In vivo intervertebral disc mechanical deformation following a treadmill walking "stress test" is inversely related to T1rho relaxation time.

OBJECTIVE: To assess the in vivo relationship between the mechanical response of intervertebral discs (IVDs) to dynamic activity and IVD biochemical composition assessed via T1rho relaxation imaging. DESIGN: Eighteen asymptomatic participants with no history of low back pain (LBP), injury, or surgery underwent magnetic resonance (MR) imaging of their lumbar spine prior to and immediately following a treadmill walking "stress test." Anatomic (SPACE, FLASH) MR images were obtained pre- and post-exercise and utilized to measure IVD mechanical deformation. Quantitative (T1rho) imaging was performed pre-exercise to reflect IVD composition. Pre-exercise anatomic images were also utilized to assess IVD degenerative status based on the modified Pfirrmann scale. To quantify mechanical response, 3D surface models of the L1-L2-L5-S1 IVDs were created from manual segmentations of pre- and post-exercise anatomic images and utilized to assess changes in IVD height. IVD strain (%) was defined as change in IVD height normalized to pre-activity height. Linear mixed models were used to assess the relationships between IVD mechanical deformation (strain), composition (T1rho relaxation time), and degenerative status (Pfirrmann grade). RESULTS: Increased compressive IVD strain was associated with lower T1rho relaxation times in the nucleus pulposus (NP) of the disc (ßT1rho=5.07,CI:[1.52,7.77],Rmarg2=0.52,p=0.005). Thus, an inverse relationship between IVD strain and NP T1rho relaxation time was observed. CONCLUSION: The in vivo mechanical response of the IVD to the "stress test" was sensitive to differences in NP composition. The results of this study suggest that quantification of in vivo IVD mechanical function and composition may provide insight into IVD health.

Obesity impacts the mechanical response and biochemical composition of patellofemoral cartilage: An in vivo, MRI-based investigation.

Obesity is a primary risk factor for osteoarthritis. While previous work has addressed relationships between in vivo cartilage mechanics, composition, and obesity in the tibiofemoral joint, there is limited information on these relationships in the patellofemoral joint. The purpose of this study was to compare the patellofemoral cartilage mechanical response to walking in participants with normal and obese body mass indices (BMIs). Additionally, patellar cartilage T1rho relaxation times were measured before exercise to characterize the biochemical composition of the tissue. Fifteen participants (eight with normal BMI and seven with obese BMI) underwent baseline magnetic resonance imaging (MRI) of their right knee. They then walked on a treadmill for 20 min at a speed normalized to their leg length before a second MRI scan. Subsequently, three-dimensional models of the bones and articular surfaces of the patellofemoral joint were created via manual segmentation of the pre- and post-exercise MR images to compute cartilage thickness and strain. Strain was defined as the change in patellofemoral cartilage thickness normalized to the baseline thickness. Results showed that participants with an obese BMI exhibited significantly increased patellofemoral cartilage strain compared to those with a normal BMI (5.4 ± 4% vs. 1.7 ± 3%, respectively; p = 0.003). Furthermore, patellar cartilage T1rho values were significantly higher in participants with obese versus normal BMIs (95 ms vs. 83 ms, respectively; p = 0.049), indicative of decreased proteoglycan content in those with an obese BMI. In summary, the altered patellofemoral cartilage strain and composition observed in those with an obese BMI may be indicative of cartilage degeneration.

Quantitative cerebral anatomy in depression. A controlled magnetic resonance imaging study.

Magnetic resonance imaging was used to examine cerebral anatomy in 48 inpatients with severe depression who were referred for electroconvulsive therapy and in 76 normal control subjects. The magnetic resonance imaging measures included determinations of regional cerebral volumes and ratings of the frequency and severity of cortical atrophy, lateral ventricular enlargement, and subcortical hyperintensity. The mean total frontal lobe volume was found to be 7% smaller in the inpatients with severe depression (235.88 mL) than in the normal control subjects (254.32 mL)--a difference that was statistically significant even after adjusting for the effects of age, sex, education, and intracranial size. No group differences were observed in the volumes of the cerebral hemispheres, the temporal lobes, or the amygdala-hippocampal complex, nor in the frequency of cortical atrophy. Neither did the groups differ with respect to the total volumes of the lateral and third ventricles, nor in the frequency of lateral ventricular enlargement. Patients with depression had a significantly higher frequency of subcortical hyperintensity in the periventricular white matter, with an odds ratio of 5.32.

