Transient susceptibility imaging as a measure of hemodynamic compromise: A pilot study.

BACKGROUND AND PURPOSE: The purpose of this study was to test the hypothesis that hemodynamically compromised brains exhibit transient changes in magnetic susceptibility throughout the cardiac cycle, and to model these changes using Linear System Theory to extract an index that reflects cerebrovascular reserve. MATERIALS AND METHODS: Eleven patients with angiographically-confirmed intracranial atherosclerotic disease with >50% stenosis were imaged with susceptibility weighted, cardiac-gated single shot images of cerebral Oxygen Extraction Fraction (OEF) at different timepoints of the cardiac cycle. Cardiac gating of the OEF acquisition allowed interrogation of oxygenated blood and the detection of changes throughout the cardiac cycle. Independent component analysis (ICA) of raw k-space data across the cardiac phase allowed MRI signal decomposition into dynamic and static components for image reconstruction. An asymmetry index score of the resultant parametric images were compared to test the hypothesis that variation in hemoglobin-induced susceptibility across the cardiac cycle indeed reflects pathophysiology of cerebrovascular disease. A mathematical model was derived to parameterize physiologic changes induced by the presence of a hemodynamically significant stenosis in the brain as a tissue impulse response parameter (ß). RESULTS: OEF was elevated in the affected hemisphere (50.34 ± 12.13% vs 46.93 ± 12.34%), but failed to reach statistical significance (p < .0796). Transient changes in the OEF signal showed significant distinction between healthy and compromised tissue (0.56 ± 0.067 vs 0.44 ± 0.067, p < .019)). The derived tissue impulse response function was found to be significant as well (10.72 ± 3.48 10-3 ms-1, 9.69 ± 3.51 10-3 ms-1; p < .037). CONCLUSION: In this pilot study, we found transient OEF and ß to be significant predictors of hemispheric compromise.

Absolute quantitative MR perfusion and comparison against stable-isotope microspheres.

PURPOSE: This work sought to compare a quantitative T1 bookend dynamic susceptibility contrast MRI based perfusion protocol for absolute cerebral blood flow (qCBF) against CBF measured by the stable-isotope neutron capture microsphere method, a recognized reference standard for measuring tissue blood flow, at normocapnia, hypercapnia, and in acute stroke. METHODS: CBF was measured in anesthetized female canines by MRI and microspheres over 2 consecutive days for each case. On day 1, 5 canines were measured before and during a physiological challenge induced by carbogen inhalation; on day 2, 4 canines were measured following permanent occlusion of the middle cerebral artery. CBF and cerebrovascular reactivity measured by MRI and microsphere deposition were compared. RESULTS: MRI correlated strongly with microspheres at the hemispheric level for CBF during normo- and hypercapnic states (r2 = 0.96), for individual cerebrovascular reactivity (r2 = 0.84), and for postocclusion CBF (r2 = 0.82). Correction for the delay and dispersion of the contrast bolus resulted in a significant improvement in the correlation between MRI and microsphere deposition in the ischemic state (r2 = 0.96). In all comparisons, moderate correlations were found at the regional level. CONCLUSION: In an experimental canine model with and without permanent occlusion of the middle cerebral artery, MRI-based qCBF yielded moderate to strong correlations for absolute quantitative CBF and cerebrovascular reactivity measurements during normocapnia and hypercapnia. Correction for delay and dispersion greatly improved the quantitation during occlusion of the middle cerebral artery, underscoring the importance for this correction under focal ischemic condition.

A fast, noniterative approach for accelerated high-temporal resolution cine-CMR using dynamically interleaved streak removal in the power-spectral encoded domain with low-pass filtering (DISPEL) and modulo-prime spokes (MoPS).

PURPOSE: To introduce a pair of accelerated non-Cartesian acquisition principles that when combined, exploit the periodicity of k-space acquisition, and thereby enable acquisition of high-temporal cine Cardiac Magnetic Resonance (CMR). METHODS: The mathematical formulation of a noniterative, undersampled non-Cartesian cine acquisition and reconstruction is presented. First, a low-pass filtering step that exploits streaking artifact redundancy is provided (i.e., Dynamically Interleaved Streak removal in the Power-spectrum Encoded domain with Low-pass filtering [DISPEL]). Next, an effective radial acquisition for the DISPEL approach that exploits the property of prime numbers is described (i.e., Modulo-Prime Spoke [MoPS]). Both DISPEL and MoPS are examined using numerical simulation of a digital heart phantom to show that high-temporal cine-CMR is feasible without removing physiologic motion vs aperiodic interleaving using Golden Angles. The combined high-temporal cine approach is next examined in 11 healthy subjects for a time-volume curve assessment of left ventricular systolic and diastolic performance vs conventional Cartesian cine-CMR reference. RESULTS: The DISPEL method was first shown using simulation under different streak cycles to allow separation of undersampled radial streaking artifacts from physiologic motion with a sufficiently frequent streak-cycle interval. Radial interleaving with MoPS is next shown to allow interleaves with pseudo-Golden-Angle variants, and be more compatible with DISPEL against irrational and nonperiodic rotation angles, including the Golden-Angle-derived rotations. In the in vivo data, the proposed method showed no statistical difference in the systolic performance, while diastolic parameters sensitive to the cine's temporal resolution were statistically significant (P < 0.05 vs Cartesian cine). CONCLUSIONS: We demonstrate a high-temporal resolution cine-CMR using DISPEL and MoPS, whose streaking artifact was separated from physiologic motion.

