Reduction of CSF artifacts on FLAIR images by using adiabatic inversion pulses.

The purpose of this study was to investigate the possibility that some artifactual high signals produced in CSF with fluid-attenuated inversion-recovery MR sequences could be due to inhomogeneity in the amplitude of the initial inversion pulse, and that this problem could be reduced or eliminated by the use of adiabatic inversion pulses. Studies with four volunteers showed dependence of high CSF signals in the posterior fossa on radiofrequency pulse amplitudes and that these signals could be eliminated by the use of adiabatic inversion pulses. Two illustrative clinical cases are included.

MR of the brain using fluid-attenuated inversion recovery (FLAIR) pulse sequences.

PURPOSE: Results from conventional T2-weighted spin-echo sequences were compared with those obtained using fluid attenuated inversion recovery (FLAIR) pulse sequences in order to assess their relative merits in detecting disease. METHODS: Forty adult patients with suspected disease of the brain were examined with spin-echo sequences (TE = 20 and TE = 80), and results were compared with FLAIR sequences of several types with inversion times of 1800-3000 msec and echo times of 130-240 msec. Scans were assessed by two radiologists for lesion number, conspicuity, and extent. RESULTS: A total of 48 lesions or groups of lesions were recognized with both sequences. In 22 instances, more lesions were seen with FLAIR sequences, and, in the remaining 26, equal numbers were seen. In 42 lesions, conspicuity was better with FLAIR sequences, equal in five and worse in one cystic lesion. Lesion extent was better assessed in 28 of the 48 cases with FLAIR sequences and equally well seen in the remainder. CONCLUSION: By virtue of their long echo time and relative freedom from cerebrospinal fluid artifact FLAIR sequences provide high sensitivity to a wide range of disease. The basic sequence is easy to implement but is relatively time consuming.

Reduction of CSF and blood flow artifacts on FLAIR images of the brain with k-space reordered by inversion time at each slice position (KRISP).

BACKGROUND AND PURPOSE: Our purpose was to test a new variant of the fluid-attenuated inversion-recovery (FLAIR) sequence that was designed to reduce CSF and blood flow artifacts by use of a non-slice-selective inversion pulse and k-space reordered by inversion time at each slice position (KRISP). METHODS: With the KRISP FLAIR sequence, the slice order was cycled so that each inversion time (TI) was associated with a region of k-space rather than a particular slice, and the effective inversion time (TI(eff)) was chosen to null the signal from CSF. Scans were obtained with both conventional and KRISP FLAIR sequences. Studies were performed in 20 adult patients with a variety of brain diseases. Images were evaluated for artifacts from patient motion, CSF, and blood flow, and scored on a four-point scale. The conspicuity of the cortex, meninges, ventricular system, brain stem, and cerebellum was evaluated, as was lesion number and conspicuity. RESULTS: The KRISP FLAIR sequence showed more patient motion artifacts but had a pronounced advantage over the conventional sequence in control of CSF artifacts around the foramen of Munro, in the third ventricle, aqueduct, and fourth ventricle, as well as in the basal cisterns and around the brain stem and cerebellum. Blood flow artifacts from the internal carotid, basilar, and vertebral arteries were also much better controlled. Spurious high signal in the sylvian branches of the middle cerebral artery was eliminated. The meninges, cortex, ventricular system, brain stem, and cerebellum were better seen due to improved artifact suppression and an edge enhancement effect. CONCLUSION: The KRISP FLAIR sequence can suppress CSF and blood flow artifacts and improve the conspicuity of the meninges, cortex, brain stem, and cerebellum. Its major disadvantage is its duration, which may be reducible with a fast spin-echo version.

A serial longitudinal quantitative MRI study of cerebral changes in first-episode schizophrenia using image segmentation and subvoxel registration.

Lateral ventricular enlargement is the most consistently replicated brain abnormality found in schizophrenia. This article reports a first episode, longitudinal study of ventricular volume using high-resolution serial magnetic resonance imaging (MRI) and recently developed techniques for image registration and quantitation. Baseline and follow-up (on average 8 months later) MRI scans were carried out on 24 patients and 12 controls. Accurate subvoxel registration was performed and subtraction images were produced to reveal areas of regional brain change. Whereas there were no differences between patients and controls with respect to the mean change in ventricular volume, the patients were much more variable in this respect and showed larger increases and decreases. The percentage increase in ventricular size was greater than one standard deviation of control values for 14 patients and the percentage decrease exceeded one standard deviation in eight patients. Although the finding of progressive ventricular enlargement in a proportion of patients supports other studies indicating an ongoing neuropathological process in the early stages of schizophrenia, the reduction of ventricular size in the remaining patients is more difficult to explain. It is suggested that this may reflect improvement in nutrition and hydration following treatment.

