[Show abstract][Hide abstract] ABSTRACT: The effect of intracranial internal carotid artery (ICA) calcification on cognitive impairment is uncertain. Our objective was to investigate whether intracranial ICA calcification is a significant cognitive predictor for cognitive impairment. Global cognition and degrees of intracranial ICA calcification of 579 subjects were assessed with Mini-Mental State Examination (MMSE) and Agatston calcium scoring method, respectively. Other risk factors for cognitive impairment, including age, education level, hypertension, diabetes mellitus, smoking, hyperlipidemia, and body mass index, were documented and analyzed for their associations with cognitive function.In univariate analyses, older age, lower education level, hypertension, diabetes mellitus, and higher intracranial ICA Agatston scores were significantly associated with cognitive impairment. In ordinal logistic regression, only age and total intracranial ICA Agatston score were significant risk factors for cognitive impairment. After adjustment for the other documented risk factors, subjects were 7% (95% CI: 5-10; P < 0.001) and 6% (95% CI: 0-13; P = 0.04) more likely to have lower cognitive category with every year increment of age and every 100-point increment of the total intracranial ICA Agatston score respectively. These results suggest an important role of the intracranial ICA calcification on cognitive impairment.
[Show abstract][Hide abstract] ABSTRACT: Background and purpose:
Brain enhancement on contrast-enhanced T1-weighted imaging (CET1-WI) after ischemic stroke is generally accepted as an indicator of the blood-brain barrier disruption. However, this phenomenon usually starts to become visible at the subacute phase. The purpose of this study was to evaluate the time-course profiles of K(trans), cerebral blood volume (vp), and CET1-WI with early detection of blood-brain barrier changes on K(trans) maps and their role for prediction of subsequent hemorrhagic transformation in acute middle cerebral arterial infarct.
Twenty-six patients with acute middle cerebral arterial stroke and early spontaneous reperfusion, whose MR images were obtained at predetermined stroke stages, were included. T2*-based MR perfusion-weighted images were acquired using the first-pass pharmacokinetic model to derive K(trans) and vp. Parenchymal enhancement observed on maps of K(trans), vp, and CET1-WI at each stage was compared. Association among these measurements and hemorrhagic transformation was analyzed.
K(trans) map showed significantly higher parenchymal enhancement in ischemic parenchyma as compared with that of vp map and CET1-WI at early stroke stages (P<0.05). The increased K(trans) at acute stage was not associated with parenchymal enhancement in CET1-WI at the same stage. Parenchymal enhancement in CET1-WI started to occur at the late subacute stage and tended to be luxury reperfusion-dependent. Patients with hemorrhagic transformation showed higher mean K(trans) values as compared with patients without hemorrhagic transformation (P=0.02).
Postischemic brain enhancement on routine CET1-WI seems to be closely related to the luxury reperfusion at the late subacute stage and is not dependent on microvascular permeability changes at the acute stage.
[Show abstract][Hide abstract] ABSTRACT: To investigate the effects of 3,4-methylenedioxymethamphetamine (MDMA, commonly known as "ecstasy") on the alterations of brain metabolites and anatomic tissue integrity related to the function of the basal ganglia-thalamocortical circuit by using proton magnetic resonance (MR) spectroscopy and diffusion-tensor MR imaging.
This study was approved by a local institutional review board, and written informed consent was obtained from all subjects. Thirty-one long-term (>1 year) MDMA users and 33 healthy subjects were enrolled. Proton MR spectroscopy from the middle frontal cortex and bilateral basal ganglia and whole-brain diffusion-tensor MR imaging were performed with a 3.0-T system. Absolute concentrations of metabolites were computed, and diffusion-tensor data were registered to the International Consortium for Brain Mapping template to facilitate voxel-based group comparison.
The mean myo-inositol level in the basal ganglia of MDMA users (left: 4.55 mmol/L ± 2.01 [standard deviation], right: 4.48 mmol/L ± 1.33) was significantly higher than that in control subjects (left: 3.25 mmol/L ± 1.30, right: 3.31 mmol/L ± 1.19) (P < .001). Cumulative lifetime MDMA dose showed a positive correlation with the levels of choline-containing compounds (Cho) in the right basal ganglia (r = 0.47, P = .02). MDMA users also showed a significant increase in fractional anisotropy (FA) in the bilateral thalami and significant changes in water diffusion in several regions related to the basal ganglia-thalamocortical circuit as compared with control subjects (P < .05; cluster size, >50 voxels).
