Strategies for Implementing Machine Learning Algorithms in the Clinical Practice of Radiology.

Despite recent advancements in machine learning (ML) applications in health care, there have been few benefits and improvements to clinical medicine in the hospital setting. To facilitate clinical adaptation of methods in ML, this review proposes a standardized framework for the step-by-step implementation of artificial intelligence into the clinical practice of radiology that focuses on three key components: problem identification, stakeholder alignment, and pipeline integration. A review of the recent literature and empirical evidence in radiologic imaging applications justifies this approach and offers a discussion on structuring implementation efforts to help other hospital practices leverage ML to improve patient care. Clinical trial registration no. 04242667 © RSNA, 2024 Supplemental material is available for this article.

Zone- and layer-specific differences in proteoglycan content in patellofemoral pain syndrome are detectable on T1ρ MRI.

OBJECTIVE: Determine if differences in T1ρ would be detected in specific regions or layers of patellofemoral cartilage between patients with symptomatic patellofemoral pain syndrome and asymptomatic control subjects. MATERIALS AND METHODS: Ten subjects diagnosed with patellofemoral pain syndrome were compared with ten age-, gender-, and BMI-matched control subjects with no knee pain or prior trauma. Conventional turbo (fast) spin echo sequences and T1ρ-weighted imaging were performed on the symptomatic knee in each of the ten subjects. At the patella and distal femur, cartilage regions of interest were divided into medial and lateral sub-regions, each then further sub-divided by layer (superficial, middle, or deep). Two-tailed t test and chi-squared tests were used to analyze demographic data. A mixed effect model was run for each sub-region of T1ρ imaging. Statistical significance was determined using the likelihood ratio test against reduced models without patellofemoral pain syndrome symptomatic status as a fixed effect. RESULTS: There was no difference in age, sex, or BMI between symptomatic and control patients. T1ρ values were significantly higher among patellofemoral pain syndrome patients when compared with controls in the superficial zone of the lateral patella (58.43 vs. 50.83, p = 0.03) and the middle zone of the lateral patella (52.67 vs. 43.60, p = 0.03). T1ρ was also higher in the superficial zone of the medial femur (50.94 vs. 46.70, p = 0.09) with a value approaching statistical significance. CONCLUSION: We report statistically significant differences in the T1ρ value in the superficial and middle zones of the lateral patella in patients with patellofemoral pain syndrome who had no abnormalities seen on conventional MRI sequences, suggesting an alteration the macromolecular structure of the cartilage in this population.

Reproducibility of 2D GluCEST in healthy human volunteers at 7 T.

PURPOSE: To investigate the reproducibility of gray and white matter glutamate contrast of a brain slice among a small group of healthy volunteers by using the 2D single-slice glutamate CEST (GluCEST) imaging technique. METHODS: Six healthy volunteers were scanned multiple times for within-day and between-day reproducibility. One more volunteer was scanned for within-day reproducibility at 7T MRI. Glutamate CEST contrast measurements were calculated for within subjects and among the subjects and the coefficient of variations are reported. RESULTS: The GluCEST measurements were highly reproducible in the gray and white matter area of the brain slice, whether it was within-day or between-day with a coefficient of variation of less than 5%. CONCLUSION: This preliminary study in a small group of healthy volunteers shows a high degree of reproducibility of GluCEST MRI in brain and holds promise for implementation in studying age-dependent changes in the brain.

Axial T1ρ MRI as a diagnostic imaging modality to quantify proteoglycan concentration in degenerative disc disease.