Two methods for semi-automated quantification of changes in ventricular volume and their use in schizophrenia.

Two semi-automated methods for quantification of ventricular volume change from baseline and follow-up magnetic resonance imaging scans have been developed. Technique 1 employs direct segmentation of the ventricles from both the scans using thresholding and contour extraction. Technique 2 operates on difference images produced by voxel based intensity subtraction of the baseline from the registered follow-up images. Here, all voxels with intensities above a noise threshold and in a restricted area are monitored to compute volumetric changes. In phantom measurements the first technique was accurate to 0.0046%, the second to 0.167% of the phantom volume. Results from normal volunteers was that the average ventricular volume changed by 1.52% and 1.54% for images acquired within 9 months using techniques 1 and 2, respectively. With schizophrenic patients mean change of 10.78% and 9.43% were found employing the first and second procedures, respectively. All measurements agreed with a radiologist's visual grading of the changes. Robust, objective, fast, easy-to-use, and fairly accurate procedures have been developed and validated to quantify volumetric changes.

Cerebral ventricular asymmetry in schizophrenia: a high resolution 3D magnetic resonance imaging study.

Lateral ventricular volume asymmetries in schizophrenia were studied using high resolution 3D magnetic resonance imaging in conjunction with segmentation and quantitation techniques. Comparisons were made between two clinical syndromes that have been associated with opposite patterns of functional hemispheric activation, namely an active and a withdrawn syndrome. Ratios of both left to right ventricular volume and left to right ventricle-to-brain ratios differed significantly between the two groups. These results primarily reflected differences in the left ventricular volume, in keeping with previous reports which have usually implicated left hemispheric structural abnormalities in schizophrenia. It is suggested that a syndromal approach might help to resolve some of the inconsistencies in the existing literature on lateralised neuroanatomical differences in schizophrenia.

Post partum magnetic resonance imaging: lumbar tissue changes are unrelated to epidural analgesia or mode of delivery.

Thirty five women consented post partum to daily lumbar back pain assessments and magnetic resonance imaging (MRI) (0.15 Tesla) within 48 hours of delivery using a T(1) weighted spin echo and a fat suppression sequence (STIR) to identify tissue water. Nine women (26%) had lumbar disc abnormalities on MRI scan. Variable degrees of soft tissue changes in the lumbar region were observed using the STIR sequence in all patients after delivery. Eight women (23%) had mild, 15 (43%) moderate, and 12 (34%) severe changes with an average of 5 segments involved. These changes were reversible and related neither to the mode of delivery, nor to the trauma of epidural cannulation.

Magnetic resonance imaging in preeclampsia and eclampsia complicated by visual disturbance and other neurological abnormalities.

This study describes magnetic resonance imaging findings in women presenting with neurological complications associated with preeclampsia and eclampsia. One eclamptic and two preeclamptic women were studied after presenting with postpartum neurological events. In two women the brain increased in size on the initial follow-up images, following the same pattern seen in normal pregnancy. In the other woman, the brain was decreased in size at 13 days postpartum but increased in size at six weeks postpartum. This initial reduction in brain size may reflect the resolution of cerebral oedema resulting from underlying pathological processes.

Schizophrenia syndromes associated with changes in ventricle-to-brain ratios: a serial high-resolution three-dimensional magnetic resonance imaging study in first-episode schizophrenia patients using subvoxel registration and semiautomated quantification.

A cohort of patients with first-episode schizophrenia was dichotomised into two age- and sex-matched groups of clinical syndromes, the active and withdrawn, and underwent high-resolution three-dimensional magnetic resonance imaging at baseline and 8 months later. A cohort of age- and sex-matched normal controls was also imaged at the same time intervals. The application of subvoxel registration and semiautomated quantification techniques demonstrated a significantly different outcome in ventricular changes between the two groups of patients. Compared with the controls, the withdrawn patients showed progressive ventricular enlargement, with an increase in ventricle-to-brain volume ratio, whereas the active group showed a reduction in ventricle-to-brain volume ratio, with a change opposite in sign and smaller in magnitude. These findings lend further support for the aetiological validity of this syndromal model of schizophrenia and are likely to be of importance in furthering our understanding of its pathogenesis and in the development of suitable therapeutic strategies.

