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Microstructural development of human newborn cerebral white matter assessed in vivo by diffusion tensor magnetic resonance imaging.

Alterations of the architecture of cerebral white matter in the developing human brain can affect cortical development and result in functional disabilities. A line scan diffusion-weighted magnetic resonance imaging (MRI) sequence with diffusion tensor analysis was applied to measure the apparent diffusion coefficient, to calculate relative anisotropy, and to delineate three-dimensional fiber architecture in cerebral white matter in preterm (n = 17) and full-term infants (n = 7). To assess effects of prematurity on cerebral white matter development, early gestation preterm infants (n = 10) were studied a second time at term. In the central white matter the mean apparent diffusion coefficient at 28 wk was high, 1.8 microm2/ms, and decreased toward term to 1.2 microm2/ms. In the posterior limb of the internal capsule, the mean apparent diffusion coefficients at both times were similar (1.2 versus 1.1 microm2/ms). Relative anisotropy was higher the closer birth was to term with greater absolute values in the internal capsule than in the central white matter. Preterm infants at term showed higher mean diffusion coefficients in the central white matter (1.4 +/- 0.24 versus 1.15 +/- 0.09 microm2/ms, p = 0.016) and lower relative anisotropy in both areas compared with full-term infants (white matter, 10.9 +/- 0.6 versus 22.9 +/- 3.0%, p = 0.001; internal capsule, 24.0 +/- 4.44 versus 33.1 +/- 0.6% p = 0.006). Nonmyelinated fibers in the corpus callosum were visible by diffusion tensor MRI as early as 28 wk; full-term and preterm infants at term showed marked differences in white matter fiber organization. The data indicate that quantitative assessment of water diffusion by diffusion tensor MRI provides insight into microstructural development in cerebral white matter in living infants.

Anisotropy↗

Spinal cord infarction demonstrated by diffusion-weighted magnetic resonance imaging.

Spinal cord infarction is a rare entity of varying etiology although most often associated with atherosclerotic aortic disease. Definitive diagnosis of (idiopathic) spinal cord infarction in the acute stage and in the absence of demonstrable predisposing factors is not always possible even with MRI. Diffusion-weighted MRI (dwMRI) may provide valuable information in the evaluation of spinal cord ischemia. A 45-year-old woman presented with idiopathic spinal cord infarction manifesting as sudden onset of paraparesis and sphincter dysfunction. Both T2-weighted and line-scan dwMRI revealed hyperintense signals in the dorsal part of the spinal conus. Apparent diffusion coefficient values were significantly low in the lesion, suggesting cytotoxic edema compatible with acute ischemia. The clinical course and other radiographic findings were also compatible with idiopathic spinal cord infarction. Diffusion-weighted MRI is an important diagnostic tool for examining patients with suspected spinal cord ischemia.

Diffusion Magnetic Resonance Imaging↗

Diffusion and high resolution MRI of traumatic brain injury in rats: time course and correlation with histology.

Although widely employed in studies of cerebral ischemia, the use of diffusion-weighted imaging (DWI) for traumatic brain injury (TBI) has been both limited and primarily confined to the first few hours after injury. Therefore, the present study examined the temporal evolution of magnetic resonance imaging (MRI) signal changes from hours to weeks after moderate fluid-percussion TBI in rats. We used isotropic diffusion along three directions and high resolution (HR) spin-echo pulse sequences to visualize DWI and HR MRI changes, respectively. Late changes were compared to histopathological and neurological outcome. A significant decrease (P<0.05) in the apparent diffusion coefficients (ADC) below preinjury levels was found in the left cortex and left hippocampus (ipsilateral to injury) at 1-2 h post-TBI. At 2 weeks post-TBI, ADCs were significantly elevated (P<0.05) above preinjury levels in both cortex and hippocampus. Regions of hypo- and hyperintensity detected in HR MRI scans also showed evidence of tissue damage by histological evaluation. Neurological assessment indicated that such changes were observed at a level of injury which produced moderate impairment 2 weeks after the insult. These results indicate that alterations in DWI and HR MRI signals occur both early (hours) and late (weeks) after lateral fluid-percussion injury. Furthermore, the study showed that DWI was sensitive to MR signal change at 1-2 h post TBI (in select ROIs), whereas HR scans showed MR signal change primarily at later time points (3-4 h and later). Moreover, regions which demonstrate late changes are associated with histological damage and neurological impairment. The study demonstrates the utility of MRI to detect early changes, in some cases, that are predictive of long-lasting damage verified histologically.

