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PubMed1995

MRI evaluation of the brain in infantile neuronal ceroid-lipofuscinosis. Part 2: MRI findings in 21 patients.

The purpose of this study was to demonstrate the course of infantile neuronal ceroid-lipofuscinosis with brain magnetic resonance imaging (MRI) in children aged 3 months to 11 years. Twenty-one patients and 46 neurologically normal controls of the same age were examined. The images were evaluated visually; then signal intensities were measured and related to those of references. MRI abnormalities were detectable before clinical symptoms. The radiologic picture of the brain varied with the duration of the disease. Pathognomonic MRI findings in the early stage of the disease were generalized cerebral atrophy, strong thalamic hypointensity to the white matter and to the basal ganglia, and thin periventricular high-signal rims from 13 months onward on T2-weighted images. In patients over 4 years old, cerebral atrophy was extreme, and the signal intensity of the entire white matter was higher than that of the gray matter, which is the reverse of normal. This study showed that the abnormalities seen on MRI progress rapidly during the first 4 years of life, then stabilize, in conformity with the clinical and histopathologic pictures of infantile neuronal ceroid-lipofuscinosis.

Age Factors↗

PubMed1997

Characterization of MRI response to treatment with interferon beta-1b: contrast-enhancing MRI lesion frequency as a primary outcome measure.

MRI is a valuable tool to examine the pathophysiology and natural history of multiple sclerosis (MS), and several large multicenter trials have utilized MRI as a secondary outcome measures. We previously examined the effect of interferon beta-1b on contrast-enhancing lesions on MRI using a baseline versus treatment design, and found that on treatment there is a reduction in mean frequency of enhancing lesions over the group. Using an expanded number of patients and the same trial design, we examined the individual response to treatment more extensively. We find that the effect seen previously is still present, and that there is heterogeneity in the amount of decrease in contrast-enhancing lesions. This expanded number of patients and trial design allows for the discussion of new criteria for individual response to treatment, which are applied in the current trial. These approaches may be useful in the examination, early testing, and comparison of experimental therapeutic agents in MS as well as in the characterization of patients who do or do not have a response seen on MRI.

Adjuvants, Immunologic↗

PubMed2000

MRI, (1)H-MRS, and functional MRI during and after prolonged nonconvulsive seizure activity.

BACKGROUND: Various structural and functional changes, such as focal edema, blood flow, and metabolism, occur in the cerebral cortex after focal status epilepticus. These changes can be assessed noninvasively by means of MRI techniques, such as fluid-attenuated inversion recovery (FLAIR), EEG-triggered functional MRI (EEG-fMRI), and proton MR spectroscopy (MRS). METHODS: The authors report on a 40-year-old patient with nonlesional partial epilepsy in the left posterior quadrant in whom these MRI techniques were applied in an active seizure focus and repeated during a follow-up of 1 year. RESULTS: FLAIR imaging taken at the time of status epilepticus showed a signal hyperintensity in the occipital region. (1)H-MRS of this cortical region showed elevated lactate, decreased N:-acetylaspartate (NAA), and elevated choline (Cho). In the same region, EEG-fMRI revealed an area of signal enhancement. After seizure control, recovery of lactate and Cho was observed, whereas the NAA level remained reduced. The structural abnormality demonstrated on FLAIR disappeared within 3 months. CONCLUSIONS: Repetitive MRI with sensitive sequences during clinically critical periods may disclose the structural correlate in a previously nonlesional epilepsy case. Corresponding to the clinical evolution, reversible and irreversible focally abnormal metabolism can be determined with (1)H-MRS, reflecting both increased neuronal activity and neuronal damage.

Adult↗

PubMed2006

High-spatial-resolution MRI of non-masslike breast lesions: interpretation model based on BI-RADS MRI descriptors.