PURPOSE: The aim of the study was to investigate if axial T1ρ MR images had similar accuracy as established sagittal T1ρ MRI for the assessment of proteoglycan concentration and content in intervertebral degenerated discs (IDDs). METHODS: T1ρ and T2-weighted MR images of 12 intervertebral discs (IVDs) from 3 harvested human lumbar spines (levels L1-L2 to L5-S1) were grouped across their degenerative grade (Pfirrmann scores) and analyzed using a 3T MRI scanner in the axial and sagittal views. Post-processing of axial T1ρ-weighted images was performed using a Wiener filter. Median axial T1ρ values for traced regions of interest (ROIs) on color maps were compared against ROIs in the corresponding location in the sagittal plane of each disc. Assessment of sulfated glycosaminoglycans (GAGs) content was also performed. RESULTS: Comparison of post Wiener filtered mid-axial T1ρ values in the NP with corresponding mid-sagittal values revealed no statistical difference (P > 0.05). Higher axial T1ρ and biochemically measured GAGs content corresponded to a lower Pfirrmann grading of the IVDs. A strong association between the T1ρ values and the GAG contents was observed (r = 0.85, P = 0.0002). CONCLUSIONS: The axial T1ρ methodology was validated against sagittal T1ρ providing an augmented spatial representation of IVD and can facilitate localization of focal degeneration within IVDs. T1ρ values provided a better granularity assessment of degenerative disc disease as it correlated with proteoglycan concentration. Thus, Wiener filtering is an effective tool for removing noise from T1ρ-weighted axial MR images.

In vivo measurement of glutamate loss is associated with synapse loss in a mouse model of tauopathy.

Glutamate is the primary excitatory neurotransmitter in the brain, and is implicated in neurodegenerative diseases such as Alzheimer's disease (AD) and several other tauopathies. The current method for measuring glutamate in vivo is proton magnetic resonance spectroscopy ((1)H MRS), although it has poor spatial resolution and weak sensitivity to glutamate changes. In this study, we sought to measure the effect of tau pathology on glutamate levels throughout the brain of a mouse model of tauopathy using a novel magnetic resonance imaging (MRI) technique. We employed glutamate chemical exchange saturation transfer (GluCEST) imaging, which has been previously validated as a complimentary method for measuring glutamate levels with several important advantages over conventional (1)H MRS. We hypothesized that the regional changes in glutamate levels would correlate with histological measurements of pathology including pathological tau, synapse and neuron loss. Imaging and spectroscopy were carried out on tau transgenic mice with the P301S mutation (PS19, n=9) and their wild-type littermates (WT, n=8), followed by immunohistochemistry of their brain tissue. GluCEST imaging resolution allowed for sub-hippocampal analysis of glutamate. Glutamate was significantly decreased by 29% in the CA sub-region of the PS19 hippocampus, and by 15% in the thalamus, where synapse loss was also measured. Glutamate levels and synapse density remained high in the dentate gyrus sub-region of the hippocampus, where neurogenesis is known to occur. The further development of GluCEST imaging for preclinical applications will be valuable, as therapies are being tested in mouse models of tauopathy.

A Cloud-Based System for Automated AI Image Analysis and Reporting.

Although numerous AI algorithms have been published, the relatively small number of algorithms used clinically is partly due to the difficulty of implementing AI seamlessly into the clinical workflow for radiologists and for their healthcare enterprise. The authors developed an AI orchestrator to facilitate the deployment and use of AI tools in a large multi-site university healthcare system and used it to conduct opportunistic screening for hepatic steatosis. During the 60-day study period, 991 abdominal CTs were processed at multiple different physical locations with an average turnaround time of 2.8 min. Quality control images and AI results were fully integrated into the existing clinical workflow. All input into and output from the server was in standardized data formats. The authors describe the methodology in detail; this framework can be adapted to integrate any clinical AI algorithm.

Clinical correlates of CT imaging-derived phenotypes among lean and overweight patients with hepatic steatosis.

