathy.

BackgroundChronic unilateral vestibulopathy (CUVP) is often accompanied by dizziness and postural instability, which restrict patients' daily activities. It is important to understand central compensation mechanisms underlying these symptoms in patients with CUVP by evaluating their brain functional status.PurposeTo analyze the changes in resting‐state intranetwork and internetwork functional connectivity (FC) and explore the state of central vestibular compensation in patients with CUVP.Study typeRetrospective.Population Eighteen patients with right‐sided CUVP and 18 age‐ and sex‐matched healthy controls.Field strength/sequenceA 3.0 T, three‐dimensional magnetization‐prepared rapid gradient‐echo (MP‐RAGE) and resting‐state echo‐planar imaging (EPI) functional MRI sequences.AssessmentFC alterations were explored using independent component analysis (ICA). Twelve independent components were identified via ICA. Dizziness Handicap Inventory (DHI) score for all patients was determined.Statistical testsTwo‐sample t test, family‐wise error (FWE) correction, Pearson correlation coefficient (r). A P value <0.05 was considered statistically significant.ResultsCompared with healthy controls, patients with CUVP showed significantly decreased FC in the right middle occipital gyrus within the lateral visual network, and significantly increased FC in the right supplementary motor area within the sensorimotor network. The FC was decreased between the medial visual and auditory networks, the right frontoparietal and posterior default networks, as well as the sensorimotor and auditory networks. There was a significant negative correlation between the FC changes in the visual, auditory networks and the DHI score in patients with CUVP (r = −0.583).Data conclusionCompared to healthy controls, the FC was significantly decreased in the right visual cortex and significantly enhanced in the right sensorimotor network in patients with CUVP. Patients with CUVP showed decreased FC between multiple whole‐brain networks, suggesting that abnormal integration of multisensory information may be involved in the occurrence of chronic dizziness and instability in patients with CUVP.Level of evidence4Technical EfficacyStage 2.

Convolutional Neural Network Based Frameworks for Fast Automatic Segmentation of Thalamic Nuclei from Native and Synthesized Contrast Structural MRI.

Thalamic nuclei have been implicated in several neurological diseases. Thalamic nuclei parcellation from structural MRI is challenging due to poor intra-thalamic nuclear contrast while methods based on diffusion and functional MRI are affected by limited spatial resolution and image distortion. Existing multi-atlas based techniques are often computationally intensive and time-consuming. In this work, we propose a 3D convolutional neural network (CNN) based framework for thalamic nuclei parcellation using T1-weighted Magnetization Prepared Rapid Gradient Echo (MPRAGE) images. Transformation of images to an efficient representation has been proposed to improve the performance of subsequent classification tasks especially when working with limited labeled data. We investigate this by transforming the MPRAGE images to White-Matter-nulled MPRAGE (WMn-MPRAGE) contrast, previously shown to exhibit good intra-thalamic nuclear contrast, prior to the segmentation step. We trained two 3D segmentation frameworks using MPRAGE images (n = 35 subjects): (a) a native contrast segmentation (NCS) on MPRAGE images and (b) a synthesized contrast segmentation (SCS) where synthesized WMn-MPRAGE representation generated by a contrast synthesis CNN were used. Thalamic nuclei labels were generated using THOMAS, a multi-atlas segmentation technique proposed for WMn-MPRAGE images. The segmentation accuracy and clinical utility were evaluated on a healthy cohort (n = 12) and a cohort (n = 45) comprising of healthy subjects and patients with alcohol use disorder (AUD), respectively. Both the segmentation CNNs yielded comparable performances on most thalamic nuclei with Dice scores greater than 0.84 for larger nuclei and at least 0.7 for smaller nuclei. However, for some nuclei, the SCS CNN yielded significant improvements in Dice scores (medial geniculate nucleus, P = 0.003, centromedian nucleus, P = 0.01) and percent volume difference (ventral anterior, P = 0.001, ventral posterior lateral, P = 0.01) over NCS. In the AUD cohort, the SCS CNN demonstrated a significant atrophy in ventral lateral posterior nucleus in AUD patients compared to healthy age-matched controls (P = 0.01), agreeing with previous studies on thalamic atrophy in alcoholism, whereas the NCS CNN showed spurious atrophy of the ventral posterior lateral nucleus. CNN-based segmentation of thalamic nuclei provides a fast and automated technique for thalamic nuclei prediction in MPRAGE images. The transformation of images to an efficient representation, such as WMn-MPRAGE, can provide further improvements in segmentation performance.

Normal prepubertal çocuklarda hipofiz hacminin üç boyutlu MRG ile değerlendirilmesi

Purpose: The aim of the present study is to measure the pituitary volume of the children who are under 12 years of age with normal pituitary function and find the reference interval of the normal pituitary volume in the prepubertal period &#x0D; Materials and Methods: A total 240 healthy children (120 boys- 120 girls) under the age of 12 yr who came our clinic for cranial MRI imaging for various indications within 2 years, were examined. The volume of pituitary gland was measured using a thin-section three dimensional magnetic resonance imaging (MRI) sequences of magnetization-prepared rapid gradient echo imaging with a 1-mm thick reconstructed sagittal images. We also examined the midline sagittal T1-weighted images for the measurement of the pituitary height&#x0D; Results: The pituitary gland volume and height demonstrated increasing trend with the age for both genders in the prepubertal period. Although the pituitary volume in the neonatal period is higher in boys than in girls, it became opposite with the age of 6 yr. The height of the pituitary gland increases gradually-slowly with age; while it was higher in boys in the neonatal period, it was higher in girls at the age of 4 years. The lowest, highest and average values of the volume and height values of pituitary gland were found for each age and gender. The reference values of the pituitary volume values containing 5-10-25-50-75-90-95th percentiles were formed for each age and gender.&#x0D; Conclusion: 3D MRI can be used for direct measurement of pituitary volume in prepubertal children. Measuring of pituitary volume using this 3D technique may permit a more precise assessment of the developing pituitary gland in children.

Etiological classification of seizures in pediatric age group (6-12years) – MRI study

Background: A seizure is an occurrence of signs or symptoms due to abnormal excessive orsynchronous neuronal activity in the brain. The present study aims to study the etiological factorsand clinical profile for new-onset seizures in children aged 6-12 years and to determine thefrequency of Magnetic resonance imaging (MRI) abnormalities in the pediatrics age group with new-onset unprovoked seizure and those with inadequately investigated longstanding epilepsy andclassify the etiology based on the MRI findings. Methods: A prospective study involving a total of 50patients was recruited aged between 6 to 12 years. All of them underwent neuro-imaging with MRI.Uncooperative patients were imaged following sedation and monitoring by the anesthetist. Allchildren aged 6-12 years who presented with new-onset seizures were included. All MR images wereobtained at a 3-mm section thickness except magnetization-prepared rapid gradient-echo images,which are obtained at a 1.8-mm section thickness. Results: Of the 50 patients 28 presented withgeneralized tonic-clonic seizures, 12 with simple partial seizures, 10 with complex partial seizures.Generalized seizures were a more common presentation than partial seizures in children 6-12 yearsof age. Conclusion: With the positivity of the MRI in the new-onset seizure in children between 6-12 years in our study gives an important aspect of the essential factor of imaging in pediatric new-onset seizures.