Native Magnetic Resonance Imaging Research Articles

A novel practical method to predict anterior cruciate ligament hamstring graft size using preoperative MRI

BackgroundPredicting hamstring graft size preoperatively for anterior cruciate ligament (ACL) reconstruction is important for preempting an insufficient diameter in graft size intraoperatively, possibly leading to graft failure. While there are multiple published methods using magnetic resonance imaging (MRI) picture archiving and communication systems (PACS), most are not feasible and practical. Our study aims to (1) practically predict the ACL hamstring graft size in a numerically continuous manner using the preoperative MRI from any native MRI PACS system, (2) determine the degree of correlation between the predicted and actual graft size, and (3) determine the performance of our prediction method if we define an adequate actual graft size as ≥ 8 mm.MethodsA retrospective review of 112 patients who underwent primary ACL reconstruction with quadrupled hamstring semitendinosus-gracilis grafts at a tertiary institution was conducted between January 2018 and December 2018. Graft diameter can be predicted in a numerically continuous manner as √[2*(AB + CD)], where A and B are the semitendinosus cross-sectional length and breath, respectively, and C and D are the gracilis cross-sectional length and breath, respectively.ResultsA moderately positive correlation exists between the predicted and actual graft diameter (r = 0.661 and p < .001). Our method yields a high specificity of 92.6% and a moderate sensitivity of 67.2% if we define an adequate actual graft size as ≥ 8 mm. An area under receiver-operating characteristic curve shows good discrimination (AUC = 0.856).ConclusionsWe present a practical method to predict the ACL hamstring graft size with high specificity using preoperative MRI measurements.

Magnetoencephalography Atlas Viewer for Dipole Localization and Viewing.

Magnetoencephalography (MEG) is a noninvasive neuroimaging technique widely recognized for epilepsy and tumor mapping. MEG clinical reporting requires a multidisciplinary team, including expert input regarding each dipole's anatomic localization. Here, we introduce a novel tool, the "Magnetoencephalography Atlas Viewer" (MAV), which streamlines this anatomical analysis. The MAV normalizes the patient's Magnetic Resonance Imaging (MRI) to the Montreal Neurological Institute (MNI) space, reverse-normalizes MNI atlases to the native MRI, identifies MEG dipole files, and matches dipoles' coordinates to their spatial location in atlas files. It offers a user-friendly and interactive graphical user interface (GUI) for displaying individual dipoles, groups, coordinates, anatomical labels, and a tri-planar MRI view of the patient with dipole overlays. It evaluated over 273 dipoles obtained in clinical epilepsy subjects. Consensus-based ground truth was established by three neuroradiologists, with a minimum agreement threshold of two. The concordance between the ground truth and MAV labeling ranged from 79% to 84%, depending on the normalization method. Higher concordance rates were observed in subjects with minimal or no structural abnormalities on the MRI, ranging from 80% to 90%. The MAV provides a straightforward MEG dipole anatomic localization method, allowing a nonspecialist to prepopulate a report, thereby facilitating and reducing the time of clinical reporting.

The comparison of magnetic resonance and fluoroscopic imaging options in the preoperative assessment of boys with anorectal malformations and a colostomy.

In recent decades, magnetic resonance imaging (MRI) has gained prominence as a standard diagnostic method for preoperative assessment in patients with anorectal malformations and a colostomy, with the potential to replace the classic fluoroscopic distal pressure colostogram (FDPC). Three MRI techniques are available: MRI-distal pressure colostogram with gadolinium (MRI-DPCG) or saline (MRI-DPCS) instillation into the colostomy and native MRI without colostomy instillation. To evaluate and compare the diagnostic accuracy of MRI (native MRI, MRI-DPCG and MRI-DPCS) in the preoperative workup of boys with an anorectal malformation and a colostomy and to compare it to FDPC. Sixty-two boys with preoperative MRI using one of the three approaches and 43 with FDPC met the inclusion criteria for this retrospective study. The presence and localization of rectal fistulas according to the Krickenbeck classification were evaluated and compared with intraoperative findings. The accuracy of fistula detection for MRI in general (regardless of the technique), MRI-DPCS, MRI-DPCG, native MRI and FDPC was 95% (59/62, P<0.001), 100% (12/12, P=0.03), 100% (30/30, P<0.001), 85% (17/20, P=0.41) and 72% (31/43, P=0.82), respectively. The accuracy ofdescribing fistula type in patients with a correctly detected fistula using these methods was 96% (45/47, P<0.001), 100% (9/9, P<0.001), 100% (23/23, P<0.001), 87% (13/15, P<0.001) and 67% (13/21, P=0.002), respectively. MRI is a reliable method for detecting and classifying fistulas in boys with an anorectal malformation and a colostomy and can be considered the modality of first choice for preoperative workup.

