Comparison of Multivendor Single-Voxel MR Spectroscopy Data Acquired in Healthy Brain at 26 Sites.

Background The hardware and software differences between MR vendors and individual sites influence the quantification of MR spectroscopy data. An analysis of a large data set may help to better understand sources of the total variance in quantified metabolite levels. Purpose To compare multisite quantitative brain MR spectroscopy data acquired in healthy participants at 26 sites by using the vendor-supplied single-voxel point-resolved spectroscopy (PRESS) sequence. Materials and Methods An MR spectroscopy protocol to acquire short-echo-time PRESS data from the midparietal region of the brain was disseminated to 26 research sites operating 3.0-T MR scanners from three different vendors. In this prospective study, healthy participants were scanned between July 2016 and December 2017. Data were analyzed by using software with simulated basis sets customized for each vendor implementation. The proportion of total variance attributed to vendor-, site-, and participant-related effects was estimated by using a linear mixed-effects model. P values were derived through parametric bootstrapping of the linear mixed-effects models (denoted Pboot). Results In total, 296 participants (mean age, 26 years ± 4.6; 155 women and 141 men) were scanned. Good-quality data were recorded from all sites, as evidenced by a consistent linewidth of N-acetylaspartate (range, 4.4-5.0 Hz), signal-to-noise ratio (range, 174-289), and low Cramér-Rao lower bounds (≤5%) for all of the major metabolites. Among the major metabolites, no vendor effects were found for levels of myo-inositol (Pboot > .90), N-acetylaspartate and N-acetylaspartylglutamate (Pboot = .13), or glutamate and glutamine (Pboot = .11). Among the smaller resonances, no vendor effects were found for ascorbate (Pboot = .08), aspartate (Pboot > .90), glutathione (Pboot > .90), or lactate (Pboot = .28). Conclusion Multisite multivendor single-voxel MR spectroscopy studies performed at 3.0 T can yield results that are coherent across vendors, provided that vendor differences in pulse sequence implementation are accounted for in data analysis. However, the site-related effects on variability were more profound and suggest the need for further standardization of spectroscopic protocols. © RSNA, 2020 Online supplemental material is available for this article.

Efficacy of a biomechanically-based yoga exercise program in knee osteoarthritis: A randomized controlled trial.

OBJECTIVE: Certain exercises could overload the osteoarthritic knee. We developed an exercise program from yoga postures with a minimal knee adduction moment for knee osteoarthritis. The purpose was to compare the effectiveness of this biomechanically-based yoga exercise (YE), with traditional exercise (TE), and a no-exercise attention-equivalent control (NE) for improving pain, self-reported physical function and mobility performance in women with knee osteoarthritis. DESIGN: Single-blind, three-arm randomized controlled trial. SETTING: Community in Southwestern Ontario, Canada. PARTICIPANTS: A convenience sample of 31 women with symptomatic knee osteoarthritis was recruited through rheumatology, orthopaedic and physiotherapy clinics, newspapers and word-of-mouth. INTERVENTIONS: Participants were stratified by disease severity and randomly allocated to one of three 12-week, supervised interventions. YE included biomechanically-based yoga exercises; TE included traditional leg strengthening on machines; and NE included meditation with no exercise. Participants were asked to attend three 1-hour group classes/sessions each week. MEASUREMENTS: Primary outcomes were pain, self-reported physical function and mobility performance. Secondary outcomes were knee strength, depression, and health-related quality of life. All were assessed by a blinded assessor at baseline and immediately following the intervention. RESULTS: The YE group demonstrated greater improvements in KOOS pain (mean difference of 22.9 [95% CI, 6.9 to 38.8; p = 0.003]), intermittent pain (mean difference of -19.6 [95% CI, -34.8 to -4.4; p = 0.009]) and self-reported physical function (mean difference of 17.2 [95% CI, 5.2 to 29.2; p = 0.003]) compared to NE. Improvements in these outcomes were similar between YE and TE. However, TE demonstrated a greater improvement in knee flexor strength compared to YE (mean difference of 0.1 [95% CI, 0.1 to 0.2]. Improvements from baseline to follow-up were present in quality of life score for YE and knee flexor strength for TE, while both also demonstrated improvements in mobility. No improvement in any outcome was present in NE. CONCLUSIONS: The biomechanically-based yoga exercise program produced clinically meaningful improvements in pain, self-reported physical function and mobility in women with clinical knee OA compared to no exercise. While not statistically significant, improvements in these outcomes were larger than those elicited from the traditional exercise-based program. Though this may suggest that the yoga program may be more efficacious for knee OA, future research studying a larger sample is required. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02370667).