The objective of this study is to define CT imaging derived phenotypes for patients with hepatic steatosis, a common metabolic liver condition, and determine its association with patient data from a medical biobank. There is a need to further characterize hepatic steatosis in lean patients, as its epidemiology may differ from that in overweight patients. A deep learning method determined the spleen-hepatic attenuation difference (SHAD) in Hounsfield Units (HU) on abdominal CT scans as a quantitative measure of hepatic steatosis. The patient cohort was stratified by BMI with a threshold of 25 kg/m2 and hepatic steatosis with threshold SHAD ≥ - 1 HU or liver mean attenuation ≤ 40 HU. Patient characteristics, diagnoses, and laboratory results representing metabolism and liver function were investigated. A phenome-wide association study (PheWAS) was performed for the statistical interaction between SHAD and the binary characteristic LEAN. The cohort contained 8914 patients-lean patients with (N = 278, 3.1%) and without (N = 1867, 20.9%) steatosis, and overweight patients with (N = 1863, 20.9%) and without (N = 4906, 55.0%) steatosis. Among all lean patients, those with steatosis had increased rates of cardiovascular disease (41.7 vs 27.8%), hypertension (86.7 vs 49.8%), and type 2 diabetes mellitus (29.1 vs 15.7%) (all p < 0.0001). Ten phenotypes were significant in the PheWAS, including chronic kidney disease, renal failure, and cardiovascular disease. Hepatic steatosis was found to be associated with cardiovascular, kidney, and metabolic conditions, separate from overweight BMI.

Quantitative cartilage degeneration associated with spontaneous osteoarthritis in a guinea pig model.

PURPOSE: To determine (i) the feasibility and intra- and inter-scan reproducibility of T(1ρ) MRI in assessing cartilage degeneration in a guinea pig model with naturally occurring joint disease that closely mimics human osteoarthritis (OA), (ii) demonstrate the sensitivity of T(1ρ) MRI in assessing the age dependent cartilage degeneration in OA progression as compared to histopathological changes. MATERIALS AND METHODS: Duncan-Hartley guinea pigs were obtained at various ages and maintained under an IACUC approved protocol. The left hind stifle joint was imaged using T(1ρ) MRI on a 9.4 Tesla Varian horizontal 20 cm bore scanner using a custom surface coil. Reproducibility of T(1ρ) MRI was assessed using 4-month-old guinea pigs (N = 3). Three age cohorts; 3 month (N = 8), 5 month (N = 6), and 9 month (N = 5), were used to determine the age-dependent osteoarthritic changes as measured by T(1ρ) MRI. Validation of age-dependent cartilage degeneration was confirmed by histology and Safranin-O staining. RESULTS: T(1ρ) values obtained in the cartilage of the stifle joint in guinea pigs were highly reproducible with an inter-scan mean coefficient of variation (CV) of 6.57% and a maximum intra-scan CV of 9.29%. Mean cartilage T(1ρ) values in animals with late stage cartilage degeneration were 56.3-56.9 ms (5-9 month cohorts) were both significantly (P < 0.01) higher than that obtained from 3-month-old cohort (44 ms) demonstrating an age-dependent variation. T(1ρ) was shown to be significantly greater than T(2) . T(1ρ) dispersion was observed in this animal model for the first time showing an increase of 45% between 500 Hz and 1500 Hz spin-locking frequency. Cartilage thickness measurements were calculated from single mid-coronal histology sections from same animals used for T(1ρ) MRI. Thickness calculations showed insignificant differences between 3- and 5-month cohorts and was significantly decreased by 9 months of age (P < 0.01). A moderate correlation (R(2) = 0.45) existed between T(1ρ) values and signal intensity of Safranin-O stain. CONCLUSION: The data presented demonstrate that T(1ρ) MRI is highly reproducible in this spontaneous model of OA and may serve as a noninvasive tool to characterize joint cartilage degeneration during OA. Age-dependent changes, verified with histological measurements of proteoglycan loss, correlated with T(1ρ) across different age groups. T(1ρ) has adequate dynamic range and is sensitive to detect and track the progression of cartilage degeneration in the guinea pig model before gross anatomical changes such as cartilage thinning has occurred. This study presents a technological advancement that would permit longitudinal studies of evaluating disease-modifying therapies useful for treating human OA.