Brain anatomic effects of electroconvulsive therapy. A prospective magnetic resonance imaging study.

To determine prospectively whether electroconvulsive therapy (ECT) produces structural brain changes, 35 inpatients with depression underwent magnetic resonance imaging before and twice after (at 2 to 3 days and at 6 months) completion of a course of brief-pulse, bilateral ECT. The magnetic resonance images were analyzed blindly for evidence of changes in brain structure using two approaches: measurement of regional brain volumes and a pairwise global comparison. Structural brain abnormalities were present in many patients before ECT. The course of ECT produced no acute or delayed (6-month) change in brain structure as measured by alterations of the total volumes of the lateral ventricles, the third ventricle, the frontal lobes, the temporal lobes, or the amygdala-hippocampal complex. In five subjects, the pairwise global comparisons revealed an apparent increase in subcortical hyperintensity, most likely secondary to progression of ongoing cerebrovascular disease during follow-up. Our results confirm and extend previous imaging studies that also found no relationship between ECT and brain damage.

Quantitative cerebral anatomy of the aging human brain: a cross-sectional study using magnetic resonance imaging.

Seventy-six healthy adults underwent magnetic resonance imaging (1.5 T) to investigate the effects of age on regional cerebral volumes and on the frequency and severity of cortical atrophy, lateral ventricular enlargement, and subcortical hyperintensity. Increasing age was associated with (1) decreasing volumes of the cerebral hemispheres (0.23% per year), the frontal lobes (0.55% per year), the temporal lobes (0.28% per year), and the amygdala-hippocampal complex (0.30% per year); (2) increasing volumes of the third ventricle (2.8% per year) and the lateral ventricles (3.2% per year); and (3) increasing odds of cortical atrophy (8.9% per year), lateral ventricular enlargement (7.7% per year), and subcortical hyperintensity in the deep white matter (6.3% per year) and the pons (8.1% per year). Many elderly subjects did not exhibit cortical atrophy or lateral ventricular enlargement, however, indicating that such changes are not inevitable consequences of advancing age. These data should provide a useful clinical context within which to interpret changes in regional brain size associated with "abnormal" aging.

Detection, characterization and functional assessment of reperfused Q-wave acute myocardial infarction by cine magnetic resonance imaging.

The capability of dynamic gradient-refocused magnetic resonance imaging (cine MRI) to detect, localize and functionally assess acute myocardial infarction (AMI) in 25 patients at a mean time interval of 7 days after AMI was evaluated. Fifteen asymptomatic volunteers were also examined to determine the specificity of the observations. Upon presentation, each patient received intravenous thrombolytic therapy, underwent immediate cardiac catheterization and had percutaneous transluminal coronary angioplasty performed when coronary reperfusion was absent. Twenty-four of the patients had documented coronary reperfusion at a mean interval of 259 +/- 129 minutes. Global ejection fraction and regional wall motion abnormalities were evaluated at 7 days by cine MRI, left ventriculography and radionuclide angiography. Twenty patients with both an absolute decrease in myocardial signal and a matched regional wall motion abnormality had AMI properly identified by cine MRI. In contrast, the finding of both decreased signal intensity and a matched regional wall motion abnormality was absent in the group of asymptomatic volunteers. The ejection fraction by cine MRI correlated better with the ejection fraction by left ventriculography (r = 0.94, standard error of the estimate = 3.6) than did the ejection fraction by radionuclide angiography (r = 0.82, standard error of the estimate = 5.8). The regional wall motion concordance rate in comparison to left ventriculography was similar for both cine MRI (69%) and radionuclide angiography (65%). These findings suggest that cine MRI may play an important role in the future detection and functional characterization of AMI.