Phosphorus magnetic resonance spectroscopic imaging using flyback echo planar readout trajectories.

OBJECT: To present and evaluate a fast phosphorus magnetic resonance spectroscopic imaging (MRSI) sequence using echo planar spectroscopic imaging with flyback readout gradient trajectories. MATERIALS AND METHODS: Waveforms were designed and implemented using a 3 Tesla MRI system. 31P spectra were acquired with 2 × 2 cm2 and 3 × 3 cm2 resolution over a 20- and 21-cm field of view and spectral bandwidths up to 1923 Hz. The sequence was first tested using a 20-cm-diameter phosphate phantom, and subsequent in vivo tests were performed on healthy human calf muscles and brains from five volunteers. RESULTS: Flyback EPSI achieved 10× and 7× reductions in acquisition time, with 68.0 ± 1.2 and 69.8 ± 2.2% signal-to-noise ratio (SNR) per unit of time efficiency (theoretical SNR efficiency was 74.5 and 76.4%) for the in vivo experiments, compared to conventional phase-encoded MRSI for the 2 × 2 cm2 and 3 × 3 cm2 resolution waveforms, respectively. Statistical analysis showed no difference in the quantification of most metabolites. Time savings and SNR comparisons were consistent across phantom, leg and brain experiments. CONCLUSION: EPSI using flyback readout trajectories was found to be a reliable alternative for acquiring 31P-MRSI data in a shorter acquisition time.

Observed Deposition of Gadolinium in Bone Using a New Noninvasive in Vivo Biomedical Device: Results of a Small Pilot Feasibility Study.

Purpose To perform a preliminary evaluation of a noninvasive measurement system to assess gadolinium deposition in bone and to investigate the relationship between the administration of gadolinium-based contrast agents (GBCAs) and gadolinium retention in bone. Materials and Methods In vivo measurement of gadolinium retention in tibia bones was performed in 11 exposed subjects who previously received GBCAs (six exposed subjects were from a study performed 5 years previously involving injection of GBCAs in healthy volunteers; five exposed subjects had self-reported GBCA exposure), and 11 sex- and age-matched control subjects without a history of GBCA exposure. Each subject underwent one measurement of gadolinium retention in the tibia with x-ray fluorescence in a laboratory at McMaster University. A one-tailed t test was performed to compare gadolinium concentration in the exposed group with that in the control group. The relationship between the dose of GBCA administered and the gadolinium concentration measured in bone was analyzed with linear regression. Results Gadolinium concentration in bone was significantly higher in exposed subjects (mean, 1.19 µg Gd/g bone mineral ± 0.73 [standard deviation]) than in control subjects (mean, -1.06 µg Gd/g bone mineral ± 0.71) (P = .01). There was also a positive correlation between the dose of GBCA administered and the gadolinium concentration measured in bone (R2 = 0.41); gadolinium concentration in bone increased by 0.39 µg Gd/g bone mineral ± 0.14 per 1 mL of GBCA administered. Gadolinium was detected in bone up to 5 years after one GBCA administration. Conclusion This x-ray fluorescence system is capable of measuring gadolinium deposition in bone noninvasively in vivo. Gadolinium can be retained in bone after one dose of GBCA in healthy subjects. © RSNA, 2017 Online supplemental material is available for this article.

EEG and fMRI agree: Mental arithmetic is the easiest form of imagery to detect.

fMRI and EEG during mental imagery provide alternative methods of detecting awareness in patients with disorders of consciousness (DOC) without reliance on behaviour. Because using fMRI in patients with DOC is difficult, studies increasingly employ EEG. However, there has been no verification that these modalities provide converging information at the individual subject level. The present study examined simultaneous EEG and fMRI in healthy volunteers during six mental imagery tasks to determine whether one mental imagery task generates more robust activation across subjects; whether activation can be predicted from familiarity with the imagined activity; and whether EEG and fMRI converge upon the same conclusions about individual imagery performance. Mental arithmetic generated the most robust activation in the majority of subjects for both EEG and fMRI, and level of activation could not be predicted from familiarity, with either modality. We conclude that overall, EEG and fMRI agree regarding individual mental imagery performance.

Safe MRI-Compatible electrical muscle stimulation (EMS) system.