Automated brain segmentation from single slice, multislice, or whole-volume MR scans using prior knowledge.

PURPOSE: An automated procedure has been developed to isolate the brain in single/multislice or whole-volume MR images obtained from various sequences. METHOD: T1-weighted, T2-weighted, and inversion recovery images were acquired. The brain segmentation procedure employed (A) a knowledge base that held generic information about the brain in the three orthogonal views and (B) a texture definition and intensity characteristics of features within the head. The brain was segmented by selectively blurring scans using components of B; contour following with region growing was initiated until the isolated feature satisfied the measurements in A. RESULTS: The brain was segmented automatically from 210 subjects (whole volume) and 52 subjects (multi/single slice). Detailed analysis of seven segmented brains showed that < 0.8% of the contour pixels were erroneously identified. Whole-volume head scans consisting of 140 x 256 x 256 pixels were segmented in < 30 min. CONCLUSION: A robust, fast, and efficient procedure has been developed to segment the brain from MR images.

Modeling and observation of temperature changes in vivo using MRI.

Models have been developed for the signal changes occurring in human peripheral muscle after thermal stress for some methods of measuring temperature in vivo. These include the dependency of T1 on temperature, observed by both direct, and magnetization transfer, experiments, and the temperature sensitivity of the diffusion coefficient and the chemical shift of the water proton line. Results show the relative complexity of the T1-dependent models when there are significant variations in, possibly amongst other things, tissue perfusion, and how the predictions made using them match the behavior of the practical values quite well. Using changes in the diffusion coefficient appears less problematic, although there can still be significant errors in temperature calibrations. The problems with this approach are likely to be due to the consequences of anisotropy in tissue.

Further observations on the measurement of tissue T1 to monitor temperature in vivo by MRI.

Previous results for the measurement of T1 as a means of monitoring temperature have demonstrated a linear calibration with a coefficient of the order of 1.5%/degrees C. We have studied the changes in T1 further, and observe that changes in tissue perfusion are substantial contributors to the effects observed, and that the model of what is happening is complex and may not permit a simple temperature calibration.

Design and implementation of magnetization transfer pulse sequences for clinical use.

The transfer of magnetization between a free and a bound pool of spins is described in terms of the respective longitudinal relaxation times and the life times of spins in each pool. The effect of an off resonance radiofrequency (RF) pulse in producing saturation in the bound pool and a consequent decrease in both the available longitudinal magnetization and the T1 of spins in the free pool is described. The effects of increasing duration of the saturating RF pulse on image pixel signal intensity were used to determine values for the decrease in both T1 and the available magnetization in gray and white matter of the brain as well as in muscle, fat, and CSF. At 0.15 T the available magnetization of muscle was reduced by approximately 60% and its T1 was decreased from 350 to 150 ms. The available magnetization of white and gray matter was reduced by 40% and their values of T1 were reduced by 80-110 ms. The reduction in available magnetization was used to increase contrast on proton density weighted or T2-weighted SE pulse sequences. These changes were also used to design inversion recovery (IR) pulse sequences with particular contrast properties. A short inversion time (TI) magnetization transfer (MT) IR (MT-STIR) pulse sequence was used to reduce the signal from normal muscle to zero to produce an angiographic effect in the leg. Increased tissue contrast was observed with a T2-weighted (MT-SE) sequence in a patient with bilateral cerebral infarction and with an MT-IR pulse sequence in a patient who had an intracranial hematoma. Three patients with cerebral tumors showed high lesion contrast with MT-STIR sequences. Components within two tumors were changed to different degrees by MT and in one case change in the brain attributable to recent radiotherapy treatment was only identified with an MT-STIR sequence. Magnetization transfer can be used to manipulate both the available longitudinal magnetization and the T1 of normal and abnormal tissues. The changes in tissue contrast produced by this can be very substantial and are likely to be of importance in clinical imaging.

Regions of interest tracking in temporal scans based on statistical analysis of gray scale and edge properties and registration of images.

Precise measurement of T1 is needed for its use in temperature monitoring in vivo. Movement of tissue relative to fixed regions of interest can result in large variations in apparent T1, with consequent substantial errors in the measured temperature. This paper evaluates methods of tracking regions of interest as tissue moves during a study in an effort to minimize errors from this cause. Tracking techniques evaluated are based on maintaining constant gray scale levels, locating nearby edges and maintaining position relative to them, and global image registration.

