Subacute clot mimicking flow in a thrombosed arterial bypass graft on two-dimensional time-of-flight and three-dimensional contrast-enhanced MRA.

Subacute intravascular thrombus can contain methemoglobin, which results in very short spin-lattice (T1) relaxation times. We describe a case of a 78-year-old man with increasing right lower extremity claudication. The patient had a thrombosed arterial bypass graft showing high signal intensity that mimicked flow on both two-dimensional time-of-flight and three-dimensional contrast-enhanced MR angiography. Misinterpretation of the high signal thrombus as flowing blood can be avoided by obtaining a precontrast T1-weighted sequence.

Congenital esophageal stenosis in adults.

OBJECTIVE: Congenital esophageal stenosis is thought to be a rare disease confined to infancy and childhood with only a few case reports in adults described. METHODS: We report five patients between the ages of 19 and 46 yr who presented with this disorder over a 2-yr period. RESULTS: Patients had been labeled with reflux strictures, webs, or as idiopathic in the past. All patients had chronic solid food dysphagia, some since early childhood. The location of the stricture varied, occurring in the mid or proximal esophagus in four, but throughout the esophagus in one. Radiographic and endoscopic appearance was a smooth concentric stricture or multiple rings, sometimes tracheal in appearance. Endosonography was performed in two patients, both of whom had focal circumferential hypoechoic wall thickening with disruption of the normal layer pattern corresponding to the areas of luminal narrowing. All patients dilated had good symptomatic response, with resolution of symptoms up to 6 months in follow-up. CONCLUSIONS: We suggest that congenital esophageal stenosis does occur in adults and may be underrecognized. Its endosonographic appearance is described.

Quantitative magnetic resonance imaging demonstrates alterations of the lingual musculature in obstructive sleep apnea.

Upper airway musculature is important in the pathogenesis of obstructive sleep apnea. Electromyographic studies of patients with obstructive sleep apnea demonstrate increased activity of upper airway dilator muscles. Biopsy studies of these muscles show both adaptation and muscle injury. In this study we utilized quantitative magnetic resonance imaging to characterize changes in the upper airway musculature of patients with obstructive sleep apnea. This technique provides measurements of the T2 relaxation times of upper airway muscles (genioglossus, geniohyoid, sternohyoid/sternothyroid) spatially localized to submillimeter resolution. Our results demonstrate that the mean T2 values of genioglossus (p = 0.04) and geniohyoid (p = 0.06) differ between the apneic and control groups, while the values for the sternohyoid/sternothyroid muscles (p = 0.6) are similar between groups. In both apneics and normals respectively the T2 values for the genioglossus (p = 0.0003, 0.0001) and geniohyoid (p = 0.0054, 0.001) were significantly greater than for the sternohyoid/sternothyroid muscles. The changes observed are compatible with the hypothesis that there is increased edema and possibly increased fat content of the tongue muscles in patients with obstructive sleep apnea.

Sodium NMR evaluation of articular cartilage degradation.

One of the first effects of degenerative osteoarthritis is the loss of proteoglycans from the matrix of articular cartilage. Using a model of osteoarthritic change where the cartilage has been enzymatically degraded with trypsin, the sodium NMR characteristics of the cartilage were determined as a function of changes in the proteoglycan content. The results demonstrate that the single quantum sodium signal decreases as the proteoglycan content of the cartilage matrix decreases. In addition, the relaxation characteristics of the sodium change such that the T1 is longer, the T2s is longer, and the T2f is shorter. Short echo-time, T1-weighted sodium images are presented which demonstrate that this information may be utilized to detect the loss of proteoglycans from articular cartilage.

Improved resolution and signal-to-noise ratio in MRI via enhanced signal digitization.

The high frequency k-space data in magnetic resonance imaging is often poorly reproduced due to the finite dynamic range of an analog-to-digital converter. The magnitude of this digitization error can equal and even exceed the magnitude of the thermal noise. Under such conditions, attempts to increase image signal-to-noise ratio via signal averaging meet with diminishing success. Because the relative size of the digitization error increases at higher spatial frequencies, a reduction in image resolution is incurred as well. By adjusting the level of the analog signal sampled by the analog-to-digital converter during the course of an imaging experiment, the magnitude of the digitization artifact can be greatly reduced. The results of simulations and imaging experiments are presented which demonstrate that this strategy improves both the signal-to-noise ratio and resolution of magnetic resonance images.

Generalized reciprocity.

The remarkable theorem of reciprocity as described by D. I. Hoult and R. E. Richards (J. Magn. Reson. 24, 71 (1976)) may be generalized to account for the near, intermediate, and radiation zone fields of a magnetic dipole. This form of reciprocity may be important when the wavelength of the NMR signal is not large compared to the distance scale of the system. In these situations the effects of interference may be significant. In addition, both the frequency dependence and distance dependence of the NMR signal amplitude are altered. In general, the distance dependence of the signal follows a weighted sum of 1/r3, 1/r2, and 1/r dependence. The frequency dependence of the signal amplitude is a function of omega, omega2, and omega3. Finally, the signal reflects the full vector field nature of the magnetic dipole. The mathematical expression of generalized reciprocity is completely equivalent to that of Hoult and Richards if the appropriate retarded potential form of the magnetic field is utilized.

