Train-of-four monitoring with the twitchview monitor electctromyograph compared to the GE NMT electromyograph and manual palpation.

The purpose of this study was to compare train-of-four count and ratio measurements with the GE electromyograph to the TwitchView electromyograph, that was previously validated against mechanomography, and to palpation of train-of-four count. Electrodes for both monitors were applied to the same arm of patients undergoing an unrestricted general anesthetic. Train-of-four measurements were performed with both monitors approximately every 5 min. In a subset of patients, thumb twitch was palpated by one of the investigators. Eleven patients contributed 807 pairs of train-of-four counts or ratios. A subset of 5 patients also contributed palpated train-of-four counts. Bland-Altman analysis of the train-of-four ratio found a bias of 0.24 in the direction of a larger ratio with the GE monitor. For 72% of data pairs, the GE monitor train-of-four ratios were larger. For 59% of data pairs, the GE monitor train-of-four counts were larger (p < 0.0001). For 11% of data pairs, the GE monitor train-of-four count was 4 when the Twitchview monitor count was zero. When manual palpation of train-of-four count was compared to train-of-four count determined by the monitors, 70% of data pairs were identical between palpation and TwitchView train-of-four count, while 30% of data pairs were identical between palpation and GE train-of-four count. For 7% of data pairs, the GE monitor train-of-four count was 4 when the palpation count was 0. The GE electromyograph may overestimate the train-of-four count and ratio. The GE electromyograph frequently reported 4 twitches when none were actually present due to misinterpretation of artifacts.

Counting train-of-four twitch response: comparison of palpation to mechanomyography, acceleromyography, and electromyography.

BACKGROUND: Train-of-four twitch monitoring can be performed using palpation of thumb movement, or by the use of a more objective quantitative monitor, such as mechanomyography, acceleromyography, or electromyography. The relative performance of palpation and quantitative monitoring for determination of the train-of-four ratio has been studied extensively, but the relative performance of palpation and quantitative monitors for counting train-of-four twitch responses has not been completely described. METHODS: We compared train-of-four counts by palpation to mechanomyography, acceleromyography (Stimpod™), and electromyography (TwitchView Monitor™) in anaesthetised patients using 1691 pairs of measurements obtained from 46 subjects. RESULTS: There was substantial agreement between palpation and electromyography (kappa = 0.80), mechanomyography (kappa = 0.67), or acceleromyography (kappa = 0.63). Electromyography with TwitchView and mechanomyography most closely resembled palpation, whereas acceleromyography with StimPod often underestimated train-of-four count. With palpation as the comparator, acceleromyography was more likely to measure a lower train-of-four count, with 36% of counts less than palpation, and 3% more than palpation. For mechanomyography, 31% of train-of-four counts were greater than palpation, and 9% were less. For electromyography, 15% of train-of-four counts were greater than palpation, and 12% were less. The agreement between acceleromyography and electromyography was fair (kappa = 0.38). For acceleromyography, 39% of train-of-four counts were less than electromyography, and 5% were more. CONCLUSIONS: Acceleromyography with the StimPod frequently underestimated train-of-four count in comparison with electromyography with TwitchView.

Identification of critical areas for motor function recovery in chronic stroke subjects using voxel-based lesion symptom mapping.

INTRODUCTION: Previous stroke studies using fMRI or lesion characterization methods to study the preservation of motor performance have been limited in defining anatomical structure critical for functional performance. This study attempts to overcome this limitation by using voxel-based lesion symptom mapping (VLSM) to identify specific anatomical regions required for preservation of motor function. METHODS: Forty-one moderate to moderately severe stroke subjects (upper extremity Fugl-Meyer between 28 and 50, Arm Motor Ability Test >35) were imaged with a 1 mm isotropic T1-weighted volumetric sequence, and their motor performance was assessed. The T1 volume images were normalized to a symmetric template using SPM5 and oriented so the lesion appeared in the left hemisphere. The lesioned areas were manually segmented on the normalized T1 image. All 3D lesion maps were entered into the VLSM analysis. Areas showing significant correlations with functional performance measures were identified using the false discovery rate corrected at p< or =0.05. RESULTS: The areas most correlated with a decrease in motor performance were at the junction of the corona radiata leading into the corticospinal tract. The Arm Motor Ability Test scores produced the most significant results, while the other measures showed similar anatomical patterns. CONCLUSION: The use of lesion symptom mapping in conjunction with behavioral measures produced anatomically specific results demonstrating that the area leading from the corticospinal tract to cortical motor areas is critical for maintaining hand motor performance after a stroke. This area may represent the joining of parallel redundant tracts that, when damaged, limit recovery potential.

