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Brain distortions in patients with primarily generalized tonic-clonic seizures.

PURPOSE: A precondition for the diagnosis of primarily generalized epilepsy with tonic-clonic seizures (GTCS) is absence of brain pathology. This definition, based on normal findings on computed tomography (CT) and magnetic resonance imaging (MRI) is challenged however, by observation of microscopic migrational disturbances in patients with GTCS. In the present study, we examined whether hitherto undiscovered gross manifestations of the reported migrational disturbances may be detected by analysis of CT and MRI scans with a computerized anatomic brain atlas. METHODS: The atlas program permitted group comparisons of size, intrinsic proportion, and shape of the brain. Healthy men (n = 20), patients with partial seizures (n = 8), secondarily generalized partial seizures (n = 8), and patients with GTCS (n = 10) were studied. The contours of the brain of the computerized atlas were first transformed and adjusted to the contours, central structures, and ventricles of each subject's MRI scans. During this process, the specific parameters for the shape, size, and proportion of the brain were determined, resulting in a set of values for each subject. These values were then applied for comparisons between the four investigated groups. RESULTS: In relation to the controls, patients with GTCS had brains significantly flattened in the craniocaudal direction (p = 0.002), with a disproportionally small caudal part. The anterior portion of their brain was also, relatively elongated as compared with the posterior portion (p = 0.04). Similar systematic abnormalities were not observed in patients with partial epilepsy. CONCLUSIONS: The observed deformations are compatible with previously reported findings of Purkinje cell degeneration and frontal lobe microdysgenesis in GTCS. The study suggests a new approach to identify effects of morphologic abnormalities in the brain when results of conventional structural neuroimaging are normal.

Adult↗

Usefulness of magnetic resonance imaging for evaluation of cardiovascular invasion: evaluation of sliding motion between thoracic mass and adjacent structures on cine MR images.

PURPOSE: To determine the feasibility and usefulness of magnetic resonance imaging (MRI) for evaluating cardiovascular invasion of a thoracic mass by demonstrating the sliding motion between the mass and adjacent structures. MATERIALS AND METHODS: Twenty-six patients (17 males and nine females, mean age = 49 years) were included in this study. They all had thoracic masses with equivocal cardiovascular invasion on chest CT scan and/or MRI that were surgically confirmed. The pathologic diagnoses were teratoma/thymic tumor (N = 12), lung cancer (N = 9), and other thoracic tumor (N = 5). Conventional T1/T2, contrast-enhanced, and breathheld ECG-gated cine MRI using a steady-state free precession (SSFP) technique was performed. The results were compared to the surgical reports. RESULTS: The cine MR images showed the presence of sliding motion in 39 structures in 20 patients, which were surgically confirmed as not being invaded, and 15 structures in six patients with the absence of sliding motion noted as tumor invasion. Therefore, the accuracy of the cine MR images was 94.4% (51/54) for evaluating cardiovascular invasion of a thoracic mass. CONCLUSION: MRI can provide additional information and improve the accuracy of preoperative staging for predicting cardiovascular invasion of a thoracic mass by evaluating the sliding motion.

Adult↗

Effect of size and charge on pharmacokinetics and in vivo MRI contrast enhancement of biodegradable polydisulfide Gd(III) complexes.

The purpose of this study is to investigate how the structures of polydisulfide Gd(III) complexes affect their pharmacokinetics and in vivo contrast enhancement as biodegradable macromolecular MRI contrast agents. A negatively charged polydisulfide Gd(III) complex, (Gd-DTPA)-cystine copolymers (GDCP), and a neutral agent, (Gd-DTPA)-cystine diethyl ester copolymers (GDCEP), with different molecular weights were prepared and characterized. The MRI contrast enhancement of the agents was studied in mice. Neutral GDCEP showed more rapid degradation than negatively charged GDCP in the blood plasma. Consequently, GDCP resulted in more significant and prolonged contrast enhancement in the blood pool and liver than GDCEP. The size of GDCEP did not significantly affect its in vivo contrast enhancement due to rapid degradation and clearance from the blood circulation. The increase in the molecular weight of GDCP resulted in prolonged in vivo contrast enhancement in the blood pool. The structural modification of polydisulfide Gd(III) complexes resulted in biodegradable macromolecular MRI contrast agents with different degradability and in vivo contrast enhancement.

