Whole-body Magnetic Resonance Scanner Research Articles

Reliability of High-resolution Gadolinium-enhanced MR Cisternography and Gasket-seal Technique for Management of Anterior Skull Base Defects

PurposePrecise preoperative localization of anterior skull base defects is important to plan surgical access, increase the success rate and reduce complications. A stable closure of the defect is vital to prevent recurrence of cerebrospinal fluid (CSF) rhinorrhea. The purpose of this retrospective case series was to evaluate the reliability of a new high-resolution gadolinium-enhanced compressed-sensing SPACE technique (CS T1 SPACE) for magnetic resonance (MR) cisternography to detect cerebrospinal fluid leaks of the anterior skull base and to assess the long-term success rate of the gasket-seal technique for closure of skull base defects.MethodAll patients with spontaneous or postoperative cerebrospinal fluid rhinorrhea and defects of the anterior skull base presenting to the Departments of Otorhinolaryngology and Neurosurgery between 2019 and 2020, receiving a computed tomography (CT) cisternography and MR cisternography (on a 3T whole-body MR scanner using a 64-channel head and neck coil) with CS T1 SPACE sequence and closure of the defect with the gasket-seal technique, were enrolled in the study. For the cisternography, iodinated contrast agent (15 ml Solutrast 250 M®), saline (4 mL) mixed with a 0.5 mL of gadoteridol was injected into the lumbar subarachnoid space.ResultsA total of four patients were included in the study and MR cisternography with CS T1 SPACE sequence was able to precisely localize CSF leaks in all patients. The imaging results correlated with intraoperative findings. All defects could be successfully closed with the gasket-seal technique. The mean follow-up was 35.25 months (range 33–37 months).ConclusionMR cisternography with CS T1 SPACE sequence could be a promising technique for precise localization of CSF leaks and the gasket-seal technique resulted in good closure of the CSF fistula in this case series.

Controlled Release of Therapeutics from Thermoresponsive Nanogels: A Thermal Magnetic Resonance Feasibility Study.

Thermal magnetic resonance (ThermalMR) accommodates radio frequency (RF)-induced temperature modulation, thermometry, anatomic and functional imaging, and (nano)molecular probing in an integrated RF applicator. This study examines the feasibility of ThermalMR for the controlled release of a model therapeutics from thermoresponsive nanogels using a 7.0-tesla whole-body MR scanner en route to local drug-delivery-based anticancer treatments. The capacity of ThermalMR is demonstrated in a model system involving the release of fluorescein-labeled bovine serum albumin (BSA-FITC, a model therapeutic) from nanometer-scale polymeric networks. These networks contain thermoresponsive polymers that bestow environmental responsiveness to physiologically relevant changes in temperature. The release profile obtained for the reference data derived from a water bath setup used for temperature stimulation is in accordance with the release kinetics deduced from the ThermalMR setup. In conclusion, ThermalMR adds a thermal intervention dimension to an MRI device and provides an ideal testbed for the study of the temperature-induced release of drugs, magnetic resonance (MR) probes, and other agents from thermoresponsive carriers. Integrating diagnostic imaging, temperature intervention, and temperature response control, ThermalMR is conceptually appealing for the study of the role of temperature in biology and disease and for the pursuit of personalized therapeutic drug delivery approaches for better patient care.

Determinants of Left Ventricular Characteristics Assessed by Cardiac Magnetic Resonance Imaging and Cardiovascular Biomarkers Related to Kidney Transplantation.