PURPOSE: To develop an inexpensive magnetic resonance imaging (MRI)-compatible electrical muscle stimulation (EMS) unit and test it for safety and efficacy. MATERIALS AND METHODS: A simple MRI-compatible EMS device was developed using radiofrequency (RF) translucent electrodes at 3T. RF heating concerns were assessed using optical temperature measurements at electrode sites, during scanning of a phantom. EMS efficacy and consistency was investigated through in vivo (n = 5) measures of 31 P-MRS phosphocreatine (PCr) reduction, and altered blood oxygen level-dependent (BOLD) signal and the results were compared to effects from equivalent voluntary effort on the same subjects. RESULTS: The presence of an EMS pulse did not interfere with the T2 * signal in a phantom. However, signal-to-noise ratio (SNR) was reduced by 70% at electrode sites, but only by 10% 4 cm distally. Under RF intense conditions, the temperature at the electrode site increased by only 4.7°C over a 16-minute time span. In vivo muscle stimulation resulted in 13.5 ± 1.8% reduction in PCr, which was not significantly (P < 0.195) different from voluntary contraction. Reproducible muscle BOLD signal changes following EMS were noted, with a maximal increase of 10.0 ± 2.6% seen in the central soleus. For soleus and gastrocnemius compartments, EMS produced significantly higher BOLD signal change compared to voluntary contraction (P < 0.05). CONCLUSION: A safe and inexpensive MRI-compatible EMS unit can be easily built for evaluating muscle function and metabolism within a 3T MRI scanner. Clinical applications might include evaluating skeletal muscle function in patients with limited or absent voluntary skeletal motor function or inadequate exercise capacity. J. Magn. Reson. Imaging 2016;44:1530-1538.

Changes in vertebral artery blood flow following various head positions and cervical spine manipulation.

OBJECTIVE: The objective of the study was to investigate the cerebrovascular hemodynamic response of cervical spine positions including rotation and cervical spine manipulation in vivo using magnetic resonance imaging technology on the vertebral artery (VA). METHODS: This pilot study was conducted as a blinded examiner cohort with 4 randomized clinical tasks. Ten healthy male participants aged 24 to 30 years (mean, 26.8 years) volunteered to participate in the study. None of the participants had a history of disabling neck, arm, or headache pain within the last 6 months. They did not have any current or history of neurologic symptoms. In a neutral head position, physiologic measures of VA blood flow and velocity at the C1-2 spinal level were obtained using phase-contrast magnetic resonance imaging after 3 different head positions and a chiropractic upper cervical spinal manipulation. A total of 30 flow-encoded phase-contrast images were collected over the cardiac cycle, in each of the 4 conditions, and were used to provide a blood flow profile for one complete cardiac cycle. Differences between flow (in milliliters per second) and velocity (in centimeters per second) variables were evaluated using repeated-measures analysis of variance. RESULTS: The side-to-side difference between ipsilateral and contralateral VA velocities was not significant for either velocities (P = .14) or flows (P = .19) throughout the conditions. There were no other interactions or trends toward a difference for any of the other blood flow or velocity variables. CONCLUSIONS: There were no significant changes in blood flow or velocity in the vertebral arteries of healthy young male adults after various head positions and cervical spine manipulations.

Attenuation of brain BOLD response following lipid ingestion.

A great deal of heterogeneity exists in fMRI data. Even within the same subject, results on successive days or scan sessions often differ in the number of significantly activated pixels and/or the intensity of activation. We sought to assess whether controllable physiologic modulators, such as dietary factors, could influence the outcome of fMRI data. A high fat diet, for example, prior to a fMRI scan could change microvascular blood rheologic factors and potentially alter brain blood oxygen-level dependent (BOLD) signal patterns. In healthy adult volunteers, we measured brain BOLD signal during bilateral finger tapping (2 Hz) in the fasted state, and at 40 and 100 minutes post-ingestion of a 235 mL can of Ensure Plus (Ross Labs), alone or supplemented with either 25 cc or 50 cc of canola oil. Both the 25 cc and 50 cc Canola oil treatments produced a significant bilateral decrease in BOLD signal 40 and 100 minutes postprandial. No significant effect was observed with Ensure in the absence of oil. Therefore, to decrease fMRI within and between subject heterogeneity, and thereby increase fMRI statistical power, it is suggested that scanning within 2 hours post high fat ingestion should be avoided. As a corollary, a thorough understanding of a subject's physiological state, prior to an fMRI exam, may reduce the impact of other confounding variables.