OBJECTIVE: The purpose of this study was to assess an interpretation model based on BI-RADS MRI descriptors and high-spatial-resolution MR images in lesions showing non-masslike enhancement. MATERIALS AND METHODS: Retrospective review was performed of 30 consecutive lesions showing non-masslike enhancement. MRI was performed on a 1.5-T scanner using the volumetric interpolated breath-hold examination sequence. The distribution patterns were classified into three categories: single quadrant/solitary lesion (linear), single quadrant/grouped lesion (focal, regional, segmental), and multiquadrant lesion (multiple regions, diffuse). The presence of a ductal pattern was assessed in the enhancing lesions after the tumor distribution had been decided. In addition to the BI-RADS MRI descriptors, the presence of clustered ring enhancement was also assessed in heterogeneous enhancing lesions. RESULTS: The most frequent morphologic finding among the benign lesions was a linear pattern (50%) followed by homogeneous internal enhancement (42%), whereas a segmental pattern (56%) (p = 0.003), heterogeneous internal enhancement (44%), and clustered ring enhancement (44%) (p = 0.01) were the most frequent findings in malignant lesions. The features with the highest positive predictive value for carcinoma were a segmental distribution (100%), a clustered ring enhancement (100%), and a clumped internal architecture (88%). Using this interpretation model, the positive predictive value for carcinoma was 94%. CONCLUSION: A combination of BI-RADS MRI descriptors and clustered ring enhancement criteria is useful for the differential diagnosis of lesions showing non-masslike enhancement.

Adolescent↗

PubMed2004

The catheter-driven MRI scanner: a new approach to intravascular catheter tracking and imaging-parameter adjustment for interventional MRI.

OBJECTIVE: Our aim was to test the feasibility of a hands-free approach to MRI that allows the interventionalist to track an angiographic catheter in real time throughout the procedure and to automatically change imaging parameters by catheter manipulation. MATERIALS AND METHODS: A tracking method that is based on an active device localization was implemented on a 1.5-T MRI scanner. The system determines the current position and orientation of a catheter in 3D space in an endless feedback loop. Automatic scanning plane-adjustment procedures written in the software of the MRI system ensure image acquisition at the location of the catheter tip. The system calculates the device velocity to automatically adjust parameters such as field of view (FOV) and resolution. To evaluate the feasibility and performance in vivo and ex vivo, we performed experiments in two vessel phantoms and on six pigs. RESULTS: The system collected the tracking data within 40 msec; an additional 10-20 msec was then required to perform the localization and velocity calculations and to update the image parameters. The system could localize a motionless catheter in the aorta in 100% and a moving catheter in 98% of measured attempts. The system responded in real time to changes in device velocity by dynamically adjusting spatial resolution and FOV in both phantom and porcine trials. Using this technique, we successfully catheterized the renal artery in two pigs. CONCLUSION: Active tracking, combined with automatic scanning plane and imaging parameter adjustment, provides an intuitive MRI scanner interface for the guidance of the vascular procedure.

Algorithms↗

PubMed2001

[Is visual assessment of MRI adequate in the investigation of patients with temporal lobe epilepsy? Evaluation of the diagnostic accuracy of the visual assessment of MRI in mesial temporal sclerosis].

INTRODUCTION: Is visual assessment of MRI adequate in patients with temporal lobe epilepsy? Visual versus quantitative MRI assessment of mesial temporal sclerosis (hippocampal gliosis (HG) and hippocampal atrophy (HA)). MATERIAL AND METHODS: The MRIs of 25 patients with temporal lobe epilepsy were assessed visually by three radiologists with different levels of neuroradiological MRI experience (expert, trained, and inexperienced). Diagnosis obtained earlier by T2-relaxometry and volume measurements were considered to be the gold standard. RESULTS: The diagnostic accuracy of visual assessment was high for unilateral HA, but low for bilateral HA and unilateral and bilateral HG, and it was not better for the expert eye than for the inexperienced. Interobserver agreement on the visual diagnosis of HG and HA (Cohen's Kappa coefficient): 0.49 (HG) and 0.84 (HA). Intraobserver reliability for the expert/trained/inexperienced observer for visual diagnosis (Kappa): 0.83/0.64/0.47 (HG) and 0.88/0.69/0.73 (HA). DISCUSSION: Reproducibility and diagnostic accuracy of visual assessment varied unacceptably from the quantitative MRI-based diagnosis. Quantitative measurements are recommended in patients suspected of MTS.

Atrophy↗

PubMed2006

Diagnostic value of contrast-enhanced fluid-attenuated inversion-recovery MRI for intracranial tumors in comparison with post-contrast T1W spin-echo MRI.