Background:Cardiac magnetic resonance (CMR) imaging accurately and precisely measures left ventricular (LV) mass and function. Identifying mechanisms by which LV mass change and functional improvement occur in some end-stage kidney disease (ESKD) patients may help to appropriately target kidney transplant (KT) recipients for further investigation and intervention. The concentration of serum adiponectin, a cardiovascular biomarker, increases in cardiac failure, its production being enhanced by B-type natriuretic peptide (BNP), and both serum adiponectin and BNP concentrations decline posttransplantation.Objective:We tested the hypothesis that kidney transplantation alters LV characteristics that relate to serum adiponectin concentrations.Design:Prospective and observational cohort study.Setting:The study was performed at 3 adult kidney transplant and dialysis centers in Ontario, Canada.Patients:A total of 82 KT candidate subjects were recruited (39 to the KT group and 43 to the dialysis group). Predialysis patients were excluded.Measurements:Subjects underwent CMR with a 1.5-tesla whole-body magnetic resonance scanner using a phased-array cardiac coil and retrospective vectorographic gating. LV mass, LV ejection fraction (LVEF), LV end-systolic volume (LVESV), and LV end-diastolic volume (LVEDV) were measured by CMR pre-KT and again 12 months post-KT (N = 39), or 12 months later if still receiving dialysis (N = 43). LV mass, LVESV, and LVEDV were indexed for height (m2.7) to calculate left ventricular mass index (LVMI), left ventricular end-systolic volume index (LVESVI), and left ventricular end-diastolic volume index (LVEDVI), respectively. Serum total adiponectin and N-terminal proBNP (NT-proBNP) concentrations were measured at baseline, 3 months, and 12 months.Methods:We performed a prospective 1:1 observational study comparing KT candidates with ESKD either receiving a living donor organ (KT group) or waiting for a deceased donor organ (dialysis group).Results:Left ventricular mass index change was −1.98 ± 5.5 and −0.36 ± 5.7 g/m2.7 for KT versus dialysis subjects (P = .44). Left ventricular mass change was associated with systolic blood pressure (SBP) (P = .0008) and average LV mass (P = .0001). Left ventricular ejection fraction did not improve (2.9 ± 6.6 vs 0.7 ± 4.9 %, P = .09), while LVESVI and LVEDVI decreased more post-KT than with continued dialysis (−3.36 ± 5.6 vs −0.22 ± 4.4 mL/m2.7, P < .01 and −4.9 ± 8.5 vs −0.3 ± 9.2 mL/m2.7, P = .02). Both adiponectin (−7.1 ± 11.3 vs −0.11 ± 7.9 µg/mL, P < .0001) and NT-proBNP (−3811 ± 8130 vs 1665 ± 20013 pg/mL, P < .0001) declined post-KT. Post-KT adiponectin correlated with NT-proBNP (P = .001), but not estimated glomerular filtration rate (eGFR) (P = .13). Change in adiponectin did not correlate with change in LVEF in the KT group (Spearman ρ = 0.16, P = .31) or dialysis group (Spearman ρ = 0.19, P = .21).Limitations:Few biomarkers of cardiac function were measured to fully contextualize their role during changing kidney function. Limited intrapatient biomarker sampling and CMR measurements precluded constructing dose-response curves of biomarkers to LV mass and function. The CMR timing in relation to dialysis was not standardized.Conclusions:The LVESVI and LVEDVI but not LVMI or LVEF improve post-KT. LVMI and LVEF change is independent of renal function and adiponectin. As adiponectin correlates with NT-proBNP post-KT, improved renal function through KT restores the normal heart-endocrine axis.

Magnetic Resonance Imaging of the Liver

The purpose of this study was to measure potential changes of the apparent diffusion coefficient (ADC) in diffusion-weighted imaging of the liver before and after caloric challenge in correlation to the induced changes in portal vein flow. The study was approved by the local ethics committee. Each of 10 healthy volunteers underwent 4 measurements in a 1.5-T whole-body magnetic resonance scanner on 2 different days: a first scan after fasting for at least 8 hours and a second scan 30 minutes after intake of a standardized caloric either a protein- or carbohydrate-rich meal. Diffusion-weighted spin-echo echo-planar magnetic resonance images were acquired at b values of 0, 50, 150, 250, 500, 750, and 1000 s/mm. In addition, portal vein flow was quantified with 2-dimensional phase-contrast imaging (velocity encoding parallel to flow direction, 60 cm/s). Mean ADC values for regions of interest in 3 different slices were measured from b50 to b250 and from b500 to b1000 images. Carbohydrate- and protein-rich food intake both resulted in a substantial increase in the portal vein flow (fasting state, 638.6 ± 202.3 mL/min; after protein intake, 1322 ± 266.8; after carbohydrate intake, 1767 ± 421.6). The signal decay with increasingly strong diffusion weighting (b values from 0 to 1000 s/mm2) exhibited a triexponential characteristic, implying fast, intermediate, and slow-moving water-molecule proton-spin ensembles in the liver parenchyma. Mean ADC for high b values (b500-b1000) after fasting was 0.93 ± 0.09 × 10 mm/s; that after protein intake, 0.93 ± 0.11 × 10; and that after carbohydrate intake, 0.93 ± 0.08 × 10. For intermediate b values (b50-b250), the signal-decay constants were 1.27 ± 0.14 × 10 mm/s, 1.28 ± 0.15 × 10, and 1.31 ± 0.09 × 10, respectively. There was no statistically significant difference between fasting and caloric challenge. The postprandial increase in portal vein flow is not accompanied by a change of liver parenchymal ADC values. In clinical diffusion imaging, patients may be scanned without prescan food-intake preparations. To minimize interference of perfusion effects, liver-tissue molecular water diffusion should be quantified using high b values (≥500 s/mm) only.

