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Biomedical subjects

G M Bydder

Publications and source records attributed to G M Bydder.

At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

Use of phosphorus-31 MR spectroscopy to monitor response to chemotherapy in non-Hodgkin lymphoma.

Two patients with non-Hodgkin lymphoma of the femur were examined with 31P magnetic resonance spectroscopy (MRS) and proton magnetic resonance imaging before and during treatment with chemotherapy. Prior to treatment, 31P MRS of the tumor showed that in comparison to normal skeletal muscle, phosphocreatine was reduced, and phosphomonoesters (PME) and phosphodiesters were elevated. The 31P spectrum became similar to that of normal muscle after 40 days of treatment in both cases. Following the initial dose of chemotherapy, an increase in PME relative to adenosine triphosphate was observed within 48 h in one patient. Magnetic resonance showed a change in the soft tissue component of both tumors and 6-12 months later there was no clinical evidence of any recurrence. Magnetic resonance spectroscopy with 31P may prove to be a sensitive technique for monitoring therapeutic response of tumors.

Adult↗
PubMedDate not supplied

Analysis of the magnitude of susceptibility effects in disease of the brain: implications for MR spectroscopy.

The results of 165 clinical examinations of the brain in which phase mapping was used to display susceptibility effects have been analysed. Significant changes were frequently observed when hemorrhage was a primary or secondary event. A substantial fraction of the examinations, including those of tumor, trauma, hemorrhage, and other patients, showed changes of up to 1 ppm. Spectral interpretation may be made more difficult in many clinical circumstances by susceptibility effects.

Adult↗
PubMedDate not supplied

Assessment of phase and amplitude effects due to susceptibility variations in MR imaging of the brain.

Susceptibility effects due to the presence of hemorrhage have been observed in a substantial number of patients and are a potential source of artifact in in vivo spectroscopy. The studies so far have concentrated on observations of phase differences, but amplitude variations also exist. This article reviews the degree to which the two are independent and suggests that at least three different pulse sequences are necessary to characterize effects due to local field inhomogeneities arising in clinical studies.

Brain Diseases↗
PubMedDate not supplied

Normal and abnormal white matter tracts shown by MR imaging using directional diffusion weighted sequences.

A pulsed magnetic field gradient spin echo technique was used to study the brain of two volunteers and eight patients. The pulsed gradients were applied both perpendicular and parallel to the image slice. Striking changes in signal intensity were demonstrated in white matter depending on the direction in which pulsed gradients were applied. These effects enabled specific white matter tracts to be identified depending on the direction of their fibres. Abnormalities were also demonstrated in these tracts in patients with a variety of diseases, including cases where only minor abnormalities were seen with conventional, highly T2-weighted sequences. The effects were attributed to anisotropically restricted diffusion within white matter. The technique may have application in a wide range of neurological disease and result in better localisation of lesions and improved detection of disease.

AIDS Dementia Complex↗
PubMedDate not supplied

MR imaging of anisotropically restricted diffusion of water in the nervous system: technical, anatomic, and pathologic considerations.

The use of MR imaging to image anisotropically restricted diffusion (ARD) of water in the nervous system is described. The theoretical basis for the use of the pulsed gradient spin echo sequences is outlined, including an estimate of the range of cell dimensions that can be studied with this technique. The importance of restricted diffusion across myelinated white matter fibre tracts is emphasised and the capacity of MR imaging to demonstrate fibre pathways as a function of their direction is illustrated. Technical developments that have been implemented include 256 x 256 spatial resolution, a wider range of diffusion times Td, and an increased range of diffusion sensitivity parameters b. Effects of these are illustrated together with the use of gradient moment nulling methods, oblique sensitisation, and a smaller set of gradient coils that enable shorter values of echo time to be used with the same value of b. The anatomical basis for ARD imaging is analysed, and association, commissural, and projection fibre tracts are demonstrated in different planes. The published literature on variations of the apparent diffusion coefficient from normal is reviewed and examples where diffusion weighted images revealed information that was not necessarily apparent with conventional sequences are illustrated. These include cases of multiple sclerosis, chronic head injury, progressive multifocal leucoencephalopathy, cerebrovascular disease, astrocytoma, and probable metastases to the brain. Imaging of ARD affords a fascinating conjunction between the microscopic movement of water, the properties of myelinated white matter fibres, gross anatomy of the brain, and changes of the diffusion of water in disease.

Adult↗
PubMedDate not supplied

MR imaging of anisotropically restricted diffusion in the brain of neonates and infants.