BACKGROUND: Contrast-enhanced fluid-attenuated inversion-recovery (FLAIR) magnetic resonance imaging (MRI) has been reported to have higher sensitivity for detecting leptomeningeal disease compared with contrast-enhanced T1-weighted MRI (CE T1WI). However, currently there are no studies showing the potential value of clinical applications of contrast-enhanced FLAIR (CE FLAIR) sequence in diagnosing intracranial tumors in a larger group of patients. The purpose of this study was to evaluate the diagnostic value of CE FLAIR in comparison with CE T1WI for intracranial tumors and to provide more information for clinical diagnosis and therapy. METHODS: One hundred and four consecutive cases of intracranial tumors referred for CE brain MRI were analyzed with regard to FLAIR and T1WI pre- and post-administration of Gd-DTPA. The CE FLAIR and CE T1WI were evaluated independently by two radiologists for the number of examinations with one or more enhanced lesions, the number and location of enhanced lesions per examination, signal-to-noise ratio (SNR) and contrast-enhancement ratio (CER) of lesions, as well as the size and extent of the enhanced lesions. RESULTS: In 98 of 104 cases, enhanced lesions were seen both on the FLAIR and T1W images. More lesions were seen on CE T1WI (n = 120) than those on CE FLAIR sequence (n = 117), but no differences of statistical significance were found between the two sequences (P > 0.05). Four lesions were revealed only on the CE FLAIR images whereas 7 lesions were only found on CE T1WI. Enhanced lesions located in the cerebral hemisphere or the forth ventricle were revealed much more on CE T1WI than on CE FLAIR images. However, CE FLAIR images may be useful in showing superficial abnormalities and those located in the sulcus or lateral ventricle. The CER and contrast-to-noise ratio (CNR) on CE T1WI was significantly higher (t = 7.10, P = 0.00; t = 9.67, P = 0.00, respectively), but grey matter/white matter contrast was lower (t = 2.46, P = 0.02) than those on CE FLAIR images. The SNR did not show any statistically significant difference between the two sequences (t = 1.1, P = 0.27). The size and extent of lesions on the CE FLAIR images were significantly larger than those on CE T1WI (t = 4.13, P = 0.00). CONCLUSIONS: CE FLAIR and CE T1WI may complement each other in showing intracranial tumors and the CE FLAIR sequence should be selected as a routine MRI sequence.

Adolescent↗

PubMed1990

[Contribution of x-ray computed tomography and MRI to the surgical diagnosis of bronchial cancers. Comparative evaluation of x-ray computed tomography, MRI and thoracotomy in 111 cases].

Computed tomography and magnetic resonance imaging have respectively decreased the incidence of exploratory thoracotomy by 11.6% to 5.7% then 5.3% after their successive inclusion in the assessment of the operability of lung cancers. Based on a systematic comparison of CT and MRI with exploratory thoracotomy in 111 patients, the yield, sensitivity and positive predictive value of these examinations was assessed in relation to tumour extension to various sites: to the chest wall, for which the sensitivity was poor (38% for CT, 54% for MRI) with a moderate predictive value (71% for CT, 77% for MRI); to the mediastinum with improved sensitivity (69% and 72%) but an uncertain predictive value (61% and 72%). The sensitivity and predictive value were then measured for lymph node involvement: N1: moderate sensitivity (69% and 76%) but a good predictive value (95% and 92%); N2 and N3: good sensitivity (79% and 93%) but a poor predictive value (70% and 66%). Apart from a few particular indications specific to MRI, especially in the apex, left hilum and in contact with the atrium, the efficacy of these two investigations is very similar. However, their lack of specificity means that certain exploratory thoracotomies are still justified in order to assess the operability of the tumour. A surgical or mediastinoscopic anatomical assessment is still necessary for a good classification of lymph node extension of lung tumours.

Carcinoma, Bronchogenic↗

PubMed1988

[Clinical application of MRI for urological malignancy. 1: Usefulness of various imaging modalities for local staging of prostatic cancer; a comparison between MRI, CT and transrectal ultrasonography].