Influence of physical activity on T1 and T2* relaxation times of healthy achilles tendons at 3T

To evaluate longitudinal (T1) and transverse (T2*) relaxation times at different Achilles tendon locations (insertion, mid-portion, and musculotendinous area) in a cohort of subjects with variable tendon straining activity, but without any signs of tendinopathy. T1 and T2* relaxation times of the Achilles tendon were measured using an ultrashort echo time (UTE) imaging sequence with flip angle and echo time variation on a 3T whole-body clinical magnetic resonance (MR) scanner. Twenty-four tendons of 12 healthy volunteers and 18 tendons of nine healthy recreational long-distance runners (average weekly running distance of 47.4 ± 5.3 km) were enrolled. Mean T1 values of the whole tendon showed no marked group differences, whereas T2* relaxation times of runners were significantly longer (mean percentage increase 15.7 ± 4.9%; P = 0.0181) compared to controls. Regarding group differences for the investigated insertional, mid-portion, and musculotendinous area of the Achilles tendon, only the mid-portion of the Achilles tendon in the running group presented significantly longer T2* values (mean percentage increase 29.1 ± 23.0%; P = 0.0420) in comparison to the control group. Prolonged T2* values especially in the mid-portion of the Achilles tendon of runners are likely to reflect an adaptation of the tendon microstructure to repetitive tendon straining activity.

Assessment of abstract reasoning abilities in alcohol-dependent subjects: an fMRI study

Chronic alcohol abuse has been traditionally associated with impaired cognitive abilities. The deficits are most evident in higher order cognitive functions, such as abstract reasoning, problem solving and visuospatial processing. The present study sought to increase current understanding of the neuropsychological basis of poor abstract reasoning abilities in alcohol-dependent subjects using functional magnetic resonance imaging (fMRI). An abstract reasoning task-based fMRI study was carried out on alcohol-dependent subjects (n = 18) and healthy controls (n = 18) to examine neural activation pattern. The study was carried out using a 3-T whole-body magnetic resonance scanner. Preprocessing and post processing was performed using SPM 8 software. Behavioral data indicated that alcohol-dependent subjects took more time than controls for performing the task but there was no significant difference in their response accuracy. Analysis of the fMRI data indicated that for solving abstract reasoning-based problems, alcohol-dependent subjects showed enhanced right frontoparietal neural activation involving inferior frontal gyrus, post central gyrus, superior parietal lobule, and occipito-temporal gyrus. The extensive activation observed in alcohol dependents as compared to controls suggests that alcohol dependents recruit additional brain areas to meet the behavioral demands for equivalent task performance. The results are consistent with previous fMRI studies suggesting decreased neural efficiency of relevant brain networks or compensatory mechanisms for the execution of task for showing an equivalent performance.

Magnetic Resonance–Guided Shielding of Prefocal Acoustic Obstacles in Focused Ultrasound Therapy

The treatment of liver cancer is a major public health issue because the liver is a frequent site for both primary and secondary tumors. Rib heating represents a major obstacle for the application of extracorporeal focused ultrasound to liver ablation. Magnetic resonance (MR)-guided external shielding of acoustic obstacles (eg, the ribs) was investigated here to avoid unwanted prefocal energy deposition in the pathway of the focused ultrasound beam. Ex vivo and in vivo (7 female sheep) experiments were performed in this study. Magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) was performed using a randomized 256-element phased-array transducer (f∼1 MHz) and a 3-T whole-body clinical MR scanner. A physical mask was inserted in the prefocal beam pathway, external to the body, to block the energy normally targeted on the ribs. The effectiveness of the reflecting material was investigated by characterizing the efficacy of high-intensity focused ultrasound beam reflection and scattering on its surface using Schlieren interferometry. Before high-intensity focused ultrasound sonication, the alignment of the protectors with the conical projections of the ribs was required and achieved in multiple steps using the embedded graphical tools of the MR scanner. Multiplanar near real-time MR thermometry (proton resonance frequency shift method) enabled the simultaneous visualization of the local temperature increase at the focal point and around the exposed ribs. The beam defocusing due to the shielding was evaluated from the MR acoustic radiation force impulse imaging data. Both MR thermometry (performed with hard absorber positioned behind a full-aperture blocking shield) and Schlieren interferometry indicated a very good energy barrier of the shielding material. The specific temperature contrast between rib surface (spatial average) and focus, calculated at the end point of the MRgHIFU sonication, with protectors vs no protectors, indicated an important reduction of the temperature elevation at the ribs' surface, typically by 3.3 ± 0.4 in vivo. This was translated into an exponential reduction in thermal dose by several orders of magnitude. The external shielding covering the full conical shadow of the ribs was more effective when the protectors could be placed close to the ribs' surface and had a tendency to lose its efficiency when placed further from the ribs. Hepatic parenchyma was safely ablated in vivo using this rib-sparing strategy and single-focus independent sonications. A readily available, MR-compatible, effective, and cost-competitive method for rib protection in transcostal MRgHIFU was validated in this study, using specific reflective strips. The current approach permitted safe intercostal ablation of small volumes (0.7 mL) of liver parenchyma.

