Image quality in reduced-dose coronary CT angiography.

RATIONALE AND OBJECTIVES: Concerns for patient's risk of radiation-induced cancer have increased demand for reduced-dose coronary computed tomography angiography (CCTA). Previous comparisons of full and reduced-dose CCTA were not conclusive, because results were compared in different groups of patients. Presented here are results in patients examined by a widely used full dose CCTA protocol and a new low-dose alternative. MATERIALS AND METHODS: Standard full-dose and low-dose CCTA with tube voltages of 120/100 kV were applied on 70 patients with intermediate probability of coronary artery disease (CAD). Both protocols used prospective electrocardiogram-gated acquisition on a 320-detector row CT scanner, whereas at low-dose CCTA the phase window was increased from 10% to 75% of R-R interval. RESULTS: Despite a mean dose reduction of 80%, from 4.9 ± 0.98 to 0.98 ± 0.24 mSv, visual image quality was not significantly affected at the low-dose protocol. Contrast level, image noise, and CNR for both protocols were similar in the majority of coronary segments. CNR for standard and low-dose protocol were 23.7 ± 17.1 and 23.2 ± 26.8, P = NS. Correlation between visual image quality and heart rate variability was strong at low dose: r = -0.58, P = .01, and absent at full dose: r = -0.07, P = .77. CONCLUSION: Image quality of blood vasculature is generally not affected by 80% CCTA dose reduction applied to standard prospective electrocardiogram-gated acquisition. The performance at the low-dose protocol owes to the increased phase window, enhancing image quality at the cost of sensitivity to heart rate variability as compared with standard CCTA.

Impact of fluoxetine on the human brain in multiple sclerosis as quantified by proton magnetic resonance spectroscopy and diffusion tensor imaging.

The antidepressant fluoxetine stimulates astrocytic glycogenolysis, which serves as an energy source for axons. In multiple sclerosis patients fluoxetine administration may improve energy supply in neuron cells and thus inhibit axonal degeneration. In a preliminary pilot study, 15 patients with multiple sclerosis (MS) were examined by diffusion tensor imaging (DTI) and (1)H magnetic resonance spectroscopy (MRS) in order to quantify the brain tissue diffusion properties (fractional anisotropy, apparent diffusion coefficient) and metabolite levels (choline, creatine and N-acetylaspartate) in cortical gray matter brain tissue, in normal appearing white matter and in white matter lesions. After oral administration of fluoxetine (20 mg/day) for 1 week, the DTI and MRS measurements were repeated and after treatment with a higher dose (40 mg/day) during the next week, a third series of DTI/MRS examinations was performed in order to assess any changes in diffusion properties and metabolism. One trend was observed in gray matter tissue, a decrease of choline measured at weeks 1 and 2 (significant in a subgroup of 11 relapsing remitting/secondary progressive MS patients). In white matter lesions, the apparent diffusion coefficient was increased at week 1 and N-acetylaspartate was increased at week 2 (both significant). These preliminary results provide evidence of a neuroprotective effect of fluoxetine in MS by the observed partial normalization of the structure-related MRS parameter N-acetylaspartate in white matter lesions.

The impact of scan length on the exposure levels in 16- and 64-row multidetector computed tomography: a phantom study.

RATIONALE AND OBJECTIVES: Higher patient exposure levels have been reported for 64-row multidetector computed tomography (MDCT) compared to 16-row MDCT. The objective of this study was to make a thorough comparison by evaluating the impact of scan length on the exposure levels at 16-row MDCT and 64-row MDCT. MATERIALS AND METHODS: Dose-length product (DLP) values were determined to compare exposure levels in 16- and 64-row MDCT. This phantom study does not deal with a possible reduction in image quality induced by an increase in scattered radiation in 64-row MDCT compared to 16-row MDCT. RESULTS: The exposure levels of 64-row MDCT (scan slice thickness, 0.5 mm) are up to 18% lower than those of 16-row MDCT at slice thickness 0.5 mm when scanning an object larger than 12.3 cm. At this value, the plots of the 16- and 64-row DLP values versus scan length cross. The DLP curves of 1- and 2-mm slice thickness 16-row MDCT are in closer resemblance to those of 0.5-mm 64-row MDCT. The respective exposure levels of 1- and 2-mm slice thickness 16-row MDCT exceed those of 0.5-mm 64-row MDCT by up to 4% and 3%, with intersections of 30 and 25 cm, respectively. CONCLUSION: Lower effective doses are obtained in 64-row MDCT compared to 16-row MDCT (0.5-mm slice thickness) provided that scan length exceeds 12.3, 30, and 25 cm, for 16-row MDCT slice thickness of 0.5, 1, and 2 mm, respectively. Reduced effective dosage in 64-row MDCT compared to 16-row MDCT has not been demonstrated before. Differences in object size may thus explain discrepancies between previous studies with regard to the exposure levels at 64-slice CT compared to 16-slice CT.

Assessment of the variations in fat content in normal liver using a fast MR imaging method in comparison with results obtained by spectroscopic imaging.