Animals↗

Imaging myocardial fiber disarray and intramural strain hypokinesis in hypertrophic cardiomyopathy with MRI.

PURPOSE: To examine the relationship between myofiber disarray and myocardial hypokinesis in human hypertrophic cardiomyopathy (HCM) using noninvasive cardiac diffusion and strain MRI. MATERIALS AND METHODS: Five patients with a diagnosis of HCM and five age-matched healthy volunteers were studied and compared. Cardiac diffusion MRI was applied to map in vivo myocardial fiber architecture. Cardiac strain MRI was applied to map myocardial motion. By acquiring registered diffusion and strain MRI images in vivo on both normal and HCM hearts, we investigated in HCM the relationship between myofiber disarray and systolic strain components, including radial, fiber, and cross-fiber strains, and sought to determine the mechanism behind disarray-related myocardial dysfunction in HCM. RESULTS: Regionally disordered fiber orientation and reduced diffusion fractional anisotropy (FA) were found in HCM, demonstrating myofiber disarray. Intramural myocardial strain hypokinesis (reduced radial, fiber, and cross-fiber strains) was also observed in HCM in the same region, and was found to be correlated with FA. The correlation between FA and hypokinesis was found to be stronger in the cross-fiber direction (part of the passive myocardial function) compared to the fiber direction (part of the active myocardial function). This is consistent with the hypothesis that the principal feature of HCM is the reduction of myocardium passive compliance. The angle between principal shortening and fiber orientation was markedly disordered in HCM, indicating an abnormal transmural coupling. CONCLUSION: Myofiber disarray in HCM is correlated with abnormalities of both passive and active myocardial function, and the normal patterns of fiber shortening and wall thickening are deranged in HCM.

Adult↗

[Diffusion, perfusion and functional magnetic resonance imaging].

Recent developments in the use of Magnetic Resonance Imaging (MRI) to measure and image molecular diffusion and blood microcirculation (perfusion) hold significant promise in the noninvasive evaluation of normal brain function and functional disorders. Molecular diffusion is the result of spontaneous random motion that involves all molecules and probes molecular motion at microscopic level. Using diffusion MRI, information on tissue geometry and compartmentation effects can be obtained. Diffusion MRI has been used to map myelin fiber orientation in brain with high accuracy. Diffusion MRI is also the only imaging modality which shows brain ischemia at a very early stage, even before T1w or T2w MR images become abnormal, offering great promises in the management of stroke patients. Also, diffusion imaging may be used to monitor tissue temperature changes noninvasively during hyperthermia or laser surgery. On the other hand, MRI can provide information on tissue perfusion. Several methods have been proposed, some of them including tracers or contrast agents. The most successful approach for brain function studies, however, is based on the sensitivity of MRI to magnetic effects induced by changes in the oxygenation status of hemoglobin (deoxyhemoglobin). These effects have already been used to characterize hematomas. These effects may also be exploited to detect small modulation in red blood cell oxygen content related to local variations in blood flow and oxygen consumption in tissues. In the brain cortex, such variations may be induced by external stimuli or internal cognitive processes. Capillary blood deoxyhemoglobin thus acts as a natural endogeneous contrast agent.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain↗

Do acute diffusion- and perfusion-weighted MRI lesions identify final infarct volume in ischemic stroke?