Method for high‐resolution imaging of creatine in vivo using chemical exchange saturation transfer

To develop a chemical exchange saturation transfer (CEST)-based technique to measure free creatine (Cr) and to validate the technique by measuring the distribution of Cr in muscle with high spatial resolution before and after exercise. Phantom studies were performed to determine contributions from other Cr kinase metabolites to the CEST effect from Cr (CrCEST). CEST, T2 , magnetization transfer ratio and (31) P magnetic resonance spectroscopy acquisitions of the lower leg were performed before and after plantar flexion exercise on a 7T whole-body magnetic resonance scanner on healthy volunteers. Phantom studies demonstrated that while Cr exhibited significant CEST effect there were no appreciable contributions from other metabolites. In healthy human subjects, following mild plantar flexion exercise, increases in the CEST effect from Cr were observed, which recovered exponentially back to baseline. This technique exhibited good spatial resolution and was able to differentiate differences in muscle utilization among subjects. The CEST effect from Cr results were compared with (31) P magnetic resonance spectroscopy results showing good agreement in the Cr and phosphocreatine recovery kinetics. Demonstrated a CEST-based technique to measure free Cr changes in in vivo muscle. The CEST effect from Cr imaging can spatially map changes in Cr concentration in muscle following mild exercise. This may serve as a tool for the diagnosis and treatment of various disorders affecting muscle.

Apparent Diffusion Coefficient and Sodium Concentration Measurements in Human Prostate Tissue via Hydrogen-1 and Sodium-23 Magnetic Resonance Imaging in a Clinical Setting at 3 T

Multiparametric magnetic resonance imaging (MRI) of the prostate involves morphologic and functional imaging techniques, which could potentially enable to distinguish between common benign prostate diseases, especially prostatitis and prostate cancer. The aim of this study was to determine the apparent diffusion coefficient (ADC) and the tissue sodium concentration (TSC) in 2 different regions of the human prostate, that is, the central gland (CG) and the peripheral gland (PG), by means of standard hydrogen-1 (H) MRI and quantitative sodium-23 (Na) MRI at 3 T to increase the spectrum of diagnostic parameters for prostate examinations. All measurements were performed on a 3-T clinical whole-body magnetic resonance (MR) scanner. Na MR images were acquired with density-adapted 3-dimensional radial sequence and isotropic voxel resolution of 5 × 5 × 5 mm. After approval by the institutional review board and informed consent were obtained, 8 healthy volunteers were included in this study. Diffusion-weighted imaging and T2-weighted images were also recorded and hence enabled the correlation of measured TSC values with current state-of-the-art H MRI techniques. The ADC in both subregions was measured to be at normal levels (CG, 1.19 [0.09] ×10 mm/s; PG, 1.54 [0.14] × 10 mm/s) in all 8 volunteers. Good spatial resolution of the Na images allowed for an easy identification of the same subregions from the Na MR images. In healthy adult volunteers (age, 29 [2] years), the TSC was measured lower in central (55 [15] mmol/L) and higher in peripheral (69 [16] mmol/L) prostate tissue. A correlation between the TSC and the ADC in the 2 subregions was found in the same volunteer group (Pearson correlation coefficient = 0.87). For the first time, TSC was spatially resolved in human prostate tissue by means of Na MRI. Interestingly, the herein found TSC values of ∼60 mmol/L were half as high as in a previously reported Na MRI study where prostate TSC was measured in 5-month-old mice. Future studies are required to determine the prostate TSC in cancer patients as well as in older volunteers. In conclusion, TSC can be measured in humans with sufficiently high spatial and temporal resolution at 3 T and could hence provide an additional noninvasive marker for the diagnosis of various prostate pathologies.