Animals↗

Voxel-based morphometry detects patterns of atrophy that help differentiate progressive supranuclear palsy and Parkinson's disease.

Progressive supranuclear palsy (PSP) and Parkinson's disease (PD) are neurodegenerative diseases with distinctive pathological appearances. Early clinical diagnosis can be difficult. MRI may help differentiate PSP from PD, but the differences are often only obvious with advanced disease. It would be useful to have an unbiased assessment of difference to guide visual assessment of MRI as an aid to clinical diagnosis. Voxel-based morphometry (VBM) offers nonbiased, observer-independent morphometric MRI analysis. Our objectives were to assess structural differences between PSP, PD, and normal controls and test the clinical utility of the results. T1-weighted MR images in 12 patients with clinically diagnosed PSP, 12 with PD, and 12 age- and sex-matched controls were normalized to a common stereotaxic space and segmented into gray matter (GM) and white matter (WM) then analyzed using VBM. MRI scans were reviewed by a neuroradiologist blinded to the clinical diagnosis and assigned to the "non-PSP" or "PSP" group based on regional differences highlighted using VBM. VBM revealed significant group differences between PSP and PD as well as PSP and controls, with tissue reduction demonstrated in the region of the cerebral peduncles and midbrain. With these regional differences as a guide, neuroradiological diagnosis achieved a sensitivity of 83% and a specificity of 79%. VBM did not detect dramatic changes in frontal regions despite significant frontal cognitive decline in the PSP group. Pathology in the basal ganglia rather than tissue loss in the frontal lobes could be responsible for this. This information may help in the differentiation of PSP in clinical practice.

Aged↗

Vibroacoustic disease: biological effects of infrasound and low-frequency noise explained by mechanotransduction cellular signalling.

At present, infrasound (0-20 Hz) and low-frequency noise (20-500 Hz) (ILFN, 0-500 Hz) are agents of disease that go unchecked. Vibroacoustic disease (VAD) is a whole-body pathology that develops in individuals excessively exposed to ILFN. VAD has been diagnosed within several professional groups employed within the aeronautical industry, and in other heavy industries. However, given the ubiquitous nature of ILFN and the absence of legislation concerning ILFN, VAD is increasingly being diagnosed among members of the general population, including children. VAD is associated with the abnormal growth of extra-cellular matrices (collagen and elastin), in the absence of an inflammatory process. In VAD, the end-product of collagen and elastin growth is reinforcement of structural integrity. This is seen in blood vessels, cardiac structures, trachea, lung, and kidney of both VAD patients and ILFN-exposed animals. VAD is, essentially, a mechanotransduction disease. Inter- and intra-cellular communication is achieved through both biochemical and mechanotranduction signalling. When the structural components of tissue are altered, as is seen in ILFN-exposed specimens, the mechanically mediated signalling is, at best, impaired. Common medical diagnostic tests, such as EKG, EEG, as well as many blood chemistry analyses, are based on the mal-function of biochemical signalling processes. VAD patients typically present normal values for these tests. However, when echocardiography, brain MRI or histological studies are performed, where structural changes can be identified, all consistently show significant changes in VAD patients and ILFN-exposed animals. Frequency-specific effects are not yet known, valid dose-responses have been difficult to identify, and large-scale epidemiological studies are still lacking.

Animals↗

Acoustic noise characteristics of a 4 Telsa MRI scanner.