Detection of deep venous thrombosis by magnetic resonance imaging.

OBJECTIVE: To determine the accuracy of gradient recalled echo magnetic resonance imaging in assessing deep venous thrombosis. DESIGN: This is a retrospective review of a prospective clinical experience in 216 consecutive patients studied using gradient recalled echo magnetic resonance imaging. Sixteen patients were unavailable for follow-up and 1 study was technically suboptimal, leaving 199 studies as the basis of this report. RESULTS: In 79 cases with confirmatory venography (n = 54), ultrasound (n = 16, thigh veins only), or computed tomography (n = 9, pelvic veins only), magnetic resonance imaging was 97 percent sensitive, 95 percent specific, and 96 percent accurate. Including cases that were normal by magnetic resonance imaging, not anticoagulated, and with uneventful follow-up as true normal cases, the corresponding sensitivity, specificity, and accuracy of magnetic resonance imaging were as follows: 97 percent, 98 percent, and 97 percent. CONCLUSION: Magnetic resonance imaging, using gradient recalled echo acquisitions, is capable of accurately diagnosing acute deep venous thrombosis.

Renal magnetic resonance angiography in the preoperative detection of supernumerary renal arteries in potential kidney donors.

RATIONALE AND OBJECTIVES: Careful evaluation of the renovascular anatomy in potential living-related kidney donors is essential regarding the presence of accessory renal arteries. Conventional arteriography remains the standard of evidence for delineating the renal arterial supply. We assessed the utility of two-dimensional phase contrast (PC) magnetic resonance angiography (MRA) in the workup of potential living-related renal donors. METHODS: Thirty-nine patients were examined with conventional arteriography and MRA, which was performed on a 1.5-T system using a two-dimensional PC technique in both coronal and axial planes (repetition time[TR]/echo time [TE] = 39/8.5 msec; flip 60 degrees; matrix 256 x 128; field of view, 28 cm2; 2 excitations; first-order gradient-moment nulling; 7-mm section with 2-mm overlap). The number of hilar and polar supernumerary renal arteries was determined. Hilar supernumerary arteries were classified as co-dominant if they were similar in size to the ipsilateral main renal artery. RESULTS: Conventional arteriography identified 78 dominant and 13 supernumerary (3 co-dominant, 10 accessory) renal arteries. Magnetic resonance angiography identified the proximal 35 mm of all 78 dominant and the 3 co-dominant renal arteries. Of the remaining ten (7 polar and 3 hilar) accessory vessels, only four were correctly identified with MRA. CONCLUSION: The high error rate (60%) suggests that two-dimensional PC MRA, as implemented, should not be used in the preoperative evaluation of potential renal donors.

Cine phase-contrast magnetic resonance imaging for analysis of flow phenomena in experimental aortic dissection.

Using a 1.5 T magnetic resonance imaging (MRI) system, cine phase-contrast and magnitude images were obtained in three phantoms that simulated different anatomic configurations of aortic dissection. The dissection phantoms were made of compliant materials, and pulsatile flow was used in all experiments. Phantoms differed only in the location of the fenestration between the true and false lumens (I: an upstream "entry" only, II: both upstream "entry" and downstream "re-entry," and III: a downstream "entry" only). Flow jets, flap motion, and wave propagation were clearly visualized in cine MR images of each phantom, and quantitatively analyzed with reference to the stimulated cardiac cycle of the pump. Flow in the false lumen was always bidirectional. Upstream and downstream flow waves collided and dispersed within the false lumen. Flow through the false lumen was the same in phantoms I and II, and least in phantom III. The average area of the true lumen was largest in phantom III and smallest in I. Phantom I had the highest overall flow rate in the false lumen and greatest change in false lumen size during the cardiac cycle, while the downstream "entry" phantom had the lowest of both parameters. Flow phenomena in aortic dissections can be studied by cine phase-contrast MRI.

Magnetic resonance imaging--cardiac ejection fraction measurements. Phantom study comparing four different methods.

