Easy Identification of Optimal Coronal Slice on Brain Magnetic Resonance Imaging to Measure Hippocampal Area in Alzheimer's Disease Patients.

INTRODUCTION: Measurement of an- hippocampal area or volume is useful in clinical practice as a supportive aid for diagnosis of Alzheimer's disease. Since it is time-consuming and not simple, it is not being used very often. We present a simplified protocol for hippocampal atrophy evaluation based on a single optimal slice in Alzheimer's disease. METHODS: We defined a single optimal slice for hippocampal measurement on brain magnetic resonance imaging (MRI) at the plane where the amygdala disappears and only the hippocampus is present. We compared an absolute area and volume of the hippocampus on this optimal slice between 40 patients with Alzheimer disease and 40 age-, education- and gender-mateched elderly controls. Furthermore, we compared these results with those relative to the size of the brain or the skull: the area of the optimal slice normalized to the area of the brain at anterior commissure and the volume of the hippocampus normalized to the total intracranial volume. RESULTS: Hippocampal areas on the single optimal slice and hippocampal volumes on the left and right in the control group were significantly higher than those in the AD group. Normalized hippocampal areas and volumes on the left and right in the control group were significantly higher compared to the AD group. Absolute hippocampal areas and volumes did not significantly differ from corresponding normalized hippocampal areas as well as normalized hippocampal volumes using comparisons of areas under the receiver operating characteristic curves. CONCLUSION: The hippocampal area on the well-defined optimal slice of brain MRI can reliably substitute a complicated measurement of the hippocampal volume. Surprisingly, brain or skull normalization of these variables does not add any incremental differentiation between Alzheimer disease patients and controls or give better results.

[Reliability of the Evaluation of MRI Examinations after the Treatment of Chondral Defects in the Knee Joint]. / Spolehlivost hodnocení vysetrení na magnetické rezonanci po osetrení chondrálních defektu kolenního kloubu.

PURPOSE OF THE STUDY This study is a component part of the project focused on cartilage imaging after the treatment of a defect. It aims to compare the evaluation of postoperative status performed by two radiologists with the use of 2D MOCART scoring system and to determine whether this method is a reliable tool for the evaluation of postoperative changes. MATERIAL AND METHODS The study evaluated 78 MRI examinations from 25 patients (one patient had two defects treated), each of whom underwent 3 MRI examinations at 6, 12 and 18 months after surgery. The MRI examinations were performed on Philips Ingenia 3T scanner with 8-channel knee coil, in line with the routine protocol (coronal, sagittal and transversal PD SPAIR, coronal T1, sagittal PD HR, sagittal bFFE). The MRI examinations were evaluated independently by two radiologists using the 2D MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score. RESULTS The raters agreed in a total of 592 of 702 evaluations, therefore the inter-rater reliability is high, namely 84.3%. The highest inter-rater agreement was in assessing subchondral lamina and subchondral bone. Whereas the lowest inter-rater agreement was achieved in assessing effusion. The total score showed a very strong and statistically significant correlation (r = 0.893). In eight out of nine questions there was no statistically significant difference between the raters. A significant difference was seen only in the assessment of repair tissue structure. Excellent reliability of the total score was also confirmed by the intraclass correlation coefficient. DISCUSSION The high degree of agreement in assessing the signal intensity of repair tissue was considered very positive as it is generally viewed as the major pitfall in evaluations. On the contrary, subjective perception was confirmed in the evaluation of tissue homogeneity, especially when comparing homogeneity with the adjacent tissue in close vicinity that could have changed already. Surprisingly, the lowest inter-rater concordance was reported in the evaluation of effusion, where in some cases, its volume was underestimated, when traced back retrospectively. CONCLUSIONS The results of this study confirm that despite certain doubts regarding subjective perception of some of the evaluation criteria the 2D MOCART scoring system is a very good and objective tool to evaluate the effects of surgery. Key words: magnetic resonance imaging , hyaline cartilage, classification.