Knee articular cartilage damage in osteoarthritis: analysis of MR image biomarker reproducibility in ACRIN-PA 4001 multicenter trial.

PURPOSE: To prospectively determine the reproducibility of quantitative magnetic resonance (MR) imaging biomarkers of the morphology and composition (spin lattice relaxation time in rotating frame [T1-ρ], T2) of knee cartilage in a multicenter multivendor trial involving patients with osteoarthritis (OA) and asymptomatic control subjects. MATERIALS AND METHODS: This study was HIPAA compliant and approved by the institutional review committees of the participating sites, with written informed consent obtained from all participants. Fifty subjects from five sites who were deemed to have normal knee joints (n = 18), mild OA (n = 16), or moderate OA (n = 16) on the basis of Kellgren-Lawrence scores were enrolled. Each participant underwent four sequential 3-T knee MR imaging examinations with use of the same imager and with 2-63 days (median, 18 days) separating the first and last examinations. Water-excited three-dimensional T1-weighted gradient-echo imaging, T1-ρ imaging, and T2 mapping of cartilage in the axial and coronal planes were performed. Biomarker reproducibility was determined by using intraclass correlation coefficients (ICCs) and root-mean-square coefficients of variation (RMS CVs, expressed as percentages). RESULTS: Morphometric biomarkers had high reproducibility, with ICCs of 0.989 or greater and RMS CVs lower than 4%. The largest differences between the healthy subjects and the patients with radiographically detected knee OA were those in T1-ρ values, but precision errors were relatively large. Reproducibility of T1-ρ values was higher in the thicker patellar cartilage (ICC range, 0.86-0.93; RMS CV range, 14%-18%) than in the femorotibial joints (ICC range, 0.20-0.84; RMS CV range, 7%-19%). Good to high reproducibility of T2 was observed, with ICCs ranging from 0.61 to 0.98 and RMS CVs ranging from 4% to 14%. CONCLUSION: MR imaging measurements of cartilage morphology, T2, and patellar T1-ρ demonstrated moderate to excellent reproducibility in a clinical trial network.

Quantification of abdominal fat from computed tomography using deep learning and its association with electronic health records in an academic biobank.

OBJECTIVE: The objective was to develop a fully automated algorithm for abdominal fat segmentation and to deploy this method at scale in an academic biobank. MATERIALS AND METHODS: We built a fully automated image curation and labeling technique using deep learning and distributive computing to identify subcutaneous and visceral abdominal fat compartments from 52,844 computed tomography scans in 13,502 patients in the Penn Medicine Biobank (PMBB). A classification network identified the inferior and superior borders of the abdomen, and a segmentation network differentiated visceral and subcutaneous fat. Following technical evaluation of our method, we conducted studies to validate known relationships with visceral and subcutaneous fat. RESULTS: When compared with 100 manually annotated cases, the classification network was on average within one 5-mm slice for both the superior (0.4 ± 1.1 slice) and inferior (0.4 ± 0.6 slice) borders. The segmentation network also demonstrated excellent performance with intraclass correlation coefficients of 1.00 (P < 2 × 10-16) for subcutaneous and 1.00 (P < 2 × 10-16) for visceral fat on 100 testing cases. We performed integrative analyses of abdominal fat with the phenome extracted from the electronic health record and found highly significant associations with diabetes mellitus, hypertension, and renal failure, among other phenotypes. CONCLUSIONS: This work presents a fully automated and highly accurate method for the quantification of abdominal fat that can be applied to routine clinical imaging studies to fuel translational scientific discovery.

Measurement of intervertebral disc pressure with T 1ρ MRI.

