Vasoreactivity and peri-infarct hyperintensities in stroke.

OBJECTIVE: It is unknown if impaired cerebral vasoreactivity recovers after ischemic stroke, and whether it compromises perfusion in regions surrounding infarct and other vascular territories. We investigated the regional differences in CO2 vasoreactivity (CO2 VR) and their relationships to peri-infarct T2 hyperintensities (PIHs), chronic infarct volumes, and clinical outcomes. METHODS: We studied 39 subjects with chronic large middle cerebral artery territory infarcts and 48 matched controls. Anatomic and three-dimensional continuous arterial spin labeling imaging at 3-Tesla MRI were used to measure regional cerebral blood flow (CBF) and CO2 VR during normocapnia, hypercapnia, and hypocapnia in main arteries distributions. RESULTS: Stroke patients showed a significantly lower augmentation of blood flow at increased CO2 but greater reduction of blood flow with decreased CO2 than the control group. This altered vasoregulatory response was observed both ipsilateral and contralateral to the stroke. Lower CO2 VR on the stroke side was associated with PIHs, greater infarct volume, and worse outcomes. The cases with PIHs (n = 27) had lower CBF during all conditions bilaterally (p < 0.0001) compared to cases with infarct only. CONCLUSIONS: Perfusion augmentation is inadequate in multiple vascular territories in patients with large artery ischemic infarcts, but vasoconstriction is preserved. Peri-infarct T2 hyperintensities are associated with lower blood flow. Strategies aimed to preserve vasoreactivity after an ischemic stroke should be tested for their effect on long-term outcomes.

Natural cycle IVF and oocyte in-vitro maturation in polycystic ovary syndrome: a collaborative prospective study.

In-vitro maturation (IVM) was performed in 350 cycles for 262 unstimulated patients diagnosed with polycystic ovary syndrome who were primed with human chorionic gonadotrophin (HCG) before oocyte retrieval. In order to improve nuclear and cytoplasmic maturation, growth hormone was added to the maturation medium. Oocytes were recovered in 94.8% of the cycles, with a mean number of nine cumulus-oocyte complexes retrieved. Within 28 h, 62% of the oocytes reached the metaphase II (MII) stage, and 17.6% were MII after a further 20 h in culture. An ongoing pregnancy rate of 15.2% was obtained, but with a high miscarriage rate, 28% of the total with a positive betaHCG test assessed after embryo transfer. Cytogenetic and DNA fragmentation analysis of the embryos was not fundamentally different from what is classically observed in routine IVF. This observation implies that the results are not necessarily due to compromised oocyte quality after IVM, and that endometrial receptivity should also be considered, especially in IVM cycles where the follicular phase is dramatically shortened.

High-resolution ultrahigh-field MRI of stroke.

BACKGROUND: Ultrahigh-field MRI at 8 T offers unprecedented resolution for imaging brain structures and microvasculature. OBJECTIVE: The aim of this study is to apply high-resolution MRI for stroke imaging and to characterize findings at 1.5 and 8 T. METHODS: Seventeen subjects with minor ischemic infarcts were studied using T2-weighted gradient echo (GE) and rapid acquisition with relaxation enhancement (RARE) images at 8 T with resolution up to 200 microm. In 10 subjects, T1- and T2-weighted fast spin echo (FSE) and fluid-attenuated inversion recovery (FLAIR) images were also acquired at 1.5-T MRI. RESULTS: The 8-T images showed infarcts as sharply demarcated areas of high-signal intensity (n=21) and revealed more infarctions than 1.5-T images (n=14) (P<.003). The low-signal intensity areas that surrounded infarctions were suggestive of hemosiderin deposits. The 8-T characteristics of microvessels terminating within the infractions were distinct from normal vasculature. The 8-T images revealed an angioma at the site of a second stroke, not apparent on 1.5-T images. CONCLUSIONS: Ultrahigh-field MRI at 8 T is feasible for stroke imaging. The 8-T MRI visualized infarcts and microvasculature with high resolution, revealing infarcts and vascular pathologies that were not apparent at 1.5 T.

Analysis of B1 field profiles and SAR values for multi-strut transverse electromagnetic RF coils in high field MRI applications.