A registration and interpolation procedure for subvoxel matching of serially acquired MR images.

OBJECTIVE: Methods for automatically registering and reslicing MR images using an interpolation function that matches the structure of the image data are described. MATERIALS AND METHODS: Phantom and human brain images were matched by rigid body rotations and translations in two and three dimensions using a least-squares optimization procedure. Subvoxel image shifts were produced with linear or sinc interpolation. RESULTS: The use of sinc interpolation ensured that the repositioned images were faithful to the original data and enabled quantitative intensity comparisons to be made. In humans, image segmentation was vital to avoid extraneous soft tissue changes producing systematic errors in registration. CONCLUSIONS: The sinc-based interpolation technique enabled serially acquired MR images to be positionally matched to subvoxel accuracy so that small changes in the brain could be distinguished from effects due to misregistration.

Brain swelling in first hour after coronary artery bypass surgery.

Six patients undergoing routine coronary artery bypass surgery were examined by magnetic resonance imaging of the brain before surgery, immediately afterwards, and 6-18 days later. Brain swelling was visible in all six patients on the immediate postoperative scan. In five patients who had later scans the swelling had subsided. No major neurological deficits were seen, and the patients were extubated successfully within 3 h of the operation. The mechanism of the cerebral swelling is uncertain, but it may provide insight into the cause of neurophysiological deficits seen after coronary artery surgery.

Artifacts due to stimulus correlated motion in functional imaging of the brain.

To assess the effect of stimulus correlated motion on the appearance of functional magnetic resonance images, conventional visual and motor protocols were each performed by four normal volunteers and an image co-registration technique was used to retrospectively monitor subject motion. In three studies synthetic data sets were constructed from single baseline images using the positional information obtained from the co-registration procedure. Cumulative difference images were then created from both the synthetic and functional image sets. Stimulus correlated motion was detected in all eight studies and the synthetic cumulative difference images showed striking similarities to the equivalent functional images in each case.

MRI diffusion-weighted imaging of the brain: contributions to image contrast from CSF signal reduction, use of a long echo time and diffusion effects.

The contributions of CSF signal reduction, use of a long echo time and diffusion weighting to the appearance of pulsed gradient spin echo (PGSE) images are analysed by reference to T2-weighted spin echo and T2-weighted fluid attenuated inversion recovery (FLAIR) pulse sequences. Both PGSE and T2-weighted FLAIR sequences reduce CSF signal and produce very heavy T2 weighting allowing the specific additional contribution produced by the diffusion weighting of PGSE sequences to be recognized. Considerable advantage accrues from CSF suppression with both PGSE and FLAIR sequences through reduction in partial volume effects and artefacts. The very heavy T2 weighting with both these pulse sequences highlights certain white matter tracts and provides high sensitivity to disease. The additional diffusion weighting with PGSE sequences can enhance or reduce white matter tract signals and may enhance or reduce lesion conspicuity relative to the FLAIR sequences. Many of the benefits attributed to the diffusion-weighted PGSE sequence may result from the reduction of the CSF signal and the heavy T2 weighting of the sequence without a contribution from diffusion effects. However, additional anatomical detail, sensitivity to myelination and increased lesion conspicuity may result from the diffusion weighting.

Detection of subtle brain changes using subvoxel registration and subtraction of serial MR images.

OBJECTIVE: The aim of this study was to examine the potential of accurate image registration for detecting subtle changes in the brain. MATERIALS AND METHODS: Isotropic T1-weighted volume images were obtained in 10 normal subjects and five patients on two or more occasions (including pre- and postcontrast studies). The images were segmented and a 3D rigid body translation and rotation technique was used with sinc interpolation to precisely match the images using a chi 2-test. The registered images and the subtraction images produced from them were used to detect changes in signal intensity, sit, shape, and size of the brain. RESULTS: Small changes due to differences in orientation of the head, growth, and development as well as inhalation of oxygen and carbogen (95% O2/5% CO2) were observed in normal subjects. Changes were also observed in patients with minor head trauma, a meningioma, an astrocytoma, and multiple sclerosis. Differences due to contrast enhancement and surgery and/or anesthesia were also seen. CONCLUSION: With use of subvoxel registration, subtle changes in the brain were detected in a variety of physiological and clinical situations where differences have hitherto been difficult or impossible to detect.