BACKGROUND AND PURPOSE: An acute mismatch on diffusion-weighted MRI (DWI) and perfusion-weighted MRI (PWI) may represent the "tissue-at-risk." It is unclear which "semiquantitative" perfusion parameter most closely identifies final infarct volume. METHODS: Acute stroke patients underwent DWI and PWI (dynamic-susceptibility contrast imaging) on admission (baseline), and T2-weighted imaging (T2WI) at 1 or 3 months after stroke. "Semiquantitative" mean transit time (MTTsq=first moment of concentration/time curve), cerebral blood volume (CBVsq=area under concentration/time curve), and cerebral blood flow (CBFsq=CBVsq/MTTsq) were calculated. DWI and PWI lesions were measured at baseline and final infarct volume on T2WI acquired > or =1 month after stroke. Baseline DWI, CBFsq, and MTTsq lesion volumes were compared with final T2WI lesion volume. RESULTS: Among 46 patients, baseline DWI and CBFsq lesions were not significantly different from final T2WI lesion volume, but baseline MTTsq lesions were significantly larger. The correlation with final T2WI lesion volume was strongest for DWI (Spearman rank correlation coefficient rho=0.68), intermediate for CBFsq (rho=0.55), and weakest for MTTsq (rho=0.49) baseline lesion volumes. Neither DWI/CBFsq nor DWI/MTTsq mismatch predicted lesion growth; lesion growth was equally common in those with and without mismatch. CONCLUSIONS: Of the 2 PWI parameters, CBFsq lesions most closely identifies, and MTTsq overestimates, final T2WI lesion volume. "DWI/PWI mismatch" does not identify lesion growth. Patients without "DWI/PWI mismatch" are equally likely to have lesion growth as those with mismatch and should not be excluded from acute stroke treatment.

Adult↗

[Diffusion-weighted magnetic resonance imaging (MRI) in acute brain stem infarction].

Diffusion-weighted magnetic resonance imaging (DWI) provides one of the earliest demonstrations of ischemic lesions. However, some lesions may be missed in the acute stage due to technical limitation of DWI. We therefore conducted the study to clarify the sensitivity of DWI to acute brain stem infarctions. Twenty-eight patients with the final diagnosis of brain stem infarction(midbrain 2, pons 9, medulla oblongata 17) who had been examined by DWI within 24 hours of onset were retrospectively analyzed for how sensitively the initial DWI demonstrated the final ischemic lesion. Only obvious(distinguishable with DWI alone without referring clinical symptoms and other informations) hyperintensity on DWI was regarded to show an ischemic lesion. Sixteen(57.1%) out of 28 patients had brain stem infarctions demonstrated by initial DWI. In the remaining 12 cases, no obvious ischemic lesion was evident on initial DWI. Subsequent MRI studies obtained 127 hours, on average after the onset showed infarction in the medulla oblongata in 11 cases and in the pons in one case. Negative findings of DWI in the acute stage does not exclude possibility of the brain stem infarction, in particulary medulla oblongata infarction.

Adult↗

Quantitative diffusion weighted magnetic resonance imaging, cerebral atrophy, and disability in multiple sclerosis.

OBJECTIVES: To investigate the relations between quantitative diffusion coefficient MRI histograms, clinical variables, and cerebral atrophy. METHODS: Twenty two patients with clinically definite multiple sclerosis and 11 healthy volunteers were studied. Histograms of apparent diffusion coefficient (ADC) from a volume of interest that included multiple slices encompassing the lateral ventricles were processed from diffusion weighted MRI. In addition, total lesion load was measured on T2 weighted dual echo images, and cerebral volume from 3D magnetisation prepared rapid acquisition gradient echo scans. All patients underwent neurological assessment, including disability on the expanded disability status scale (EDSS). RESULTS: Histograms from the patient group showed a reduced peak height and a "right shift" compared with healthy controls. Peak height of the diffusion histogram correlated with both EDSS (r=-0.54, p=0.0101) and disease duration (r=-0.52, p=0.0140), but not with age. Brain volume correlated with peak height of the ADC histogram (r=0.55, p=0.0129), but not with disability. Total lesion load also correlated moderately with EDSS (r=0.46, p=0.03). CONCLUSIONS: This study shows for the first time that quantitative MRI measures of diffusion correlate with clinical variables (disability, disease duration) and cerebral atrophy in multiple sclerosis. Cerebral atrophy and fixed neurological deficit may be attributed to axonal loss, which would be expected to have a significant effect on ADC. Extension of this method to more patients and longitudinal studies will further elucidate its sensitivity, reproducibility, and potential role in clinical practice and treatment trials.