Adhesive capsulitis

Adhesive capsulitis (CA; also called Frozen shoulder) is acommon, usually unilateral disease of the shoulder joint primarily affecting middle-aged women. Primary, idiopathic, and secondary forms are distinguished. Painful active and passive movement restriction are the clinically leading symptoms. The disease usually progresses in three successive stages: freezing phase, frozen phase, and thawing phase. CA is primarily diagnosed clinically, with imaging being used to assess or exclude differential diagnoses. Radiography as part of basic diagnostics allows exclusion of common differential diagnoses such as osteoarthritis of the shoulder or calcific tendinitis. Native magnetic resonance imaging (MRI) and MR arthrography (MRA) reveal pathomorphologies typical of CA. Intravenously administered gadolinium increases the sensitivity of MRI. Sonography may be used as acomplementary diagnostic modality or as an alternative in case of contraindications to MRI. Fluoroscopy-guided arthrography has been replaced by MRI because of its invasiveness. Computed tomography (CT) has no role in diagnostics due to its radiation exposure and significantly lower sensitivity and specificity compared to MRI. Therapy of CA is stage-adapted and includes conservative measures such as analgesics and physiotherapy and surgical procedures such as arthroscopic arthrolysis. The therapeutic spectrum is supplemented by new, innovative procedures such as transarterial periarticular embolization. CA is self-limiting and usually persists for 2-3years. However, the patients may even suffer from pain and limited range of motion beyond this time.

Label-Free Chemically and Molecularly Selective Magnetic Resonance Imaging.

Biomedical imaging, especially molecular imaging, has been a driving force in scientific discovery, technological innovation, and precision medicine in the past two decades. While substantial advances and discoveries in chemical biology have been made to develop molecular imaging probes and tracers, translating these exogenous agents to clinical application in precision medicine is a major challenge. Among the clinically accepted imaging modalities, magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) exemplify the most effective and robust biomedical imaging tools. Both MRI and MRS enable a broad range of chemical, biological and clinical applications from determining molecular structures in biochemical analysis to imaging diagnosis and characterization of many diseases and image-guided interventions. Using chemical, biological, and nuclear magnetic resonance properties of specific endogenous metabolites and native MRI contrast-enhancing biomolecules, label-free molecular and cellular imaging with MRI can be achieved in biomedical research and clinical management of patients with various diseases. This review article outlines the chemical and biological bases of several label-free chemically and molecularly selective MRI and MRS methods that have been applied in imaging biomarker discovery, preclinical investigation, and image-guided clinical management. Examples are provided to demonstrate strategies for using endogenous probes to report the molecular, metabolic, physiological, and functional events and processes in living systems, including patients. Future perspectives on label-free molecular MRI and its challenges as well as potential solutions, including the use of rational design and engineered approaches to develop chemical and biological imaging probes to facilitate or combine with label-free molecular MRI, are discussed.

Magnetic resonance imaging based radiomics prediction of Human Papillomavirus infection status and overall survival in oropharyngeal squamous cell carcinoma