PURPOSE: To quantify the acoustic noise characteristics of a 4 Tesla MRI scanner, and determine the effects of structural acoustics and gradient pulse excitations on the sound field so that feasible noise control measures can be developed. MATERIALS AND METHODS: Acoustic noise emissions were measured in the ear and mouth locations of a typical adult. The sound pressure measurements were acquired simultaneously with the electrical current signals of the gradient pulses. Two forms of gradient waveforms (impulsive and operating pulses) were studied. RESULTS: The sound pressure levels (SPLs) emitted by the MRI scanner operating in echo-planar imaging (EPI) mode were in the range of 120-130 decibels. Three types of sound pressure responses were observed in the EPI sequences: 1) harmonic, 2) nonharmonic, and 3) broadband. The frequency-encoding gradient pulses were the most dominant and produced generally odd-number harmonics and nonharmonics. The phase-encoding gradient pulses generated mostly even-number harmonics, and the slice-selection gradient pulses produced primarily a broadband spectrum. CONCLUSION: The operating condition acoustic spectrum can be predicted from the magnet-structural acoustic transfer functions, which are independent of imaging sequences. This finding is encouraging because it shows that it is possible to treat such noises with an active noise control application.

Acoustics↗

Celiac disease, bilateral occipital calcifications and intractable epilepsy: mechanisms of seizure origin.

PURPOSE: To elucidate the mechanisms of seizure origin in patients with celiac disease and bilateral occipital calcifications (CEBOC). Individuals with CEBOC frequently present with occipital lobe seizures, but additional lesions and additional attack patterns may occur. METHODS: We studied two men and one woman who had CEBOC. Villous atrophy was revealed in the two patients who underwent duodenal biopsy. All had a comprehensive presurgical evaluation, including prolonged video-EEG recordings. Two had magnetic resonance imaging (MRI) with volumetric study of mesial temporal structures (MRIV). One patient had undergone stereotactic intracranial depth electrode studies (SEEG). RESULTS: All patients presented with intractable complex partial seizures. Two had partial simple seizures with visual aura. Neurologic examination was normal; one was of normal intelligence, and two were mildly retarded. Neuroimaging studies showed that each had bilateral occipital calcifications as well as epileptiform abnormalities over temporal lobes. In one, MRI showed an additional right frontal lesion, but SEEG demonstrated right occipital lobe seizure origin with anterior spread; this male patient later underwent a right occipital lobe resection. Another with a history of prolonged febrile convulsions had bilateral hippocampal and amygdalar atrophy demonstrated by MRIV. CONCLUSIONS: In one patient, SEEG confirmed that seizures originated in the occipital lobe. The presence of dual pathology was demonstrated in another, raising the possibility of both occipital and temporal seizure onset. The presence of extraoccipital lesions or of mesial temporal atrophy requires SEEG for clarification of seizure onset. In the absence of confounding factors and when laterality can be demonstrated, surgical treatment may be considered.

Adult↗

Evaluation of polyaza macrocyclic methylene phosphonate chelates of Gd3+ ions as MRI contrast agents.

Gd(DTPA)2- (diethylenetriaminepentaacetic acid) and the polyaza macrocyclic Gd(DOTA)- (1,4,7,10-tetraazacyclododecane-N,N',N'',N''') are paradigms of general purpose paramagnetic complexes useful for enhancing contrast in magnetic resonance imaging (MRI). It is of both fundamental and practical interest to determine how one might modify the chemical structure of these chelate complexes to improve their utility for MRI in specific circumstances. In the present work, we investigated polyaza methylene phosphonate complexes of Gd3+ ions to compare their NMRD profiles with those of their carboxylate analogs and with Gd(DTPA)2-. We find that the number q of exchangeable water molecules coordinated directly to the Gd3+ ions tends to be smaller in the phosphonates, in principle reducing their utility in MRI. However, these phosphonates have a tendency to oligomerize, and the resulting decrease in rotational mobility of the paramagnetic oligomers increases their relaxivity at higher fields, offsetting the effect of decreases in q. In particular, Gd(DOTRP)3- (1,5,9-triazacyclododecane-N,N',N'',-tris(methylenephosphonic++ + acid] would be an increasingly effective contrast agent above approximately 10 MHz if the oligomerization was stable in vivo (and the Gd3+ ions were sufficiently well bound). At lower fields, the relaxivity of these small chelate complexes is dominated by tau S0, the relaxation time of the spin moments of the paramagnetic ions. We find this to be favorably long for complexes of Gd3+ with the macrocyclic phosphonate ligands, as was found earlier by us for Gd(DOTA)-. This situation, ostensibly related to the relatively high symmetry and rigidity of the macrocyclic complexes, can increase the low-field relaxivity of the phosphonates almost a factor of 2 beyond that of Gd(DTPA)2-.