Twenty-three pathologically revealed prostatic cancer patients were examined by magnetic resonance imaging (MRI), computed tomography (CT) and transrectal ultrasonography, (US) and 6 of them underwent radical prostatectomy. A localized prostatic cancer was identified as a low intensity area in the outer zone with high intensity or showed a partial or total destruction of the border line between the internal and the outer zone when cancer invaded into the internal zone from the outer zone, on T2 weighted image of MRI, as we have already reported. On US, a localized prostatic cancer was identified as a hypoehoic area in the outer zone, and showed a heterogeneous image when cancer enlarged. On CT, a localized cancer could not be identified. A diagnostic criteria for local staging by MRI was made and preoperative staging were done in 6 total prostatectomy cases. The accuracy of preoperative staging of cancer seemed to be the highest by MRI, because it was more accurate in diagnosing the extracapsular invasion, seminal vesicle invasion and bladder neck invasion of the tumor than by CT and US.

Aged↗

PubMed1994

[Basics of MRI technique and MRI image interpretation].

Today magnetic resonance imaging (MRI) is an important routine diagnostic tool in orthopaedics. It is based on the nuclear magnetic resonance phenomenon: "free" hydrogen atoms (mainly from water) become field-parallel in a strong outer magnetic field. They reach a higher energy level by application of an additional electromagnetic field. After shutdown of this outer field the atoms send out electromagnetic waves (radiowaves), representing the MR signal. Different amounts of "free" water result in various image characteristics. Typically, a higher tissue water content is represented by high MR signals, e.g. in blastomas, inflammations and degenerative changes. Waterless structures such as calcified or fibrous tissues, tendons and ligaments show low MR signals. Fatty structures have high signals; proteins dissolved in "free" water change the water signal dramatically. Besides these basic parameters, para-, ferro- and super-paramagnetic materials--ether naturally present in the human body, such as methemoglobin, or artificially introduced, such as MR contrast media--and flow are responsible for different grey shades in MRI. MRI is not associated with ionizing radiation and allows imaging in all planes without changing the patient's position. Disadvantages of MRI are high costs and low availability. Future technical developments will result in shorter imaging times and broadening of the application spectrum, leading towards "MR fluoroscopy" and MR interventions.

Adolescent↗

PubMed1997

In vivo characterization of Gd(BME-DTTA), a myocardial MRI contrast agent: tissue distribution of its MRI intensity enhancement, and its effect on heart function.

We have determined an LD50 of 0.56 +/- 0.05 mmol/kg for liposomal Gd(BME-DTTA) in mice and also shown that liposomal Gd(BME-DTTA) has no deleterious effects on heart rate, blood pressure, left ventricular force and AV conductance in ferret hearts in vivo at the magnetic resonance imaging (MRI)-effective dose of 0.05 mmol/kg body weight. In MRI images, a 1H signal intensity enhancement is observed in the following organs in decreasing order of the effect: heart approximately spleen > kidney > liver. This enhancement is stable for over 3 h in all organs. The results of 1H MRI and electron micrographs indicate that the lipophilic fatty acyl groups in the ligand BME structure and the particle sizes of liposomal Gd(BME-DTTA) are two important factors for tissue specificity of liposomal Gd(BME-DTTA) in the intensity enhancement. In vitro relaxivity of a liposomal Gd(BME-DTTA) sample, stored at 4 degrees C, remained stable for over 4 months of observation, but a significant decrease in relaxivity was observed in a sample stored at room temperature, most likely reflecting some deterioration in liposome chemistry.

Animals↗

PubMed2000

Unsupervised segmentation of multiparameter MRI in experimental cerebral ischemia with comparison to T2, diffusion, and ADC MRI parameters and histopathological validation.

This study presents histological validation of an objective (unsupervised) computer segmentation algorithm, the iterative self-organizing data analysis technique (ISODATA), for analysis of multiparameter magnetic resonance imaging (MRI) data in experimental focal cerebral ischemia. T2-, T1-, and diffusion (DWI) weighted coronal images were acquired from 4 to 168 hours after stroke on separate groups of animals. Animals were killed immediately after MRI for histological analysis. MR images were coregistered/warped to histology. MRI lesion areas were defined using DWI, apparent diffusion coefficient (ADC) maps, T2-weighted images, and ISODATA. The last techniques clearly discriminated between ischemia-altered and morphologically intact tissue. ISODATA areas were congruent and significantly correlated (r = 0.99, P < 0.05) with histologically defined lesions. In contrast, DWI, ADC, and T2 lesion areas showed no significant correlation with histologically evaluated lesions until subacute time points. These data indicate that multiparameter ISODATA methodology can accurately detect and identify ischemic cell damage early and late after ischemia, with ISODATA outperforming ADC, DWI, and T2-weighted images in identification of ischemic lesions from 4 to 168 hours after stroke.