ObjectivesHuman papillomavirus- (HPV) positive oropharyngeal squamous cell carcinoma (OPSCC) differs biologically and clinically from HPV-negative OPSCC and has a better prognosis. This study aims to analyze the value of magnetic resonance imaging (MRI)-based radiomics in predicting HPV status in OPSCC and aims to develop a prognostic model in OPSCC including HPV status and MRI-based radiomics. Materials and methodsManual delineation of 249 primary OPSCCs (91 HPV-positive and 159 HPV-negative) on pretreatment native T1-weighted MRIs was performed and used to extract 498 radiomic features per delineation. A logistic regression (LR) and random forest (RF) model were developed using univariate feature selection. Additionally, factor analysis was performed, and the derived factors were combined with clinical data in a predictive model to assess the performance on predicting HPV status. Additionally, factors were combined with clinical parameters in a multivariable survival regression analysis. ResultsBoth feature-based LR and RF models performed with an AUC of 0.79 in prediction of HPV status. Fourteen of the twenty most significant features were similar in both models, mainly concerning tumor sphericity, intensity variation, compactness, and tumor diameter. The model combining clinical data and radiomic factors (AUC = 0.89) outperformed the radiomics-only model in predicting OPSCC HPV status. Overall survival prediction was most accurate using the combination of clinical parameters and radiomic factors (C-index = 0.72). ConclusionPredictive models based on MR-radiomic features were able to predict HPV status with sufficient performance, supporting the role of MRI-based radiomics as potential imaging biomarker. Survival prediction improved by combining clinical features with MRI-based radiomics.

Population-Average Brain Templates and Application to Automated Voxel-Wise Analysis Pipelines for Cynomolgus Macaque.

The growing number of neuroimaging studies of cynomolgus macaques require extending existing templates to facilitate species-specific application of voxel-wise neuroimaging methodologies. This study aimed to create population-averaged structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) templates for the cynomolgus macaques and apply the templates in fully automated voxel-wise analyses. We presented the development of symmetric and asymmetric MRI and DTI templates from a sample of 63 young male cynomolgus monkeys with the use of optimized template creation approaches. We also generated the associated average tissue probability maps and Diffeomorphic Anatomical Registration using Exponentiated Lie Algebra templates for use with the Statistical Parametric Mapping (SPM), as well as the average fractional anisotropy/skeleton targets for incorporation into tract-based spatial statistics (TBSS) framework. Both asymmetric and symmetric templates in a standardized coordinate space demonstrated low bias and high contrast. Fully automated processing using SPM was accomplished for all native MRI datasets and demonstrated outstanding performance regarding skull-stripping, segmentation, and normalization when using the MRI templates. Automated normalization to the DTI template was excellently achieved for all native DTI images using the TBSS pipeline. The cynomolgus MRI and DTI templates are anticipated to provide a common platform for precise single-subject data analysis and facilitate comparison of neuroimaging findings in cynomolgus monkeys across studies and sites. It is also hoped that the procedures of template creation and fully-automated voxel-wise frameworks will provide a straightforward avenue for investigating brain function, development, and neuro-psychopathological disorders in non-human primate models.

Magnetic resonance angiography without contrast agents

The use of magnetic resonance imaging (MRI) contrast agents should be minimized in MR angiography. Overview of existing native MRI techniques for MR angiography MATERIAL AND METHODS: Native MRI angiography uses the fact that unsaturated flowing blood is hyperintense to static tissue (time-of-flight MRA), that blood flow induces adetectable phase shift (phase contrast MRA), that labeling by selective inversion can dynamically image abolus passage (arterial spin labeling) and that special MRI sequences exist which utilize the contrast properties of blood. Native MRI angiography, if properly selected, can reliably delineate vessels such as cerebral arteries and coronary arteries and can provide additional information about the flow dynamics.

Acute noncontrast T1-weighted magnetic resonance imaging predicts chronic radiofrequency ablation lesions.