A recently published Dixon-based MRI method for quantifying liver fat content using dual-echo breath-hold gradient echo imaging was validated by phantom experiments and compared with results of biopsy in two patients (Radiology 2005;237:1048-1055). We applied this method in ten healthy volunteers and compared the outcomes with the results of MR spectroscopy (MRS), the gold standard in quantifying liver fat content. Novel was the use of spectroscopic imaging yielding the variations in fat content across the liver rather than a single value obtained by single voxel MRS. Compared with the results of MRS, liver fat content according to MRI was too high in nine subjects (range 3.3-10.7% vs. 0.9-7.7%) and correct in one (21.1 vs. 21.3%). Furthermore, in one of the ten subjects the MRI fat content according to the Dixon-based MRI method was incorrect due to a (100-x) versus x percent lipid content mix-up. The second problem was fixed by a minor adjustment of the MRI algorithm. Despite systematic overestimation of liver fat contents by MRI, Spearman's correlation between the adjusted MRI liver fat contents with MRS was high (r = 0.927, P < 0.001). Even after correction of the algorithm, the problem remaining with the Dixon-based MRI method for the assessment of liver fat content,is that, at the lower end range, liver fat content is systematically overestimated by 4%.

Parallel imaging for first-pass myocardial perfusion.

Two parallel imaging methods used for first-pass myocardial perfusion imaging were compared in terms of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and image artifacts. One used adaptive Time-adaptive SENSitivity Encoding (TSENSE) and the other used GeneRalized Autocalibrating Partially Parallel Acquisition (GRAPPA), which are both applied to a gradient-echo sequence. Both methods were tested on 12 patients with coronary artery disease. The order of perfusion sequences was inverted in every other patient. Image acquisition was started during the administration of a contrast bolus followed by a 20-ml saline flush (3 ml/s), and the next perfusion was started at least 15 min thereafter using an identical bolus. An acceleration rate of 2 was used in both methods, and acquisition was performed during breath-holding. Significantly higher SNR, CNR and image quality were obtained with GRAPPA images than with TSENSE images. GRAPPA, however, did not yield a higher CNR when applied after the second bolus. GRAPPA perfusion imaging produced larger differences between subjects than did TSENSE. Compared to TSENSE, GRAPPA produced significantly better CNR on the first bolus. More consistent SNR and CNR were obtained from TSENSE images than from GRAPPA images, indicating that the diagnostic value of TSENSE may be better.

Correlation between serum ferritin levels and liver iron concentration determined by MR imaging: impact of hematologic disease and inflammation.

Liver iron concentration was determined in 28 patients by magnetic resonance imaging using the method of Gandon et al. (Non-invasive assessment of hepatic iron stores by MRI. Lancet 2004;363:357-362). The result showed a significant correlation with blood plasma ferritin content (Spearman's r=.66; P<.001) and a slightly improving correlation coefficient when limited to those patients not known to have inflammation (r=.82; n=17; P<.001). Zooming in on patients with hematologic disease also had a beneficial effect on the correlation between liver iron content and plasma ferritin level (r=.79; n=13; P=.001). It is concluded that in patients without inflammation and in patients with hematologic disease, the content of ferritin in blood is a better predictor of liver iron content than in other patient categories.

Fast 3D coronary artery contrast-enhanced magnetic resonance angiography with magnetization transfer contrast, fat suppression and parallel imaging as applied on an anthropomorphic moving heart phantom.

A magnetic resonance sequence for high-resolution imaging of coronary arteries in a very short acquisition time is presented. The technique is based on fast low-angle shot and uses fat saturation and magnetization transfer contrast prepulses to improve image contrast. GeneRalized Autocalibrating Partially Parallel Acquisitions (GRAPPA) is implemented to shorten acquisition time. The sequence was tested on a moving anthropomorphic silicone heart phantom where the coronary arteries were filled with a gadolinium contrast agent solution, and imaging was performed at varying heart rates using GRAPPA. The clinical relevance of the phantom was validated by comparing the myocardial relaxation times of the phantom's homogeneous silicone cardiac wall to those of humans. Signal-to-noise ratio and contrast-to-noise ratio were higher when parallel imaging was used, possibly benefiting from the acquisition of one partition per heartbeat. Another advantage of parallel imaging for visualizing the coronary arteries is that the entire heart can be imaged within a few breath-holds.

Prediction of functional recovery after revascularization in patients with chronic ischaemic left ventricular dysfunction: head-to-head comparison between 99mTc-sestamibi/18F-FDG DISA SPECT and 13N-ammonia/ 18F-FDG PET.

