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PubMed2005

Brain/language relationships identified with diffusion and perfusion MRI: Clinical applications in neurology and neurosurgery.

Diffusion and perfusion MRI have contributed to stroke management by identifying patients with tissue "at risk" for further damage in acute stroke. However, the potential usefulness of these imaging modalities, along with diffusion tensor imaging, can be expanded by using these imaging techniques with concurrent assessment of language and other cognitive skills to identify the specific cognitive deficits that are associated with diffusion and perfusion abnormalities in particular brain regions. This paper illustrates how this combined behavioral and imaging methodology can yield information that is useful for predicting specific positive effects of intervention to restore blood flow in hypoperfused regions of brain identified with perfusion MRI, and for predicting negative effects of resection of particular brain regions or fiber bundles. Such data allow decisions about neurological and neurosurgical interventions to be based on specific risks and benefits in terms of functional consequences.

Brain↗
PubMed1999

Pathophysiological topography of acute ischemia by combined diffusion-weighted and perfusion MRI.

BACKGROUND AND PURPOSE: Combined echoplanar MRI diffusion-weighted imaging (DWI), perfusion imaging (PI), and magnetic resonance angiography (MRA) can be used to visualize acute brain ischemia and predict lesion evolution and functional outcome. The appearance of a larger lesion by PI than by DWI quantitatively defines a mismatch of potential clinical importance. Qualitative lesion variations exist in the topographic concordance of this mismatch. We examined both the topographic heterogeneity and relative frequency of mismatched patterns in acute stroke using these MRI techniques. METHODS: Acute DWI, PI, and MRA studies of 34 prospectively recruited patients with supratentorial ischemic lesions scanned within 24 hours of stroke onset (range 2.5 to 23.3 hours, 12 patients <6 hours) were analyzed. RESULTS: Ischemic lesions were predominantly in the middle cerebral artery (MCA) territory (94%), with DWI lesions most commonly affecting the insular region. Mismatched patterns with PI lesion larger than DWI lesion occurred in 21 patients (62% overall), in all 4 patients imaged within 3 hours, and in 44% of patients imaged after 18 hours. A patient with a large PI but no DWI lesion and severe clinical deficit at 2.5 hours after stroke onset recovered completely. Regional variations in DWI and PI lesion loci were found, inferring site of proximal MCA occlusion, embolic pathogenesis, and regional arterial reperfusion. CONCLUSIONS: Analysis of the topographic concordance of PI and DWI lesions in acute stroke reveals regional PI lesions without concomitant DWI lesions, which do not necessarily progress to infarction but may suggest stroke pathogenesis and site of current arterial occlusion. Location of DWI lesions may suggest an earlier site of arterial occlusion and regions of maximal perfusion deficit.

Aged↗
PubMed2006

Hippocampal and thalamic diffusion abnormalities in children with temporal lobe epilepsy.

PURPOSE: Previous studies using diffusion MRI in patients with temporal lobe epilepsy have shown abnormal water diffusion in the hippocampus. Because thalamus and lentiform nuclei are considered important for the regulation of cortical excitability and seizure propagation, we analyzed diffusion tensor imaging (DTI) abnormalities in these subcortical structures and in hippocampus of children with partial epilepsy with and without secondary generalization. METHODS: Fourteen children with partial epilepsy involving the temporal lobe underwent MRI including a DTI sequence. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained in the hippocampus, thalamus, and lentiform nucleus, and compared with DTI data of 14 control children with no epilepsy, as well as glucose positron emission tomography (PET) findings. RESULTS: Decreased FA (p < 0.001) and increased ADC (p = 0.003) values were found in the hippocampi ipsilateral to the seizure focus. Significant FA decreases (p = 0.002) also were seen in the contralateral hippocampi, despite unilateral seizure onset and excellent surgical outcome in patients who underwent surgery. ADC values showed a trend for increase in the thalami ipsilateral to the epileptic focus in the seven children with secondarily generalized seizures (p = 0.09). No group differences of ADC or FA were found in the lentiform nuclei. The DTI variables did not correlate with regional glucose metabolism in any of the structures analyzed. CONCLUSIONS: Increased ADC values in hippocampus can assist in lateralizing the seizure focus, but decreased FA in the contralateral hippocampus suggests that it too may be dysfunctional despite unilateral seizure onset. Less-robust thalamic abnormalities of water diffusion in patients with secondarily generalized seizures suggest secondary involvement of the thalamus, perhaps due to recruitment of this structure into the epileptic network; however, this must be confirmed in a larger population. DTI appears to be a sensitive method for detection abnormalities in children with partial epilepsy, even in structures without apparent changes on conventional MRI.