Magnetic resonance imaging (MRI) has been used to visualize radiofrequency (RF) ablation lesions but the relationship between volumes that enhance in acute MRI and the chronic lesion size is unknown. The main goal was to use noncontrast (native) T1-weighted (T1w) MRI and late gadolinium enhancement (LGE)-MRI to visualize lesions acutely and chronically and correlate the acute area of enhancement with chronic lesion size in histology. In a canine (n = 9) model RF ablation lesions were created in both ventricles. Native T1w MRI and LGE-MRI were acquired acutely after the ablation procedure. After 8 weeks, another set of RF ablations was performed, and the MRI study was repeated. Volume and depth of enhancement in native T1w MRI and LGE-MRI acquired after the initial ablation procedure were correlated with chronic lesion volume and depth in histology. Thirty-three lesions were analyzed. Native T1w MRI visualized the acute lesions but not the chronic lesions. LGE-MRI showed both acute and chronic lesions. Acute native T1w MRI volume (average of 102.1 ± 48.5 mm3 ) and depth (4.9 ± 1.2 mm) correlated well with chronic histological volume (105.9 ± 51.8 mm3 ) and depth (4.8 ± 1.3 mm) with R2 of 0.881 (P < 0.001) and 0.874 (P < 0.001), respectively. Acute LGE-MRI had a significantly higher volume of enhancement of 499.7 ± 214.4 mm3 (P < 0.001) and depth of 7.5 ± 1.8 mm ( P < 0.001) when compared with chronic histological lesion volume and depth. Native T1w MRI acquired acutely after RF ablation is a good predictor of chronic lesion size. Acute LGE-MRI significantly overestimates the chronic lesion size.

MRI Controlled Metaphyseal Core Decompression of the Distal Radius in Lunate Avascular Necrosis

Objective: Metaphyseal core decompression (MCD) of the radius is known as minimally invasive treatment option for lunate avascular necrosis. As treatment of early stages, whether conservatively or surgically, still remains in discussion, we analyzed a consecutive magnetic resonance imaging (MRI) controlled series of MCD to evaluate effectiveness on short-term and mid-term follow-up. Materials and Methods: Between 2008 and 2015, 14 consecutive patients with lunate avascular necrosis (Lichtman stages I n = 5/II n = 6/IIIA n = 3) were included. Diagnosis and determination of ulna variance were based on native MRI and x-ray images. MCD’s were performed in ambulatory setting by 1 surgeon. Postoperative regime consisted in 4 weeks of cast immobilization and a splint during daytime for another 12 weeks without heavy loading. Early postoperative MRI controls (range, 3 to 8 months postoperatively) evaluated bone edema and signs of progression: normal bone signal (1); reduction of edema, but not normal (2); and unchanged edema or signs of progression (3). As several asymptomatic patients refused a final follow-up visit, we framed questions for self-evaluation by telephone interview. Accordingly, pain was recorded as painless (1), pain only after heavy loading but no splint or medication needed (2), or any worse (3). Return to work and sports was recorded both positive (1), only work positive (2), and work negative (3). Mobility in wrist flexion-extension was compared with the opposite, normal side, and described by the patient as normal (1), less without functional impairment (2), or worse: less with functional impairment (3). Grip strength was described by the patient discriminating between normal (1), less without functional impairment (2), or worse: less with functional impairment (3). Results: Ulna variance was negative (n = 5), neutral (n = 6), or positive (n = 3). Within 10 weeks after surgery (mean, 5.7 weeks), all patients had returned to their previous occupation (1), no complications were observed. Postoperative MRI controls were obtained in 13 patients confirming reduction of lunate bone marrow edema (2) in all cases except one (3), being normal in 5 (1). One patient with an electronic implant could not have MRI control but showed normal x-ray images 14 months postoperatively. At final follow-up (mean, 35 months; range, 8-76), 11 were without pain (1) whereas 3 reported pain only after heavy loading in hyperextension of the wrist (2). Mobility was reported normal (1) in 13 cases and reduced without functional impairment in 1 (2). Grip strength was reported normal (1) in 11 cases and reduced without functional impairment (2) in 3. One case, even though subjectively satisfied, had progressed from stage IIIA to IIIB (neutral ulna variance). Adapted to Mayo wrist score, 13 rated excellent and 1 good. Conclusion: MCD is an extra-articular, minimally invasive, and technically easy low-cost-procedure with minor complication risk. As independently from ulna variance excellent clinical results and radiological evolution are demonstrated, similar as for established, but more complex treatment modalities, MCD is recommended as primary treatment option for low stage lunate avascular necrosis.