Increased myo-inositol and Cho concentrations in the basal ganglia of MDMA users are suggestive of glial response to degenerating serotonergic functions. The abnormal metabolic changes in the basal ganglia may consequently affect the inhibitory effect of the basal ganglia to the thalamus, as suggested by the increased FA in the thalamus and abnormal changes in water diffusion in the corresponding basal ganglia-thalamocortical circuit.
[Show abstract][Hide abstract] ABSTRACT: To investigate quantitatively the topographic perfusion characteristics of the adenohypophysis by using dynamic contrast material-enhanced magnetic resonance (MR) imaging in a subgroup of patients with idiopathic growth hormone deficiency (IGHD) and with normal-appearing pituitary morphology on MR images.
This HIPAA-compliant, prospective study was approved by an institutional review board, and informed consent was obtained for all patients. Twenty-five patients (mean age, 10.6 years ± 3.3 [standard deviation]) with clinical growth retardation, proved IGHD, and normal pituitary morphology on MR images were included for analysis. Sixteen children (mean age, 10.8 years ± 5.5) were included as control subjects. Time to peak (TTP) perfusion properties of the adenohypophysis in 10 regions of interest from multisection coronal dynamic contrast-enhanced T1-weighted MR images were quantitatively derived by using the Brix pharmacokinetic model. Significant difference was determined with a two-tailed Student t test. The Pearson correlation coefficient was used to correlate the perfusion parameters, including maximal enhancement peak and slope, with serum growth hormone levels in the IGHD group.
TTP for the IGHD group was significantly prolonged compared with that for the control group (P < .005). The prolonged TTP in the IGHD group was found to be diffuse. The levels of growth hormone deficiency were negatively correlated with the peak enhancement and the slope of the wash-in phase, which suggests increased blood volume in IGHD within the pituitary gland.
IGHD and the degree of growth hormone deficiency are associated with nonregional perfusion delay in morphologically normal adenohypophyses. The lack of lateralization of perfusion delay may suggest that microvascular structural abnormalities play a role in IGHD.
[Show abstract][Hide abstract] ABSTRACT: Intrascan subject movement in clinical MR spectroscopic examinations may result in inconsistent water suppression that distorts the metabolite signals, frame-to-frame variations in spectral phase and frequency, and consequent reductions in the signal-to-noise ratio due to destructive averaging. Frame-to-frame phase/frequency corrections, although reported to be successful in achieving constructive averaging, rely on consistent water suppression, which may be difficult in the presence of intrascan motion. In this study, motion correction using non-water-suppressed data acquisition is proposed to overcome the above difficulties. The time-domain matrix-pencil postprocessing method was used to extract water signals from the non-water-suppressed spectroscopic data, followed by phase and frequency corrections of the metabolite signals based on information obtained from the water signals. From in vivo experiments on seven healthy subjects at 3.0 T, quantification of metabolites using the unsuppressed water signal as a reference showed improved correlation with water-suppressed data acquired in the absence of motion (R(2) = 0.9669; slope = 0.94). The metabolite concentrations derived using the proposed approach were in good agreement with literature values. Computer simulations under various degrees of frequency and phase variations further demonstrated robust performance of the time-domain postprocessing approach.
No preview · Article · Dec 2009 · Magnetic Resonance in Medicine
[Show abstract][Hide abstract] ABSTRACT: To compare the image distortion and the quantification variation in parotid gland apparent diffusion coefficients (ADCs) on periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) versus echo-planar diffusion-weighted (DW) magnetic resonance (MR) images and to investigate the relationship between parotid gland ADC and parotid gland fat content.
This prospective study was approved by a local institutional review board. Written informed consent was obtained from all 33 enrolled healthy volunteers (15 men, 18 women; mean age, 36.4 years +/- 11.8 [standard deviation]). All participants underwent 1.5-T non-fat-saturated and fat-saturated PROPELLER DW MR imaging as well as 1.5-T nonaccelerated and twofold-accelerated echo-planar DW MR imaging. Image distortion on the DW images was qualitatively scored, and parotid ADC was quantitatively analyzed. The correlation between parotid ADC and parotid fat content was evaluated by using linear regression analysis. Wilcoxon signed rank and t tests were used for statistical analysis, with Bonferroni correction applied for multiple comparisons.