Brain MR examinations were performed on one normal and 30 abnormal neonates and infants with a variety of clinical problems using pulsed gradient spin echo (PGSE) sequences sensitized in different directions to detect changes due to anisotropically restricted diffusion of water within the brain. Anisotropically restricted diffusion was demonstrated within white matter, which appeared to be myelinated with T1-weighted inversion recovery or spin echo sequences and within white matter where the presence of myelin was not demonstrated with these sequences. Cysts and fluid collections were recognised by their low signal intensity using PGSE sequences in the subcortical regions, lentiform nuclei, and periventricular regions. An intracerebral hematoma and a subdural hematoma showed a high signal intensity with PGSE sequences consistent with isotropically restricted diffusion. Chronic infarction displayed a low signal intensity consistent with relatively free isotropic diffusion. Patients with leukodystrophy associated with congenital muscular dystrophy showed an anisotropic pattern with different components of the abnormality present on images with sensitization in different directions. The corticospinal tracts failed to show highlighting in three cases where conventional imaging was normal. In several patients with a history of birth asphyxia, asymmetry and a relative reduction in signal intensity were seen in the corticospinal tracts.

Asphyxia Neonatorum↗
PubMedDate not supplied

Design and implementation of magnetization transfer pulse sequences for clinical use.

The transfer of magnetization between a free and a bound pool of spins is described in terms of the respective longitudinal relaxation times and the life times of spins in each pool. The effect of an off resonance radiofrequency (RF) pulse in producing saturation in the bound pool and a consequent decrease in both the available longitudinal magnetization and the T1 of spins in the free pool is described. The effects of increasing duration of the saturating RF pulse on image pixel signal intensity were used to determine values for the decrease in both T1 and the available magnetization in gray and white matter of the brain as well as in muscle, fat, and CSF. At 0.15 T the available magnetization of muscle was reduced by approximately 60% and its T1 was decreased from 350 to 150 ms. The available magnetization of white and gray matter was reduced by 40% and their values of T1 were reduced by 80-110 ms. The reduction in available magnetization was used to increase contrast on proton density weighted or T2-weighted SE pulse sequences. These changes were also used to design inversion recovery (IR) pulse sequences with particular contrast properties. A short inversion time (TI) magnetization transfer (MT) IR (MT-STIR) pulse sequence was used to reduce the signal from normal muscle to zero to produce an angiographic effect in the leg. Increased tissue contrast was observed with a T2-weighted (MT-SE) sequence in a patient with bilateral cerebral infarction and with an MT-IR pulse sequence in a patient who had an intracranial hematoma. Three patients with cerebral tumors showed high lesion contrast with MT-STIR sequences. Components within two tumors were changed to different degrees by MT and in one case change in the brain attributable to recent radiotherapy treatment was only identified with an MT-STIR sequence. Magnetization transfer can be used to manipulate both the available longitudinal magnetization and the T1 of normal and abnormal tissues. The changes in tissue contrast produced by this can be very substantial and are likely to be of importance in clinical imaging.

Adult↗
PubMedDate not supplied

High signal regions in normal white matter shown by heavily T2-weighted CSF nulled IR sequences.

Inversion recovery (IR) sequences with an inversion time (TI) designed to markedly reduce or null the signal from CSF (TI of approximately 2,100 ms at 1.0 T) and a very long echo time (TE) of 240 ms were used to image the brain of two normal adult volunteers, one 34-year-old man with an intrinsic tumor, and one 3-month-old infant with an infarct. Using these very heavily T2-weighted pulse sequences, adult gray and white matter showed similar signal intensity in many areas of the brain, but normal white matter in regions of the centrum semiovale, posterior internal capsule, parietopontile tract, occipitothalamic radiation, and brain stem showed a much higher signal intensity than surrounding gray or white matter. The infant displayed a low signal intensity in myelinated regions in the internal capsule and occipitothalamic radiation and a high signal in unmyelinated white matter. In many of the images there were strong similarities to the distribution of high signal within white matter seen with pulsed gradient spin echo sequences (TE 130 ms) designed to demonstrate effects due to anisotropic diffusion. Arguments are advanced to support the view that the high signal intensity in white matter tracts is due to one or more long T2 components that may be associated with unmyelinated or sparsely myelinated fibres within white matter. The resemblance to diffusion weighted images may reflect the fact that both employ long TEs and both produce a low signal from CSF. If myelin possessed a different susceptibility from axoplasm so that magnetic field gradients were generated around nerve fibres when their orientation was not parallel to B0, diffusion of water might then produce the observed dependence on fibre direction. The high signal regions in white matter are a potential source of confusion in image interpretation, and measurements of T2 in white matter need to be made with these regional variations in mind. The concept of normal appearing white matter also needs to be applied with a knowledge of these differences. The IR sequences used in this study provide a very high T2 dependence with a low signal from CSF and may be useful for detecting disease in the CNS of adults and children.