PURPOSE: (18)F-FDG PET is an important modality for myocardial viability assessment in patients with left ventricular (LV) dysfunction. Dual-isotope simultaneous acquisition (DISA) SPECT may be an alternative to PET. The aim of this study was to compare the diagnostic performance of PET and DISA SPECT for the prediction of improvement in regional and global LV function as well as LV reverse remodelling after revascularization. METHODS: Patients (n=47) with chronic coronary artery disease and LV dysfunction underwent DISA SPECT (with (99m)Tc-sestamibi and (18)F-FDG) and PET (with (13)N-ammonia and (18)F-FDG) on the same day to assess viability. All patients underwent revascularization and recovery of function was derived from serial magnetic resonance imaging studies. RESULTS: Of 264 revascularized, dysfunctional segments, 143 (54%) improved in function. For prediction of improvement in regional LV function, PET and DISA SPECT had similar sensitivity (90% versus 89%, NS) and specificity (86% versus 86%, NS). For prediction of improvement in global LV function, sensitivity was 83% for DISA SPECT and 86% for PET (p=NS), whereas both modalities had a specificity of 100%. Finally, sensitivity and specificity for the prediction of LV reverse remodelling were also similar for DISA SPECT and PET. CONCLUSION: In patients undergoing revascularization, DISA SPECT and PET predict the improvement in regional and global LV function and LV remodelling equally well post revascularization.

Relationships between brain water content and diffusion tensor imaging parameters (apparent diffusion coefficient and fractional anisotropy) in multiple sclerosis.

Fifteen multiple sclerosis patients were examined by diffusion tensor imaging (DTI) to determine fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in a superventricular volume of interest of 8 x 8 x 2 cm(3) containing gray matter (GM) and white matter (WM) tissue. Point resolved spectroscopy 2D-chemical shift imaging of the same volume was performed without water suppression. The water contents and DTI parameters in 64 voxels of 2 cm(3) were compared. The water content was increased in patients compared with controls (GM: 244+/-21 vs. 194+/-10 a.u.; WM: 245+/-32 vs. 190+/-11 a.u.), FA decreased (GM: 0.226+/-0.038 vs. 0.270+/-0.020; WM: 0.337+/-0.044 vs. 0.402+/-0.011) and ADC increased [GM: 1134+/-203 vs. 899+/-28 (x10(-6) mm(2)/s); WM: 901+/-138 vs. 751+/-17 (x10(-6) mm(2)/s)]. Correlations of water content with FA and ADC in WM were strong (r=-0.68, P<0.02; r=0.75; P<0.01, respectively); those in GM were weaker (r=-0.50, P<0.05; r=0.45, P<0.1, respectively). Likewise, FA and ADC were more strongly correlated in WM (r=-0.88; P<0.00001) than in GM (r=-0.69, P<0.01). The demonstrated relationship between DTI parameters and water content in multiple sclerosis patients suggests a potential for therapy monitoring in normal-appearing brain tissue.

Correlation of proton MR spectroscopy and diffusion tensor imaging.

Proton magnetic resonance spectroscopy ((1)H-MRS) provides indices of neuronal damage. Diffusion tensor imaging (DTI) relates to water diffusivity and fiber tract orientation. A method to compare (1)H-MRS and DTI findings was developed, tested on phantom and applied on normal brain. Point-resolved spectroscopy (T(R)/T(E)=1500/135) was used for chemical shift imaging of a supraventricular volume of interest of 8 x 8 x 2 cm(3) (64 voxels). In DTI, a segmental spin-echo sequence (T(R)/T(E)=5500/91) was used and slices were stacked to reproduce the slab used in MRS. The spatial distributions of choline and N-acetylaspartate (NAA) correlated to mean fractional anisotropy and apparent diffusion coefficient (ADC) for the inner 6 x 6=36 voxels defined in MRS, most notably NAA and ADC value (r=-.70, P<.00001; correlation across four subjects, 144 data pairs). This is the first association of neuron metabolite contents in volunteers with structure as indicated by DTI.

Analysis of the human brain in primary progressive multiple sclerosis with mapping of the spatial distributions using 1H MR spectroscopy and diffusion tensor imaging.

Primary progressive multiple sclerosis (ppMS; n=4) patients and controls (n=4) were examined by 1H magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) in order to map choline (Cho), creatine and N-acetylaspartate (NAA), the fractional anisotropy (FA) and the apparent diffusion constant (ADC). After chemical shift imaging (point-resolved spectroscopy, repetition time/echo time 1,500 ms/135 ms) of a supraventricular volume of interest of 8x8x2 cm3 (64 voxels) MRS peak areas were matched to the results of DTI for the corresponding volume elements. Mean FA and NAA values were reduced in the ppMS patients (P<0.01, both) and the ADC increased (P<0.02). The spatial distribution of NAA showed strong correlation to ADC in both ppMS patients and controls (r =-0.74 and r= -0.70; P<0.00001, both), and weaker correlations to FA (r=0.49 and r=0.41; P<0.00001, all). FA and ADC also correlated significantly with Cho in patients and controls (P<0.00001, all). The relationship of Cho and NAA to the ADC and the FA and thus to the content of neuronal structures suggests that these metabolite signals essentially originate from axons (NAA) and the myelin sheath (Cho). This is of interest in view of previous reports in which Cho increases were associated with demyelination and the subsequent breakdown of neurons.