Echo-planar DW images showed distortion, which was completely eliminated on the PROPELLER DW images. The mean parotid ADCs measured with non-fat-saturated PROPELLER (0.670 x 10(-3) mm(2) +/- 0.149), nonaccelerated echo-planar (0.892 x 10(-3) mm(2) +/- 0.128), twofold-accelerated echo-planar (1.088 x 10(-3) mm(2) +/- 0.124), and fat-saturated PROPELLER (1.307 x 10(-3) mm(2) +/- 0.217) DW imaging differed significantly from one another (P < .001 for all comparisons). Parotid ADC had a significant negative correlation with parotid fat content (x) measured at non-fat-saturated PROPELLER DW imaging: ADC = -0.0087x + 1.1173 (r = 0.80, P < .001).
PROPELLER DW imaging pulse sequences can yield distortion-free images for parotid ADC measurements and enable quantitative evaluation of the relationship between parotid ADC and parotid fat content. Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.2531082228/-/DC1.
[Show abstract][Hide abstract] ABSTRACT: Although isotropic diffusion-weighted imaging (isoDWI) is very sensitive to the detection of acute ischemic stroke, it may occasionally show diffusion negative result in hyper-acute stroke. We hypothesize that high diffusion contrast diffusion trace-weighted image with enhanced T2 may improve stroke lesion conspicuity.
Five hyper acute stroke patients (M:F=0:5, average age=61.8+/-20.5 y/o) and 16 acute stroke patients (M:F=11:5, average age=67.7+/-12 y/o) were examined six-direction tensor DWIs at b=707s/mm(2). Three different diffusion-weighted images, including isotropic (isoDWI), diffusion trace-weighted image (trDWI) and T2-enhanced diffusion trace-weighted image (T2E_trDWI), were generated. Normalized lesion-to-normal ratio (nLNR) and contrast-to-noise ratio (CNR) of three diffusion images were calculated from each patient and statistically compared.
The trDWI shows better nLNR than isoDWI on both hyper-acute and acute stroke lesions, whereas no significant improvement in CNR. Nevertheless, the T2E_trDWI has statistically superior CNR and nLNR than those of isoDWI and trDWI in both hyper-acute and acute stroke.
We concluded that tensor diffusion trace-weighted image with T2 enhancement is more sensitive to stroke lesion detection, and can provide higher lesion conspicuity than the conventional isotropic DWI for early stroke lesion delineation without the need of high-b-value technique.
No preview · Article · Jun 2009 · European journal of radiology
[Show abstract][Hide abstract] ABSTRACT: Although the ABC/2 formula has been widely used to estimate the volume of intracerebral hematoma (ICH), the formula tends to overestimate hematoma volume. The volume-related imprecision of the ABC/2 formula has not been documented quantitatively.
To investigate the volume-dependent overestimation of the ABC/2 formula by comparing it with computer-assisted volumetric analysis (CAVA).
Forty patients who had suffered spontaneous ICH and who had undergone non-enhanced brain computed tomography scans were enrolled in this study. The ICH volume was estimated based on the ABC/2 formula and also calculated by CAVA. Based on the ICH volume calculated by the CAVA method, the patients were divided into three groups: group 1 consisted of 17 patients with an ICH volume of less than 20 ml; group 2 comprised 13 patients with an ICH volume of 20 to 40 ml; and group 3 was composed of 10 patients with an ICH volume larger than 40 ml.
The mean estimated hematoma volume was 43.6 ml when using the ABC/2 formula, compared with 33.8 ml when using the CAVA method. The mean estimated difference was 1.3 ml, 4.4 ml, and 31.4 ml for groups 1, 2, and 3, respectively, corresponding to an estimation error of 9.9%, 16.7%, and 37.1% by the ABC/2 formula (P<0.05).
The ABC/2 formula significantly overestimates the volume of ICH. A positive association between the estimation error and the volume of ICH is demonstrated.
[Show abstract][Hide abstract] ABSTRACT: We aimed to quantitatively investigate the alteration of parotid perfusion after irradiation using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) based on a two-compartment tracer kinetic model. This study enrolled 19 patients (53.2 ± 14.9 years) treated by head and neck radiotherapy and 19 age-relevant and sex-matched subjects as a control group. Perfusion parameters (K
21 and A) of parotid glands were analyzed based on the Brix model from T1-weighted DCE-MRI. Suitability of the Brix model was evaluated via Monte Carlo simulation for the goodness-of-fit. Analysis of nonlinear goodness-of-fit showed that the Brix model is appropriate in evaluating the parotid perfusion (R2 = 0.938 ± 0.050). The irradiated parotid glands showed significantly lower K
(P < 0.0005) and k
21(P < 0.05) and consequently significantly higher value of peak enhancement (P < 0.0005) and time-to-peak (P < 0.0005) compared with non-irradiated ones, suggestive of gradual and prolonged accumulation and delayed wash-out of contrast agent due to increased extracellular extravascular space and decreased vascular permeability in the irradiated glands. Linear regression analysis showed dose-dependent perfusion changes of the irradiated parotid glands. We conclude that quantitative DCE-MRI is a potential tool in investigating parotid gland perfusion changes after radiotherapy.