Chelating Agents↗

Accuracy of fast spin echo magnetic resonance imaging in the diagnosis of vestibular schwannoma.

PURPOSE: An ideal screening test is noninvasive, inexpensive, and has a high specificity and sensitivity. Auditory brain-stem response testing has been the usual screening test for the diagnosis of vestibular schwannoma, although its accuracy in diagnosing small vestibular schwannomas has caused its effectiveness as a screening test to be questioned. Magnetic resonance imaging (MRI) with gadolinium has a high sensitivity and specificity for the diagnosis of vestibular schwannoma. Its use as a screening test for vestibular schwannoma has been limited due to its high cost. Fast spin echo MRI is a technique that provides T2-weighted images with excellent contrast between fluid and neural structures, and its cost is a fraction of a gadolinium MRI scan. This study compares the accuracy of fast spin echo MRI to gadolinium MRI in the diagnosis of vestibular schwannoma. MATERIALS & METHODS: Twenty-five patients (50 ears) in whom there was a clinical suspicion of vestibular schwannoma were scanned with both modalities. All studies were read independently and scored as positive, negative, or indeterminate. RESULTS: There were 11 true positives and 39 true negatives. There were no false positives or negatives, resulting in a sensitivity of 100% and a specificity of 100%. CONCLUSION: Fast spin echo MRI appears to be an excellent choice as a screening test for vestibular schwannoma due to its low cost, noninvasiveness, and high sensitivity and specificity.

Cranial Nerve Neoplasms↗

Imaging of the pituitary gland in dogs with pituitary-dependent hyperadrenocorticism.

Detailed imaging of the pituitary gland is a prerequisite for a successful outcome of transsphenoidal hypophysectomy in dogs because it allows for accurate preoperative localization and assessment of the size of the pituitary gland. Cisternography allows assessment of even small increases in the height of the pituitary gland, but the magnitude of suprasellar expansion of pituitary tumors cannot be assessed with this technique. Large pituitary tumors with suprasellar expansion can readily be detected with conventional contrast-enhanced computed tomography (CT), while pituitary microadenomas can be localized with dynamic contrast-enhanced CT. Dynamic examination of the entire pituitary may be possible with spiral dynamic CT. Magnetic resonance imaging (MRI) of the canine pituitary gland provides a clear differentiation between the pituitary gland and the surrounding structures, but it remains to be investigated whether in dogs MRI can replace dynamic CT for the detection of microadenomas and whether it allows accurate localization of the pituitary gland relative to the surgical landmarks.

Adrenocortical Hyperfunction↗

Magnetic resonance imaging of injuries to bone and articular cartilage. Emphasis on radiographically occult abnormalities.

Magnetic resonance imaging (MRI) has emerged as the premier noninvasive imaging method for evaluation of the musculoskeletal system. Among the most widely recognized and accepted applications of MRI is that of trauma-related imaging. While the initial emphasis on MRI was directed toward the assessment of soft-tissue structures previously difficult to image (eg, knee menisci and cruciate ligaments), it has become increasingly apparent that MRI is superbly suited to the depiction of a wide spectrum of injuries to bone and articular cartilage. MRI has proved capable of depicting abnormalities ranging from clinically innocuous bone bruises to posttraumatic osteonecrosis. Many of the abnormalities that have been detected by MRI have been radiographically occult and often clinically unsuspected. MRI has become established in the assessment of chondral and osteochondral injuries, insufficiency and stress fractures, occult proximal femoral fractures, tibial plateau fractures, and scaphoid injuries. This review will attempt to present the current state of the art with respect to the application of MRI to the assessment of injuries to bone and articular cartilage. Particular emphasis will be placed on radiographically occult abnormalities.