The relationship between white matter fiber damage and gray matter perfusion in large-scale functionally defined networks in multiple sclerosis.

BACKGROUND: Recent studies utilizing perfusion as a surrogate of cortical integrity show promise for overall cognition, but the association between white matter (WM) damage and gray matter (GM) integrity in specific functional networks is not previously studied. OBJECTIVE: To investigate the relationship between WM fiber integrity and GM node perfusion within six functional networks of relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) patients. METHODS: Magnetic resonance imaging (MRI) and neurocognitive testing were performed on 19 healthy controls (HC), 39 RRMS, and 45 SPMS patients. WM damage extent and severity were quantified with T2-hyper/T1-hypointense (T2h/T1h) lesion volume and degree of perfusion reduction in lesional and normal-appearing white matter (NAWM), respectively. A two-step linear regression corrected for confounders was employed. RESULTS: Cognitive impairment was present in 20/39 (51%) RRMS and 25/45 (53%) SPMS patients. GM node perfusion was associated with WM fiber damage severity (WM hypoperfusion) within each network-including both NAWM ( R2 = 0.67-0.89, p < 0.0001) and T2h ( R2 = 0.39-0.62, p < 0.0001) WM regions-but was not significantly associated ( p > 0.01) with WM fiber damage extent (i.e. T2h/T1h lesion volumes). CONCLUSION: Overall, GM node perfusion was associated with severity rather than extent of WM network damage, supporting a primary etiology of GM hypoperfusion.

Diffusion-compensated tofts model suggests contrast leakage through aneurysm wall.

PURPOSE: The purpose of this study was to investigate the diffusional transport of contrast agent and its effects on kinetic modeling of dynamic contrast enhanced (DCE) images. METHODS: We performed simulations of our diffusion-compensated model and compared these results to human intracranial aneurysms (IAs). We derive an easy-to-use parameterization of diffusional effects that can provide an accurate estimate of diffusion corrected contrast agent leakage rates (ktrans ). Finally, we performed re-ansalysis of an existing data set to determine whether diffusion-corrected kinetic parameters improve the identification of high-risk IAs, thereby providing a new MRI-based imaging metric of IA stability based on wall integrity. RESULTS: Probability distributions of simulated versus measured data show contrast leakage away from the aneurysm wall. Parameterization of diffusional effects on ktrans showed high correlation with long-chain methods in both surrounding tissue and near the aneurysm wall (r2 = 0.91 and r2 = 0.90, respectively). Finally, size, ktrans , and ( ktrans-kDCtrans) showed significant univariate relationships with rupture risk (P < 0.05). CONCLUSIONS: We report the first evidence of diffusion-compensated permeability modeling in intracranial aneurysms and propose a parameterization of diffusional effects on ktrans . Furthermore, a comparison of measured versus simulated data suggests that contrast leakage occurs across the aneurysm wall. Magn Reson Med 78:2388-2398, 2017. © 2017 International Society for Magnetic Resonance in Medicine.

Snapshot MR technique to measure OEF using rapid frequency mapping.

Magnetic resonance (MR)-based oxygen extraction fraction (OEF) measurement techniques that use blood oxygen level-dependent (BOLD)-based approaches require the measurement of the R2' decay rate and deoxygenated blood volume to derive the local oxygen saturation in vivo. We describe here a novel approach to measure OEF using rapid local frequency mapping. By modeling the MR decay process in the static dephasing regime as two separate dissipative and oscillatory effects, we calculate the OEF from local frequencies measured across the brain by assuming that the biophysical mechanisms causing OEF-related frequency changes can be determined from the oscillatory effects. The Parameter Assessment by Retrieval from Signal Encoding (PARSE) technique was used to acquire the local frequency change maps. The PARSE images were taken on 11 normal volunteers, and 1 patient exhibiting hemodynamic stress. The mean MR-OEF in 11 normal subjects was 36.66±7.82%, in agreement with positron emission tomography (PET) literature. In regions of hemodynamic stress induced by vascular steal, OEF exhibits the predicted focal increases. These preliminary results show that it is possible to measure OEF using a rapid frequency mapping technique. Such a technique has numerous advantages including speed of acquisition, is noninvasive, and has sufficient spatial and temporal resolution.