The accuracy of cardiac ejection fraction (EF) measurements with thin, contiguous cine-magnetic resonance imaging (MR) sections is well established. Still, faster imaging and measurement techniques would be desirable. The authors evaluated the accuracy of four different MR EF measurements methods in a biventricular, anthropomorphic, foam-latex rubber phantom which was connected via noncompliant fluid-filled tubing to a pulsatile flow pump. Nine contiguous 10 mm cine-MR sections (TR/TE, 25/13; flip angle, 45 degrees) were obtained through the heart in long and short cardiac axes at 16 frames per cardiac cycle at a pump rate of 60 beats/minute. EF measurements were based on either the multi-slice summation technique (nine contiguous 10-mm sections versus four 10-mm sections spaced 10 mm apart) or the area-length method (single largest long section versus combination of largest long- and short-axis section). Three replications were performed for each of the tested EFs (40.8%, 29.4%, and 13.4%), which were compared with actual EFs. EF measurements based on contiguous 1-cm sections correlated best with the actual EFs. Average relative errors ranged from 3.2% to 6.0%. EF measurements based on every other section were less accurate; average relative errors were between 5.2% and 10.2%. Single and biplane area-length algorithm EF measurements were significantly less accurate; average relative errors were as high as 59%. EF measurements based on multi-slice summation are more accurate than those based on the area-length algorithm. Contiguous 1-cm section acquisitions are most accurate and most time consuming. With slight decrease of accuracy, acquisition and processing times can be halved by skipping every other slice.

Effects of turbulence on signal intensity in gradient echo images.

Although the appearance of laminar vascular flow in magnetic resonance (MR) images has been characterized, there is no general agreement about the effect of turbulent flow on MR signal intensity. This study uses a fast scan gradient echo pulse sequence to evaluate nonpulsatile turbulent flow in two different models. The first model simulated flow in normal vascular structure. It generated nonpulsatile, laminar and turbulent flow in straight, smooth-walled Plexiglas tubes. The second model simulated flow through a vascular stenosis. It generated nonpulsatile, laminar, and turbulent flow through an orifice. Velocities and flow rates ranged from low physiologic to well above the physiologic range (velocity = .3 to 280 cm/second, flow rate from .15 to 40 L/minute). Transition from laminar to turbulent flow was observed with dye streams. Turbulent flow in straight, smooth-walled vessels was not associated with a decrease in MR signal intensity even at the highest velocities and flow rates studied. The transition from laminar to turbulent flow through an orifice is not associated with a decrease in gradient echo signal intensity. As the intensity of the turbulent flow increases, however, there is a threshold above which signal intensity decreases linearly as turbulence increases (r = .97). This study suggests that flow in normal vascular structures should not be associated with decreased signal intensity in gradient echo images. Turbulent flow through areas such as valves, valvular lesions or vascular stenoses, may be associated with a decrease in gradient echo signal intensity.

Magnetic resonance imaging of blood flow with a phase subtraction technique. In vitro and in vivo validation.

RATIONALE AND OBJECTIVES: One promising approach to flow quantification uses the velocity-dependent phase change of moving protons. A velocity-encoding phase subtraction technique was used to measure the velocity and flow rate of fluid flow in a phantom and blood flow in volunteers. METHODS: In a model, the authors measured constant flow velocities from 0.1 to 270.0 cm/second with an accuracy (95% confidence intervals) of +/- 12.5 cm/second. There was a linear relationship between the magnetic resonance imaging (MRI) measurement and the actual value (r2 = .99; P = .0001). RESULTS: Measuring mean pulsatile flow from 125 to 1,900 mL/minute, the accuracy of the MRI pulsatile flow measurements (95% confidence intervals) was +/- 70 mL/minute. There was a linear relationship between the MRI pulsatile flow measurement and the actual value (r2 = .99; P = .0001). In 10 normal volunteers, the authors tested the technique in vivo, quantitating flow rates in the pulmonary artery and the aorta. The average difference between the two measurements was 5%. In vivo carotid flow waveforms obtained with MRI agreed well with the shape of corresponding ultrasound Doppler waveforms. CONCLUSIONS: Velocity-encoding phase subtraction MRI bears potential clinical use for the evaluation of blood flow. Potential applications would be in the determination of arterial blood flow to parenchymal organs, the detection and quantification of intra- and extra-cardiac shunts, and the rapid determination of cardiac output and stroke volume.