Bone Diseases↗

Method for preparing permanent brain slices and serial slice images for education and MRI correlation.

It is important to understand the anatomical structures of the human brain in horizontal planes. Serially sectioned brain slices can easily be made with a meat slicer. The objective of this research was to enhance the educational value of serial brain slices made with a meat slicer through various applications. Two brains were taken out of two cadavers and embedded with gelatin solution to make two brain blocks. The first brain block was serially sectioned at 5 mm thickness using a meat slicer to make 28 horizontal brain slices. Each brain slice was embedded with a synthetic resin mixture to make 28 permanent specimens. The second brain block was magnetic resonance-scanned at 1.4 mm thickness to make 130 horizontal magnetic resonance images, then serially sectioned at the same thickness using the meat slicer to make 130 horizontal brain slices. Each brain slice was scanned into a computer to make a series of slice images. Ten anatomical structures in the slice images were outlined to make segmented images. Corresponding magnetic resonance images, slice images, and segmented images were stacked and volume-reconstructed to make three-dimensional images, which were sectioned and rotated at free angles. We show that the serial brain slices made with a meat slicer can be permanently preserved and used in a variety of educational settings. Anat Rec (Part B: New Anat) 289B:64-71, 2006. (c) 2006 Wiley-Liss, Inc.

Brain↗

Facial nerve neuromas: MR imaging. Report of four cases.

Four cases of facial nerve neuroma were evaluated by computed tomographic (CT) scan and magnetic resonance imaging (MRI). The extension of the tumor in the petrous bone or the parotid gland was well defined by MRI in all cases. CT scan was useful to demonstrate bone erosions and the relation of the tumor to inner ear structures. In cases of progressive facial palsy, CT and MRI should be combined to detect a facial neuroma and to plan the surgical approach for tumor removal and nerve grafting.

Adult↗

Anatomic and MRI study of the subtalar ligamentous support.

The diagnosis of subtalar instability remains difficult both clinically and radiographically. The authors present an anatomic and MRI study of the subtalar ligamentous support. The anatomic study has consisted in dissections and sections of cryoconserved hindfeet (15 cases) which precises the organisation of ligamentous bundles in the lateral (sinus tarsi) and central (canalis tarsi) subtalar compartments, mainly represented by the trilayered inferior extensor retinaculum, the cervical talo-calcaneal ligament and the interosseous talo-calcaneal ligament. MRI study (1.5 tesla) of anatomic specimens was performed according to defined types of sections: sagittal, coronal, coronal oblique, axial transverse. The correlations of anatomic and MRI sections allowed a precise interpretation of the subtalar ligamentous support as anatomically described. A complementary clinical MRI study was performed which allowed the validation of "the inversion test": this test optimizes the visualization of the different ligamentous structures. Relative to the difficulties of conventional imaging procedures, MRI appears of clinical relevance in the diagnosis of subtalar instabilities. This technique allows direct visualization of ligaments (or their rupture) and therefore a better evaluation of subtalar involvement in ankle sprain. This paper present a functional concept in MRI articular ligamentous restraints concern.

Humans↗

Ternary Gd(III)L-HSA adducts: evidence for the replacement of inner-sphere water molecules by coordinating groups of the protein. Implications for the design of contrast agents for MRI.