Adult↗
PubMedDate not supplied

Use of fluid attenuated inversion recovery (FLAIR) pulse sequences in MRI of the brain.

Fluid attenuated inversion recovery pulse sequences with a long echo time (TE) have been used to image the brain in one volunteer and four patients. The long inversion time used with this sequence suppresses the signal from CSF and the long TE produces very heavy T2 weighting. The marked reduction in flow artefact from CSF and the high T2 weighting enabled anatomical detail to be seen within the brain stem and produced high lesion contrast in areas close to CSF. Lesions were demonstrated with greater conspicuity than with conventional T2-weighted sequences in patients with cerebral infarction, low grade astrocytoma, and diplegia.

Adolescent↗
PubMedDate not supplied

A registration and interpolation procedure for subvoxel matching of serially acquired MR images.

OBJECTIVE: Methods for automatically registering and reslicing MR images using an interpolation function that matches the structure of the image data are described. MATERIALS AND METHODS: Phantom and human brain images were matched by rigid body rotations and translations in two and three dimensions using a least-squares optimization procedure. Subvoxel image shifts were produced with linear or sinc interpolation. RESULTS: The use of sinc interpolation ensured that the repositioned images were faithful to the original data and enabled quantitative intensity comparisons to be made. In humans, image segmentation was vital to avoid extraneous soft tissue changes producing systematic errors in registration. CONCLUSIONS: The sinc-based interpolation technique enabled serially acquired MR images to be positionally matched to subvoxel accuracy so that small changes in the brain could be distinguished from effects due to misregistration.

Humans↗
PubMedDate not supplied

Detection of subtle brain changes using subvoxel registration and subtraction of serial MR images.

OBJECTIVE: The aim of this study was to examine the potential of accurate image registration for detecting subtle changes in the brain. MATERIALS AND METHODS: Isotropic T1-weighted volume images were obtained in 10 normal subjects and five patients on two or more occasions (including pre- and postcontrast studies). The images were segmented and a 3D rigid body translation and rotation technique was used with sinc interpolation to precisely match the images using a chi 2-test. The registered images and the subtraction images produced from them were used to detect changes in signal intensity, sit, shape, and size of the brain. RESULTS: Small changes due to differences in orientation of the head, growth, and development as well as inhalation of oxygen and carbogen (95% O2/5% CO2) were observed in normal subjects. Changes were also observed in patients with minor head trauma, a meningioma, an astrocytoma, and multiple sclerosis. Differences due to contrast enhancement and surgery and/or anesthesia were also seen. CONCLUSION: With use of subvoxel registration, subtle changes in the brain were detected in a variety of physiological and clinical situations where differences have hitherto been difficult or impossible to detect.

Adult↗
PubMedDate not supplied

MRI of the anal sphincter.

OBJECTIVE: The anal sphincter was imaged with MR using an internal coil to demonstrate its anatomy, contrast enhancement patterns, and appearance in disease. MATERIALS AND METHODS: A cylindrical saddle geometry coil was placed in the anal canal. Sixteen volunteers and 18 patients were examined. Imaging was performed on a 0.5 T Picker Asset MRI scanner in all the volunteers and nine patients and on a 1.0 T Picker HPQ Vista in nine patients. Then T1- and T2-weighted SE, T1-weighted GE and STIR images transverse to the sphincter, and T1-weighted SE images parallel to the sphincter in the coronal oblique plane were obtained. Intravenous gadopentetate dimeglumine (0.1 mmol/kg) was given to 2 normal subjects for dynamic studies and 10 patients for conventional postcontrast imaging. RESULTS: The coils were easy to insert and well tolerated and provided high spatial resolution. The internal sphincter had a higher signal intensity than the external sphincter on all sequences but particularly on STIR images. Brisk contrast enhancement of the internal sphincter was seen. Sphincteric abscesses and fistulous tracks were identified in three patients and confirmed at surgery. Sphincter defects were seen in three patients with past obstetric trauma, and these were also confirmed at surgery. Sphincter atrophy was seen in three patients with idiopathic fecal soiling. CONCLUSION: MRI of the anal sphincter with an internal coil provides excellent visualization of normal anatomy and may be of considerable value in diagnosis.

Abscess↗
PubMedDate not supplied

Evaluation of a FLAIR sequence designed to reduce CSF and blood flow artifacts by use of k-space reordered by inversion time at each slice position (KRISP) in high grade gliomas of the brain.