Late Functional and Morphological Findings after Methylalcohol Poisoning.

AIM: The aim of the study was to determine the morphological and functional findings in a patient after methanol poisoning. Examination methods: The patient (male, 38 years old) was suffered methanol poisoning in eight years ago (2012). The following tests and examinations were performed: neurological visual field XR test (Medmont M700), retinal nerve fibre layer (RNFL), ganglion cell complex (GCC) and peripapillary vessel density (all using Avanti RTvue, Optovue), pattern electroretinography (PERG) and pattern visual evoked potential (PVEP) examination according to ISCEV methodology (Roland Consult Instrument) and brain MRI examination (Philips Achieva Dstream 3 T). RESULTS: The biggest changes were found in RNFL and VD. PERG also showed damage to retinal ganglion cell axons. In left eye we determined decrease in oscillations (in comparison with contralateral eye) at N35-P50 and P50-N95. VEPs in both eyes were significantly reduced, almost inconspicuous in the left eye. Extension of latency time of P100 was not identified. Functional MRI showed a bilateral decrease in voxel activity with a greater decrease in the left eye. There were postmalatical changes in the dorsal parts of the putamen on MRI. The width of the optic nerve and chiasm was physiological. CONCLUSION: Asymmetric damaging of RNFL and cortical centres of the brain were determined. We registered large pathological changes in VD, which are probably responsible for the deepening of optic nerve excavation and further loss of nerve fibers of retinal ganglion cells, which have not yet been described in the literature. Following these results is possible to define direct damage of nerve structures and blood vessels by toxins of methanol metabolism in the acute stage and upcoming reparation processes in following periods.

Individual prolactin reactivity modulates response of nucleus accumbens to erotic stimuli during acute cannabis intoxication: an fMRI pilot study.

RATIONALE: Self-report studies indicate that cannabis could increase sexual desire in some users. We hypothesized that intoxication increases activation of brain areas responsive to visual erotica, which could be useful in the treatment of hypoactive sexual desire disorder, a condition marked by a lack of sexual desire. OBJECTIVES: The aim of this study is to assess the aphrodisiacal properties of cannabis. METHODS: We conducted an open-randomized study with 21 heterosexual casual cannabis users. A 3T MRI was used to measure brain activation in response to erotic pictures. Blood samples were collected to determine the serum levels of cannabinoids, cortisol and prolactin. Participants were grouped according to whether they had ever experienced any aphrodisiacal effects during intoxication (Group A) or not (Group non-A). RESULTS: Intoxication was found to significantly increase activation in the right nucleus accumbens in the Group A while significantly decreasing activation in the Group non-A. There was also a significant interaction between the group and intoxication, with elevated prolactin in the Group non-A during intoxication. No intoxication-related differences in subjective picture evaluations were found. CONCLUSION: Cannabis intoxication increases activation of the right nucleus accumbens to erotic stimuli. This effect is limited to users whose prolactin is not elevated in response to intoxication. This effect may be useful in the treatment of low sexual desire.

[Functional Magnetic Resonance Imaging in Selected Eye Diseases]. / Funkcní magnetická rezonance u vybraných ocních onemocnení.

In the study, an actual overview of eyes examinations by means of functional magnetic resonance focused on selected eyes diseases is presented. Special attention is paid to hypertension glaucomas, normotension glaucoma, age-related macular degeneration, and peeling of the epimacular membrane and the internal limiting membrane. The authors point out the decreased activity of the visual cortex in diseases in which the damage of retinal ganglion cells occurs.

One-year results from cryopreserved mitral allograft transplantation into the tricuspid position in a sheep experimental model.