The aim of this study is to demonstrate T(1ρ) MRI's capability for measuring intervertebral disc osmotic pressure. Self-coregistered sodium and T(1ρ) -weighted MR images were acquired on ex vivo bovine intervertebral discs (N = 12) on a 3 T clinical MRI scanner. The sodium MR images were used to calculate effective nucleus pulposus fixed-charge-density (mean = 138.2 ± 27.6 mM) and subsequently osmotic pressure (mean = 0.53 ± 0.18 atm), whereas the T(1ρ) -weighted images were used to compute T(1ρ) relaxation maps. A significant linear correlation (R = 0.56, P < 0.01) between nucleus pulposus fixed-charge-density and T(1ρ) relaxation time constant was observed. More importantly, a significant power correlation (R = 0.72, P < 0.01) between nucleus pulposus osmotic pressure as predicted by sodium MRI and T(1ρ) relaxation time constant was also observed. The current clinical method for assessing disc pressure is discography, which is an invasive procedure that has been shown to have negative effects on disc biomechanical and biochemical properties. In contrast, T(1ρ) MRI is noninvasive and can be easily implemented in a clinical setting due to its superior signal-to-noise ratio compared with sodium MRI. Therefore, T(1ρ) MRI may serve as a noninvasive clinical tool for the longitudinal evaluation of disc osmotic pressure.

Magnetization transfer ratio mapping of intervertebral disc degeneration.

The magnetization transfer ratio of the lumbar discs was spatially quantified from age-matched subjects and the nucleus pulposus magnetization transfer ratio was correlated with T2-weighted Pfirrmann grades. A moderate and significant linear correlation between magnetization transfer ratio and Pfirrmann grades was observed, suggesting that nucleus pulposus collagen relative density increases with degeneration. High-resolution axial magnetization transfer ratio maps revealed elevated magnetization transfer ratio in the nucleus pulposa of injured and heavily degenerated discs. In the injured disc, significant elevation in nucleus pulposa magnetization transfer ratio was not accompanied by significant decrease in disc height. This observation may suggest a possible increase in absolute collagen content, in addition to increased collagen relative density. In summary, magnetization transfer MRI of the disc may serve as a noninvasive diagnostic tool for disc degeneration, in addition to other MRI techniques specific to proteoglycan content.

T1rho MRI quantification of arthroscopically confirmed cartilage degeneration.

Nine asymptomatic subjects and six patients underwent T(1)rho MRI to determine whether Outerbridge grade 1 or 2 cartilage degeneration observed during arthroscopy could be detected noninvasively. MRI was performed 2-3 months postarthroscopy, using sagittal T(1)-weighted and axial and coronal T(1)rho MRI, from which spatial T(1)rho relaxation maps were calculated from segmented T(1)-weighted images. Median T(1)rho relaxation times of patients with arthroscopically documented cartilage degeneration and asymptomatic subjects were significantly different (P < 0.001), and median T(1)rho exceeded asymptomatic articular cartilage median T(1)rho by 2.5 to 9.2 ms. In eight observations of mild cartilage degeneration at arthroscopy (Outerbridge grades 1 and 2), mean compartment T(1)rho was elevated in five, but in all observations, large foci of increased T(1)rho were observed. It was determined that T(1)rho could detect some, but not all, Outerbridge grade 1 and 2 cartilage degeneration but that a larger patient population is needed to determine the sensitivity to these changes.

WITHDRAWN: Radiology Extenders: Impact on Throughput and Accuracy for Routine Chest Radiographs.

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Single shot T1rho magnetic resonance imaging of metabolically generated water in vivo.

The use of Oxygen-17 MRI provides great promise for the clinically-useful quantification of metabolism. To bring techniques based on 17O closer to clinical application, we demonstrate imaging of metabolically generated H2 17O in pigs after 17O2 delivery with increased temporal resolution T1rho-weighted imaging and precision delivery of 17O2 gas. The kinetics of the appearance of H2 17O in pig brains are displayed with one to two minutes of 17O2 delivery, the shortest delivery times reported in the literature. It is also shown that H2 17O concentrations can be quantified with single shot T1rho imaging based on a balanced steady state free precession readout, and that with this strategy pausing to reduce T1 saturation increases sensitivity to H2 17O over acquisition in the steady state. Several additional considerations with this sequence, which can be generalized to any pre-encoding cluster, such as energy deposition are considered.

