Comparison of 3 T MRI and CT for the measurement of visceral and subcutaneous adipose tissue in humans.

OBJECTIVE: CT is considered the gold standard imaging modality for measurement of visceral adipose tissue area. However, as CT imaging exposes subjects to ionising radiation, a comparable imaging technique without this exposure is desirable, such as MRI. Therefore, we compared the agreement of measures of visceral adipose tissue and subcutaneous adipose tissue area from single-slice images obtained at the umbilicus using a 3 T MRI scanner with single-slice images obtained via CT scan. METHODS: 64 images were obtained from 27 subjects who underwent MRI and CT scanning on the same day, after 10-12 hours of fasting. Visceral and subcutaneous adipose tissue depots were manually separated and quantified using a multimodality image-processing software program. RESULTS: We found good agreement between CT and MRI for the measurement of both visceral adipose tissue and subcutaneous adipose tissue. Bland-Altman difference analysis demonstrated a mean bias of -2.9% (as a portion of total abdominal area) for visceral adipose tissue and +0.4% for subcutaneous adipose tissue, as measured by MRI compared with CT. CONCLUSION: MRI is a safe, accurate and precise imaging modality for measuring both visceral and subcutaneous adipose tissue, making it a favourable alternative to CT for quantification of these adipose depots.

Temporal lobe magnetic resonance spectroscopic imaging following selective amygdalohippocampectomy for treatment-resistant epilepsy.

OBJECTIVES: Magnetic resonance spectroscopic imaging (MRSI) may show circumscribed or extensive decreased brain N-acetyl aspartate (NAA)/creatine and phosphocreatine (Cr) in epilepsy patients. We compared temporal lobe MRSI in patients seizure-free (SzF) or with persistent seizures (PSz) following selective amygdalohippocampectomy (SAH) for medically intractable mesial temporal lobe epilepsy (mTLE). We hypothesized that PSz patients had more extensive temporal lobe metabolite abnormalities than SzF patients. MATERIALS AND METHODS: MRSI was used to study six regions of interest (ROI) in the bilateral medial and lateral temporal lobes in 14 mTLE patients following SAH and 11 controls. RESULTS: PSz patients had more temporal lobe ROI with abnormally low NAA/Cr than SzF patients, including the unoperated hippocampus and ipsilateral lateral temporal lobe. CONCLUSION: Postoperative temporal lobe MRSI abnormalities are more extensive if surgical outcome following SAH is poor. MRSI may be a useful tool to improve selection of appropriate candidates for SAH by identifying patients requiring more intensive investigation prior to epilepsy surgery. Future prospective studies are needed to evaluate the utility of MRSI, a predictor of successful outcome following SAH.

Chemical shift: the artifact and clinical tool revisited.

The chemical shift phenomenon refers to the signal intensity alterations seen in magnetic resonance (MR) imaging that result from the inherent differences in the resonant frequencies of precessing protons. Chemical shift was first recognized as a misregistration artifact of image data. More recently, however, chemical shift has been recognized as a useful diagnostic tool. By exploiting inherent differences in resonant frequencies of lipid and water, fatty elements within tissue can be confirmed with dedicated chemical shift MR pulse sequences. Alternatively, the recognition of chemical shift on images obtained with standard MR pulse sequences may corroborate the diagnosis of lesions with substantial fatty elements. Chemical shift can aid in the diagnosis of lipid-containing lesions of the brain (lipoma, dermoid, and teratoma) or the body (adrenal adenoma, focal fat within the liver, and angiomyolipoma). In addition, chemical shift can be implemented to accentuate visceral margins (e.g., kidney and liver).

Aortic and lower-extremity arterial disease: evaluation with MR angiography versus conventional angiography.