In this work, the B1 field homogeneity and specific absorption rate (SAR) values were evaluated for three high-frequency (340 MHz) radio frequency coils designed for use in human magnetic resonance imaging at 8 tesla. Eight-, 16-, and 24-strut transverse electromagnetic (TEM) resonators were examined both experimentally and with the finite difference time domain numerical method. It was observed that increasing the number of TEM elements acted to lower the maximal achievable frequency of the coil and to increase the experimental complexities associated with tuning and matching. In addition, it is demonstrated from experiment and numerical analysis that the circularly polarized component of the B1 (B1+) field homogeneity in the head improved most from 8- to 16-strut coils. Numerical analysis revealed little difference in terms of SAR distribution between these coils; however, stronger tissue/coil coupling and consequently higher SAR peak values were obtained for the 8-strut case.

Intracranial ossifications and microangiopathy at 8 Tesla MRI.

UNLABELLED: Clinical evaluation and MR imaging of microangiopathy associated with hypertension is limited. We describe a case that illustrates sensitivity of MRI at 8 Tesla for imaging of microvasculature, iron, calcium deposits and silent white matter lesions (WML). A 60-year-old black hypertensive woman was evaluated for numbness in the face and extremities. MRI at 1.5 Tesla was unrevealing.MRI at 8 Tesla: Axial and sagittal Gradient Echo images were obtained with an 8T/80 cm human scanner and showed: 1) Large areas of signal voids due to ossifications and fat deposits within the falx. 2) Obstructed small vessels in the periventricular regions and distended cortical veins. 3) Numerous small WML, suggestive of mini-infarcts (<1 cm) and microhemorrhages. 4) Intracranial calcifications in the falx, tentorium, basal ganglia and chorioid plexus that were confirmed by CT scan. Atherosclerotic plaque in right carotid artery and reduced vasomotor reserve in middle cerebral arteries, documented by ultrasound, indicated large and small vessel disease. CONCLUSIONS: MRI at 8 Tesla improves visualization of microangiopathy, ossifications and iron deposits due to enhanced magnetic susceptibility at ultra high magnetic field.

Dielectric resonances and B(1) field inhomogeneity in UHFMRI: computational analysis and experimental findings.

B(1) Field inhomogeneity and the relative effects of dielectric resonances are analyzed within the context of ultra high field MRI. This is accomplished by calculating the electromagnetic fields inside spherical phantoms and within a human head model in the presence and absence of an RF coil. These calculations are then compared to gradient echo and RARE images, respectively. For the spherical phantoms, plane incident wave analyses are initially presented followed by full wave finite difference time domain (FDTD) calculations. The FDTD methods are then utilized to examine the electromagnetic interactions between the TEM resonator and an anatomically detailed human head model. The results at 340 MHz reveal that dielectric resonances are most strongly excited in objects similar in size to the human head when the conducting medium has a high dielectric constant and a low conductivity. It is concluded that in clinical UFHMRI, the most important determinants of B(1) field homogeneity consist of 1) the RF coil design, 2) the interaction between the RF coil, the excitation source and the sample, and finally 3) the geometry and electrical properties of the sample.

Ultra high field MRI at 8 Tesla of subacute hemorrhagic stroke.

PURPOSE: Optimal treatment strategies and neurologic outcome after stroke depend on an accurate characterization of the lesion. There is a need for high resolution noninvasive imaging for assessment of the infarct size, perfusion, and vascular territory. MRI at the ultra high field (UHF) of 8 T offers unprecedented resolution, but its utility for stroke evaluation has not been determined yet. METHOD: A 55-year-old man with hypertension experienced sudden onset of speech arrest and right-sided hemiparesis that resolved in < 24 h with minimal neurologic deficit. MRI at 1.5 T showed initially a left posterior frontal lesion with subacute infarct (hyperintense on T2-weighted spin echo images) and right-sided frontal and periventricular lesions consistent with chronic infarct. There were many smaller white matter lesions. Delayed studies showed high signal changes involving the gray matter only on T1-weighted images. RESULTS: Gradient echo and rapid acquisition with relaxation enhancement (RARE) multislice images revealed a serpentine area of low signal in the left posterior frontal lobe gray matter suggestive of a hemorrhagic infarct, right-sided frontal lesion also showing iron deposits, multiple periventricular and cortical areas with abnormal high signal regions that were consistent with old infarcts, and numerous small vessels readily visible, more prominent on the right. CONCLUSION: MRI at 8 T displays lesions with a high resolution and striking anatomic details. Susceptibility to iron and sensitivity to detect blood products are increased at 8 T. The imaging characteristics at high field are different from those at low field, but both represent findings of iron products.