Preliminary experience with magnetic resonance imaging in patients with third-trimester bleeding.

Fifteen patients with third-trimester bleeding, in whom transabdominal ultrasound had failed to identify a definitive source of bleeding, underwent magnetic resonance imaging (MRI). Magnetic resonance imaging correctly identified three cases of placenta previa. In four patients, intrauterine blood was identified in hematomas. One hematoma was associated with a previa, two progressed to acute abruptions, and one was associated with a clot at the marginal cord insertion. Blood was seen leading away from the placenta in a case that progressed to an acute abruption. It was also seen in the region of the cervix in two patients with placenta previa. One patient had a normal MRI but had a fresh clot at delivery, which presumably formed after the imaging. In the remaining seven patients, MRI scans were negative and the placentas were normal at delivery. Our preliminary results suggest that MRI is helpful in evaluating patients with unexplained third-trimester bleeding.

Magnetic resonance imaging of deep venous thrombosis in pregnant women with lower extremity edema.

OBJECTIVE: To review our experience with magnetic resonance imaging (MRI) in the diagnosis of deep venous thrombosis in pregnant women. METHODS: Ten gravidas with lower extremity findings suspicious for pelvic or thigh thrombosis were examined by MRI using a gradient recalled echo technique. RESULTS: In one case, MRI confirmed pelvic extension of a femoral thrombus diagnosed by Doppler ultrasound. In a second case, MRI diagnosed thrombus isolated to the pelvis. In another, MRI detected a femoral thrombus without extension into the iliac veins. Although no thrombus was detected in the remaining seven cases, pelvic vein compression by the gravid uterus was identified in five. CONCLUSION: Magnetic resonance imaging can detect deep venous thrombosis during pregnancy and should be considered when thrombosis of the pelvic veins is a clinical consideration.

Congenital aortic stenosis and patent ductus arteriosus in the adult.

Concurrent aortic stenosis and patent ductus arteriosus are not infrequent in children but are rare in adults. An adult case is described with diagnosis by cardiac catheterization and magnetic resonance imaging and with management by combined aortic valve replacement and patent ductus ligation. Review of the English-language literature produced only 8 such cases in adults, 2 of which were managed by a single-stage operation. Successful diagnosis in the adult requires careful observation at cardiac catheterization, and simultaneous valve replacement and ductus ligation may be a useful option in patient management.

Magnetic resonance imaging of the femoral head after acute intracapsular fracture of the femoral neck.

In fifteen patients who had a subcapital fracture of the femoral neck (twelve displaced fractures and three non-displaced fractures), magnetic resonance imaging of the femoral head was done with two-dimensional Fourier transform spin-echo technique within forty-eight hours of injury. The magnetic resonance image did not show avascular necrosis of the femoral head in any of the patients. In eleven patients, there was a decreased signal at the base of the femoral head, immediately adjacent to the fracture. This decreased signal corresponded to a recognized band of necrosis and hemorrhage next to the site of the fracture and was not related to the viability of the femoral head. No other changes were seen on the images. We concluded that this type of magnetic resonance imaging is inadequate to determine the viability of the femoral head within forty-eight hours after a patient sustains an acute intracapsular fracture of the femoral neck.

Fast spoiled gradient-recalled MR imaging of thoracic aortic dissection: preliminary clinical experience at 1.5 T.