Mitral allografts are still used only exceptionally in the mitral or tricuspid position. The main indication remains infectious endocarditis of atrioventricular valves for its flexibility and low risk of infection. The aim of our study was to evaluate 1-year results of mitral allografts transplantation into the tricuspid position in a sheep model. Mitral allografts were processed, cryopreserved, and transplanted into the tricuspid position anatomically (Group I - 11 animals) or antianatomically (Group II - 8 animals). All survivors (4 from Group I, and 3 from Group II) were checked at 3, 6, and 12 months by echocardiography with the exception of one survivor from Group II (which was examinated only visually). Examination throughout follow-up included for mitral allograft regurgitation and annuli dilatation. At postmortem, the papillary muscles were healed and firmly anchored to the right ventricular wall in all subjects. Transventricular fixation of the papillary muscles with buttressed sutures was proven to be a stable, reproducible, and safe method for anchoring mitral allograft leaflets. There were no significant differences between the two implantation methods. Annulus support of mitral allografts might be very useful in this type of operation and could prevent annular dilatation.

White matter changes in first episode psychosis and their relation to the size of sample studied: a DTI study.

BACKGROUND: White matter abnormality has been recently proposed as a pathophysiological feature of schizophrenia (SZ). However, most of the data available has been gathered from chronic patients, and was therefore possibly confounded by factors such as duration of the disease, and treatment received. The extent and localization of these changes is also not clear. METHODS: We examined a population of early stage SZ patients using diffusion tensor imaging (DTI). 77 SZ patients and 60 healthy controls (HCs) were included in the analysis using Tract-Based Spatial Statistics (TBSS). We have also analyzed 250 randomly created subsets of the original cohort, to investigate the relation between the result of TBSS analysis, and the size of the sample studied. RESULTS: We have found a significant decrease in fractional anisotropy (FA) in the patient group. This change is present in most major white matter (WM) tracts including the corpus callosum, superior and inferior longitudinal fasciculi, inferior fronto-occipital fasciculus, and posterior thalamic radiation. Furthermore, we identified a clear trend towards an increase in the number and spatial extent of significant voxels reported, with an increasing number of subjects included in the analysis. CONCLUSION: Our study shows that FA is significantly decreased in patients at an early stage of schizophrenia, and that the extent of this finding is dependent on the size of studied sample; therefore underpowered studies might produce results with false spatial localization.

Diffusion tensor imaging and MR morphometry of the central auditory pathway and auditory cortex in aging.

Age-related hearing loss (presbycusis) is caused mainly by the hypofunction of the inner ear, but recent findings point also toward a central component of presbycusis. We used MR morphometry and diffusion tensor imaging (DTI) with a 3T MR system with the aim to study the state of the central auditory system in a group of elderly subjects (>65years) with mild presbycusis, in a group of elderly subjects with expressed presbycusis and in young controls. Cortical reconstruction, volumetric segmentation and auditory pathway tractography were performed. Three parameters were evaluated by morphometry: the volume of the gray matter, the surface area of the gyrus and the thickness of the cortex. In all experimental groups the surface area and gray matter volume were larger on the left side in Heschl's gyrus and planum temporale and slightly larger in the gyrus frontalis superior, whereas they were larger on the right side in the primary visual cortex. Almost all of the measured parameters were significantly smaller in the elderly subjects in Heschl's gyrus, planum temporale and gyrus frontalis superior. Aging did not change the side asymmetry (laterality) of the gyri. In the central part of the auditory pathway above the inferior colliculus, a trend toward an effect of aging was present in the axial vector of the diffusion (L1) variable of DTI, with increased values observed in elderly subjects. A trend toward a decrease of L1 on the left side, which was more pronounced in the elderly groups, was observed. The effect of hearing loss was present in subjects with expressed presbycusis as a trend toward an increase of the radial vectors (L2L3) in the white matter under Heschl's gyrus. These results suggest that in addition to peripheral changes, changes in the central part of the auditory system in elderly subjects are also present; however, the extent of hearing loss does not play a significant role in the central changes.