PURPOSE: To compare magnetic resonance (MR) angiography with conventional angiography in evaluation of the aorta and lower-extremity arterial system. MATERIALS AND METHODS: Fifty-seven patients were evaluated with femoral conventional and MR angiography. Iliac artery segments were evaluated with two-dimensional and contrast material-enhanced three-dimensional time-of-flight MR angiography. Infrainguinal regions were evaluated with two-dimensional time-of-flight MR angiography with a dedicated lower-extremity coil. Arteries depicted on femoral images were separately interpreted as 20 anatomic segments. Disease classification included normal to moderate disease (0%-50% stenosis), severe stenosis (> 50% stenosis), diffuse disease (more than one severe stenosis), and occlusion. Four readers interpreted the images and rendered treatment recommendations. RESULTS: Substantial to almost perfect interobserver agreement (kappa, 0.66-1.00) was achieved in most cases for MR angiogram interpretation. The three most experienced readers achieved substantial to almost perfect intraobserver agreement (kappa, 0.61-1.00) between conventional and MR angiogram interpretation in most cases. Among three readers, moderate agreement (kappa, 0.43-0.53) was found between treatment recommendations based on conventional versus MR angiographic findings; for the most experienced reader, this agreement was almost perfect (kappa, 0.90). CONCLUSION: For experienced readers, there was substantial to almost perfect agreement between conventional and MR angiographic image interpretations of the aorta and lower-extremity arterial system.

Two-point Dixon technique for water-fat signal decomposition with B0 inhomogeneity correction.

To separate water and lipid resonance signals by phase-sensitive MRI, a two-point Dixon (2PD) reconstruction is presented in which phase-unwrapping is used to obtain an inhomogeneity map based on only in-phase and out-of-phase image data. Two relaxation-weighted images, a "water image" and a "fat image," representing a two-resonance peak model of proton density, are output. The method is designed for T1- or density-weighted spin-echo imaging; a double-echo scheme is more appropriate for T2-weighted spin-echo imaging. The technique is more time-efficient for clinical fat-water imaging than 3PD schemes, while still correcting for field inhomogeneity.

Alteration of ascending thoracic aorta compliance after treatment with menotropin.

OBJECTIVE: Our purpose was to determine whether aortic size and compliance are altered by an exogenously induced rise in estrogen. STUDY DESIGN: Magnetic resonance imaging was used to determine the aortic cross-sectional area/aortic pressure relationship in nine premenopausal women before and after menotropin therapy. Simultaneous electrocardiograms, carotid pulse tracings, phonocardiograms, and brachial artery pressures were obtained before each magnetic resonance imaging acquisition. Ascending thoracic aorta cross-sectional area was obtained every 32 msec and aligned with brachial artery pressures extrapolated from the carotid pulse tracing, allowing construction of the ascending thoracic aorta cross-sectional area/aortic pressure relationships. Aortic cross-sectional area was normalized to body surface area, and the shifts in the position for the ascending thoracic aorta cross-sectional area/aortic pressure relationship were determined with use of analysis of covariance. RESULTS: Heart rate and aortic pressure were unchanged before and after menotropin treatment. Initial estradiol levels were < 20 pg/ml. After menotropin treatment (7.4 +/- 1.0 days) estradiol levels rose to 905 +/- 371 pg/ml (p < 0.0001). Ascending thoracic aorta cross-sectional area/body surface area was not significantly increased, adjusted y mean of 389 +/- 7 mm2/m2 before and 403 +/- 7 mm2/m2 after menotropin treatment (p < 0.24). The slope of the ascending aorta cross-sectional area/aortic pressure relationship, an index of aortic compliance, increased from 1.4 +/- 0.6 mm2/m2/mm Hg before to 1.7 +/- 0.6 mm2/m2/mm Hg after menotropin treatment (p < 0.001). CONCLUSION: In premenopausal women a short-term rise in estrogen induced by menotropin treatment is associated with an increase in aortic compliance. Aorta size is not significantly increased within this time frame.

Evaluation of the iliac arteries: comparison of two-dimensional time of flight magnetic resonance angiography with cardiac compensated fast gradient recalled echo and contrast-enhanced three-dimensional time of flight magnetic resonance angiography.