Adolescent↗
PubMed1989

Pathological findings correlated with magnetic resonance imaging in subcortical arteriosclerotic encephalopathy (Binswanger's disease).

Formalin-fixed brain slices from four cases of subcortical arteriosclerotic encephalopathy in which a firm diagnosis could be made both clinically and pathologically have been studied by magnetic resonance imaging (MRI). The slices were subsequently embedded in paraffin-wax or celloidin and sections were cut in the same plane as the MRI slices. There was a good correlation between the extent and severity of the abnormal MRI signal and the pathological changes. Areas of diffuse MRI abnormality corresponded with areas of axonal and myelin loss with gliosis, and small "lacune"-like lesions corresponded with lacunar infarcts histologically. Sparing of the subcortical U-fibres was seen histologically and on MRI. The abnormal signal probably originates from increased tissue water attributable to gliosis and an expanded extracellular space.

Adult↗
PubMed1994

[Diffusion anisotropy in cerebral white matter lesion].

Diffusion MRI studies were performed on 14 patients with diffuse high-signal lesions of the cerebral white matter on T2-weighted MR images. There were two patients with adrenoleukodystrophy, four with dentato-rubro-pallido-luysian atrophy, three with familial spastic paraplegia, two with myotonic dystrophy and three with dementia of unknown origin. In addition, a patient with of Sanfilippo disease and one of the three patients who exhibited dementia of unknown origin were also found to be low-signal in the cerebral cortex T2-weighted MR images. In every case except the last two, diffusion-weighted MR images yielded significantly higher apparent diffusion coefficients perpendicular to nerve fibers in the frontal white matter and the corpus callosum than in the normal controls. The lesions displayed increased diffusion anisotropy, calculated as the ratio of the diffusion coefficient perpendicular to the nerve fibers to the diffusion coefficient parallel to the nerve fibers, i.e., diffusion anisotropy was lost in the white matter, suggesting a demyelinating process in the lesion. In the last two cases, on the other hand, the diffusion coefficient and diffusion anisotropy were within normal range. The white matter lesions in these cases were thought to represent degeneration secondary to the cortical involvement. Thus, it was confirmed that diffusion-weighted MR images, unlike T2-weighted MR images, were confirmed to allow differentiation between at least two types of white matter lesions.

Adrenoleukodystrophy↗
PubMed2003

MRI-clinical correlations in the primary progressive course of MS: new insights into the disease pathophysiology from the application of magnetization transfer, diffusion tensor, and functional MRI.

Despite patients with primary progressive multiple sclerosis (PPMS) experience a progressive disease course from onset, the burden and activity of lesions on conventional magnetic resonance imaging (MRI) scans of the brain are lower than in all other main clinical phenotypes of MS. This review outlines the major contributions given by magnetization transfer MRI, diffusion tensor MRI and functional MRI to the understanding of the pathophysiology of PPMS and provides evidence that, at least, three factors might explain this clinical/MRI discrepancy: (a) the presence of a diffuse tissue damage at a microscopic level; (b) a prevalent involvement of the cervical cord, and (c) an impairment of the adaptive capacity of the cortex to limit the functional consequences of subcortical structural damage.