Sodium MRI of human articular cartilage in vivo.

Preliminary results from in vivo sodium MRI of human patellar articular cartilage are presented. Sodium images generated of an in vitro bovine patella clearly distinguish the region of proteoglycan depletion from the region of healthy cartilage. This provides the first evidence that sodium imaging may be used to detect changes due to osteoarthritis in vivo. The process of optimizing imaging time and signal-to-noise ratio, as well as potential implications in the detection of osteoarthritic change, are discussed.

High resolution, short echo time sodium imaging of articular cartilage.

The sodium present in articular cartilage interacts with the negatively charged proteoglycan aggregates in the matrix of the cartilage. Sodium images of short echo time may be useful for detecting changes that occur in the proteoglycan content of the cartilage. Such changes are indicative of early osteoarthritic damage, for example. Using an asymmetric short echo technique, sodium images of high resolution and signal-to-noise ratio that demonstrate anatomic features of the cartilage are presented. These images were obtained with echo times as short as 1 msec, at an in-plane resolution of 39 microns by 117 microns and signal-to-noise ratios of up to 40:1.

Quantification of cerebral ventricular volume in English bulldogs.

Quantitative measurement of cerebral ventricle volume of eight English bulldogs was performed using magnetic resonance (MR) imaging. The mean ventricular volume was 14.8 ml. with a range of 8.6 ml.-38.1 ml. The mean ventricular volume of two beagles was 2.2 ml with a range of 0.7 ml.-3.7 ml. The percent of intracranial volume occupied by ventricle was found to be significantly larger in bulldogs (14.0%; S.D. = 7.9%) than in beagles (Range = 1.0-4.8%). The relationship between the percent of intracranial volume occupied by ventricle and measurements of body weight, age, sex, and various measures of skull anatomy of the bulldog was also determined. The relationship between ventricular volume and neurologic dysfunction was examined. There was a possible trend between high percent of intracranial volume occupied by ventricle and low body weight. This study will serve as a pilot study for examining the relationship between ventricular volume and neurologic disease in bulldogs.

Triple quantum sodium imaging of articular cartilage.

Triple quantum (TQ) sodium imaging of bovine articular cartilage is presented. True triple quantum imaging sequence was modified to incorporate asymmetric echo acquisition. Triple quantum signal expression in the presence of residual quadrupolar interaction is presented. The filtering capability of the sequence is first demonstrated on an agarose phantom. Both single and triple quantum images of articular cartilage are compared. The TQ image shows non-zero signal intensity solely from cartilage, indicating complete suppression of signals from bone marrow and saline. The advantages of TQ imaging of articular cartilage, its feasibility in in vivo situations and further improvements in SNR are described.

Volumetric measurement of human calf muscle from magnetic resonance imaging.

Muscle mass is a determining factor in skeletal muscle function and is affected by inactivity, immobilization, disease, and aging. The aim of this study was to develop an objective and time-efficient method to quantify the volume and cross-sectional area of human calf muscles using three-dimensional magnetic resonance images. We have estimated the errors incurred in muscle volume measurements arising from artifacts known to occur in magnetic resonance imaging (MRI). The largest source of error was due to partial volume effects, which resulted in overestimation of phantom volumes ranging from 145 to 900 cc by 6% to 13%. The magnitude of this effect has been shown to increase with decreasing object size and decreasing spatial resolution. We have presented a straightforward correction for this effect, which has reduced the volume measurement error to less than 4% for all cases. Through the use of computer simulations, the correction algorithm has been shown to be independent of object shape and orientation. To reduce user subjectivity, a semiautomated computer program has been developed to segment MRI data for particular muscle groups. Images from seven human subjects were analyzed by the program, yielding muscle volumes of 154.2 +/- 23.2, 281.2 +/- 35.8, and 432.2 +/- 83.7 for the lateral gastrocnemius, medial gastrocnemius, and soleus, respectively.

Multicoil array for high resolution imaging of the breast.

An RF multicoil array for high resolution imaging of the breast is presented. The RF multicoil is incorporated into a dedicated breast imaging apparatus that holds either breast in gentle compression during imaging. Simulations and imaging experiments demonstrate the high sensitivity and RF homogeneity of the multicoil array. Direct comparisons are made between the multicoil and a surface coil. In vivo images are presented to demonstrate the homogeneity of the RF field of the multicoil over the entire breast. An in vivo image of both high temporal and spatial resolution is shown, which demonstrates the sensitivity of the RF multicoil array that may be achieved in a practical imaging experiment.

Antiphospholipid syndrome: patterns of life-threatening and severe recurrent vascular complications.