Spatial and temporal characteristics of physiological noise in fMRI at 3T.

RATIONALE AND OBJECTIVES: Physiological noise in blood oxygen level-dependent functional magnetic resonance imaging (BOLD fMRI) has been shown to have characteristics similar to the BOLD signal itself, suggesting that it may have a vascular dependence. In this study, we evaluated the influence of physiological noise in fMRI as revealed by the differences in vasculature sensitivity of gradient-echo echo-planar imaging (GE-EPI) and spin-echo EPI (SE-EPI). MATERIALS AND METHODS: The contribution of physiological noise to the fMRI signal during activation of the visual cortex was assessed by comparing its temporal characteristics with respect to echo time (TE), using both GE-EPI and SE-EPI. The correlation of the noise in fMRI with apparent diffusion coefficient (ADC) and the number of components required to describe its variance, as determined by principal-component analysis (PCA), were also assessed. RESULTS: The SE-EPI data were less affected by a TE-dependence of noise, in contrast to the apparent physiological noise in GE-EPI. Voxel-wise analysis revealed that total apparent noise increased as ADC values increased, and the relationship was different for GE-EPI and SE-EPI. PCA revealed that while the number of components characterizing the noise in SE-EPI data increased in a TE-dependent manner, approaching that of white noise at long echo time, the number of components from GE-EPI data was TE-independent. CONCLUSIONS: The difference in sensitivities to physiological noise between SE-EPI and GE-EPI suggests that extravascular BOLD processes around draining veins contribute significantly to physiological noise in BOLD fMRI, and the suppression of this noise component may enhance SE-EPI BOLD sensitivity at higher fields.

The effects of geometric distortion correction on motion realignment in fMRI.

RATIONALE AND OBJECTIVES: Subject motion is well recognized as a significant impediment to resolution and sensitivity in functional magnetic resonance imaging (fMRI). A parallel confounder to fMRI data quality is geometric image distortion, particularly at high field strengths, due to susceptibility-induced magnetic field inhomogeneity. Consequently, many high-field echo-planar imaging methods incorporate a post-processing distortion correction by acquiring a field map of the sample prior to the fMRI measurement. However, field mapping methods impose a spatial mask on the data, since field information is only obtainable from regions with adequate signal-to-noise ratio (SNR). This masking, when applied to subsequent images in the fMRI time series, can clip the effects of motion, resulting in inaccurate estimation and correction of motion-based changes in the images. MATERIALS AND METHODS: The effects of geometric distortion correction on automated realignment (motion correction) of fMRI data are investigated from data acquired at 4 T. The results of image realignment with and without prior application of distortion correction are compared, using the estimated motion parameters and overall image realignment as metrics. RESULTS: The application of field-map-based distortion correction prior to image realignment reduces the amount of motion detected by a standard motion correction algorithm. Moreover, motion correction applied before distortion correction is shown to result in superior realignment of motion-correction images. CONCLUSION: It is preferable to perform motion realignment prior to correcting for geometric distortion.

A pulse sequence for rapid in vivo spin-locked MRI.