Brain↗
PubMed2005

Markedly reduced apparent blood volume on bolus contrast magnetic resonance imaging as a predictor of hemorrhage after thrombolytic therapy for acute ischemic stroke.

BACKGROUND AND PURPOSE: Accurate assessment of the risk of hemorrhage could help to improve patient selection for thrombolytic therapy and reduce hemorrhagic complications, especially for patients with longer or uncertain time after symptom onset. This study sought to define characteristics of hemodynamic magnetic resonance imaging (MRI), which best predict hemorrhage. METHODS: Bolus contrast and diffusion MRI were performed before intravenous tissue plasminogen activator (tPA) therapy in 20 patients presenting with acute stroke symptoms within the first 6 hours after symptom onset. Hemorrhage was assessed on follow-up MRI (n=15) and computed tomography (n=5) scans. RESULTS: Of the 20 patients studied, 5 had detectable hemorrhage on follow-up scans. Blood volume maps demonstrated virtually no signal within much of the hemorrhagic region, indicating contrast did not arrive by the end of the imaging series (80 seconds). Within the hemodynamically abnormal region, a threshold of at least 126 voxels with blood volume <5% of contralateral normal gray matter separated hemorrhagic patients from nonhemorrhagic with a sensitivity of 100% and a specificity of 73% (P<0.01). All subjects with hemorrhage were at least partially reperfused after thrombolysis, whereas most false-positives did not reperfuse (P<0.05). The number of low blood volume voxels within individual patients correlated with the number of voxels with apparent diffusion coefficient values <550x10(-6) mm2/s (P<0.019), another previously proposed predictor of hemorrhage. CONCLUSIONS: Extremely low or completely absent contrast arrival may indicate tissue-at-risk for hemorrhage before tPA treatment and thus may aid in risk-benefit assessments. Occurrence of hemorrhage within at-risk areas may depend on tissue reperfusion.

Adult↗
PubMed2000

[Does diffusion and perfusion MRI modify the diagnosis and management of cerebral ischemic accidents?].

Since 25 years, CT has the capability to recognize hemorrhagic infarcts in emergency. On the other hand, cytotoxic oedema is visible only 12 or 24 hours after the onset of the ischemic stroke. T2 weighted MR-sequences are more sensitive and few hours after the onset, cytotoxic oedema appears as hypersignal, particularly using FLAIR sequences (Fluid Attenuated Inversion Recuperation). Described in 1986, diffusion-weighted MRI is a very sensitive technique to detect the cytotoxic oedema few minutes after the onset. The attenuation of the apparent diffusion coefficient must be evaluated with a map. This attenuation appears as hypersignal and its sensibility is close than 100%. The mismatch between data of perfusion MRI and diffusion MRI is the area of the ischemic penumbra. These new MRI techniques are easy to learn and must be available 24 h a day and 7 days a week in the stroke centers. They are simple, rapid and highly accurate for the diagnosis of acute ischemic stroke. They could be useful to select candidates to aggressive therapy during the first 3 or 6 hours. Potentially, they improve patient's outcome.

Brain Ischemia↗
PubMed1999

Intra-arterial rtPA treatment of stroke assessed by diffusion- and perfusion-weighted MRI.

BACKGROUND: Diffusion-weighted MRI (DWI) and perfusion-weighted MRI (PWI) are new techniques that can be used for the evaluation of acute ischemic stroke. However, their potential role in the management of patients treated with recombinant tissue plasminogen activator (rtPA) has yet to be determined. CASE DESCRIPTION: The authors present the case of a 73-year-old man who was treated with intra-arterial rtPA, and they compare findings on DWI and PWI scans with angiography. PWI revealed decreased cerebral perfusion corresponding to an area that was not successfully recanalized, but revealed no abnormality in regions in which blood flow was restored. DWI was unremarkable in the region that was reperfused early (3 hours) but revealed hyperintensity in an area that was reperfused 3. 5 hours after symptom onset and in the area that was not reperfused. CONCLUSIONS: Findings on PWI correlated well with angiography, and DWI detected injured tissue in the hyperacute stage, whereas conventional MRI findings were negative. This suggests that these techniques may be useful to noninvasively evaluate the success of thrombolytic therapy.