A Novel Receive-Only Liquid Nitrogen ($\hbox{LN}_{2}$ )-Cooled RF Coil for High-Resolution In Vivo Imaging on a 3-Tesla Whole-Body Scanner

The design and operation of a receive-only liquid nitrogen ( LN <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> )-cooled coil and cryostat suitable for medical imaging on a 3-T whole-body magnetic resonance scanner is presented. The coil size, optimized for murine imaging, was determined by using electromagnetic (EM) simulations. This process is therefore easier and more cost effective than building a range of coils. A nonmagnetic cryostat suitable for small-animal imaging was developed having good vacuum and cryogenic temperature performance. The LN <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> -cooled probe had an active detuning circuit allowing the use with the scanner's built-in body coil. External tuning and matching was adopted to allow for changes to the coil due to temperature and loading. The performance of the probe was evaluated by comparison of signal-to-noise ratio (SNR) with the same radio-frequency (RF) coil operating at room temperature (RT). The performance of the RF coil at RT was also benchmarked against a commercial surface coil with a similar dimension to ensure a fair SNR comparison. The cryogenic coil achieved a 1.6- to twofold SNR gain for several different medical imaging applications: For mouse-brain imaging, a 100-μm resolution was achieved in an imaging time of 3.5 min with an SNR of 25-40, revealing fine anatomical details unseen at lower resolutions for the same time. For heavier loading conditions, such as imaging of the hind legs and liver, the SNR enhancement was slightly reduced to 1.6-fold. The observed SNR was in good agreement with the expected SNR gain correlated with the loaded-quality factor of RF coils from the EM simulations. With the aid of this end-user-friendly and economically attractive cryogenic RF coil, the enhanced SNR available can be used to improve resolution or reduce the duration of individual scans in a number of biomedical applications.

Magnetization Transfer in Human Achilles Tendon Assessed by a 3D Ultrashort Echo Time Sequence: Quantitative Examinations in Healthy Volunteers at 3T

Magnetization transfer contrast (MTC) imaging provides insight into interactions between free and bounded water. Newly developed ultrashort echo time (UTE) sequences implemented on whole-body magnetic resonance (MR) scanners allow MTC imaging in tissues with extremely fast signal decay such as tendons. The aim of this study was to develop a technique for the quantification of the MT effect in healthy Achilles tendons in-vivo at 3 Tesla. 16 normal tendons of volunteers with no history of tendinopathy were examined using a 3D-UTE sequence with a rectangular on-resonant excitation pulse and a Fermi-shaped off-resonant MT preparation pulse. The frequency of the MT pulse was varied from 1 to 5 kHz. MT effects were calculated in terms of the MT ratio (MTR) between measurements without and with MT preparation. Direct saturation effects of MT preparation on the signal intensity were evaluated using numerical simulation of Bloch equations. One patient with tendinopathy was examined to exemplarily show changes of MTR under pathologic conditions. Calculation of MTR data was feasible in all examined tendons and showed a decrease from 0.53 ± 0.05 to 0.25 ± 0.03 (1 kHz to 5 kHz) for healthy volunteers. Evaluation of variation with gender and dominance of ankle revealed no significant differences (p > 0.05). In contrast, the patient with confirmed tendinopathy showed MTR values between 0.36 (1 kHz) and 0.19 (5 kHz). MT effects in human Achilles tendons can be reliably assessed in-vivo using a 3D UTE sequence at 3 T. All healthy tendons showed similar MTR values (coefficient of variation 10.0 ± 1.2 %). The examined patient showed a clearly different MT effect revealing a changed microstructure in the case of tendinopathy.

The appearance of ADCs in the non-affected areas of the patients with MELAS

The exact mechanism of the mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) remain unclear. Diffusion-weighted imaging (DWI) is a magnetic resonance (MR) imaging technique for studying the pathophysiologic change of the MELAS. The purpose of the study is to see whether the apparent diffusion coefficient (ADC) of MELAS in the non-affected areas is different from the ADC of the normal subjects and to speculate the pathophysiological mechanisms of the MELAS. Sixteen cases of MELAS were retrospectively analyzed. Thirty healthy subjects were chosen to constitute the control group. All of them were performed on the 3.0T whole-body MR scanner with axial view T2 fluid attenuated inversion recovery (flair), T2-weighted imaging, T1flair, and DWI. An ADC map was reconstructed in the workstation. Two to five regions of interest were put in the non-affected frontal lobe and basal ganglia. All data took statistical analysis. There were significant differences between the ADC of the patients with MELAS and the controls in the non-affected areas, including the superior frontal gyrus, precentral gyrus, corpus striatum, thalamus, and white matter of the semi-oval centrum. ADCs in the non-affected areas of the patients with MELAS are higher than those of the normal subjects. Pathological changes take place in the non-affected areas of the patients with MELAS.