Algorithms↗

PubMed2000

Statistical artifacts in diffusion tensor MRI (DT-MRI) caused by background noise.

This work helps elucidate how background noise introduces statistical artifacts in the distribution of the sorted eigenvalues and eigenvectors in diffusion tensor MRI (DT-MRI) data. Although it was known that sorting eigenvalues (principal diffusivities) by magnitude introduces a bias in their sample mean within a homogeneous region of interest (ROI), here it is shown that magnitude sorting also introduces a significant bias in the variance of the sample mean eigenvalues. New methods are presented to calculate the mean and variance of the eigenvectors of the diffusion tensor, based on a dyadic tensor representation of eigenvalue-eigenvector pairs. Based on their use it is shown that sorting eigenvalues by magnitude also introduces a bias in the mean and the variance of the sample eigenvectors (principal directions). This required the development of new methods to calculate the mean and variance of the eigenvectors of the diffusion tensor, based on a dyadic tensor representation of eigenvalue-eigenvector pairs. Moreover, a new approach is proposed to order these pairs within an ROI. To do this, a correspondence between each principal axis of the diffusion ellipsoid, an eigenvalue-eigenvector pair, and a dyadic tensor constructed from it is exploited. A measure of overlap between principal axes of diffusion ellipsoids in different voxels is defined that employs projections between these dyadic tensors. The optimal eigenvalue assignment within an ROI maximizes this overlap. Bias in the estimate of the mean and of the variance of the eigenvalues and of their corresponding eigenvectors is reduced in DT-MRI experiments and in Monte Carlo simulations of such experiments. Improvement is most significant in isotropic regions, but some is also observed in anisotropic regions. This statistical framework should enhance our ability to characterize microstructure and architecture of healthy tissue, and help to assess its changes in development, disease, and degeneration. Mitigating these artifacts should also improve the characterization of diffusion anisotropy and the elucidation of fiber-tract trajectories in the brain and in other fibrous tissues. Magn Reson Med 44:41-50, 2000. Published 2000 Wiley-Liss, Inc.

Artifacts↗

PubMed1999

MRI findings of thoracolumbar spine fractures: a categorisation based on MRI examinations of 100 fractures.

OBJECTIVE: To define the state of different structures of the fractured thoracolumbar spine which may play a role in the immediate and long-term mechanical stability on MR images and to investigate the relationship of these findings with the AO classification of spinal injuries. DESIGN: The state of the anterior longitudinal ligament, posterior longitudinal ligament, posterior ligamentous complex, cranial and caudal endplates, cranial and caudal discs and the vertebral body were defined using clinical, experimental and radiological data. The state of these structures was reported for each fracture on the MRI examinations and the different MRI features appropriate for different fracture classes were defined. PATIENTS: MRI examinations of 70 patients with 100 fractures of the thoracolumbar spine were used for this study. RESULTS: Wide variations were seen in the state of the structures studied. We could not find a definite pattern to relate these findings with the AO classification scheme. CONCLUSIONS: MR findings should be integrated into future classification schemes of thoracolumbar spine fractures. This would enable specific data about the structures involved in the stability of the spine to be acquired. Prospective studies using the criteria developed in this study may help resolve some of the controversies concerning the diagnosis and prognosis of these injuries as well as the development of new classification systems.

Humans↗

PubMed2004

Lung MRI at 3.0 T: a comparison of helical CT and high-field MRI in the detection of diffuse lung disease.