Aged↗
PubMed2004

Structural changes in glutamate cell swelling followed by multiparametric q-space diffusion MR of excised rat spinal cord.

Diffusion in the extracellular and intracellular spaces (ECS and ICS, respectively) was evaluated in excised spinal cords, before and after cell swelling induced by glutamate, by high b-value q-space diffusion MR of specific markers and water. The signal decays of deuterated tetramethylammonium (TMA-d(12)) chloride, an exogenous marker of the ECS, and N-acetyl aspartate (NAA), an endogenous marker of the ICS, were found to be non-mono-exponential at all diffusion times. The signal decays of these markers were found to depend on the diffusion time and the cell swelling induced by the glutamate. It was found, for example, that the mean displacements of the apparent fast and slow diffusion components of TMA-d(12) are 7.21 +/- 0.11 and 1.16 +/- 0.05 microm, respectively at a diffusion time of 496 ms. After exposure of the spinal cords to 10 mM of glutamate, these values decreased to 6.62 +/- 0.13 and 1.01 +/- 0.05 microm, respectively. The mean displacement of NAA, however, showed a less pronounced opposite trend and increased after cell swelling induced by exposure to glutamate. q-Space diffusion MR of water was found to be sensitive to exposure to glutamate, and q-space diffusion MRI showed that a more pronounced decrease in the apparent diffusion coefficient and the mean displacement of water is observed in the gray matter (GM) of the spinal cord. All these changes demonstrate that diffusion MR is indeed sensitive to structural changes caused by cell swelling induced by glutamate. Multiparametric high b-value q-space diffusion MR is useful for obtaining microstructural information in neuronal tissues.

Animals↗
PubMed2004

The effect of rotational angle and experimental parameters on the diffraction patterns and micro-structural information obtained from q-space diffusion NMR: implication for diffusion in white matter fibers.

Diffusion NMR may provide, under certain experimental conditions, micro-structural information about confined compartments totally non-invasively. The influence of the rotational angle, the pulse gradient length and the diffusion time on the diffusion diffraction patterns and q-space displacement distribution profiles was evaluated for ensembles of long cylinders having a diameter of 9 and 20 microm. It was found that the diffraction patterns are sensitive to the rotational angle (alpha) and are observed only when diffusion is measured nearly perpendicular to the long axis of the cylinders i.e., when alpha= 90 degrees +/- 5 degrees under our experimental conditions. More importantly, we also found that the structural information extracted from the displacement distribution profiles and from the diffraction patterns are very similar and in good agreement with the experimental values for cylinders of 20 microm or even 9 microm, when data is acquired with parameters that satisfy the short gradient pulse (SGP) approximation (i.e., delta -->0) and the long diffusion time limit. Since these experimental conditions are hardly met in in vitro diffusion MRI of excised organs, and cannot be met in clinical MRI scanners, we evaluated the effect of the pulse gradient duration and the diffusion time on the structural information extracted from q-space diffusion MR experiments. Indeed it was found that, as expected, accurate structural information, and diffraction patterns are observed when Delta is large enough so that the spins reach the cylinders' boundaries. In addition, it was found that large delta results in extraction of a compartment size, which is smaller than the real one. The relevance of these results to q-space MRI of neuronal tissues and fiber tracking is discussed.

Diffusion Magnetic Resonance Imaging↗
PubMed2001

Diffusion imaging in pediatric central nervous system infections.