One-day kinetics of myocardial engraftment after intracoronary injection of bone marrow mononuclear cells in patients with acute and chronic myocardial infarction.

OBJECTIVE: To investigate the kinetics of myocardial engraftment of bone marrow-derived mononuclear cells (BMNCs) after intracoronary injection using 99mTc-d,l-hexamethylpropylene amine oxime (99mTc-HMPAO) nuclear imaging in patients with acute and chronic anterior myocardial infarction. DESIGN: Nuclear imaging-derived tracking of BMNCs at 2 and 20 h after injection in the left anterior descending (LAD) coronary artery. SETTING: Academical cardiocentre. PATIENTS: Five patients with acute (mean (SD) age 58 (11) years; ejection fraction range 33-45%) and five patients with chronic (mean (SD) age 50 (6) years; ejection fraction range 28-34%) anterior myocardial infarction. INTERVENTIONS: A total of 24.2 x 10(8)-57.0 x 10(8) BMNCs (20% labelled with 700-1000 MBq 99mTc-HMPAO) were injected in the LAD coronary artery. RESULTS: At 2 h after BMNC injection, myocardial activity was observed in all patients with acute (range 1.31-5.10%) and in all but one patient with chronic infarction (range 1.10-3.0%). At 20 h, myocardial engraftment was noted only in three patients with acute myocardial infarction, whereas no myocardial activity was noted in any patient with chronic infarction. CONCLUSIONS: Engraftment of BMNCs shows dynamic changes within the first 20 h after intracoronary injection. Persistent myocardial engraftment was noted only in a subset of patients with acute myocardial infarction.

The effect of tryptophan depletion on brain activation measured by functional magnetic resonance imaging during the Stroop test in healthy subjects.

We investigated the role of serotonin in cognitive activation of the frontal cortex. The serotonergic system was affected by the administration of an amino acids mixture without tryptophan (tryptophan depletion). In a placebo-controlled double-blind cross-over study with 20 healthy volunteers, we tested the hypothesis that a tryptophan (serotonin) decrease affects the activation of prefrontal cortex by the Stroop test. Cognitive brain activation was evaluated by functional magnetic resonance imaging (fMRI). Tryptophan depletion decreased the plasma tryptophan level up to 90 % for five hours after the tryptophan-free drink had been consumed when compared with the same mixture with tryptophan (p?0.0001). Tryptophan depletion did not affect the Stroop test performance. We compared fMRI activation in both conditions (tryptophan depletion and placebo) with plasma tryptophan levels as the covariates. The tryptophan depletion increased the activation (fMRI signal) in the bilateral mediofrontal cortex, anterior cingulate and left dorsolateral prefrontal cortex. The present findings allow the postulate that serotonergic medial forebrain and cingulum bundle pathways play a role in the activity of cortical structures involved in Stroop test processing.

Quantification of intra-abdominal fat during controlled weight reduction: assessment using the water-suppressed breath-hold MRI technique.

A group of 14 healthy female subjects was studied using MRI during 2 months of life-style intervention. A series of 21 water-suppressed images was used to determine the intra-abdominal fat volume before and after the controlled loss of weight. The average weight decrease was 8.2 %, but the average relative loss of visceral fat was 20.3 %, whereas subcutaneous fat decreased by 13.4 %. A small but significant increase of insulin sensitivity (decrease in fasting insulin and blood glucose) was observed, but no changes in lipoprotein parameters were demonstrated. There was a significant negative correlation (r=-0.633, p=0.028) between the relative abdominal fat decrease and the initial amount of subcutaneous fat.

Olfactory activity in the human brain identified by fMRI.