Current Problems and Future Opportunities of Abdominal Magnetic Resonance Imaging at Higher Field Strengths

Introduction of high-field-strength whole-body MR scanners to clinical routine made abdominal magnetic resonance (MR) imaging widely available. Higher field strength provides improved signal yield, but other issues such as shorter wavelength and increased power deposition of radiofrequency in tissue must also be taken into account. This review describes current problems and future opportunities of abdominal MR imaging at 3.0 T under special consideration of relevant physical properties and technical challenges: impact of higher field strength on signal-to-noise ratio, Larmor frequency, and chemical shift effects are elucidated in detail. Furthermore, changes in longitudinal and transverse relaxation times as well as increased susceptibility effects at 3.0 T are reported. General safety issues and limitations in radiofrequency power deposition are discussed. Subsequently, implications of the previously mentioned changed MR properties at 3.0 T on clinical abdominal examinations applying different sequence types are described.

Biphasic Blood Pool Contrast Agent-Enhanced Whole-Body MR Angiography for Treatment Planning in Patients With Significant Arterial Stenosis

To prospectively evaluate diagnostic accuracy of first pass and combined first pass and steady state high-spatial-resolution whole-body magnetic resonance (MR) angiography with a blood pool contrast agent for quantification of arterial stenosis in different vascular territories. After Institutional Review Board approval and informed consent, 50 patients with known 50% or greater stenosis in at least one vascular territory; as shown by the standard-of-reference (14 digital subtraction angiographies, 4 computed tomographies, 32 ultrasound examinations), were included. The patients underwent MR angiography at 1.5 Tesla, using a standardized nonbody-weight-adapted i.v. bolus injection of 11 mL gadofosveset trisodium. First pass imaging with 4 different table positions in a whole-body MR scanner (MAGNETOM Avanto, Siemens Healthcare), using individual circulation time determined by a test bolus, was performed. Steady state imaging was performed using an isometric spatial resolution of 1.0 mm. Image quality was rated. Each vascular segment in MR angiography was evaluated by 2 independent and blinded reviewers and the stenosis degree was compared with the preferred standard-of-reference, using a 5-point scale. Differences between first pass and combined MR angiography were assessed with a 95% confidence interval (CI) by applying the adjusted modified chi(2) test. Changes in therapy based on the whole-body examination strategy were evaluated. The number of nondiagnostic territories was 24 of 197 (12.2%) for first pass MR angiography and decreased to 3 of 197 (1.5%) after addition of steady state MR angiography. The diagnostic accuracy for quantification of arterial stenosis in combined MR angiography (94.7%; 95% CI: 92.4-97.1) was superior to first pass MR angiography (81.7%; 95% CI: 73.7-89.8; statistically significant). Patient management was changed in 12 of 49 patients, in 7 of 12 patients the change was applied to an additional lesion detected by the whole-body examination strategy. The quantification and detection of arterial stenosis is improved by the steady state high-resolution gadofosveset trisodium-enhanced MR angiography. Additional lesions detected by whole-body examination strategy or differences in stenosis quantification may lead to changes in therapy.

Three-Dimensional Ultrashort Echo Time Imaging of Solid Polymers on a 3-Tesla Whole-Body MRI Scanner

With the introduction of ultrashort echo time (UTE) sequences solid polymeric materials might become visible on clinical whole-body magnetic resonance (MR) scanners. The aim of this study was to characterize solid polymeric materials typically used for instruments in magnetic resonance guided interventions and implants. Relaxation behavior and signal yield were evaluated on a 3-Tesla whole-body MR unit. Nine different commonly used solid polymeric materials were investigated by means of a 3-dimensional (3D) UTE sequence with radial k-space sampling. The investigated polymeric samples with cylindrical shape (length, 150 mm; diameter, 30 mm) were placed in a commercial 8-channel knee coil. For assessment of transverse signal decay (T2*) images with variable echo times (TE) ranging from 0.07 milliseconds to 4.87 milliseconds were recorded. Spin-lattice relaxation time (T1) was calculated for all MR visible polymers with transverse relaxation times higher than T2* = 300 mus using an adapted method applying variable flip angles. Signal-to-noise ratio (SNR) was calculated at the shortest achievable echo time (TE = 0.07 milliseconds) for standardized sequence parameters. All relaxation times and SNR data are given as arithmetic mean values with standard deviations derived from 5 axially oriented slices placed around the isocenter of the coil and magnet. Six of the 9 investigated solid polymers were visible at TE = 0.07 milliseconds. Visible solid polymers showed markedly different SNR values, ie, polyethylene SNR = 1146 +/- 41, polypropylene SNR = 60 +/- 6. Nearly mono-exponential echo time dependent signal decay was observed: Transverse relaxation times differed from T2*=36 +/- 5 mus for polycarbonate to T2*=792 +/- 7 mus for polyvinylchloride (PVC). Two of the investigated solid polymers were applicable to T1 relaxation time calculation. Polyurethane had a spin-lattice relaxation time of T1 = 172 +/- 1 milliseconds, whereas PVC had T1 = 262 +/- 7 milliseconds, respectively. A variety of solid polymers can be visualized by means of clinical whole-body MR scanners and 3D ultrashort echo time (UTE) sequences. The investigated polymers differ substantially in signal yield, signal-decay, and spin-lattice relaxation time. The knowledge of the signal behavior of solid polymers on whole-body clinical MR scanners may help to select suitable polymeric materials for instruments and implants which are visible using UTE sequences.