Adult↗

A diffusion and T2 relaxation MRI study of the ovine lumbar intervertebral disc under compression in vitro.

The ovine lumbar intervertebral disc is a useful model for the human lumbar disc. We present preliminary estimates of diffusion coefficients and T2 relaxation times in a pilot MRI study of the ovine lumbar intervertebral disc during uniaxial compression in vitro, and identify factors that hamper the ability to accurately monitor the temporal evolution of the effective diffusion tensor at high spatial resolution.

Animals↗

[Normal and abnormal water diffusion in the brain].

Diffusion magnetic resonance imaging (MRI) has become an important tool in the radiologic diagnosis of diseases of the brain as it measures molecular motion of water that characterizes the microstructure of tissues. Its most important clinical use to date is the early detection of cerebral ischemia by revealing the ischemic injury shortly after vessel occlusion and simultaneously providing therapy-relevant information on the tissue at risk. Furthermore, diffusion MRI is diagnostically promising in other diseases of the brain and is thus increasingly becoming part of routine clinical protocols in the diagnosis of tumors, inflammation, trauma, demyelination, dysmyelination and neurodegeneration. Although abnormalities of diffusion are generally not pathognomonic, diffusion MRI affords information about tissue changes for specific disorders that complements information obtained with standard MR techniques and frequently shows pathology earlier. In addition, diffusion MRI can be applied to plan, guide and follow-up biopsies or resective surgery. Particularly diffusion tensor imaging (DTI), which displays the orientation of white matter fibers, holds promise for improved surgical planning. Moreover, DTI can be used to detect changes in connectivity between functional brain areas. Therefore, DTI is highly relevant not only in advancing the knowledge of white matter diseases but also in stimulating research on normal brain development and brain aging.

Blood-Brain Barrier↗

Diffusion-weighted magnetic resonance imaging of white matter in bipolar disorder: a pilot study.

OBJECTIVE: Diffusion-weighted magnetic resonance imaging (MRI) has shown increased sensitivity in detecting brain white matter disease compared to traditional T2-weighted MRI. Diffusion-weighted imaging (DWI) can quantitatively assess the microstructural integrity of white matter using the average apparent diffusion coefficient (ADC(av)), a measure of the extent to which water molecules move freely within tissue. On the basis of numerous studies suggesting white matter disease in bipolar patients, particularly patients with more severe illness, this study aimed to test the utility of DWI in assessing the white matter integrity of bipolar patients with severe illness. METHODS: The existing MRI scans of eight bipolar patients and eight age-matched controls with neurological illness were examined retrospectively. ADC(av) values for pixels within white matter regions of interest (ROIs) were calculated and used to plot ADC(av) frequency histograms for each ROI. Mean ADC(av) values for the two groups were then compared by ANCOVA. RESULTS: The bipolar mean ADC(av) (0.855 +/- 0.051 x 10(-3) mm2/s) for combined white matter ROIs significantly exceeded that of controls (0.799 +/- 0.046 x 10(-3) mm2/s), while covarying for age (F = 4.47, df = 3, p = 0.025). CONCLUSIONS: This is the first report of an elevated ADC(av) in the white matter of a group of patients with bipolar disorder. In this group of patients with severe illness, increased white matter ADC(av) suggests microstructural changes consistent with decreased white matter integrity. DWI may be an additional, useful tool to assess white matter abnormalities in bipolar disorder.