BACKGROUND: Modern imaging methods such as functional magnetic resonance imaging (fMRI) or positron emission tomography (PET) enable us to map brain activities associated with stimulation of various functional systems in the human brain. Data concerning the localization and lateralization of secondary olfactory areas are not in agreement. THE AIM OF THE STUDY: localization of secondary olfactory brain areas activated by a pleasant stimulus--vanillin. METHODS AND MATERIAL: Our fMRI method was based on the blood-oxygen-level dependent effect. All measurements were carried out on a 1.5 T scanner (Siemens-Vision), using gradient-echo EPI technic. The basic block-like scheme included no odour/and odour was repeated 8 times. In the definitive phase of the study, experiments were performed on 12 healthy volunteers aged from 20 to 68 (9 men and 3 women) stimulated birhinally by vanillin odour. RESULTS: Bilateral activations of the inferior frontal gyrus, anterior insular-periinsular area, hippocampus, amygdala, caudate nucleus and cerebellum were seen. A greater extent of activation was evident in the right hemisphere and in the right half of the cerebellum. CONCLUSIONS: The anterior insular-periinsular area and hippocampus can be considered as secondary olfactory areas in human brain. Strong activation of the right inferior frontal gyrus demonstrated in our study may be related to effort to name the presented odour. Activation of the cerebellum may be evaluated as a consequent phenomenon due to extensive activation of the frontal lobe.

Differences in fMRI and MRS in a monozygotic twin pair discordant for schizophrenia (case report).

OBJECTIVE: This paper presents functional magnetic resonance imaging (fMRI) and magnetic resonance spectroscopy (MRS) findings in a monozygotic twin pair discordant for schizophrenia. METHOD: Functional magnetic resonance imaging was used to determine hemispheric lateralization for speech and proton MRS (1H-MRS) was employed to assess the extent of putative insult to anterior hippocampus. RESULTS: Despite concordant right handedness, subject with schizophrenia displayed bilateral activation in areas subserving speech with greater extent of the total activated area compared with the healthy twin. The affected twin displayed relative bilateral decrease in N-acetylaspartate/creatin concentration in the anterior hippocampus compared with the healthy one. CONCLUSION: This is an evidence for non-genetic impairment of cerebral lateralization in monozygotic twin with schizophrenia.

Water ADC, extracellular space volume, and tortuosity in the rat cortex after traumatic injury.

The diffusion parameters in rat cortex were studied 3-35 days following a cortical stab wound, using diffusion-weighted MR to determine the apparent diffusion coefficient of water (ADC(W)) in the tissue, and the real-time iontophoretic tetramethylammonium (TMA) method to measure the extracellular space (ECS) diffusion parameters: ECS volume fraction alpha and the ADC of TMA(+) (ADC(TMA)). Severe astrogliosis was found close to the wound, and mild astrogliosis was found in the ipsilateral but not the contralateral cortex. Chondroitin sulfate proteoglycan (CSPG) expression was increased throughout the ipsilateral cortex. In the hemisphere contralateral to the wound, alpha, ADC(TMA), and ADC(W) were not significantly different from control values. ECS volume fraction was increased only in the vicinity of the wound, in the region of cell death and severe astrogliosis, at 3 and 7 days after injury. However, both ADC(TMA) and ADC(W) were significantly decreased after lesion in the vicinity of the wound as well as in the rest of the ipsilateral hemisphere distant from the wound. Thus, both ADC(W) and ADC(TMA) decreased in regions wherein alpha did not change but CSPG increased. An increase in extracellular matrix expression may therefore impose diffusion barriers for water as well as for TMA molecules.

Medical application of 3-D polymer gel dosemeter evaluated by nuclear magnetic resonance.

A polymer-gel dosemeter, which can be evaluated by nuclear magnetic resonance (NMR), was prepared and then a few samples were homogeneously irradiated by a Leksell gamma knife using an 18 mm collimator (60Co gamma photons) to obtain a calibration curve (NMR 1/T2 response to absorbed dose). To measure dose distribution from the Leksell gamma knife, a testing flask tilled with the gel was fixed in the head phantom and then irradiated based on a calculated treatment plan. Evaluation of dosemeters was performed on a Siemens EXPERT 1T NMR scanner. Dose profiles in X, Y and Z coordinates through the ellipsoidal shape of the dose distribution were obtained to compare experimental results from the irradiated phantom with the treatment planning system calculations. The use of a polymer-gel dosemeter for a verification of stereotactic procedures has some unique advantages which can be summarised as follows: (1) the dosemeter itself is tissue equivalent, (2) three-dimensional dose distributions can be measured, (3) the dosemeter allows patient's procedures to be simulated without any limitations.