High resolution MRI of the brainstem at 8 T.

A recently developed ultra high field MRI system operating at 8 T (UHFMRI) was applied for brainstem imaging. UHFMRI was performed in five healthy volunteers (three men, two women; age range 34--46 years). Sagittal and axial slices were obtained with the following settings: GE, TR 750--1,000 ms, TE 7-9 ms, FOV 20 cm, matrix 1,024 x 1,024 or 512 x 512 points, slice thickness 2 mm, resolution 195 or 390 microm/pixel. The brainstem structures were assigned based on anatomy and course. Images with good signal strength and homogeneity were acquired from the midbrain and the pons. Main intraaxial structures could be directly visualized. The periaqueductal gray matter and nuclei had higher signal intensity than the predominantly white matter structures such as the corticobulbar/corticopontine/corticospinal tracts, the sensory lemnisci, and the medial longitudinal fasciculus. Structures with high iron content such as the substantia nigra and the red nucleus were seen as prominent signal hypointensities. Numerous vessels traversing the brainstem including small perforators were also distinguished. It is concluded that UHFMRI enables the acquisition of high quality images of the upper brainstem with details approaching that of histologic specimen.

Effect of RF coil excitation on field inhomogeneity at ultra high fields: a field optimized TEM resonator.

In this work, computational methods were utilized to optimize the field produced by the transverse electromagnetic (TEM) resonator in the presence of the human head at 8 Tesla. Optimization was achieved through the use of the classical finite difference time domain (FDTD) method and a TEM resonator loaded with an anatomically detailed human head model with a resolution of 2 mm x 2 mm x 2 mm. The head model was developed from 3D MR images. To account for the electromagnetic interactions between the coil and the tissue, the coil and the head were treated as a single system at all the steps of the model including, numerical tuning and excitation. In addition to 2, 3, 4, 6, and 10-port excitations, an antenna array concept was utilized by driving all the possible ports (24) of a 24-strut TEM resonator. The results show that significant improvement in the circularly polarized component of the transverse magnetic field could be obtained when using multiple ports and variable phase and fixed magnitude, or variable phase and variable magnitude excitations.

Ultra high resolution imaging of the human head at 8 tesla: 2K x 2K for Y2K.

PURPOSE: To acquire ultra high resolution MRI images of the human brain at 8 Tesla within a clinically acceptable time frame. METHOD: Gradient echo images were acquired from the human head of normal subjects using a transverse electromagnetic resonator operating in quadrature and tuned to 340 MHz. In each study, a group of six images was obtained containing a total of 208 MB of unprocessed information. Typical acquisition parameters were as follows: matrix = 2,000 x 2,000, field of view = 20 cm, slice thickness = 2 mm, number of excitations (NEX) = 1, flip angle = 45 degrees, TR = 750 ms, TE = 17 ms, receiver bandwidth = 69.4 kHz. This resulted in a total scan time of 23 minutes, an in-plane resolution of 100 microm, and a pixel volume of 0.02 mm3. RESULTS: The ultra high resolution images acquired in this study represent more than a 50-fold increase in in-plane resolution relative to conventional 256 x 256 images obtained with a 20 cm field of view and a 5 mm slice thickness. Nonetheless, the ultra high resolution images could be acquired both with adequate image quality and signal to noise. They revealed numerous small venous structures throughout the image plane and provided reasonable delineation between gray and white matter. DISCUSSION: The elevated signal-to-noise ratio observed in ultra high field magnetic resonance imaging can be utilized to acquire images with a level of resolution approaching the histological level under in vivo conditions. However, brain motion is likely to degrade the useful resolution. This situation may be remedied in part with cardiac gating. Nonetheless, these images represent a significant advance in our ability to examine small anatomical features with noninvasive imaging methods.

