MR characterization of hepatic storage iron in transfusional iron overload.

PURPOSE: To quantify the two principal forms of hepatic storage iron, diffuse, soluble iron (primarily ferritin), and aggregated, insoluble iron (primarily hemosiderin) using a new MRI method in patients with transfusional iron overload. MATERIALS AND METHODS: Six healthy volunteers and 20 patients with transfusion-dependent thalassemia syndromes and iron overload were examined. Ferritin- and hemosiderin-like iron were determined based on the measurement of two distinct relaxation parameters: the "reduced" transverse relaxation rate, RR2 , and the "aggregation index," A, using three sets of Carr-Purcell-Meiboom-Gill (CPMG) datasets with different interecho spacings. Agarose phantoms, simulating the relaxation and susceptibility properties of tissue with different concentrations of dispersed (ferritin-like) and aggregated (hemosiderin-like) iron, were used for validation. RESULTS: Both phantom and in vivo human data confirmed that transverse relaxation components associated with the dispersed and aggregated iron could be separated using the two-parameter (RR2 , A) method. The MRI-determined total hepatic storage iron was highly correlated (r = 0.95) with measurements derived from biopsy or biosusceptometry. As total hepatic storage iron increased, the proportion stored as aggregated iron became greater. CONCLUSION: This method provides a new means for noninvasive MRI determination of the partition of hepatic storage iron between ferritin and hemosiderin in iron overload disorders.

Separate MRI quantification of dispersed (ferritin-like) and aggregated (hemosiderin-like) storage iron.

A new MRI method is proposed for separately quantifying the two principal forms of tissue storage (nonheme) iron: ferritin iron, a dispersed, soluble fraction that can be rapidly mobilized, and hemosiderin iron, an aggregated, insoluble fraction that serves as a long-term reserve. The method utilizes multiple spin echo sequences, exploiting the fact that aggregated iron can induce nonmonoexponential signal decay for multiple spin echo sequences. The method is validated in vitro for agarose phantoms, simulating dispersed iron with manganese chloride, and aggregated iron with iron oxide microspheres. To demonstrate feasibility for human studies, preliminary in vivo data from two healthy controls and six patients with transfusional iron overload are presented. For both phantoms and human subjects, conventional R(2) and R(2)* relaxation rates are also measured in order to contrast the proposed method with established MRI iron quantification techniques. Quantification of dispersed (ferritin-like) iron may provide a new means of monitoring the risk of iron-induced toxicity in patients with iron overload and, together with quantification of aggregated (hemosiderin-like) iron, improve the accuracy of estimates for total storage iron.

Prospective real-time correction for arbitrary head motion using active markers.

Patient motion during an MRI exam can result in major degradation of image quality, and is of increasing concern due to the aging population and its associated diseases. This work presents a general strategy for real-time, intraimage compensation of rigid-body motion that is compatible with multiple imaging sequences. Image quality improvements are established for structural brain MRI acquired during volunteer motion. A headband integrated with three active markers is secured to the forehead. Prospective correction is achieved by interleaving a rapid track-and-update module into the imaging sequence. For every repetition of this module, a short tracking pulse-sequence remeasures the marker positions; during head motion, the rigid-body transformation that realigns the markers to their initial positions is fed back to adaptively update the image-plane-maintaining it at a fixed orientation relative to the head-before the next imaging segment of k-space is acquired. In cases of extreme motion, corrupted lines of k-space are rejected and reacquired with the updated geometry. High-precision tracking measurements (0.01 mm) and corrections are accomplished in a temporal resolution (37 ms) suitable for real-time application. The correction package requires minimal additional hardware and is fully integrated into the standard user interface, promoting transferability to clinical practice.

Transient lesion in the splenium of the corpus callosum in acute uncomplicated falciparum malaria.

Patients with acute uncomplicated Plasmodium falciparum malaria have no evident neurologic disorder, vital organ dysfunction, or other severe manifestations of infection. Nonetheless, parasitized erythrocytes cytoadhere to the endothelium throughout their microvasculature, especially within the brain. We aimed to determine if 3 Tesla magnetic resonance imaging studies could detect evidence of cerebral abnormalities in these patients. Within 24 hours of admission, initial magnetic resonance imaging examinations found a lesion with restricted water diffusion in the mid-portion of the splenium of the corpus callosum of 4 (40%) of 10 male patients. The four patients who had a splenial lesion initially had evidence of more severe hemolysis and thrombocytopenia than the six patients who had no apparent abnormality. Repeat studies four weeks later found no residua of the lesions and resolution of the hematologic differences. These observations provide evidence for acute cerebral injury in the absence of severe or cerebral malaria.

Measurement and correction of stimulated echo contamination in T2-based iron quantification.

The purpose of this study was to characterize the effects of stimulated echo contamination on MR-based iron measurement derived from quantitative T2 images and develop a method for retrospective correction. Two multiple spin-echo (MSE) pulse sequences were implemented with different amounts of stimulated echo contamination. Agarose-based phantoms were constructed that simulate the relaxation and susceptibility properties of tissue with different concentrations of dispersed (ferritin-like) and aggregated (hemosiderin-like) iron. Additionally, myocardial iron was assessed in nine human subjects with transfusion iron overload. These data were used to determine the influence of stimulated echoes on iron measurements made by an MR-based iron quantification model that can separately measure dispersed and aggregated iron. The study found that stimulated echo contamination caused an underestimation of dispersed (ferritin-like) iron and an overestimation of aggregated (hemosiderin-like) iron when applying this model. The relationship between the measurements made with and without stimulated echo appears to be linear. The findings suggest that while it is important to use MSE sequences with minimal stimulated echo in T2-based iron quantification, it appears that data acquired with sub-optimal sequences can be retrospectively corrected using the methodology described here.

Initial experience with balanced turbo field echo in depicting carotid artery stenosis: comparison with multiple overlapping thin slab acquisition and 3D contrast-enhanced magnetic resonance angiography.

PURPOSE: To compare balanced turbo field echo (bTFE) with multiple overlapping thin slice acquisition (MOTSA) and contrast-enhanced MR angiography (CE-MRA) in depicting carotid artery stenosis. MATERIALS AND METHODS: In this study 86 patients with cerebrovascular disease, who had been referred for a carotid examination, were imaged. All of the patients underwent MOTSA and one of four bTFE sequences followed by CE-MRA. Formatted maximum intensity projections (MIPs) and source images were read in a blinded fashion by a radiologist. Inter- and intrasequence statistical analyses were performed. RESULTS: We first compared image quality (IQ) and fat, background, and venous suppression using four distinct bTFE protocols in 118 carotid arteries, and found that bTFE4 performed the best. We then compared IQ, grades of stenosis, and background and venous suppression among bTFE4, MOTSA, and CE-MRA. bTFE produced significantly better IQ and venous suppression (P < 0.001), and higher SNR and CNR (P < 0.05) when compared to MOTSA. CONCLUSION: The bTFE sequence is robust and provides high-quality images in patients with mild to moderate carotid artery stenosis. Even though there is a tendency to overestimate stenosis with bTFE compared to CE-MRA, the shorter scan time of bTFE coupled with enhanced SNR and CNR measurements validates it as a clinically useful adjunct to MOTSA, if not a replacement.