Adult↗

Bilateral internal carotid artery dissection mimicking inflammatory demyelinating disease.

BACKGROUND AND PURPOSE: Internal carotid artery (ICA) dissection (ICAD) may be extremely difficult to diagnose only on the basis of historical information and clinical signs, and even standard brain imaging (computed tomography [CT], T2-weighted magnetic resonance imaging [MRI]) may not be sufficient to delineate the underlying pathology clearly, as shown in this case. METHODS: The clinical presentation and parenchymal lesion pattern on CT were suggestive of inflammatory demyelinating disease, and additional multiparametric MRI was performed. RESULTS: Diffusion-weighted MRI, magnetic resonance angiography, and perfusion-weighted MRI revealed acute ischemic lesions, bilateral ICA obstruction, and bilateral hypoperfusion in the middle cerebral artery territories. Bilateral ICAD was confirmed by Doppler and duplex ultrasound, and anticoagulation therapy was initiated. A follow-up examination showed recanalization of the obstructed ICAs and the normalization of cerebral perfusion. CONCLUSION: This case illustrates the importance of demonstrating the pathology and the value of multiparametric MRI techniques for the diagnosis and monitoring of ICAD and its hemodynamic consequences.

Carotid Artery, Internal, Dissection↗

MRI of the knee in diffuse pigmented villonodular synovitis.

Magnetic resonance imaging (MRI) was performed on 11 patients with surgically proven pigmented villonodular synovitis (PVNS) of the knee. PVNS was diagnosed on the basis of presence of hemosiderin, joint effusion, and hyperplastic synovium without significant joint destruction. MRI provided a detailed map of the distribution of the disease within the joint, emphasizing the common occurrence of the disease behind the cruciate ligaments and in synovial cysts in the popliteal fossa. MRI aided in preoperative planning and postoperative follow-up for residual and recurrent disease. Nine additional cases of joint hemorrhage, hemophilia, desmoplastic tumors, and synovial chondromatosis were included to delineate differential diagnostic criteria.

Adult↗

Magnetic resonance imaging (MRI) and diseases of the liver and biliary tract. Part 1. Basic principles, MRI in the assessment of diffuse and focal hepatic disease.

Magnetic resonance imaging (MRI) relies on the physical properties of unpaired protons in tissues to generate images. Unpaired protons behave like tiny bar magnets and will align themselves in a magnetic field. Radiofrequency pulses will excite these aligned protons to higher energy states. As they return to their original state, they will release this energy as radio waves. The frequency of the radio waves depends on the local magnetic field and by varying this over a subject, it is possible to build the images we are familiar with. In general, MRI has not been sufficiently sensitive or specific in the assessment of diffuse liver disease for clinical use. However, because of the specific characteristics of fat and iron, it may be useful in the assessment of hepatic steatosis and iron overload. Magnetic resonance imaging is useful in the assessment of focal liver disease, particularly in conjunction with contrast agents. Haemangiomas have a characteristic bright appearance on T2 weighted images because of the slow flowing blood in dilated sinusoids. Focal nodular hyperplasia (FNH) has a homogenous appearance, and enhances early in the arterial phase after gadolinium injection, while the central scar typically enhances late. Hepatic adenomas have a more heterogenous appearance and also enhance in the arterial phase, but less briskly than FNH. Hepatocellular carcinoma is similar to an adenoma, but typically occurs in a cirrhotic liver and has earlier washout of contrast. The appearance of metastases depends on the underlying primary malignancy. Overall, MRI appears more sensitive and specific than computed tomography with contrast for the detection and evaluation of malignant lesions.

Biliary Tract Diseases↗

Detection of the anoxic depolarization of focal ischemia using manganese-enhanced MRI.