We compared dynamic contrast-enhanced three-dimensional time of flight (3DTOF) magnetic resonance angiography (MRA) with two-dimensional time of flight (2DTOF) MRA with cardiac compensated fast gradient recalled echo (C-MON) and conventional angiography (CA) when it was available. C-MON re-orders the normal data acquisition to minimize ghosting artifacts generated by pulsatile flow. The initial phase of the study involved optimization of parameters and comparison C-MON with no C = MON in eight patients and volunteers. The final phase of the study involved 53 patients who were imaged with contrast-enhanced 3DTOF MRA and 2DTOF MRA with C-MON. Thirty of these patients also had CA. In the initial phase, 2DTOF MRA with C-MON was found to be equal (n = 3) or superior (n = 5) to 2DTOF without C-MON. In the final phase, the agreement among all imaging modalities varied from substantial to almost perfect (Cohen's kappa = .6-.83). The lowest agreement was using 2DTOF to evaluate the external iliac segments. The among suggested treatments varied from substantial to almost perfect for all imaging modalities (Cohen's kappa = .73-93). The diagnostic efficacies of 2DTOF with C-MON and contrast-enhanced 3DTOF were high overall, with the lowest value being a specificity of 63% for one reader in the evaluation of an external iliac segment using 2DTOF. In summary, 2DTOF with C-MON helped to eliminate artifacts due to pulsatility in the iliac arterial segments. In our experience, both dynamic contrast-enhanced 3DTOF MRA and 2DTOF MRA with C-MON performed well in the evaluation of the iliac arteries. Both studies have high interobeserver agreement and high diagnostic efficacy. Contrast-enhanced 3DTOF MRA should be reserved for situations in which the iliac vessels are extremely tortuous or occluded or the external iliac segments are poorly seen.

MR imaging of silicone breast implants: evaluation of prospective and retrospective interpretations and interobserver agreement.

MR imaging was used to evaluate the integrity of silicone breast implants in 54 women with 108 implants. MR images were interpreted by relatively inexperienced readers who tried to reproduce the experiences reported in the literature. The study examines the interobserver agreement using different diagnostic signs and the influence of experience on interpretation errors. Prospective and retrospective interpretations were compared with surgical findings at the time of explanation. Diagnostic indicators, including the linguine sign, the inverted tear drop sign, the C sign, water droplets mixed with silicone, and extracapsular globules of silicone, were evaluated for diagnostic efficacy and interobserver agreement. The prospective sensitivity and specificity were 87% and 78%, respectively. With the retrospective interpretations, the sensitivity and specificity increased to 93% and 92%, respectively. Most of the prospective false-positive interpretations were due to misinterpreting radial folds as signs of implant rupture. Six implants interpreted retrospectively as false positives had gross amounts of silicone around the implants at surgery but there were no obvious rents in the implant shells. There was fair to excellent interobserver agreement with the individual diagnostic signs except for extracapsular globules of silicone. All of the signs had specificities of greater than 90%. The sensitivities of the individual signs were less than the overall retrospective sensitivity. With experience, the sensitivity improved from 87% to 93% and the specificity improved from 78% to 92%. This study helps substantiate the use of diagnostic signs used by other authors to detect silicone loss from breast implants by MR imaging; however, questions remain as to the clinical role of MR imaging in evaluating implants for silicone loss.

Coronal fat suppression fast spin echo images of the knee: evaluation of 202 patients with arthroscopic correlation.

We optimized fat-suppressed fast spin echo (FS-FSE) parameters for coronal imaging of the knee and then evaluated the technique in a clinical setting. Five volunteers and 12 patients were used to evaluate various repetition (TR), echo (TE), and echo train lengths (ETL). Then, 202 patients underwent both knee MR imaging using coronal plane FS-FSE and arthroscopy. The coronal FS-FSE images were compared with radial multiplanar gradient-recalled echo (MPGRE), axial T1-weighted SE, and parasagittal double echo SE images. Proton density images (2,000/19) with an ETL of 2 best depicted the menisci, ligaments, and capsules. The conspicuity of osteochondral abnormalities depicted by the coronal FS-FSE imaging was significantly higher than for axial T1-weighted SE (p < .003) and parasagittal echo SE images (p < .003). The accuracy of the coronal FS-FSE imaging for medial and lateral meniscal tears was 91.6% and 87.6%, respectively. Combined imaging interpretation of the coronal FS-FSE, axial T1-weighted SE, and radial MPGRE imaging improved the accuracy for meniscal tears slightly over any sequence used alone, but the difference was not statistically significant. Fourteen capsular injuries were demonstrated by the coronal FS-FSE imaging. FS-FSE imaging in the coronal plane is a useful complementary sequence in MR examinations of the knee for the evaluation of meniscal tears, capsular injuries, and osteochondral abnormalities.