Macroscopic susceptibility in ultra high field MRI.

PURPOSE: Magnetic susceptibility provides the basis for functional studies and image artifacts in MRI. In this work, magnetic susceptibility and the associated artifacts were analyzed at 8 T in phantoms and in the human head. METHOD: A mineral oil phantom was constructed in which three cylindrical air-filled tubes were inserted. This phantom was analyzed with gradient-recalled echo and SE imaging techniques acquired using varying TEs and receiver bandwidths. To visualize the presence of magnetic susceptibility artifacts in the head at 8 T, near axial, coronal, and sagittal GE images were also acquired from human volunteers. RESULTS: The use of gradient-recalled echo imaging resulted in the production of significant magnetic susceptibility artifacts. These artifacts could be readily visualized in phantom samples containing air-filled cylindrical tubes. In the human head, susceptibility artifacts produced significant image distortion in the skull base region. In this area, susceptibility artifacts often resulted in the complete loss of MR signal. Magnetic susceptibility artifacts were manifested as bands of varying signal intensity in the frontal lobe and temporal bone region. In addition, they produced clear distortions in the appearance of brain vasculature and seemed to accentuate the relative size of venous structures within the brain. CONCLUSION: When using gradient-recalled echo imaging in combination with relatively long TE values, magnetic susceptibility artifacts can be severe at 8 T. These artifacts could be reduced by increasing receiver bandwidths and by lowering effective TEs. As ultra high field MRI provides a fertile ground for the study of susceptibility artifacts in MRI, improvements obtained at this field strength will have a direct impact on studies performed at lower field strengths.

Dielectric resonance phenomena in ultra high field MRI.

PURPOSE: Dielectric resonances have previously been advanced as a significant cause of image degradation at higher fields. In this work, a study of dielectric resonances in ultra high field MRI is presented to explore the real importance of dielectric resonances in the human brain in this setting. METHOD: Gradient-recalled echo images were acquired using a transverse electromagnetic resonator at 1.5, 4.7, and 8 T. Images were obtained from the human head and from phantoms filled with pure water, saline, and mineral oil. In addition, an exact theoretical analysis of dielectric resonances is presented for a spherical phantom and for a model of the human head. RESULTS: Theoretical results demonstrate that distilled water can sustain dielectric resonances in head-sized spheres near 200 and 360 MHz, but the presence of significant conductivity suppresses these resonances. These findings are confirmed experimentally with proton images of water and saline (0.05 and 0.125 M NaCl). For lossy phantoms, coupling between the source and phantom overwhelms the dielectric resonance. Because of their low relative permittivity, mineral oil phantoms with 20 cm diameter do not exhibit dielectric resonances below approximately 900 MHz. Significant dielectric resonances were not observed in human head images obtained at 1.5, 4.7, and 8 T.

High resolution MRI of the deep brain vascular anatomy at 8 Tesla: susceptibility-based enhancement of the venous structures.

PURPOSE: The purpose of this work was to describe the deep vascular anatomy of the human brain using high resolution MR gradient echo imaging at 8 T. METHOD: Gradient echo images were acquired from the human head using a transverse electromagnetic resonator operating in quadrature and tuned to 340 MHz. Typical acquisition parameters were as follows: matrix = 1,024 x 1,024, flip angle = 45 degrees, TR = 750 ms, TE = 17 ms, FOV = 20 cm, slice thickness = 2 mm. This resulted in an in-plane resolution of approximately 200 microm. Images were analyzed, and vascular structures were identified on the basis of location and course. RESULTS: High resolution ultra high field magnetic resonance imaging (UHFMRI) enabled the visualization of many small vessels deep within the brain. These vessels were typically detected as signal voids, and the majority represented veins. The prevalence of the venous vasculature was attributed largely to the magnetic susceptibility of deoxyhemoglobin. It was possible to identify venous structures expected to measure below 100 microm in size. Perforating venous drainage within the deep gray structures was identified along with their parent vessels. The course of arterial perforators was more difficult to follow and not as readily identified as their venous counterparts. CONCLUSION: The application of high resolution gradient echo methods in UHFMRI provides a unique detailed view of particularly the deep venous vasculature of the human brain.