Functional magnetic resonance imaging during deep brain stimulation: a pilot study in four patients with Parkinson's disease.

Functional magnetic resonance imaging (fMRI) was performed in patients with Parkinson's disease during deep brain stimulation of the subthalamic nucleus (three patients) and during deep brain stimulation of the ventral intermedius nucleus of the thalamus (one patient). All showed an increase in blood oxygenation level-dependent signal in the subcortical regions ipsilateral to the stimulated nucleus. This effect cannot be simply explained by a mechanism of depolarization blockade; rather, it is caused by overstimulation of the target nucleus, resulting in the suppression of its spontaneous activity. We confirm that fMRI during deep brain stimulation is a safe method with considerable potential for elucidating the functional connectivity of the stimulated nuclei.

MR in phenylketonuria-related brain lesions.

PURPOSE: Phenylketonuria (PKU) patients were examined by different MR techniques to explain the pathological changes observed in periventricular white brain matter using conventional MR imaging. MATERIAL AND METHODS: Fifteen patients with treated classical PKU were examined by 1H spectroscopy, relaxometry and diffusion imaging on a whole-body 1.5-T MR imager. RESULTS: Known PKU lesions characterized by T2 enhancement in periventricular white matter were observed in all patients. The MR spectra from the lesioned areas showed a significant decrease in choline concentration. The mean ADC of water decreased and tortuosity increased in PKU lesions compared to control data. CONCLUSION: The results support the following hypothesis: The T2 increase in the PKU lesion reflects a raised concentration of free water molecules (about 15%) that have an increased trajectory between collisions compared to the same region in controls. The increase in water mobility might be explained by changes in extracellular space volume and myelin sheaths, which, presumably, have a different geometry with more hydrophobic sites in PKU patients. The changes result in increased tortuosity and may be confirmed by the loss of anisotropy in PKU lesions.

Application of two-dimensional CSI for absolute quantification of phosphorus metabolites in the human liver.

There have recently been a number of studies dealing with the absolute quantification of concentrations of MR-visible phosphorus compounds in different tissues. The use of absolute values rather than intensity ratios may furnish additional information about metabolic changes associated with different diseases. The purpose of this study was to develop a general procedure for measuring molar metabolite concentrations and to apply it with respect to the evaluation of human liver 31P-MRS data measured using a standard slice-selective two-dimensional CSI sequence and commercial 1H/31P surface coil. The experimental determination of all surface coil-related factors influencing signal intensity was undertaken using a gradient echo imaging technique that can be adapted to commercial systems. The resulting values for healthy volunteers (N = 9) showed concentrations of PME = 2.8 +/- 1.3 mM, PDE = 9.9 +/- 2.7 mM, P(i) = 1.7+/-0.7 mM, and ATP = 3.6 +/- 0.9 mM in the human liver. The data are quite consistent with published findings.

Brain activation during volitional control of breathing.

Functional magnetic resonance imaging (fMRI) was used to demonstrate the brain activation during volitional control of breathing in nine healthy human subjects. This type of breathing was induced by acoustic stimuli dictating the respiratory frequency. During the period of dictated breathing not only the frontal and temporal lobes of the brain, but also the parietal lobes were bilaterally activated. The frontal lobe was activated bilaterally in all subjects, with frequent activation of Brodmann areas 4 and 6. In the parietal lobe, activation could mostly be demonstrated in gyrus postcentralis and the same was true for area 22 in the temporal lobe.