Cerebrospinal fluid leakage. Indications, technique and results of treatment with a blood patch

In most cases cerebrospinal fluid (CSF) leaks are iatrogenic and caused by medical interventions, such as lumbar puncture, peridural anesthesia and surgical interventions on the spine, However, spontaneous cerebral hypotension is currently detected more frequently due to improvements in diagnostic possibilities but often the cause cannot be clarified with certainty. There are various diagnostic tools for confirming the diagnosis and searching for the site of CSF leakage, such as postmyelography computed tomography (postmyelo-CT), indium(111) radioisotope cisternography and (myelo) magnetic resonance imaging (MRI), which show different sensitivities. In accordance with own experience native MRI with fat-saturated T2-weighted sequences is often sufficient for diagnosing CSF leakage and the site. For the remaining cases an additional postmyelo-CT or alternatively myelo-MRI is recommended. In some patients with spontaneous cranial hypotension multiple CSF leaks are found at different spinal levels. The main symptom in most cases is an orthostatic headache. While post-puncture syndrome is self-limiting in many cases, spontaneous CSF leakage usually requires blood patch therapy. A lumbar blood patch can be safely carried out under guidance by fluoroscopy. In the case of a cervical or dorsal blood patch, CT guidance is recommended, which ensures epidural application of the blood patch and minimizes the risk of damaging the spinal cord. Despite a high success rate at the first attempt with a blood patch of up to 85%, some cases require repeating the blood patch. A targeted blood patch of a CSF leak should generally be favoured over a blindly placed blood patch; nevertheless, if a CSF leak cannot be localized by CT or MRI a therapeutic attempt with a lumbar blood patch can be carried out. After a successful blood patch intracranial hygromas and pachymeningeal enhancement in the head show fast regression; however, epidural hygromas of the spine can persist for a period of several months, even though patients are already free of symptoms. In total, blood patch therapy is a safe and technically relative simple method with a high success rate. Therefore, it represents the therapy of choice in patients with spontaneous cerebrospinal fluid leakage as well as in cases of post-lumbar puncture syndrome refractory to conservative therapy.

Molecular imaging in cardiovascular diseases.

Cardiovascular diseases remain the leading cause of morbidity and mortality in industrialized and developing countries. In clinical practice, the in-vivo identification of atherosclerotic lesions, which can lead to complications such as heart attack or stroke, remains difficult. Imaging techniques provide the reference standard for the detection of clinically significant atherosclerotic changes in the coronary and carotid arteries. The assessment of the luminal narrowing is feasible, while the differentiation of stable and potentially unstable or vulnerable atherosclerotic plaques is currently not possible using non-invasive imaging. With high spatial resolution and high soft tissue contrast, magnetic resonance imaging (MRI) is a suitable method for the evaluation of the thin arterial wall. In clinical practice, native MRI of the vessel wall already allows the differentiation and characterization of components of atherosclerotic plaques in the carotid arteries and the aorta. Additional diagnostic information can be gained by the use of non-specific MRI contrast agents. With the development of targeted molecular probes, that highlight specific molecules or cells, pathological processes can be visualized at a molecular level with high spatial resolution. In this review article, the development of pathophysiological changes leading to the development of the arterial wall are introduced and discussed. Additionally, principles of contrast enhanced imaging with non-specific contrast agents and molecular probes will be discussed and latest developments in the field of molecular imaging of the vascular wall will be introduced. Molecular magnetic resonance imaging has great potential to improve the in vivo characterization of atherosclerotic plaques. Based on the molecular information is feasible to enable a better differentiation of stable and unstable (vulnerable) atherosclerotic plaques.

Hippocampal spatial position evaluation on MRI for research and clinical practice.

In clinical practice as well as in many volumetric studies we use different reorientations of the brain position towards x and y axis on the magnetic resonance imaging (MRI) scans. In order to find out whether it has an overall effect on the resulting 2D data, manual hippocampal area measurements and rotation variability of the brain (in two reoriented axes) and the skull were performed in 23 Alzheimer's disease patients and 31 healthy controls. After the MRI scanning, native brain scans (nat) were reoriented into the two different artificial planes (anterior commissure – posterior commissure axis (AC-PC) and hippocampal horizontal long axis (hipp)). Hippocampal area and temporal horn of the lateral ventricle was measured manually using freeware Image J program. We found that 1) hippocampal area of nat images is larger compared to hipp images, area of the nat images is equal to the AC-PC images and area of the hipp images is smaller compared to AC-PC images, 2) hippocampal area together with the area of the temporal horn for nat images is larger compared to hipp images, area of the hipp images is smaller compared to the AC-PC images and area of the nat images is smaller compared to the AC-PC images. The conclusion is that the measured area of the hippocampus in the native MRI is almost the same as the area of MRI reoriented only into the AC-PC axis. Therefore, when performing 2D area studies of the hippocampus or in the clinical practice we recommend usage of not-reoriented MRI images or to reorient them into the AC-PC axis. Surprising finding was that rotation of both AC-PC and hipp line towards x-axis among patients varies up to 35° and the same is true for the skull rotation so that it is not only a matter of the brain position.