Design and assembly of an 8 tesla whole-body MR scanner.

PURPOSE: The purpose of this report is to describe the design and construction of an 8 T/80 cm whole-body MRI system operating at 340 MHz. METHOD: The 8 T/80 cm magnet was constructed from 414 km of niobium titanium superconducting wire. The winding of this wire on four aluminum formers resulted in a total inductance of 4,155 H. Gradient subsystems included either a body gradient or a head gradient along with a removable shim insert. The magnet and gradient subsystems were interfaced to two spectrometers. These provided the control of the gradient amplifiers and the two sets of four RF power amplifiers. The latter provide in excess of 8 kW of RF power from 10 to 140 MHz and 10 kW of RF power from 245 to 345 MHz. A dedicated computer-controlled patient table was designed and assembled. The entire system is located in a clinical setting, facilitating patient-based studies. RESULTS: The 8 T/80 cm magnet was energized without complication and achieved persistent operation using 198.9 A of current, thereby storing 81.5 MJ of magnetic energy. Exceptional performance was observed for nearly all components both in isolation and when combined within the complete system. CONCLUSION: An 8 T/80 cm MRI system has been assembled. The magnet subsystem is extremely stable and is characterized by good homogeneity and acceptable boil-off rates.

High resolution MRI of the deep gray nuclei at 8 Tesla.

PURPOSE: High resolution MR images obtained from a normal human volunteer at 8 T are utilized to describe the appearance of iron-containing deep gray nuclei at this field strength. METHOD: High resolution (1,024 x 1,024 matrix) near-axial gradient echo images of the deep gray nuclei were acquired on a human volunteer by using an 8 T scanner. The images were acquired using a transverse electromagnetic resonator operating in quadrature. The following parameters were utilized: TR = 750 ms, TE = 17 ms, flip angle = 45 degrees, receiver bandwidth = 50 kHz, slice thickness = 2 mm, FOV = 20 cm. The 8 T images were reviewed and correlated to the known anatomy of the deep nuclei by comparing them with images observed at lower field strength, published diagrams, and histologic sections. In addition, the appearance of the nuclei was related to the known imaging characteristics of brain iron at lower fields. RESULTS: The caudate, globus pallidus, putamen, thalami, substantia nigra, and red nuclei were clearly identified. The structures with the highest levels of iron, the globus pallidus, substantia nigra, and red nuclei, demonstrated significantly decreased signal, providing a map of iron distribution in the human brain. CONCLUSION: Preliminary imaging at 8 T demonstrates the ability to acquire ultra high resolution images of the deep nuclei, with signal characteristics believed to represent the distribution of brain iron. This may prove to be important in the early diagnosis of several neurodegenerative disorders.

RF penetration in ultra high field MRI: challenges in visualizing details within the center of the human brain.

PURPOSE: The purpose of this work is to discuss radio frequency (RF) penetration and its relevance to imaging the human head and to acquire images containing intricate structures located at the center of the brain with ultra high field MRI (UHFMRI). METHOD: A simple plane wave analysis of RF penetration was performed based on Maxwell equations as a function of frequency up to 900 MHz. Gradient-recalled images were acquired at 8 T (340 MHz) using an RF resonator operating in quadrature. Typical acquisition parameters were as follows: TR = 750 ms, TE = 17 ms, slice thickness = 2 mm, FOV = 20 x 20 cm, matrix = 1,024 x 1,024. The specific absorption rate was well below 1 W/kg. RESULTS: A simple analytical treatment, for a plane wave up to 900 MHz, reveals a lack of decreasing penetration depth with frequency beyond 200 MHz. Gradient-recalled echo images acquired from the human head displayed good contrast, homogeneity, and resolution. Importantly, excellent structural detail was observed on the resulting MR images, demonstrating that RF penetration is not a problem at 8 T. Images reveal excellent detail including the red nucleus, anterior commissure, fornix, mamillary body, pineal gland, and ependymal lining of the fourth ventricle. CONCLUSION: Structures located at the center of the human brain can be clearly visualized at 8 T with no detectable loss in signal intensity arising from RF penetration. The ability to examine these structures with UHFMRI will provide a powerful new modality for diagnostic radiology.

