MRI evaluation of cerebral metabolic rate of oxygen (CMRO2) in obstructive sleep apnea.

Patients with obstructive sleep apnea (OSA) are at elevated risk of developing systemic vascular disease and cognitive dysfunction. Here, cerebral oxygen metabolism was assessed in patients with OSA by means of a magnetic resonance-based method involving simultaneous measurements of cerebral blood flow rate and venous oxygen saturation in the superior sagittal sinus for a period of 10 minutes at an effective temporal resolution of 1.3 seconds before, during, and after repeated 24-second breath-holds mimicking spontaneous apneas, yielding, along with pulse oximetry-derived arterial saturation, whole-brain CMRO2 via Fick's Principle. Enrolled subjects were classified based on their apnea-hypopnea indices into OSA (N = 31) and non-sleep apnea reference subjects (NSA = 21), and further compared with young healthy subjects (YH, N = 10). OSA and NSA subjects were matched for age and body mass index. CMRO2 was lower in OSA than in the YH group during normal breathing (105.6 ± 14.1 versus 123.7 ± 22.8 µmol O2/min/100g, P = 0.01). Further, the fractional change in CMRO2 in response to a breath-hold challenge was larger in OSA than in the YH group (15.2 ± 9.2 versus 8.5 ± 3.4%, P = 0.04). However, there was no significant difference in CMRO2 between OSA and NSA subjects. The data suggest altered brain oxygen metabolism in OSA and possibly in NSA as well.

Ultrasound-based sensors for respiratory motion assessment in multimodality PET imaging.

Breathing motion can displace internal organs by up to several cm; as such, it is a primary factor limiting image quality in medical imaging. Motion can also complicate matters when trying to fuse images from different modalities, acquired at different locations and/or on different days. Currently available devices for monitoring breathing motion often do so indirectly, by detecting changes in the outline of the torso rather than the internal motion itself, and these devices are often fixed to floors, ceilings or walls, and thus cannot accompany patients from one location to another. We have developed small ultrasound-based sensors, referred to as 'organ configuration motion' (OCM) sensors, that attach to the skin and provide rich motion-sensitive information. In the present work we tested the ability of OCM sensors to enable respiratory gating duringin vivoPET imaging. A motion phantom involving an FDG solution was assembled, and two cancer patients scheduled for a clinical PET/CT exam were recruited for this study. OCM signals were used to help reconstruct phantom andin vivodata into time series of motion-resolved images. As expected, the motion-resolved images captured the underlying motion. In Patient #1, a single large lesion proved to be mostly stationary through the breathing cycle. However, in Patient #2, several small lesions were mobile during breathing, and our proposed new approach captured their breathing-related displacements. In summary, a relatively inexpensive hardware solution was developed here for respiration monitoring. Because the proposed sensors attach to the skin, as opposed to walls or ceilings, they can accompany patients from one procedure to the next, potentially allowing data gathered in different places and at different times to be combined and compared in ways that account for breathing motion.

Cerebral metabolic rate of oxygen during transition from wakefulness to sleep measured with high temporal resolution OxFlow MRI with concurrent EEG.

During slow-wave sleep, synaptic transmissions are reduced with a concomitant reduction in brain energy consumption. We used 3 Tesla MRI to noninvasively quantify changes in the cerebral metabolic rate of O2 (CMRO2) during wakefulness and sleep, leveraging the 'OxFlow' method, which provides venous O2 saturation (SvO2) along with cerebral blood flow (CBF). Twelve healthy subjects (31.3 ± 5.6 years, eight males) underwent 45-60 min of continuous scanning during wakefulness and sleep, yielding one image set every 3.4 s. Concurrent electroencephalography (EEG) data were available in eight subjects. Mean values of the metabolic parameters measured during wakefulness were stable, with coefficients of variation below 7% (average values: CMRO2 = 118 ± 12 µmol O2/min/100 g, SvO2 = 67.0 ± 3.7% HbO2, CBF = 50.6 ±4.3 ml/min/100 g). During sleep, on average, CMRO2 decreased 21% (range: 14%-32%; average nadir = 98 ± 16 µmol O2/min/100 g), while EEG slow-wave activity, expressed in terms of δ-power, increased commensurately. Following sleep onset, CMRO2 was found to correlate negatively with relative δ-power (r = -0.6 to -0.8, P < 0.005), and positively with heart rate (r = 0.5 to 0.8, P < 0.0005). The data demonstrate that OxFlow MRI can noninvasively measure dynamic changes in cerebral metabolism associated with sleep, which should open new opportunities to study sleep physiology in health and disease.