The objective of this study was to compare conventional and KRISP (k-space reordered by inversion time at each slice position) fluid-attenuated inversion recovery (FLAIR) sequences in high grade gliomas for artifact control, conspicuity of intracranial structures, and lesions as well as sensitivity to contrast enhancement. Artifacts were lower with the KRISP FLAIR sequence, and the conspicuity of all assessed structures and lesions was better. The degree of contrast enhancement was similar with T1-weighted and KRISP FLAIR sequences.

Adult↗
PubMedDate not supplied

Eicosapentaenoic acid treatment in schizophrenia associated with symptom remission, normalisation of blood fatty acids, reduced neuronal membrane phospholipid turnover and structural brain changes.

The administration of the omega-3 fatty acid eicosapentaenoic acid (EPA) to a drug-naive patient with schizophrenia, untreated with conventional antipsychotic medication, led to a dramatic and sustained clinical improvement in both positive and negative symptoms. This was accompanied by a correction in erythrocyte membranes of abnormalities in both n-3 and n-6 highly unsaturated fatty acids and with reduced neuronal membrane phospholipid turnover, as evidenced by serial 31-phosphorus cerebral magnetic resonance spectroscopy. Using recently developed techniques of image segmentation, subvoxel registration and quantitation, analysis of serial high-resolution 3D cerebral MRI scans showed that, in the year before EPA treatment, cerebral atrophy was taking place and that this atrophy was reversed by six months of EPA treatment. These results demonstrate that EPA can reverse both the phospholipid abnormalities previously described in schizophrenia and cerebral atrophy. They provide strong further evidence in support of the membrane phospholipid model of schizophrenia.

Adult↗
PubMedDate not supplied

MR of the brain using fluid-attenuated inversion recovery (FLAIR) pulse sequences.

PURPOSE: Results from conventional T2-weighted spin-echo sequences were compared with those obtained using fluid attenuated inversion recovery (FLAIR) pulse sequences in order to assess their relative merits in detecting disease. METHODS: Forty adult patients with suspected disease of the brain were examined with spin-echo sequences (TE = 20 and TE = 80), and results were compared with FLAIR sequences of several types with inversion times of 1800-3000 msec and echo times of 130-240 msec. Scans were assessed by two radiologists for lesion number, conspicuity, and extent. RESULTS: A total of 48 lesions or groups of lesions were recognized with both sequences. In 22 instances, more lesions were seen with FLAIR sequences, and, in the remaining 26, equal numbers were seen. In 42 lesions, conspicuity was better with FLAIR sequences, equal in five and worse in one cystic lesion. Lesion extent was better assessed in 28 of the 48 cases with FLAIR sequences and equally well seen in the remainder. CONCLUSION: By virtue of their long echo time and relative freedom from cerebrospinal fluid artifact FLAIR sequences provide high sensitivity to a wide range of disease. The basic sequence is easy to implement but is relatively time consuming.

Adult↗
PubMedDate not supplied

MR imaging: clinical use of the inversion recovery sequence.

The properties of the inversion recovery (IR) sequence are considered and its use in clinical practice is illustrated. The effect of changing repetition time, inversion time (TI), and echo time; the method of data encoding; the type of data collection; and the method of image processing are analysed. Normal appearances and clinical examples in the central nervous system and the remainder of the body are used to illustrate the many options available with this sequence. The short TI IR sequence has advantages in magnetic resonance imaging of the body, and medium TI sequences are of value in localisation in the brain and in demonstrating contrast enhancement. Long TI sequences can be used in pediatrics and for separating tumour and oedema. Suppression or partial suppression of fat and fluid signals are two useful options with IR sequences.

Astrocytoma↗
PubMedDate not supplied

Serial MR imaging in neonatal cerebral injury.

The results of serial MR imaging of the brain in 32 patients with neonatal cerebral injury who had two or more examinations are reviewed. By comparison with normal age-matched controls, delayed or deficient myelination was identified in eight patients on follow-up examination. Developmental delay was present in all of these patients. In three patients delayed myelination was identified at the first study and was normal at follow-up. These patients improved clinically. The most severe delays or deficits in myelination and the most severe handicaps were present in patients with subcortical and periventricular leukomalacia. Ventricular size was readily assessed. Development of porencephalic cysts at sites of previous hemorrhage and infarction was recognized. The lack of ionizing radiation is of particular importance in follow-up MR of children, and an increasing role for this technique in pediatric developmental neurology appears likely.

Birth Injuries↗