Mismatch between diffusion- and perfusion-weighted MRI was used to indicate a treatable area following focal ischemia, called the penumbra. Activity-induced manganese contrast MRI has been reported as a new visualization method for neural activation using manganese ions as a depolarization-dependent contrast agent. It is well known that energy failure induced by cerebral ischemia produces anoxic depolarization. The purpose of this study was to detect manganese accumulation caused by permanent middle cerebral artery occlusion (MCAO) of rat brain and to compare regional differences between manganese accumulation and decreased apparent diffusion coefficient (ADC). The ratios of signal intensity of manganese-enhanced MRI in the ipsilateral cortex to that in the contralateral cortex were 171.0 +/- 17.5% in MCAO group and 108.4 +/- 13.2% in the sham group. In addition, the enhanced region was much smaller than the area which was detected as having a reduced ADC.

Animals↗

Advances in treatment of pediatric brain tumors.

The long-term survival of children with brain tumor has improved considerably in the last three decades, owing to advances in neuroimaging, neurosurgical, and radiation therapy modalities, coupled with the application of conventional chemotherapy. MRI, MR spectroscopy and diffusion-weighted MRI have contributed to more accurate diagnosis, prognostication and better treatment planning. Neurosurgical treatment has been advanced by the use of functional MRI, and intraoperative image-guided stereotactic techniques and electrophysiologic monitoring. The use of 3-D conformal and intensity-modulated radiation therapy, stereotactic radiosurgery, and radiosensitizing agents has made radiation therapy safer and more effective. Conventional chemotherapy, administered either alone or combined with radiation therapy has improved survival and quality of life of children with brain tumors. These improved outcomes have also occurred, due, in part, to their treatment on collaborative national and international studies. Recent promising diagnostic and therapeutic strategies have resulted from advances in understanding molecular brain tumor biology. Important new approaches include the refinement of drug-delivery strategies, the evaluation of biologic markers to stratify patients for optimal treatment and to exploit these molecular differences using "targeted" therapeutic strategies. These approaches include blocking tumor cell drug resistance mechanisms, immunotherapy, inhibition of molecular signal transduction pathways important in tumorigenesis, anti-angiogenic therapy, and gene therapy. The thrust of such approaches for children with brain tumors is especially directed at reducing the toxicity of therapy and improving quality-of-life, as well as increasing disease-free survival.

Brain Neoplasms↗

Dynamic imaging of emerging resistance during cancer therapy.

One of the greatest challenges in developing therapeutic regimens is the inability to rapidly and objectively assess tumor response due to treatment. Moreover, tumor response to therapeutic intervention in many cases is transient, and progressive alterations within the tumor may mask the effectiveness of an initially successful therapy. The ability to detect these changes as they occur would allow timely initiation of alternative approaches, maximizing therapeutic outcome. We investigated the ability of diffusion magnetic resonance imaging (MRI) to provide a sensitive measure of tumor response throughout the course of treatment, possibly identifying changes in sensitivity to the therapy. Orthotopic 9L gliomas were subjected to two separate therapeutic regimens, with one group receiving a single 5-day cycle (1omega) of low-dose 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) and a second group receiving two cycles at the same dose, bisected with 2 days of rest (2omega). Apparent diffusion coefficient maps were acquired before and throughout treatment to observe changes in water mobility, and these observations were correlated to standard measures of therapeutic response and outcome. Our results showed that diffusion MRI was indeed able to detect the emergence of a drug-resistant tumor subpopulation subsequent to an initially successful cycle of BCNU therapy, leading to minimal gains from a second cycle. These diffusion MRI findings were highly correlated with tumor growth delay, animal survival, and ex vivo growth inhibition assays showing emerging resistance in excised tumors. Overall, this study highlights the ability of diffusion MRI to provide sensitive dynamic assessment of therapy-induced response, allowing early opportunities for optimization of therapeutic protocols.

Animals↗