MRI evaluation of cerebrovascular reactivity in obstructive sleep apnea.

Obstructive sleep apnea (OSA) is characterized by intermittent obstruction of the airways during sleep. Cerebrovascular reactivity (CVR) is an index of cerebral vessels' ability to respond to a vasoactive stimulus, such as increased CO2. We hypothesized that OSA alters CVR, expressed as a breath-hold index (BHI) defined as the rate of change in CBF or BOLD signal during a controlled breath-hold stimulus mimicking spontaneous apneas by being both hypercapnic and hypoxic. In 37 OSA and 23 matched non sleep apnea (NSA) subjects, we obtained high temporal resolution CBF and BOLD MRI data before, during, and between five consecutive BH stimuli of 24 s, each averaged to yield a single BHI value. Greater BHI was observed in OSA relative to NSA as derived from whole-brain CBF (78.6 ± 29.6 vs. 60.0 ± 20.0 mL/min2/100 g, P = 0.010) as well as from flow velocity in the superior sagittal sinus (0.48 ± 0.18 vs. 0.36 ± 0.10 cm/s2, P = 0.014). Similarly, BOLD-based BHI was greater in OSA in whole brain (0.19 ± 0.08 vs. 0.15 ± 0.03%/s, P = 0.009), gray matter (0.22 ± 0.09 vs. 0.17 ± 0.03%/s, P = 0.011), and white matter (0.14 ± 0.06 vs. 0.10 ± 0.02%/s, P = 0.010). The greater CVR is not currently understood but may represent a compensatory mechanism of the brain to maintain oxygen supply during intermittent apneas.

The use of Fourier-domain analyses for unwrapping phase images of low SNR.

PURPOSE: We report a new postprocessing procedure that uses Fourier-domain data analyses to improve the accuracy and reliability of phase unwrapping for MRI data of low SNR. METHODS: The developed method first identifies the Fourier-domain energy peak locations corresponding to different image-domain areas from which a robust measurement of image-domain phase gradients can be obtained even for MRI data of low SNR. The phase-gradient information measured from critical brain regions using the above-mentioned Fourier-domain analysis is then combined with the conventional temporal-domain or spatial-domain phase-unwrapping procedure to remove phase wraps. The developed method was tested with MRI data obtained from 30 healthy adult volunteers, and its performance was quantitatively evaluated. RESULTS: The developed Fourier-domain analysis could robustly quantify image-domain phase gradients even for MRI data with low SNR (e.g., SNR ≃ 2). Experimental results show that the Fourier-domain analyses could further reduce phase wrap artifact in data produced by the conventional temporal-domain or spatial-domain phase-unwrapping procedures. CONCLUSION: Our results demonstrate that the developed phase-unwrapping method can reduce residual phase wraps resulting from conventional procedures in critical brain regions (e.g., near the air-tissue interfaces) and should prove valuable for studies that require accurate measurements of MRI phase values, such as QSM, B0 field mapping, and temperature mapping.

Pixel-wise derivation of pulmonary regurgitation index could influence clinical decision: A phase-contrast MR imaging study on patients with repaired tetralogy of Fallot.

PURPOSE: Regurgitant fraction (RF) measured from 2D phase-contrast MRI has been used as a standard to quantitate the degree of pulmonary regurgitation and serves as a determinant indicator of prognosis for tetralogy of Fallot after surgical repair. This study demonstrated the potential underestimate of RF using the conventional definition and its impact on clinical decision when backward flow occurred during systolic periods. METHODS: Quantitative flow parameters, including forward flow volume (FFV), backward flow volume (BFV), and RF were estimated by two approaches: One derived from conventional ROI-averaged curve (bulk quantity) and the other in a pixel-wise manner to spatially reflect inhomogeneous flow profile (pixel-wise quantity). Eccentricity at systolic peak (Eccsys) was adopted as an index reflecting spatial flow inhomogeneity. RESULTS: Flow parameters derived from ROI-averaged curves on main pulmonary artery were significantly smaller than that of pixel-wise measurement (P<0.001). Difference between RFbulk and RFpx for the group of Eccsys > 0.3 appears greater compared to the group with Eccsys < 0.3. Thirteen out of 68 RF values (19%) were underrated while using bulk analysis. CONCLUSIONS: The spatial-related flow parameters showed more consistency with the qualitative flow profile pattern for pulmonary arteries, and could be a decisive complement for diagnostic classification.