Lower extremities: MR angiography with a unilateral telescopic phased-array coil.

In a comparison of conventional and magnetic resonance (MR) angiography of the lower extremities, MR imaging was performed with extremity and body coils and a unilateral six-coil telescopic phased-array coil. In one of seven volunteers, average signal-to-noise ratio was 140% higher with the latter (p < .01), only three of five stations were necessary, and examination time was decreased 50%. In the four patients, correlation in findings was 100%.

Detection of discrete white matter lesions after irreversible compression of MR images.

PURPOSE: To validate the use of techniques of irreversible compression of images, which can be performed using a block-based discrete cosine transform technique as defined by the Joint Photographic Experts Group, before they can be used in clinical applications, by evaluating the effect of compression on the ability of observers to detect discrete white matter lesions on MR images of the brain. METHODS: Sixty T2- and intermediate-weighted spin-echo images were compressed with varying degrees of coefficient quantization with compression ratios from 1:1 to more than 40:1, randomized, and evaluated by three observers blinded to the degree of compression. RESULTS: No significant difference in the number of lesions detected was apparent until compression ratios reached 40:1, despite a significant subjective loss in perceived image quality at 20:1. Only small (< or = 5 mm) lesions were missed at the highest degree of compression. No significant differences were observed in the detection of confluent periventricular white matter disease at any degree of compression tested. CONCLUSIONS: The use of high degrees of irreversible compression of MR images may be acceptable for diagnostic tasks.

Double-echo three-point-Dixon method for fat suppression MRI.

A double-echo two-excitation pulse sequence encoding fat and water signals for a phase-sensitive three-point Dixon-type analysis (DE-3PD) was developed and implemented on a 1.5 T MR imager. Data processing was performed using a previously developed two-dimensional (2D) region-growing algorithm, adapted to use double-echo data. Density-, T1-, and T2-weighted fat suppression images were obtained from six volunteers using the new fat suppression method. The images were compared with corresponding images obtained using frequency-selective excitation fat suppression (FATSAT) and a single-echo three-point-Dixon method (SE-3PD). The results demonstrate that the DE-3PD sequence shortens the imaging time by one-third compared with the SE-3PD method, without loss in image quality. The data also show that a 2D region-growing algorithm effectively unwraps the phase of DE-3PD data sets, and that results of DE-3PD fat signal suppression are consistently better than those obtained using a standard FATSAT method. The authors conclude that the double-echo sequence provides density-, T1-, and T2-weighted images that appear to be promising for routine clinical applications.

Evaluation of the combination of vinblastine and quinidine in patients with metastatic renal cell carcinoma. A phase I study.

Quinidine is known to inhibit p-glycoprotein and enhance the activity of vinblastine against cultured renal carcinoma cells. We have combined quinidine and vinblastine in a Phase I trial in patients with metastatic renal cell carcinoma. Twenty-three patients were entered. Prior treatment included nephrectomy (15 patients), radiation (1 patient) and interferons (8 patients). Cohorts of patients were treated at one of three quinidine dose levels (100, 200, and 400 mg); one patient received 300 mg. Quinidine was given orally 4 times daily starting 3 days prior to the first dose of vinblastine of 5 mg/m2 intravenously given once a week. Hematologic parameters, EKG, and quinidine levels were monitored weekly. Mean quinidine levels in each dose tier were 1.58, 2.59, and 4.24 micrograms/ml, respectively. The dose-limiting toxicity was leukopenia, which necessitated dose interruptions in 16 patients. The mean nadir WBC count (x 10(9)/L) was 3.47, 2.3, and 1.73 in each dose tier, respectively. Corresponding values for the mean maximum decrease in WBC count from baseline were 3.85, 5.86, and 6.53, respectively. There was a trend for leukopenia to become more severe with increasing doses of quinidine. Other toxicities included mild nausea and vomiting in all patients, and hypotension and paralytic ileus in one patient each. No cardiac toxicity was observed. One patient had a complete remission and 4 patients had stable disease. We conclude that quinidine and vinblastine may be administered together safely in a clinical setting, with leukopenia being dose-limiting. Further studies are needed to determine any therapeutic advantage over vinblastine alone.