Increased prevalence of white matter hyperintensities in patients with panic disorder

The aim of the current study is to compare the prevalence, severity and location of cerebral white matter hyperintensities (WMH) between patients with panic disorder (PD) and healthy control subjects. Patients with PD (n = 24) and matched healthy control subjects (n = 24) were scanned using a 3.0 Tesla whole-body magnetic resonance scanner. Axial T2-weighted and fluid-attenuated inversion recovery images were acquired and evaluated for the prevalence, severity and location of WMH using the modified composite scale of Fazekas and Coffey and coded separately for deep and periventricular WMH. Logistic regression analyses were used to assess the association between WMH and the diagnosis of PD. A greater severity of total WMH was associated with a diagnosis of PD in a dose-dependent pattern (odds ratio [OR] = 8.8, P = 0.005 for mild WMH; OR = 27.7, P = 0.007 for moderate to severe WMH). Deep WMH, where most group differences originated, were predominantly located in the frontal region of the brain (n = 16 in PD, n = 1 in control). The current report is the first study to report an increased prevalence of WMH in patients with PD.

Reply:

We read with interest the recent letter by Cobbold and colleagues regarding our study published in HEPATOLOGY. Using a clinical 1.5 T whole-body magnetic resonance (MR) scanner, we validated purported indices of lipid saturation (SI) and polyunsaturation (PUI) using oil phantoms of known composition. Application of this technique to measure lipid signals in human liver in vivo produced results that were consistent with human biopsy-based approaches demonstrating that, when compared with healthy lean individuals (lean), relative hepatic lipid saturation increases and purported “polyunsaturation” decreases with obesity (OB) and obesity-related hepatic steatosis (OB+HS).1 Based on in vitro high field strength (11.7 T) MR studies of liver tissue, Cobbold et al. have suggested that the peak assigned as the “diallylic” lipid resonance upon which our PUI index was based reflects total choline-containing compounds (tCho). We point out the comparative lack of spectral resolution of peaks this size in in vivo studies performed at clinical field strength (1.5 T), compared with high-resolution in vitro spectroscopy of rodent2 and human3 liver tissue. In our in vivo spectra, the peak in question is broad (≈2.9–3.3 ppm). The recommended use of chemical shift from an internal reference for peak nomination ameliorates but does not ablate this issue. Given the high concentration of polyunsaturated fatty acids in healthy human liver tissue samples4 and the amplitude of this peak in rodent2 and human3 MR spectroscopy, one would expect to observe a signal at ≈2.85 ppm. The separation of this peak from that of choline in vivo may well be limited at 1.5 T. This issue may have been clarified by comparing these findings with those from liver biopsy samples. However, this was not indicated in our healthy cohort. Cobbold and colleagues have raised important issues and highlight the difficulties of obtaining well-resolved human in vivo spectra at a lower field strength. The precise nature of this peak in vivo at 1.5 T warrants clarification, because the index we employed (PUI) shows significant power in discriminating individuals on the basis of obesity and level of hepatic steatosis. Our study provides an important first step in applying clinically available MR spectroscopy scanning to the measurement of hepatic lipid composition in vivo. Interpretation of our data on the basis of the suggestion of Cobbold et al. that this resonance be assigned as tCho and omitting the “diallylic” resonance from our SI index still shows that hepatic lipid SI is significantly higher in OB and OB+HS versus lean individuals (P < 0.01), and further that obesity-related hepatic steatosis is characterized by saturation of hepatic lipids (OB+HS versus OB, P < 0.05). Thus, 1H-MR spectroscopy provides a rapid method to qualitatively assess hepatic lipid composition. Nathan A. Johnson* , Toos Sachinwalla , Jacob George?, * Discipline of Exercise and Sport Science, The University of Sydney, Sydney, Australia, Institute of Obesity, Nutrition and Exercise, The University of Sydney, Sydney, Australia, Department of Magnetic Resonance, Rayscan Imaging Liverpool, Australia, ? Storr Liver Unit, Westmead Millennium Institute and Westmead Hospital, The University of Sydney, Westmead, Australia.