PURPOSE: To develop a novel pulse sequence called spin-locked echo planar imaging (EPI), or (SLEPI), to perform rapid T1rho-weighted MRI. MATERIALS AND METHODS: SLEPI images were used to calculate T1rho maps in two healthy volunteers imaged on a 1.5-T Sonata Siemens MRI scanner. The head and extremity coils were used for imaging the brain and blood in the popliteal artery, respectively. RESULTS: SLEPI-measured T1rho was 83 msec and 103 msec in white (WM) and gray matter (GM), respectively, 584 msec in cerebrospinal fluid (CSF), and was similar to values obtained with the less time-efficient sequence based on a turbo spin-echo readout. T1rho was 183 msec in arterial blood at a spin-lock (SL) amplitude of 500 Hz. CONCLUSION: We demonstrate the feasibility of the SLEPI pulse sequence to perform rapid T1rho MRI. The sequence produced images of higher quality than a gradient-echo EPI sequence for the same contrast evolution times. We also discuss applications and limitations of the pulse sequence.

Spatial sensitivity and temporal response of spin echo and gradient echo bold contrast at 3 T using peak hemodynamic activation time.

Recent theoretical and experimental work has suggested that spin echo (SE) functional MRI (fMRI) has improved localization of neural activity compared to gradient echo (GE) fMRI at high field strengths, albeit with a decrease in blood oxygenation level-dependent (BOLD) contrast. The present study investigated spatial and temporal variations in GE and SE fMRI at 3 T in response to a brief visual stimulus. The results demonstrate that SE BOLD contrast reaches its maximum amplitude more quickly than does GE contrast at long echo times. We have called this metric the peak hemodynamic activation time (PHAT). Because BOLD changes in response to increased neuronal activity occur earlier in the microvasculature and then later propagate into the venous compartment, these results provide further evidence that SE-based BOLD contrast provides superior localization to the site of activation at 3 T. Spatial overlay of SE and GE PHAT maps onto structural images reveal markedly different spatial profiles and further support the interpretation that shorter peak times correlate to improved spatial sensitivity.

Temporal resolving power of spin echo and gradient echo fMRI at 3T with apparent diffusion coefficient compartmentalization.

The temporal resolving power of blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI) at 3T was investigated in the visual and auditory cortices of the human brain. By using controlled temporal delays and selective visual hemifield stimulation, regions with similar (left vs. right occipital cortex) and different (occipital cortex vs. auditory cortex) vascular architectures were compared. Estimates of the time-to-peak (TTP) of the BOLD hemodynamic response function (hrf) were obtained using a spin echo (SE) sequence and compared to those acquired using a traditional gradient echo (GE) sequence. The hrf TTP in the visual cortex was found to be 4.73 s and 4.21 s for GE and SE, respectively. The auditory cortex response was significantly delayed, with TTPs of 4.95 s and 4.51 s for GE and SE, respectively. The GE response was able to resolve visual stimuli separated by 250 ms, whereas SE could resolve stimuli 500 ms apart. Apparent-diffusion-coefficient (ADC) compartmentalization of the BOLD signal was applied to restrict the vascular sensitivity of the SE and GE sequences. Limiting the response to voxels with ADCs < 0.8 x 10(-3) mm(2)/s improved the temporal resolving power of GE and SE BOLD to 125 ms and 250 ms, respectively.

T1rho contrast in functional magnetic resonance imaging.

The application of T1 in the rotating frame (T1rho) to functional MRI in humans was studied at 3 T. Increases in neural activity increased parenchymal T1rho. Modeling suggested that cerebral blood volume mediated this increase. A pulse sequence named spin-locked echo planar imaging (SLEPI) that produces both T1rho and T2* contrast was developed and used in a visual functional MRI (fMRI)experiment. Spin-locked contrast significantly augments the T2* blood oxygen level-dependent (BOLD) contrast in this sequence. The total functional contrast generated by the SLEPI sequence (1.31%) was 54% larger than the contrast (0.85%) obtained from a conventional gradient-echo EPI sequence using echo times of 30 ms. Analysis of image SNR revealed that the spin-locked preparation period of the sequence produced negligible signal loss from static dephasing effects. The SLEPI sequence appears to be an attractive alternative to conventional BOLD fMRI, particularly when long echo times are undesirable, such as when studying prefrontal cortex or ventral regions, where static susceptibility gradients often degrade T2*-weighted images.