Automated segmentation and volumetric analysis of renal cortex, medulla, and pelvis based on non-contrast-enhanced T1- and T2-weighted MR images

The aim of our study was to enable automatic volumetry of the entire kidneys as well as their internal structures (cortex, medulla, and pelvis) from native magnetic resonance imaging (MRI) data sets. Segmentation of the entire kidneys and differentiation of their internal structures were performed in 12 healthy volunteers based on non-contrast-enhanced T1- and T2-weighted MR images. Two data sets (each acquired in one breath-hold) were co-registered using a rigid registration algorithm compensating for possible breathing-related displacements. An automatic algorithm based on thresholding and shape detection segmented the kidneys into their compartments and was compared to a manual labeling procedure. The resulting kidney volumes of the automated segmentation correlated well with those created manually (R(2) = 0.96). Average volume errors were determined to be 4.97 ± 4.08% (entire kidney parenchyma), 7.03 ± 5.56% (cortex), 12.33 ± 7.35% (medulla), and 17.57 ± 14.47% (pelvis). The variation of the kidney volume resulting from the automatic algorithm was found to be 4.76% based on the measuring of one volunteer with three independent examinations. The results demonstrate the feasibility of an accurate and repeatable automatic segmentation of the kidneys and their internal structures from non-contrast-enhanced magnetic resonance images.

Magnetic resonance imaging study of the in vivo position of the extraglottic airway devices i-gel™ and LMA-Supreme™ in anaesthetized human volunteers

Exact information on the anatomical in situ position of extraglottic airway (EGA) devices is lacking. We used magnetic resonance imaging (MRI) to visualize the positions of the i-gel™ and the LMA-Supreme™ (LMA-S) relative to skeletal and soft-tissue structures. Twelve volunteers participated in this randomized, prospective, cross-over study. Native MRI scans were performed before induction of anaesthesia. Anaesthesia was induced, and the two EGAs were inserted in a randomized sequence. Their positions were assessed functionally, optically by fibrescope, and with MRI scans of the head and neck. The LMA-S protruded deeper into the upper oesophageal sphincter than the i-gel™ (P<0.001). Both devices reduced the area of the glottic aperture (P<0.001), and the LMA-S had the largest effect (P=0.049). The i-gel™ significantly compressed the tongue (P<0.001). Both devices displaced the hyoid bone ventrally (P<0.001); the i-gel™ to a greater degree (P=0.029). The fibreoptically determined position of the bowl of the devices was identical. The LMA-S and i-gel™ differ significantly with regard to in situ position and spatial relationship with adjacent structures assessed by MRI, despite similar clinical and fibreoptical findings. This could be relevant with regard to risk of aspiration, glottic narrowing, and airway resistance and soft-tissue morbidity.

An Optimized System for Interventional Magnetic Resonance Imaging-Guided Stereotactic Surgery