Our purpose was to investigate the role of diffusion imaging (DI) in central nervous system (CNS) infections in pediatric patients. It was anticipated that DI would be more sensitive than conventional MRI in the detection of the infarctive complications of infection, and possibly, in the detection of the infectious process as well. Seventeen pediatric patients, eight having meningitis,, five with herpes encephalitis, three with brain abscess or cerebritis and one with sepsis, were evaluated at 1.5-T with DI. All herpes patients had positive DI at the site of herpetic involvement, and two had the addition of watershed infarctions. DI demonstrated more lesions in three of the four cases of herpetic encephalitis. Half the meningitis cases had watershed infarction where DI was better and half had vasculitic infarctions in which DI was equal to or better than conventional MRI. Diffusion imaging was more sensitive than conventional MRI alone in detection of changes due to infections and ischemic lesions, but did not differentiate between them by DI or apparent diffusion coefficient (ADC), although anatomic distribution of lesions proved useful.

Adolescent↗
PubMed2004

Correlation of quantitative EEG in acute ischemic stroke with 30-day NIHSS score: comparison with diffusion and perfusion MRI.

BACKGROUND AND PURPOSE: Magnetic resonance imaging (MRI) methods such as diffusion- (DWI) and perfusion-weighted (PWI) imaging have been widely studied as surrogate markers to monitor stroke evolution and predict clinical outcome. The utility of quantitative electroencephalography (qEEG) as such a marker in acute stroke has not been intensively studied. The aim of the present study was to correlate ischemic cortical stroke patients' clinical outcomes with acute qEEG, DWI, and PWI data. MATERIALS AND METHODS: DWI and PWI data were acquired from 11 patients within 7 and 16 hours after onset of symptoms. Sixty-four channel EEG data were obtained within 2 hours after the initial MRI scan and 1 hour before the second MRI scan. The acute delta change index (aDCI), a measure of the rate of change of average scalp delta power, was compared with the National Institutes of Health Stroke Scale scores (NIHSSS) at 30 days, as were MRI lesion volumes. RESULTS: The aDCI was significantly correlated with the 30-day NIHSSS, as was the initial mean transit time (MTT) abnormality volume (rho=0.80, P<0.01 and rho=0.79, P<0.01, respectively). Modest correlations were obtained between the 15-hour DWI lesion volume and both the aDCI and 30-day NIHSSS (rho=0.62, P<0.05 and rho=0.73, P<0.05, respectively). CONCLUSIONS: In this small sample the significant correlation between 30-day NIHSSS and acute qEEG data (aDCI) was equivalent to that between the former and MTT abnormality volume. Both were greater than the modest correlation between acute DWI lesion volume and 30-day NIHSSS. These preliminary results indicate that acute qEEG data might be used to monitor and predict stroke evolution.

Acute Disease↗
PubMed1998

MRI white matter diffusion anisotropy and PET metabolic rate in schizophrenia.

A disturbance in the frontal-striatal-thalamic circuitry has been proposed for schizophrenia, but this concept has been based primarily on indirect evidence from psychopharmacology and analogies with animal research. Diffusion tensor imaging, a new MRI technique that permits direct assessment of the large axon masses stretching from the prefrontal cortex to the striatum, was used to study white matter axon bundles. Diffusion tensor images, high-resolution structural MRI and positron emission tomography scans with 18-fluorodexoyglucose were obtained on five patients with schizophrenia and six age- and sex-matched normal controls. Significantly lower diffusion anisotropy in the white matter of the prefrontal cortex in schizophrenic patients than in normal controls was observed in statistical probability maps. Co-registered PET scans revealed significantly lower correlation coefficients between metabolic rates in the prefrontal cortex and striatum in patients than in controls. These twin findings provide convergent evidence for diminished fronto-striatal connectivity in schizophrenia.

Adult↗
PubMed2004

Diffusion imaging for evaluation of tumor therapies in preclinical animal models.

