Thigh muscle function in stroke patients revealed by velocity-encoded cine phase-contrast magnetic resonance imaging.

Current methods of clinical assessment of muscle coordination and function after stroke do not provide information on deep muscles. The objective of this study was to examine how stroke affects both superficial and deep muscles' coordination and whether muscle function improves after rehabilitation. Muscle function, coordination, and activity of quadriceps femoris (QF) and hamstrings were evaluated in 10 stroke patients with mild hemiparesis and in 6 controls using velocity-encoded cine phase-contrast magnetic resonance imaging (VE-PC MRI), surface electromyography (sEMG), and maximal voluntary isometric contraction torque (MVC). At baseline, the peak muscle velocity of the rectus femoris (RF) and the ratio between the peak velocities of the RF and vasti were lower in the affected limb (AL) of stroke patients than in controls. Co-contraction of agonists and antagonists was higher in the AL than in controls. Muscle activity measured by sEMG showed similar behavior. After rehabilitation, the activity ratio of hamstrings and adductors to QF decreased slightly toward normal so there were no significant differences between the AL and controls. Impaired biarticular RF muscle function in stroke patients is the limiting factor during knee extension-flexion movements. After rehabilitation, improved functional performance was partly explained by the fact that the activities of the RF and vasti became more synchronized. VE-PC MRI can provide quantitative in vivo measurements of both superficial and deep muscles, and the information acquired after stroke can be utilized to render therapy more efficient and individually tailored.

Mechanical behavior of the quadriceps femoris muscle tendon unit during low-load contractions.

We examined the relationships between morphology and muscle-tendon dynamics of the quadriceps femoris muscle of 11 men using velocity-encoded phase-contrast magnetic resonance imaging (MRI). Thigh muscle electromyography and joint range of motion were first measured outside the MRI scanner during knee extension-flexion tasks that were performed at a rate of 40 times/min with elastic bands providing peak resistance of 5.2 kp (SD 0.4) to the extension. The same movement was repeated inside the MRI scanner bore where tissue velocities and muscle morphology were recorded. The average displacement in the proximal and distal halves of the rectus femoris and vastus intermedius aponeuroses was different (P = 0.049), reflecting shortening (1.6%), but the tensile strain along the length of the aponeuroses was uniform. The aponeurosis behavior varied among individuals, and these individual patterns were best explained by the differences in relative cross-sectional area of rectus femoris to vastus muscles (r = 0.71, P = 0.014). During dynamic contraction, considerable deformation of muscles in the axial plane caused an anatomic measure such as muscle thickness to change differently (decrease or increase) in different sites of measurement. For example, when analyzed from the axial images, the vastus lateralis thickness did not change (P = 0.946) in the frontal plane through femur but increased in a 45 degrees oblique plane between the frontal and sagittal planes (P = 0.004). The present observations of the heterogeneity and individual behavior emphasize the fact that single-point measurements do not always reflect the overall behavior of muscle-tendon unit.

A feasibility study of magnetic resonance imaging of silicone breast implants in Finland.

Cosmetic breast implants have become increasingly popular throughout the world. However, there is insufficient knowledge about the frequency and severity of local complications such as rupture and capsular contracture. A pilot study of 25 Finnish women with 50 cosmetic breast implants was organized to determine the feasibility of conducting a magnetic resonance imaging (MRI)-based study of rupture incidence. The pilot investigation included a clinical examination by a plastic surgeon, MRI scan, and self-administered questionnaire. The participation rate was 100%. Implants in our study represented a cross-section of the different generations of implants in Finland, with implant ages varying from 4 months to 20 years. The average implant size was 215 mL, typical in Finnish cosmetic surgery. MR images were evaluated by two independent readers. The first reader diagnosed six implants with intracapsular rupture, while the other diagnosed all implants as intact. The procedures of the feasibility study proved successful, and the results demonstrate the importance of a rigid image evaluation protocol with employment of well-defined rupture criteria, as well as the benefits of several image readers.

Assessment of cerebral hemodynamics and oxygen extraction using dynamic susceptibility contrast and spin echo blood oxygenation level-dependent magnetic resonance imaging: applications to carotid stenosis patients.

Blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) has been recently used to quantify cerebral blood volume (CBV) and oxygen extraction ratio (OER). In the present study, we have exploited the intravascular BOLD model to assess gray matter (GM) OER at hemispheric level using parenchymal T(2) and CBV data at 1.5 T, obtained by single spin echo and dynamic susceptibility contrast (DSC) perfusion MRI, respectively. An OER of 0.40 +/- 0.07 was determined in gray matter for control subjects. A group of carotid stenosis (CS) patients (n = 22) was examined by multiparametric MRI. The degree of CS was determined by contrast agent-enhanced magnetic resonance angiography. Within the group, eight cases with <70% narrowing of a carotid lumen, nine cases with 70-99%, and five cases with complete occlusion of either carotid arteries were found. DSC MRI revealed abnormalities in 14 patients in dynamic parameters of perfusion images. These included four cases with elevated hemispheric gray matter CBV ipsilateral to the stenosis, above 2 SD of the level determined in control subjects. These four patients showed large variation in the degree of stenosis. We also found three cases with ipsilateral gray matter CBV below 2 SD of the control value, two of these with >70% stenosis. Gray matter OER ipsilateral to the stenosis was above 2 SD of the control range in eight CS patients, three of these showing also high CBV. Use of the present approach to determine OER for the assessment of hemodynamic adaptations in CS patients is discussed in the light of documented hemodynamic adaptations to carotid stenosis.

An evaluation of pelvic floor anatomy and function by MRI.

OBJECTIVE: In this experimental study, we wanted to evaluate the informative value of dynamic magnetic resonance imaging in pelvic floor anatomy during pelvic floor muscle contractions in asymptomatic women and women with urinary continence dysfunction. STUDY DESIGN: Eight outpatients with stress urinary symptoms and eight asymptomatic women were scanned with a 1.5 T GE Signa CV/i high-speed scanner with real time fluorescopic imaging possibilities. The static and dynamic anatomical status of the levator ani muscle was registered. RESULTS: In sagittal magnetic resonance imaging (MRI) images, the iliococcygeus muscle appeared as dome-shaped at rest. The thickness of the distal part of pubococcygeal muscle correlated significantly with EMG values during a maximal contraction. The most obvious defects seen in the pubococcygeal muscle were asymmetry in thickness and loss of fiber continuity. CONCLUSION: Functional and anatomic relationships in the pelvic floor can be demonstrated by the combined use of EMG and MRI, providing a better understanding of the pathophysiological mechanisms behind stress incontinence in women.

Comparison of BOLD fMRI and MEG characteristics to vibrotactile stimulation.

The characteristics of blood oxygenation level-dependent (BOLD) fMRI and magnetoencephalographic (MEG) responses to vibrotactile stimuli in humans were studied and compared. The stimuli, presented with interstimulus intervals (ISIs) ranging from 1 to 5 s, yielded highly reproducible MEG responses, with current dipoles in the primary somatosensory (SI) cortex in all subjects. BOLD fMRI responses to similar stimuli showed substantial intrasubject variation in the activation sites around the SI cortex. BOLD responses were detected in all subjects in the secondary somatosensory (SII) cortices as well, with comparable BOLD response amplitudes to those in the SI cortex. Current dipoles, used to model the MEG signals, were stronger at longer ISIs than shorter ISIs. The BOLD response amplitudes did not show a similar dependence on ISI, but the activated brain area was larger when longer ISIs or longer stimuli were applied. Our results support the view that combined use of brain mapping methods provides complementary information and should be considered in functional brain examinations.