Comparison of Study Activity Times for "Full" versus "Fast MRI" for Breast Cancer Screening.

PURPOSE: To optimize operations for a newly implemented abbreviated MR (AB-MR) breast cancer screening protocol, activity times were compared with the full-protocol examination. METHODS: Activity times from 70 AB-MR and 736 full MR screening studies were analyzed. Total study time was measured from opening to closing examinations and expected scan time by summing the time of acquisition for each imaging series for either protocol. Actual scan time was obtained from DICOM headers. Total technologist activity time was obtained by subtracting expected scan time from total study time. Technologist activity time included both scan-related and non-scan-related activities. RESULTS: The actual scan time for the AB protocol was 17.5 ± 0.5 min, compared with 28.8 ± 0.3 min (mean ± SE) for the full protocol (difference, 11.3 min; P < .0001). The total study time was 36.0 ± 3.2 min for AB-MRI and 49.7 ± 0.8 min for the full protocol (difference, 13.7 min; P < .0001), implying that the AB-MR protocol had only a 38% greater patient flow rate than the full protocol. CONCLUSIONS: The realized gains in patient flow rate were lower than expected based on scan times (65%) because of increased technologist activity time for the AB-MR protocol.

The UTE Disc Sign on MRI: A Novel Imaging Biomarker Associated With Degenerative Spine Changes, Low Back Pain, and Disability.

STUDY DESIGN: Cross-sectional. OBJECTIVE: To assess the distribution of the ultra-short time-to-echo (UTE) disc sign (UDS) and its association with disc degeneration, other magnetic resonance imaging (MRI) phenotypes, pain, and disability profiles. SUMMARY OF BACKGROUND DATA: Disc degeneration has been conventionally assessed by T2-weighted (T2W) signal intensity on MRI; however, its clinical utility has been questionable. UTE MRI assesses short T2 components. The authors have identified a new imaging biomarker on UTE-the UDS. METHODS: One hundred eight subjects were recruited. T2W MRI assessed disc degeneration and other phenotypes, and T1-rho MRI values represented quantitative proteoglycan disc profiles of L1-S1. UDS was detected on UTE (i.e., hyper-/hypointense disc band). A UDS score (cumulative number of UDS levels) and T2W summated lumbar degenerated scores (cumulative disc degeneration score) were assessed. Subject demographics, chronic low back pain (LBP), and disability profiles (Oswestry Disability Index: ODI) were obtained. RESULTS: UDS was noted in 39.8% subjects, 61.4% occurred at the lower lumbar spine and 39.5% had multilevel UDS. UDS subjects had significantly greater severity and extent of disc degeneration, and Modic changes (P < 0.05). By disc levels, a higher prevalence of disc degeneration/displacement, Modic changes, and spondylolisthesis were noted in UDS discs than non-UDS discs (P < 0.05). T1-rho values were also lower in UDS discs (P = 0.022). The majority of UDS could not be detected on T2W. The UDS score significantly correlated with worse ODI scores (r = 0.311; P = 0.001), whereas T2W cumulative disc degeneration score did not (r = 0.13; P = 0.19). LBP subjects exhibited more multilevel UDS (P < 0.015) but not on T2W MRI (P = 0.53). The UDS score was significantly related to LBP (P = 0.009), whereas T2W cumulative disc degeneration score was not (P = 0.127). CONCLUSION: This is the first study to report "UDS" in humans. UDS is a novel imaging biomarker that is highly associated with degenerative spine changes, chronic LBP, and disability than conventional T2W MRI. LEVEL OF EVIDENCE: 2.