Rotator cuff tendon tears: evaluation with fat-suppressed MR imaging with arthroscopic correlation in 100 patients.

PURPOSE: To evaluate the diagnostic accuracy of fat-suppressed magnetic resonance (MR) imaging of rotator cuff tears in a large symptomatic population. MATERIALS AND METHODS: One hundred patients underwent both MR imaging and arthroscopy of the shoulder. Ninety-two patients underwent fat-suppressed conventional spin-echo MR imaging (repetition time msec/echo time msec = 2,500/20, 60), and eight patients underwent fat-suppressed, fast spin-echo MR imaging (2,000/80). RESULTS: With data combined for complete and partial tears of the rotator cuff (n = 31), MR imaging had an accuracy of 93%; sensitivity, 84%; and specificity, 97%. Seventeen of 20 complete tears and nine of 11 partial tears were properly identified with MR imaging. Two partial tears were not detected and three complete tears were incorrectly called partial tears at MR imaging. Of two false-positive MR imaging findings, one was called a complete tear and the other, a partial tear. CONCLUSION: Fat-suppressed MR imaging has high diagnostic accuracy in evaluating tears of the rotator cuff tendon.

Differential permeability and quantitative MR imaging of a human lung carcinoma brain xenograft in the nude rat.

This study characterized agent differential permeability, three-dimensional tumor volume, and survival in an LX-1 human small cell lung carcinoma intracerebral xenograft model in the nude rat. The percent accessible tissue space (distribution volume) and the permeability x capillary surface product for aminoisobutyric acid (M(r) 103), methotrexate (M(r) 454), dextran 10 (M(r) 10,000), and dextran 70 (M(r) 70,000) were measured between 8 and 16 days after inoculation of tumor. Magnetic resonance imaging and histology were used to quantitate intracerebral tumor volume (mm3). Accessible tissue space (ml/g) and permeability x capillary surface product in intracranial tumor, surrounding brain, and subcutaneous tumor decreased with increasing molecular weight of the agent, regardless of the number of days after inoculation. Accessible tissue space in intracranial tumor increased between 8 and 16 days for all agents except dextran 70. There was little change in the subcutaneous tumor or other tissues with time. Tumor volume calculations from imaging studies correlated with volumetric measurements from histological sections (r2 = 98.5%) and illustrated natural tumor progression (9 to 225 mm3). These results provide a basis for therapeutic design based on differential permeability of specific agents and the ability to quantitatively measure brain tumor volume for accessing tumor response.

Chondromalacia patellae: fat-suppressed MR imaging.

PURPOSE: To evaluate the accuracy of fat-suppressed magnetic resonance (MR) imaging in diagnosing chondromalacia patellae. MATERIALS AND METHODS: Seventy-one patients underwent fat-suppressed MR imaging and arthroscopy of the patellofemoral compartment. Findings were classified as early or advanced chondromalacia or as normal and were correlated with arthroscopic findings. RESULTS: Early and advanced stages of chondromalacia patellae were reliably detected, with positive predictive values of 85% and 92%, respectively. Specificity in early stages was 94% and in late stages was 98%. However, the overall accuracies did not differ substantially from those reported in studies that did not use fat-suppressed imaging. CONCLUSION: Axial, fat-suppressed MR imaging accurately depicts changes caused by chondromalacia patellae. Early stages can be seen as intrasubstance changes of increased signal intensity. Results of this study suggest a high degree of specificity in excluding both early and advanced changes.

Quantitative contrast-enhanced MR imaging of the optic nerve.