PURPOSE: To demonstrate the variety and recurrence patterns of severe arterial and venous thromboembolic events that occur in patients with the antiphospholipid syndrome. MATERIALS AND METHODS: Radiology records were reviewed in 800 of 1,633 patients with positive test results of antiphospholipid syndrome. Patients with radiologic evidence of antiphospholipid syndrome and no other hypercoagulable state were included if the observed thromboembolic event met one or more of four criteria for severity: extreme complications or mortality, three or more recurrent events, unusually young age, and/or unusual sites affected. RESULTS: In the 24 patients who met the selection criteria, 72 thromboembolic episodes and 56 (78%) recurrences were found. Arterial complications included aortic occlusions, visceral infarctions, upper- and lower-extremity arterial thrombosis, strokes, and repeated graft occlusions. Venous complications included portal vein thrombosis, transverse and sagittal sinus thrombosis, upper- and lower-extremity thrombosis, and recurrent pulmonary emboli. CONCLUSION: Vascular complications of antiphospholipid syndrome include serious and life-threatening events. Primary thromboembolic episodes often recur at the same site or within the same system (arterial vs venous system). These events can also trigger a rapid succession of critical thrombotic episodes at multiple sites.

Quantitative magnetic resonance imaging of upper airways musculature in an animal model of sleep apnea.

Electromyographic studies of patients with sleep apnea and of the English bulldog, an animal model of sleep apnea, indicate that there is increase activity of the airways dilator muscles. The muscles, when biopsied, show both adaptation and muscle injury. In this study we have utilized quantitative magnetic resonance imaging to characterize changes in the upper airway musculature of the bulldog in vivo. The imaging procedure utilized provided a quantitative measurement of the T2 relaxation times of airway muscle (geniohyoid, sternohyoid, sternothyroid, thyropharyngeus, and hyopharyngeus) and nonairway muscles spatially localized to submillimeter-resolution levels. Quantitative differences between the medians and distributions of T2 relaxation times of airway vs. nonairway muscles were demonstrated. These differences were related to the degree of sleep-disordered breathing. The changes observed are compatible with the hypothesis that there is both increased edema and fibrosis in upper airway muscle in sleep apnea.

17O-decoupled 1H detection using a double-tuned coil.

17O-decoupled proton MR spectroscopy imaging with a double-tuned radiofrequency (RF) coil at 2 T was used to detect and quantify H2 17O in tissue containing various concentrations of 17O-enriched water in 5% gelatin. The pulse sequence used in these experiments consisted of a conventional proton spin-echo sequence with RF irradiation at the 17O resonance frequency applied between the proton 90 degrees pulse and the signal acquisition window. The double-tuned coil provided several advantages over systems using separate RF coils for 17O decoupling and proton excitation/detection, including ensuring that the same (or similar) sample volumes are excited and decoupled and permitting accurate calibration of the 17O decoupling pulse amplitude. The efficiency of 17O decoupling as a function of decoupling RF amplitude, decoupling duration, and decoupling resonance offset was investigated. Finally, the specific absorption rate of the 17O decoupled pulse sequence was investigated and found to lie within federal guidelines at 1.5 T.

Renal perfusion in humans: MR imaging with spin tagging of arterial water.

The authors tested a noninvasive technique for magnetic resonance imaging of perfusion in human kidneys. Magnetic labeling (spin tagging) of aortic arterial water was performed to generate an endogenous tracer. Breath-hold renal perfusion images obtained in seven volunteers yielded average perfusion rates in cortex and medulla of 278 mL.100 g-1.min-1 +/- 55 (standard error) and 55 mL.100 g-1.min-1 +/- 25, respectively.

Quantitative magnetic resonance imaging of human brain perfusion at 1.5 T using steady-state inversion of arterial water.

We report our experience using a noninvasive magnetic resonance technique for quantitative imaging of human brain perfusion at 1.5 T. This technique uses magnetically inverted arterial water as a freely diffusible blood flow tracer. A perfusion image is calculated from magnetic resonance images acquired with and without arterial blood inversion and from an image of the apparent spin-lattice relaxation time. Single-slice perfusion maps were obtained from nine volunteers with approximately 1 x 2 x 5-mm resolution in an acquisition time of 15 min. Analysis yielded average perfusion rates of 93 +/- 16 ml.100 g-1.min-1 for gray matter, 38 +/- 10 ml.100 g-1.min-1 for white matter, and 52 +/- 8 ml.100 g-1.min-1 for whole brain. Significant changes in perfusion were observed during hyperventilation and breath holding. This technique may be used for quantitative measurement of perfusion in human brain without the risks and expense of methods which use exogenous tracers.

Continuous inversion angiography.

A subtractive time-of-flight technique for magnetic resonance angiography is described. In this approach, the arterial supply to an organ is inverted in a steady-state fashion by applying off-resonance irradiation in the presence of a linear magnetic field gradient. An angiogram is formed by subtracting an image acquired with arterial inversion from a control image acquired with no arterial inversion. A single coil is used to apply both the inversion and observation pulses. Intracranial angiograms obtained from normal volunteers using a two-dimensional projective implementation of this technique at 1.5 T illustrate excellent small vessel detail and background suppression.