The purpose of this study was to evaluate fast spoiled gradient-recalled (FSPGR) magnetic resonance (MR) imaging in the diagnosis of thoracic aortic dissection (TAD). Twenty-eight patients with suspected TAD underwent MR imaging with FSPGR and either cine or cardiac-gated spin-echo MR techniques. The average scanning time for the FSPGR images was approximately 1 min. Three readers interpreted the FSPGR images for the presence or absence of TAD. An ROC analysis was done. At a specificity of 90%, the sensitivity ranged from 52% to 90% for the three readers. Pulsatility artifacts and mural thrombus were causes of false-positive and false-negative readings. The areas under the ROC curves (Az) ranged from 0.85 to 0.97 for the three readers. There was a statistically significant difference in the Az values for two of the experienced readers (p = .02). The correct type of dissection was determined in only 65% of the true-positive diagnoses. FSPGR has a very limited role in screening and for rapid evaluation of the unstable patient. The results are reader dependent and susceptible to pulsatility artifacts. Determination of the type of dissection is limited. With a suspected thoracic aortic dissection, therefore, additional imaging sequences should be obtained to maximize accuracy.

Pitfalls in myocardial perfusion assessment with dynamic MR imaging after administration of a contrast material bolus in dogs.

RATIONALE AND OBJECTIVES: The authors evaluated the artifacts observed on myocardial perfusion curves derived from an inversion-prepared fast gradient-echo (GRE) imaging sequence in dogs after injection of a gadolinium-based contrast agent. MATERIALS AND METHODS: Six mongrel dogs were divided into three groups. In groups 1 and 2, anesthesia was maintained with pentobarbital. Group 2 also received an intravenous injection of atropine (0.03 mg/kg). In group 3, anesthesia was maintained with isoflurane (1.0%). Imaging was performed on a 1.5-T magnetic resonance (MR) imaging unit (one section per heart beat, a 30 x 15-cm field of view, 10-mm section thickness, and 64-kHz bandwidth). Region-of-interest (ROI) markers were placed on the blood pool of the left intraventricular cavity, anterior wall of the left ventricle, and anterior to the chest wall to track respiratory motion. RESULTS: In group 1, the signal intensity (SI) periodically increased during each inspiration due to respiratory sinus arrhythmia. The relation between the SI increase and the variation of the delay between images was demonstrated in vitro and by computer simulations. No periodic increase of the SI was observed when regular cardiac rhythm was maintained by pharmacologic inhibition of the vagal-mediated chronotropic response with either the addition of atropine to pentobarbital or the use of isoflurane as the anesthetic agent. CONCLUSION: In an inversion-prepared fast GRE sequence, respiratory sinus arrhythmia can induce periodic SI increase by varying the respiratory rate interval and delay between images.

Proton-decoupled phosphorus-31 magnetic resonance spectroscopy in the evaluation of native and well-functioning transplanted kidneys.

RATIONALE AND OBJECTIVES: To evaluate whether decoupling improves signal-to-noise ratio and frequency resolution of in vivo kidney spectra, and to compare native and well-functioning transplant kidneys. METHODS: Proton decoupling in conjunction with three-dimensional chemical shift imaging (3D-CSI) in phosphorus-31 magnetic resonance (MR) spectroscopy was used with a spatial resolution of 64 cm3 and 17-minute acquisition time to compare native (n = 10) and well-functioning transplant (n = 9) kidneys. RESULTS: Proton decoupling improved peak amplitudes by almost 30%, as well as chemical shift resolution of in vivo kidney spectra. No statistically significant differences in phosphometabolite ratios and renal spectra were observed between healthy volunteers and patients with nonrejecting transplants. The phosphodiester-phosphomonoester ratio was 3.02 +/- 0.88, phosphomonoester-inorganic phosphate ratio was 1.07 +/- 0.44, and inorganic phosphate-adenosine triphosphate ratio was 0.58 +/- 0.22 after correction for saturation effects. CONCLUSION: Improved spectra of native and transplant kidneys can be obtained in vivo with MR spectroscopy by using a short acquisition time.

Disseminated thrombosis in primary antiphospholipid syndrome: MR findings.

We report the MR imaging findings in a patient with primary antiphospholipid syndrome, adrenal infarction and widespread thrombosis involving abdominal, pelvic, and pulmonary vessels. This syndrome should be suspected in patients with thromboses and organ infarctions of otherwise undetermined etiology.