During the acute stages of optic neuritis damage to the blood-optic nerve barrier can be detected using i.v. paramagnetic contrast-enhanced MR imaging. Quantification of the enhancement pattern of the optic nerve, intraorbital fat and muscle was determined in 15 normal subjects using 3 fat-suppression MR imaging methods: T1-weighted spin-echo and spoiled gradient-echo sequences preceded by a fat-frequency selective pulse (FATSAT+SE and FATSAT+SPGR, respectively) and a pulse sequence combining CHOPPER fat suppression with a fat-frequency selective preparation pulse (HYBRID). Pre- and postcontrast-enhanced studies were acquired for FATSAT+SE and FATSAT+SPGR. There was no significant enhancement of the optic nerve by either method (mean increase of 0.96% and 5.3%, respectively), while there was significant enhancement in muscle (mean 118.2% and 108.2%, respectively; p < 0.005) and fat (mean increase of 13% and 37%, respectively; p < 0.05). Postcontrast optic nerve/muscle signal intensity ratios (mean, SD) were 0.51 (0.07), 0.58 (0.05) and 0.75 (0.05) for FATSAT+SE, FATSAT+SPGR and HYBRID, respectively. These results suggest a practical methodology and range of values for normal signal intensity increases and ratios of tissue signal that can be used as objective measures of optic neuritis for natural history studies and treatment trials.

Effects of Gd-DTPA after osmotic BBB disruption in a rodent model: toxicity and MR findings.

OBJECTIVE: This experiment was done to evaluate the gross neurotoxicity of intravenous Gd-DTPA administered in conjunction with osmotic blood-brain barrier (BBB) disruption and to image a human small cell lung carcinoma intracerebral tumor xenograft before and after osmotic BBB disruption. MATERIALS AND METHODS: Neurotoxicity studies were performed in normal Sprague-Dawley rats following osmotic BBB disruption by the injection of 25% mannitol in the right internal carotid artery and intravenous administration of Gd-DTPA (n = 10). Animals were observed for major neurologic changes such as seizure or substantial motor defects, and after death neuropathologic examination was performed. Human small cell lung carcinoma cells were implanted intracerebrally in athymic nude rats (n = 4). Gadopentetate dimeglumine was injected intravenously and serial T1-weighted images were obtained. Blood-brain barrier disruption was produced in each animal, followed by a second dose of intravenous Gd-DTPA, and imaging studies were repeated. RESULTS: No gross neurologic toxicity was observed. Tumors showed dense enhancement in a small area, and BBB disruption resulted in marked enhancement in most of the gray matter of the right cerebral hemisphere. CONCLUSION: Gadopentetate dimeglumine appears to be safe in doses up to 21 mmol/m2 in conjunction with barrier disruption in rats. A human small cell lung carcinoma intracerebral xenograft provides a useful method to study brain tumors.

Phase unwrapping in the three-point Dixon method for fat suppression MR imaging.

PURPOSE: TO present an algorithm for performing phase unwrapping for fat and water signal separation in the three-point Dixon (3PD) method of magnetic resonance (MR) imaging. MATERIALS AND METHODS: The algorithm is based on a two-dimensional region-growing approach, which tracks phase evolution in 3PD images and unwraps the phase when a 2 pi jump is detected. The unwrapped phase data are consecutively used to calculate fat and water signal components on a per-pixel basis. The method was tested in eight volunteers. RESULTS: The algorithm creates four output images: standard spin-echo, fat suppression, water suppression, and phase map images. This method corrects for the effects of magnetic field inhomogeneities and provides spatially uniform fat signal suppression superior to that achievable with the standard method. CONCLUSION: This method of 3PD data reconstruction appears to be promising for routine application of fat suppression MR imaging in a clinical setting.

Delivery of virus-sized iron oxide particles to rodent CNS neurons.

Delivery of viral particles to the brain is limited by the volume of distribution that can be obtained. Additionally, there is currently no way to non-invasively monitor the distribution of virus following delivery to the central nervous system (CNS). To examine the delivery of virus-sized particles across the blood-brain barrier (BBB), dextran coated, superparamagnetic monocrystalline iron oxide particles, with a hydrodynamic diameter of 20 +/- 4 nm, were delivered to rat brain by direct intracerebral inoculation or by osmotic BBB disruption with hypertonic mannitol. Delivery of these particles was documented by magnetic resonance (MR) imaging and, unexpectedly, neuronal uptake was demonstrated by histochemical staining. Electron microscopy (EM) confirmed iron particle delivery across the capillary basement membrane and localization within CNS parenchymal cells following administration with BBB disruption. This is the first histologic and ultrastructural documentation of the delivery of particles the size of virions across the blood-brain barrier. Additionally, these dextran-coated, iron oxide particles may be useful, in and of themselves, as vectors for diagnostic and/or therapeutic interventions directed at the CNS.