The increasing development of novel targeted therapies for treating solid tumors has necessitated the development of technology to determine their efficacy in preclinical animal models. One such technology that can non-invasively quantify early changes in tumor cellularity as a result of an efficacious therapy is diffusion MRI. In this overview we present some theories as to the origin of diffusion changes as a result of tumor therapy, a robust methodology for acquisition of apparent diffusion coefficient maps and some applications of determining therapeutic efficacy in a variety therapeutic regimens and animal models.

Animals↗
PubMed2003

Conventional DTI vs. slow and fast diffusion tensors in cat visual cortex.

Diffusion tensor imaging (DTI) uses water diffusion anisotropy in axonal fibers to provide a tool for analyzing and tracking those fibers in brain white matter. In the present work, multidirectional diffusion MRI data were collected from a cat brain and decomposed into slow and fast diffusion tensors and directly compared with conventional DTI data from the same imaging slice. The fractional anisotropy of the slow diffusing component (D(slow)) was significantly higher than the anisotropy measured by conventional DTI while reflecting a similar directionality and appeared to account for most of the anisotropy observed in gray matter, where the fiber density is notoriously low. Preliminary results of fiber tracking based on the slow diffusion component are shown. Fibers generated based on the slow diffusion component appear to follow the vertical fibers in gray matter. D(slow)TI may provide a way for increasing the sensitivity to anisotropic structures in cortical gray matter.

Animals↗
PubMed2000

Structural brain lesions do not influence the prognosis of juvenile myoclonic epilepsy.

OBJECTIVES: In juvenile myoclonic epilepsy (JME) neuroimaging procedures are usually unnecessary but are often performed following the first generalized tonic-clonic seizure before a specific diagnosis has been reached. Our aim was to evaluate the influence of abnormal findings on the clinical presentation and prognosis of JME. MATERIAL AND METHODS: We retrospectively analyzed all medical records of JME patients first referred in two epilepsy centers (Marseilles, Nice) between 1981 and 1998. RESULTS: Among 170 consecutive unselected newly diagnosed JME patients, neuroimaging was performed in 82 cases (MRI: 22, CT: 75, including MRI+CT: 15). In 4 subjects, specific neurological abnormalities had justified neuroimaging: severe head trauma after the onset of JME (2, both with lesions related to the trauma), multiple sclerosis with onset after JME (1, with normal MRI before the onset of multiple sclerosis and abnormal, specific findings later), severe mental retardation (1, with diffuse MRI changes but a typical electro-clinical presentation and evolution). In the other 78 cases, 9 had abnormal findings: common arachnoid cyst (3), mild diffuse cerebral atrophy and ventricular enlargement (1), mild ventricular enlargement only (3), septum lucidum cavum (1), mildly increased T2 signal in the left temporal lobe (1). Abnormal neuroimaging did not influence therapeutic decisions or prognosis. CONCLUSIONS: These data confirm that neuroimaging procedures should not be routinely performed in patients with typical JME, unless additional neurological problems, that are unrelated to the diagnosis of epilepsy, occur.

Adolescent↗
PubMed2005

Membrane gas diffusion measurements with MRI.

Gas transport across polymeric membranes is fundamental to many filtering and separation technologies. To elucidate transport mechanisms, and understand the behaviors of membrane materials, accurate measurement of transport properties is required. We report a new magnetic resonance imaging (MRI) methodology to measure membrane gas phase diffusion coefficients. The MRI challenges of low spin density and short gas phase relaxation times, especially for hydrogen gas, have been successfully overcome with a modified one-dimensional, single-point ramped imaging with T(1) enhancement, measurement. We have measured the diffusion coefficients of both hydrogen gas and sulfur-hexafluoride in a model polymeric membrane of potential interest as a gas separator in metal hydride batteries. The experimental apparatus is a modified one-dimensional diaphragm cell which permits measurement of the diffusion coefficient in experimental times of less than 1 min. The H(2) gas diffusion coefficient in the membrane was 0.54 +/- 0.01 mm(2)/s, while that of sulfur-hexafluoride was 0.14 +/- 0.01 mm(2)/s, at ambient conditions.

Algorithms↗