Magnetic Resonance Elastography for the Noninvasive Staging of Liver Fibrosis

The purpose of our study was to prospectively compare the success rate and diagnostic accuracy of magnetic resonance elastography, ultrasound elastography, and aspartate aminotransferase to platelets ratio index (APRI) measurements for the noninvasive staging of fibrosis in patients with chronic liver disease. We performed a prospective blind comparison of magnetic resonance elastography, ultrasound elastography, and APRI in a consecutive series of patients who underwent liver biopsy for chronic liver disease in a university-based hospital. Histopathologic staging of liver fibrosis according to the METAVIR scoring system served as the reference. A total of 141 patients were assessed. The technical success rate of magnetic resonance elastography was higher than that of ultrasound elastography (133/141 [94%] vs 118/141 [84%]; P = .016). Magnetic and ultrasound elastography, APRI measurements, and histopathologic analysis of liver biopsy specimens were technically successful in 96 patients. The areas under the receiver operating characteristic curves of magnetic resonance elasticity (0.994 for F >or= 2; 0.985 for F >or= 3; 0.998 for F = 4) were larger (P < .05) than those of ultrasound elasticity, APRI, and the combination of ultrasound elasticity and APRI (0.837, 0.709, and 0.849 for F >or= 2; 0.906, 0.816, and 0.936 for F >or= 3; 0.930, 0.820, and 0.944 for F = 4, respectively). Magnetic resonance elastography has a higher technical success rate than ultrasound elastography and a better diagnostic accuracy than ultrasound elastography and APRI for staging liver fibrosis.

Feasibility of functional magnetic resonance lung imaging in Australia with long distance transport of hyperpolarized helium from Germany

MRI of the lung using hyperpolarized helium as an inhaled contrast agent has important research applications and clinical potential. Owing to the limited availability of hyperpolarized helium, this type of imaging has not been performed in the human lung outside of North America or Europe. The objective of this study was to test the feasibility of imaging human lungs in Australia using hyperpolarized helium gas imported from Germany. A Bruker 2-Tesla whole-body magnetic resonance scanner located in Brisbane, Australia was adapted with a helium-3 radiofrequency transceiver coil. Helium-3 was hyperpolarized to 72% in Mainz, Germany and airfreighted to Brisbane. The time taken for the journey was 32 h and scanning was performed 36-40 h after departure from Mainz, with an estimated polarization level of 44%. Procedures were developed to transfer 300 mL of the hyperpolarized helium to Tedlar bags filled with 700 mL of nitrogen. Healthy volunteers inhaled the 1 L helium/nitrogen mixture from FRC, and imaging was performed with a 10 s breathhold. Imaging showed very detailed and even ventilation of all regions of the lung with a good signal-to-noise ratio. No adverse effects of inhaling the gas mixture were noted. This report of MRI of the human lung using hyperpolarized helium demonstrates the feasibility of long distance gas transport from Germany to Australia. This will help to facilitate research and clinical application of this innovative functional lung imaging technique.

Diffusion-weighted MR imaging findings of kidneys in patients with early phase of obstruction

Diffusion-weighted (DW) magnetic resonance (MR) imaging is an MR technique used to show molecular diffusion. The apparent diffusion coefficient (ADC), as a quantitative parameter calculated from the DW MR images. The purpose of this study is to evaluate the ability of DW MR imaging in early phase of obstruction due to urolithiasis. Twenty-six patients with acute dilatation of the pelvicalyceal system detected by intravenous urography were included in this study. MR imaging was performed using a 1.5 T whole-body superconducting MR scanner. DW imaging can be performed using single-shot spin-echo, echo-planar imaging (EPI) sequences with the following diffusion gradient b values: 100, 600, 1000 s/mm(2). Circular region of interest (ROI) was placed in the renal parenchyma for the measurement of ADC values in the normal and obstructed kidney. For statistical analyses, Paired t test were used. In spite of obstructed kidneys had the lower ADC values compared to normal kidneys, these alterations were statistically insignificant. We did not observe significantly different ADC values of early phase of obstructed kidneys compared to normal kidneys.