Two novel gadolinium(III) chelates based on the structure of the heptadentate macrocyclic 1,4,7,10-tetraazacyclododecane-1,4,7-triacetic acid (DO3A) ligand have been synthesized and their relaxometric and luminescent properties thoroughly investigated. They contain two water molecules in the inner coordination sphere in fast exchange with the bulk solvent and bear either a p-bromobenzyl or a p-phosphonatomethylbenzanilido substituent for promoting further interaction with macromolecular substrates. Upon interaction with human serum albumin the expected relaxation enhancement is not observed owing to displacement of the two inner-sphere water molecules of the complexes by a donor atom (likely from a carboxylate group) on the protein and possibly the phosphate anion of the buffered solution, respectively. We modeled the observed behavior by measuring the decrease of the relaxation rate of the water protons upon addition of malonate anion to aqueous solutions of the complexes. Conversely, no change in the hydratation state of the Gd(III) center for both complexes has been observed when the substrate for the formation of the macromolecular adduct is represented by poly-beta-cyclodextrin.

Contrast Media↗

Landmark-based morphometric analysis of first-episode schizophrenia.

BACKGROUND: The goal of this investigation was to utilize landmark-based shape analysis and image averaging to determine the sites and extent of specific structural changes in first-episode schizophrenia. METHODS: Neuroanatomic structures identified on midsagittal magnetic resonance imaging (MRI) scans were compared between 20 patients with schizophrenia and 22 normal control subjects. The difference between averaged landmark configurations in the two groups was visualized as a shape deformation by a thin-plate spline and through averaged MRI images for both groups. RESULTS: A shape difference was found to be statistically significant; by inspection, it is contrast between differences in two closely abutting regions, involving primarily the posterior corpus callosum and upper brain stem--the "focus" is the relation between them. CONCLUSIONS: The findings are consistent with prior studies suggesting involvement in schizophrenia of the corpus callosum and the limbic structures contributing to the corpus callosum; the possibility of local pathology primarily involving the brain stem cannot be excluded. The methods of landmark-based shape analysis and image averaging utilized in this study can complement the "region-of-interest" method of investigating morphometric abnormalities by characterizing the spatial relationships among structural brain abnormalities in schizophrenia.

Adolescent↗

Neuroradiology and clinical aspects of Usher syndrome.

We describe the neurological evaluation and MRI analysis of 30 patients, belonging to 16 families with Usher syndrome (US) type I and type II (US1 and US2). In addition to the classic visual and audiological abnormalities seen in these patients, we observed abnormal gait in 88.9% of US1 and in 66.7% of US2 patients and abnormal coordination in 33.4% of US1, and in 58.3% of US2. Borderline mental retardation, depression or bipolar affective disorder were observed in 16.7% of US1 and 33.3% of US2 patients. MRI analysis showed cerebellar abnormalities in 50% of US1 and 75% of US2 patients, but no clear correlation was observed between structural abnormalities and clinical findings. A pattern for the MRI classification of US patients is suggested.

Abnormalities, Multiple↗

Allometric scaling of wall shear stress from mice to humans: quantification using cine phase-contrast MRI and computational fluid dynamics.

Allometric scaling laws relate structure or function between species of vastly different sizes. They have rarely been derived for hemodynamic parameters known to affect the cardiovascular system, e.g., wall shear stress (WSS). This work describes noninvasive methods to quantify and determine a scaling law for WSS. Geometry and blood flow velocities in the infrarenal aorta of mice and rats under isoflurane anesthesia were quantified using two-dimensional magnetic resonance angiography and phase-contrast magnetic resonance imaging at 4.7 tesla. Three-dimensional models constructed from anatomic data were discretized and used for computational fluid dynamic simulations using phase-contrast velocity imaging data as inlet boundary conditions. WSS was calculated along the infrarenal aorta and compared between species to formulate an allometric equation for WSS. Mean WSS along the infrarenal aorta was significantly greater in mice and rats compared with humans (87.6, 70.5, and 4.8 dyn/cm(2), P < 0.01), and a scaling exponent of -0.38 (R(2) = 0.92) was determined. Manipulation of the murine genome has made small animal models standard surrogates for better understanding the healthy and diseased human cardiovascular system. It has therefore become increasingly important to understand how results scale from mouse to human. This noninvasive methodology provides the opportunity to serially quantify changes in WSS during disease progression and/or therapeutic intervention.

Animals↗