Quantifying the impact of underlying measurement error on cervical spinal cord diffusion tensor imaging at 3T.

PURPOSE: To empirically characterize and quantify the impact of gradient weighting schemes on the appearance and fidelity of diffusion tensor imaging of the human spinal cord in vivo in clinically relevant scan time equivalents (STE). MATERIALS AND METHODS: In five healthy controls at 3T, we evaluated test-retest reproducibility and performed voxelwise analysis of diffusion tensor imaging (DTI)-derived indices (fractional anisotropy [FA], mean [MD], axial [AD], and radial [RD] diffusivity) in the cervical spinal cord to assess spatial dependencies of measurement error and differences across three different sampling schemes (6, 15, and 32 directions) at STE of 4.5, 9, and 18 minutes. A subjective assessment was also performed. RESULTS: With six directions, column-specific errors are highest (effect size = 2.9%, 4.4%, 7.2% for FA in dorsal column, lateral column, and gray matter) and different than the 15-direction scheme (P < 0.05). STE sequences with 15 and 32 directions exhibited small differences in error (P > 0.05). For FA and AD, measurement errors are prevalent in gray matter, while partial volume effects with cerebrospinal fluid heavily influence RD. Measurement errors decreased with increasing scan time (P < 0.01), albeit with diminishing returns at scan times longer than 9 minutes (P < 0.05). CONCLUSION: A 15-direction scheme of 9 minutes yields measurements of the cervical spinal cord with low error. J. Magn. Reson. Imaging 2016;44:1608-1618.

ACR Appropriateness Criteria® on cerebrovascular disease.

Stroke is the sudden onset of focal neurologic symptoms due to ischemia or hemorrhage in the brain. Current FDA-approved clinical treatment of acute ischemic stroke involves the use of the intravenous thrombolytic agent recombinant tissue plasminogen activator given <3 hours after symptom onset, following the exclusion of intracerebral hemorrhage by a noncontrast CT scan. Advanced MRI, CT, and other techniques may confirm the stroke diagnosis and subtype, demonstrate lesion location, identify vascular occlusion, and guide other management decisions but, within the first 3 hours after ictus, should not delay or be used to withhold recombinant tissue plasminogen activator therapy after the exclusion of acute hemorrhage on noncontrast CT scans. MR diffusion-weighted imaging is highly sensitive and specific for acute cerebral ischemia and, when combined with perfusion-weighted imaging, may be used to identify potentially salvageable ischemic tissue, especially in the period >3 hours after symptom onset. Advanced CT perfusion methods improve sensitivity to acute ischemia and are increasingly used with CT angiography to evaluate acute stroke as a supplement to noncontrast CT. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

High-resolution 7T MRI of the human hippocampus in vivo.

PURPOSE: To describe an initial experience imaging the human hippocampus in vivo using a 7T magnetic resonance (MR) scanner and a protocol developed for very high field neuroimaging. MATERIALS AND METHODS: Six normal subjects were scanned on a 7T whole body MR scanner equipped with a 16-channel head coil. Sequences included a full field of view T1-weighted 3D turbo field echo (T1W 3D TFE: time of acquisition (TA)=08:58), T2*-weighted 2D fast field echo (T2*W 2D FFE: TA=05:20), and susceptibility-weighted imaging (SWI: TA=04:20). SWI data were postprocessed using a minimum intensity projection (minIP) algorithm. Total imaging time was 23 minutes. RESULTS: T1W 3D TFE images with 700 microm isotropic voxels provided excellent anatomic depiction of macroscopic hippocampal structures. T2*W 2D FFE images with 0.5 mm in-plane resolution and 2.5 mm slice thickness provided clear discrimination of the Cornu Ammonis and the compilation of adjacent sublayers of the hippocampus. SWI images (0.5 mm in-plane resolution, 1.0 mm slice thickness) delineated microvenous anatomy of the hippocampus. CONCLUSION: In vivo 7T MR imaging can take advantage of higher signal-to-noise and novel contrast mechanisms to provide increased conspicuity of hippocampal anatomy.