Full-text · Article · Jan 2009 · European Radiology
[Show abstract][Hide abstract] ABSTRACT: 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.
Full-text · Article · Feb 2007 · Magnetic Resonance in Medicine
[Show abstract][Hide abstract] ABSTRACT: To include biologic factors in parallel-architecture normal-tissue complication probability (NTCP) model for radiation-induced liver disease (RILD) after three-dimensional conformal radiotherapy (3D-CRT) for gastric or hepatic cancer.
A total of 151 patients (89 with hepatocellular carcinoma and 62 with gastric cancer) who received 3D-CRT to the liver were included (isocenter dose range 33.0 to 66.0 Gy; mean 48.0 Gy). RILD was defined as grade 3 or higher liver toxicity according to Common Toxicity Criteria Version 2.0 of the National Cancer Institute within 4 months after 3D-CRT. Possible correlations of patient-related or dosimetric factors with RILD were tested. Maximum-likelihood analysis estimated NTCP model parameters for group and subgroups. Goodness-of-fit analysis estimated deviance of NTCP model parameters between subgroups.
RILD developed in 25 patients. Hepatitis B virus carrier status (p < 0.001) was the only significant independent factor. The 4 parallel NTCP model parameters, mean functional reserve (V(50)), width of functional reserve distribution (sigma), dose damage to 50% of liver subunits (D(50)), and slope parameter for subunit dose-response (k), were respectively, 0.54, 0.14, 50 Gy, 0.18 (group); 0.53, 0.07, 50 Gy, 4.6 x 10(-7) (carriers); 0.59, 0.12, 25 Gy, 59.8 (noncarriers). In carrier-state subgroups, goodness-of-fit deviance with 1 subgroup's parameter set would have been worse in the other group. Across subgroups, patients with RILD all had liver fraction damage (f) greater than 0.4 compared with wider distribution for the whole group.
RILD is described with a parallel-architecture NTCP model for HBV carriers and noncarriers with a threshold effect greater than 0.4. The main difference is in slope parameter for subunit dose-response.
Preview · Article · Jul 2005 · International Journal of Radiation OncologyBiologyPhysics
[Show abstract][Hide abstract] ABSTRACT: To identify the factors associated with radiation-induced liver disease (RILD) and to describe the difference in normal tissue complication probability (NTCP) between subgroups of hepatocellular carcinoma patients undergoing three-dimensional conformal radiotherapy (3D-CRT).
A total of 89 hepatocellular carcinoma patients who completed 3D-CRT for local hepatic tumors were included. The average isocenter dose was 49.9 +/- 6.2 Gy. Logistic regression analysis was used for the association between statistically significant factors and RILD (defined as Grade 3 or 4 hepatic toxicity of elevated transaminases or alkaline phosphatase within 4 months of completing 3D-CRT) in multivariate analysis. Maximal likelihood analysis was conducted to obtain the best estimates of the NTCP model parameters.
Of the 89 patients, 17 developed RILD. In univariate analysis, hepatitis B virus (HBV)-positive status and the mean radiation dose to the liver were the two factors significantly associated with the development of RILD. Of the 65 patients who were HBV carriers, 16 had RILD compared with 1 of 24 non-carrier patients (p = 0.03). The mean radiation dose to liver was significantly greater in patients with RILD (22.9 vs. 19.0 Gy, p = 0.05). On multivariate analysis, HBV carrier status (odds ratio, 9.26; p = 0.04) and Child-Pugh B cirrhosis of the liver (odds ratio, 3.65; p = 0.04) remained statistically significant. The best estimates of the NTCP parameters were n = 0.35, m = 0.39, and TD(50)(1) = 49.4 Gy. The n, m, TD(50)(1) specifically estimated from the HBV carriers was 0.26, 0.40, and 50.0 Gy, respectively, compared with 0.86, 0.31, and 46.1 Gy, respectively, for non-carrier patients.
Hepatocellular carcinoma patients who were HBV carriers or had Child-Pugh B cirrhosis presented with a statistically significantly greater susceptibility to RILD after 3D-CRT.
Preview · Article · Jan 2005 · International Journal of Radiation OncologyBiologyPhysics