Effects of RF profile on precision of quantitative T2 mapping using dual-echo steady-state acquisition.

The dual echo steady-state (DESS) sequence has been shown successful in achieving fast T2 mapping with good precision. Under-estimation of T2, however, becomes increasingly prominent as the flip angle decreases. In 3D DESS imaging, therefore, the derived T2 values would become a function of the slice location in the presence of non-ideal slice profile of the excitation RF pulse. Furthermore, the pattern of slice-dependent variation in T2 estimates is dependent on the RF pulse waveform. Multi-slice 2D DESS imaging provides better inter-slice consistency, but the signal intensity is subject to integrated effects of within-slice distribution of the actual flip angle. Consequently, T2 measured using 2D DESS is prone to inaccuracy even at the designated flip angle of 90°. In this study, both phantom and human experiments demonstrate the above phenomena in good agreement with model prediction.

High spatial resolution brain functional MRI using submillimeter balanced steady-state free precession acquisition.

PURPOSE: One of the technical advantages of functional magnetic resonance imaging (fMRI) is its precise localization of changes from neuronal activities. While current practice of fMRI acquisition at voxel size around 3 × 3 × 3 mm(3) achieves satisfactory results in studies of basic brain functions, higher spatial resolution is required in order to resolve finer cortical structures. This study investigated spatial resolution effects on brain fMRI experiments using balanced steady-state free precession (bSSFP) imaging with 0.37 mm(3) voxel volume at 3.0 T. METHODS: In fMRI experiments, full and unilateral visual field 5 Hz flashing checkerboard stimulations were given to healthy subjects. The bSSFP imaging experiments were performed at three different frequency offsets to widen the coverage, with functional activations in the primary visual cortex analyzed using the general linear model. Variations of the spatial resolution were achieved by removing outer k-space data components. RESULTS: Results show that a reduction in voxel volume from 3.44 × 3.44 × 2 mm(3) to 0.43 × 0.43 × 2 mm(3) has resulted in an increase of the functional activation signals from (7.7 ± 1.7)% to (20.9 ± 2.0)% at 3.0 T, despite of the threefold SNR decreases in the original images, leading to nearly invariant functional contrast-to-noise ratios (fCNR) even at high spatial resolution. Activation signals aligning nicely with gray matter sulci at high spatial resolution would, on the other hand, have possibly been mistaken as noise at low spatial resolution. CONCLUSIONS: It is concluded that the bSSFP sequence is a plausible technique for fMRI investigations at submillimeter voxel widths without compromising fCNR. The reduction of partial volume averaging with nonactivated brain tissues to retain fCNR is uniquely suitable for high spatial resolution applications such as the resolving of columnar organization in the brain.

Frequency stabilization using infinite impulse response filtering for SSFP fMRI at 3T.

The steady-state free precession (SSFP) method has been shown to exhibit strong potential for distortion-free functional magnetic resonance imaging (fMRI). One major challenge of SSFP fMRI is that the frequency band corresponding to the highest functional sensitivity is extremely narrow, leading to substantial loss of functional contrast in the presence of magnetic field drifts. In this study we propose a frequency stabilization scheme whereby an RF pulse with small flip angle is applied before each image scan, and the initial phase of the free induction decay (FID) signals is extracted to reflect temporal field drifts. A simple infinite impulse response (IIR) filter is further employed to obtain a low-pass-filtered estimate of the central reference frequency for the upcoming scan. Experimental results suggest that the proposed scheme can stabilize the frequency settings in accordance with field drifts, with oscillation amplitudes of <0.5 Hz. Phantom studies showed that both slow drifts and fast fluctuations were prominently reduced, resulting in less than 5% signal variations. Visual fMRI at submillimeter in-plane resolution further demonstrated 15% activation signals that were nicely registered in the microvessels within the sulci. It is concluded that the IIR-filtered frequency stabilization is an effective technique for achieving reliable SSFP fMR images at high field strengths.