Deep brain stimulation electrode placement with interventional magnetic resonance imaging (MRI) has previously been reported using a commercially available skull-mounted aiming device (Medtronic Nexframe MR) and native MRI scanner software. This first-generation method has technical limitations that are inherent to the hardware and software used. A novel system (SurgiVision ClearPoint) consisting of an aiming device (SMARTFrame) and software has been developed specifically for interventional MRI, including deep brain stimulation. To report a series of phantom and cadaver tests performed to determine the capability, preliminary accuracy, and workflow of the system. Eighteen experiments using a water phantom were used to determine the predictive accuracy of the software. Sixteen experiments using a gelatin-filled skull phantom were used to determine targeting accuracy of the aiming device. Six procedures in 3 cadaver heads were performed to compare the workflow and accuracy of ClearPoint with Nexframe MR. Software prediction experiments showed an average error of 0.9 ± 0.5 mm in magnitude in pitch and roll (mean pitch error, -0.2 ± 0.7 mm; mean roll error, 0.2 ± 0.7 mm) and an average error of 0.7 ± 0.3 mm in X-Y translation with a slight anterior (0.5 ± 0.3 mm) and lateral (0.4 ± 0.3 mm) bias. Targeting accuracy experiments showed an average radial error of 0.5 ± 0.3 mm. Cadaver experiments showed a radial error of 0.2 ± 0.1 mm with the ClearPoint system (average procedure time, 88 ± 14 minutes) vs 0.6 ± 0.2 mm with the Nexframe MR (average procedure time, 92 ± 12 minutes). This novel system provides the submillimetric accuracy required for stereotactic interventions, including deep brain stimulation placement. It also overcomes technical limitations inherent in the first-generation interventional MRI system.

Effect of bradykinin on pressure changes in the femur head epiphysis--an experimental and magnetic resonance tomography study

The aim of this study was to evaluate the response of the femoral head to intraosseous pressure increases and to document blood flow of periarticular soft tissue after infusion of vasoactive substances. Beside that the value and imagery of native MRI after induced intraosseous pressure increase should be estimated for early detection of femoral head necrosis. The alteration of intraosseous pressure and peripheral blood flow of the femoral head of beagle dogs was examined after administration of bradykinin as a vasoactive substance followed by subsequent magnetic resonance imaging (MRI). Bradykinin was injected into the arteriae circumflexae femoris lateralis and medialis of six beagle dogs. The administrations were made using a standard protocol with simultaneous measurement of venous blood flow and intraosseous pressure distribution in the epiphysis of the femoral head. Bradykinin was applied in regular time intervals followed by MRI. At a mean epiphyseal pressure 14.66 mmHg (sigma: 2.42) in the femoral head, a mean flow of 91.6 ml/min (sigma: 16.08) was measured in the vena femoralis. After an administration of a defined concentration of bradykinin an increased epiphyseal pressure was recorded in the measured area. An average increase blood flow of the vena femoralis was observed at the beginning of the bradykinin-injection, followed by a circulatory volume reduction. The post-experimental MRIs showed massive oedema in the femoral musculature after bradykinin-application, however without osseous signal alterations in T1- or STIR-weighted images. Our results indicate that acute intraosseous pressure increases are not accompanied by signal alterations in MRI. Obviously more extensive pressure induced lesions are necessary for detectable signal alterations, as these have already been demonstrated in patients with diagnosed femoral head necrosis.

Animal: Validation and Applications of Nonlinear Registration-Based Segmentation

Magnetic resonance imaging (MRI) has become the modality of choice for neuro-anatomical imaging. Quantitative analysis requires the accurate and reproducible labeling of all voxels in any given structure within the brain. Since manual labeling is prohibitively time-consuming and error-prone we have designed an automated procedure called ANIMAL (Automatic Nonlinear Image Matching and Anatomical Labeling) to objectively segment gross anatomical structures from 3D MRIs of normal brains. The procedure is based on nonlinear registration with a previously labeled target brain, followed by numerical inverse transformation of the labels to the native MRI space. Besides segmentation, ANIMAL has been applied to non-rigid registration and to the analysis of morphometric variability. In this paper, the nonlinear registration approach is validated on five test volumes, produced with simulated deformations. Experiments show that the ANIMAL recovers 64% of the nonlinear residual variability remaining after linear registration. Segmentations of the same test data are presented as well. The paper concludes with two applications of ANIMAL using real data. In the first, one MRI volume is nonlinearly matched to a second and is automatically segmented using labels, predefined on the second MRI volume. The automatic segmentation compares well with manual labeling of the same structures. In the second application, ANIMAL is applied to seventeen MRI data sets, and a 3D map of anatomical variability estimates is produced. The automatic variability estimates correlate well (r =0.867, p = 0.01) with manual estimates of inter-subject variability.