The purpose of this study was to evaluate the feasibility of high-field magnetic resonance imaging (MRI) of the lung using a T2-weighted fast-spin echo (TSE) sequence. Comparison was made with helical computed tomography CT findings in patients with diffuse pulmonary diseases. Prospective segment-wise analysis of high-field MR imaging findings in 15 patients with diffuse pulmonary diseases was made using helical CT and HRCT as the standard of reference. The MR studies were performed on a 3.0-T whole body system (Intera 3T, Philips Medical Systems) using a T2w TSE sequence with respiratory and cardiac gating (TE 80 ms TR 1,500-2,500 ms; turbo factor 17; 22 slices with 7/2-mm slice thickness and gap; 256x192 matrix). MR artifacts were graded on a three-point scale (low, moderate, high). Lung MR studies were prospectively analyzed segment-by-segment and diagnosed as healthy or pathological; results were compared with helical CT findings. In all 15 patients, MR imaging of the lung was successful. All 15 MR studies were compromised by artifacts; however, the severity of these artifacts was classified as low or moderate in 8/15, respectively, 7/15 cases. A total of 143/285 lung segments showed diffuse lung disease in helical CT. With MRI, 133 of these 143 segments (93%) were judged to be diseased. The ten segments that received false negative MR diagnoses displayed non-acute pulmonary lesions with inherently low proton density (scars, granulomas). MRI at 3.0 T can detect diffuse pulmonary disease with a high sensitivity. Based on this experience, further pulmonary studies with high-field systems appear justified and promising.

Adult↗

PubMed2005

[Acute myocardial infarction and MRI: a comparison of infarct size by MRI and peak creatine kinase after a first episode].

AIM: To compare the assessment of infarct size using MRI and peak CK value. POPULATION AND METHODS: 16 patients presenting with a first MI and seriall measurement of CK underwent gadolinium-enhanced MRI. RESULTS: A significant correlation was observed between both estimates of infarct size (r=0.56, p=0.0025). In addition, an inverse correlation was found between residual viability and peak CK (r=-0.51; p=0.043). CONCLUSION: After a first episode of MI, infarct size estimate by MRI correlates with that determined by peak CK measurement.

Aged↗

PubMed2004

Assessment of MRI and dynamic contrast-enhanced MRI in the differential diagnosis of adenomatoid odontogenic tumor.

The radiographical differentiation of adenomatoid odontogenic tumor (AOT) from dentigerous cysts, calcifying odontogenic cysts, calcifying epithelial odontogenic tumors, odontogenic keratocysts and amelobastomas is sometimes difficult. We attempted to differentiate AOT from other lesions similar to AOT in radiographic findings using MRI. The MRI features of AOT in our three cases included homogeneous low SI in the cystic portion and homogeneous intermediate SI in the solid portion on T1WI, homogeneous high SI in the cystic portion and intermediate to slightly high SI in the solid portion on T2WI and enhancement of only the solid portion on CE-T1WI although none of the sequences included SI of calcifications. The contrast index curves in the three cases of AOT showed a gradual increase to 300 s, which signified a benign tumor. These MRI features were characteristic features of AOT and might be a basis for differentiating AOT from the above possible lesions in radiographic examinations.

Adolescent↗

PubMed2005

Optimizing brain MRI protocols in the follow-up of patients with multiple sclerosis T2-weighted MRI of the brain after the administration of gadopentetate dimeglumine.

The aim of our study was to determine whether T2-weighted (T2w) MRI of the brain could be performed immediately after the administration of gadopentetate dimeglumine (gadolinium DTPA) in patients with multiple sclerosis (MS) without a loss in image quality or diagnostic reliability. Sixteen patients with clinically diagnosed MS were included in the study. Twenty-four patients with various cerebral pathologies (14 patients with multiple lacunar lesions) were examined in order to exclude masking of T2 hyperintense lesions other than MS lesions. Images of 10 patients without pathological changes served as a control condition for the qualitative analysis. In these 50 patients, T1w and T2w MRI was performed before and after the administration of gadolinium DTPA. Signal intensities were measured within T2 hyperintense cerebral lesions, in T1-enhancing lesions and in normal appearing brain tissue on T2w turbo spin-echo (TSE) sequences. Both quantitative and qualitative analysis did not show significant differences between T2w pre- and postcontrast series. T2w MRI performed prior to and after the administration of gadolinium DTPA provides similar information in patients with MS. With a TR of 3.2 s, not a single lesion was obscured on T2w postcontrast series. Acquisition of T2w MR images immediately after the administration of gadolinium DTPA allows for shorter examination time and assures sufficient time for contrast enhancement in cerebral lesions with a disrupted blood-brain barrier.

Adolescent↗