Macroscopic susceptibility in ultra high field MRI. II: acquisition of spin echo images from the human head.

The presence of magnetic susceptibility can lead to substantial geometric distortions when imaging the human head at 8 T. These are particularly significant in gradient echo images where susceptibility often results in a noticeable loss of MR signal in the temporal lobe, the frontal lobe, and the paranasal sinus regions. In this work, anterior coronal gradient and spin echo images were acquired from the frontal lobe and sinus regions. The spin echo was shown to significantly overcome the loss of signal observed in the corresponding gradient echo images, resulting in data of greatly increased quality. In conclusion, whereas susceptibility artifacts are significant in ultra high field MRI, they can be largely surmounted by using spin echo techniques, as had been previously demonstrated in studies at lower field strength.

T1- and T2-weighted imaging at 8 Tesla.

In this work, both T1- and T2-weighted fast imaging methods at 8 T are presented. These include the modified driven equilibrium Fourier transform (MDEFT) and rapid acquisition with relaxation enhancement (RARE) methods, respectively. Axial MDEFT images were acquired with large nutation angles, both partially suppressing gray and white matter and permitting the visualization of vascular structures rich in unsaturated spins. Sagittal RARE images, acquired from the same volunteer, were highly T2-weighted, thus highlighting the CSF. At the same time, they provided good visualization of the corpus callosum, cerebellum, and gray and white matter structures. Importantly, both MDEFT and RARE images could be acquired without violating specific absorption rate guidelines.

Human leptomeningeal and cortical vascular anatomy of the cerebral cortex at 8 Tesla.

PURPOSE: The purpose of this work was to describe the human leptomeningeal and cortical vascular anatomy as seen at high resolution on an 8 T UHFMRI system. METHOD: With a 1024 x 1024 matrix, axial gradient echo images of the cerebral cortex were acquired on a human volunteer at 8 T with TR 500 ms, TE 16 ms, flip angle 22.5 degrees, bandwidth 53 kHz, and slice thickness 2.84 mm. The same subject was evaluated at 1.5 T using similar parameters. The images were then reviewed in detail and compared with known cortical and leptomeningeal vascular anatomy. RESULTS: Two hundred forty micron in-plane resolution images of the human brain were acquired at 8 T without evident artifact from susceptibility distortions, RF penetration, or dielectric resonances. The CSF, gray matter, and white matter structures were well discerned. The microscopic leptomeningeal vascular anatomy was well visualized, and the course of small perforating cortical vessels could be followed from the cortical surface to the white matter junction. CONCLUSION: Initial 8 T images of the brain demonstrate detailed leptomeningeal and cortical vascular anatomy.

Cognitive, cardiac, and physiological safety studies in ultra high field magnetic resonance imaging.

A systematic analysis of the effect of an 8.0 tesla static magnetic field on physiological and/or cognitive function is presented in the normal volunteer and in the swine. A study of ten human subjects revealed no evidence of detectable changes in body temperature, heart rate, respiratory rate, systolic pressure, and diastolic blood pressure after 1 hour of exposure. In addition, no cognitive changes were detected. Important ECG changes were noted which were related both to the position of the subject in the magnet and to the absolute strength of the magnetic field. As such, the ECG tracing at 8 tesla was not diagnostically useful. Nonetheless, all subjects exhibited normal ECG readings both before and following exposure to the 8 tesla field. Cardiac function was also examined in detail in the swine. No significant changes in body temperature, heart rate, left ventricular pressure, left ventricular end diastollic pressure, time rate of change of left ventricular pressure, myocardial stiffness index, cardiac output, systolic volume, troponin, and potassium levels could be detected following 3 h of exposure to a field strength of 8.0 tesla. It is concluded that no short term cardiac or cognitive effects are observed following significant exposure to a magnetic field of up to 8.0 tesla.