In vivo GluCEST MRI: Reproducibility, background contribution and source of glutamate changes in the MPTP model of Parkinson's disease.

Glutamate Chemical Exchange Saturation Transfer (GluCEST) MRI is a recently developed technique to image glutamate. In the present study, we evaluated the reproducibility and background contamination to the GluCEST and source of the GluCEST changes in a mouse model of Parkinson's disease. Repeated measurements in five mice demonstrated an intra-animal coefficient of variation (CV) of GluCEST signal to be 2.3 ± 1.3% and inter-animal CV of GluCEST to be 3.3 ± 0.3%. Mice were treated with MPTP to create a localized striatal elevation of glutamate. We found an elevation in the GluCEST contrast of the striatum following MPTP treatment (Control: 23.3 ± 0.8%, n = 16; MPTP: 26.2 ± 0.8%, n = 19; p ≤ 0.001). Additionally, the positive association between glutamate concentration measured via 1H MRS and GluCEST signal was used to estimate background contribution to the measured GluCEST. The contribution of signal from non-glutamate sources was found to be ~28% of the total GluCEST. Immunohistochemical analysis of the brain showed co-localization of glutamate with GFAP in the striatum. This suggests that the elevated glutamate present in the striatum in this mouse model reflects astroglial proliferation or reactivity due to the action of MPTP. The potential of GluCEST as a biomarker for imaging inflammation mediated gliosis is discussed.

Artifacts in T1 rho-weighted imaging: compensation for B(1) and B(0) field imperfections.

The origin of spin locking image artifacts in the presence of B(0) and B(1) magnetic field imperfections is shown theoretically using the Bloch equations and experimentally at low (omega(1) << Delta omega(0)), intermediate (omega(1) approximately Delta omega(0)) and high (omega(1) >> Delta omega(0)) spin locking field strengths. At low spin locking fields, the magnetization is shown to oscillate about an effective field in the rotating frame causing signature banding artifacts in the image. At high spin lock fields, the effect of the resonance offset Deltao mega(0) is quenched, but imperfections in the flip angle cause oscillations about the omega(1) field. A new pulse sequence is presented that consists of an integrated spin echo and spin lock experiment followed by magnetization storage along the -z-axis. It is shown that this sequence almost entirely eliminates banding artifacts from both types of field inhomogeneities at all spin locking field strengths. The sequence was used to obtain artifact free images of agarose in inhomogeneous B(0) and B(1) fields, off-resonance spins in fat and in vivo human brain images at 3 T. The new pulse sequence can be used to probe very low frequency (0-400 Hz) dynamic and static interactions in tissues without contaminating B(0) and B(1) field artifacts.

Gender-based analysis of cortical thickness and structural connectivity in Parkinson's disease.

Parkinson's disease (PD) is a progressive neurological disorder and appears to have gender-specific symptoms. Studies have observed a higher frequency for development of PD in male than in female. In the current study, we evaluated the gender-based changes in cortical thickness and structural connectivity in PD patients. With informed consent, 64 PD (43 males and 21 females) patients, and 46 (12 males and 34 females) age-matched controls underwent clinical assessment including Mini-Mental State Examination (MMSE) and magnetic resonance imaging on a 1.5 Tesla clinical MR scanner. Whole brain high-resolution T1-weighted images were acquired from all subjects and used to measure cortical thickness and structural network connectivity. No significant difference in MMSE score was observed between male and female both in control and PD subjects. Male PD patients showed significantly reduced cortical thickness in multiple brain regions including frontal, parietal, temporal, and occipital lobes as compared with those in female PD patients. The graph theory-based network analysis depicted lower connection strengths, lower clustering coefficients, and altered network hubs in PD male than in PD female. Male-specific cortical thickness changes and altered connectivity in PD patients may derive from behavioral, physiological, environmental, and genetical differences between male and female, and may have significant implications in diagnosing and treating PD among genders.