In Vivo Fat Quantification: Monitoring Effects of a 6-Week Non-Energy-Restricted Ketogenic Diet in Healthy Adults Using MRI, ADP and BIA.

The ketogenic diet (KD) is a very low-carbohydrate, high-fat, and adequate-protein diet that induces many metabolic adaptations when calorie intake is not limited. Its therapeutic use in a range of diseases including cancer is currently being investigated. Our objective was to firstly assess the impact of a 6-week non-energy-restricted KD on the abdominal fat distribution and the hepatic fat composition in healthy adults. Body fat distribution and composition were measured by comparing magnetic resonance imaging (MRI) and spectroscopy (MRS) results with air displacement plethysmography (ADP) and bioelectrical impedance analysis (BIA) measurements. A total of 12 subjects from the KetoPerformance study were recruited for this ancillary study. Body mass index (BMI), total mass, total fat mass, total subcutaneous mass, and subcutaneous fat mass decreased significantly. None of the MRS parameters showed a significant change during the study. Even though the average change in body weight was >2kg, no significant changes in intrahepatic lipid (IHL) content could be observed. Total fat mass and total fat-free mass derived from MRI has a strong correlation with the corresponding values derived from BIA and ADP data. BMI and the absolute fat parameter of all three modalities decreased, but there were no or only minor changes regarding the fat-free parameter. Magnetic resonance imaging provides body composition information on abdominal fat distribution changes during a ketogenic diet. This information is complementary to anthropomorphic and laboratory measures and is more detailed than the information provided by ADP and BIA measures. It was shown that there was no significant change in internal fat distribution, but there was a decrease in subcutaneous fat.

Comprehensive lifestyle intervention vs soy protein-based meal regimen in non-alcoholic steatohepatitis.

BACKGROUND: Non-alcoholic steatohepatitis (NASH) has become one of the leading causes of liver disease in the western world. In obese patients weight reduction is recommended. Up to now there are no specific guidelines for weight loss in order to reduce hepatic fat content. AIM: To investigate the effects of a 24-wk guided lifestyle intervention program compared to a meal replacement regimen based on soy protein. METHODS: Twenty-six subjects with NASH participated in a randomized single-center study. They were randomly assigned to either meal replacement group (MR-G) with soy-yogurt-honey preparation or to guided lifestyle change group (LC-G) with endurance activity and nutrition counselling. Serum alanine transaminase (ALT), aspartate transaminase (AST), lipid parameters, and adipokines were measured. Liver fat content and lipid composition were determined by magnetic resonance imaging and magnetic resonance spectroscopy. Body fat mass and lean body mass were assessed using Bod Pod® device. Pre- and post-intervention monitoring of parameters was performed. Statistical analyses were conducted with SPSS software, results were expressed as median (interquartile range). RESULTS: Twenty-two subjects (MR-G, n = 11 and LC-G, n = 11) completed the study (9 women, 13 men; age 52.1 (15.0) years, body mass index (BMI) 32.3 (3.3) kg/m²). In both groups a significant weight loss was achieved (MR-G: -6.4 (3.6) kg, P < 0.01; LC-G: -9.1 (10.4) kg, P < 0.01). BMI dropped in both groups (MR-G: -2.3 (1.5) kg/m2, P = 0.003; LC-G: -3.0 (3.4) kg/m2, P = 0.006). Internal fat and hepatic lipid content were markedly reduced in both groups in comparable amount. There was a strong correlation between reduction in liver fat and decrease in ALT. Likewise, both groups showed an improvement in glycemic control and lipid profile. Changes in adipokines, particularly in adiponectin and leptin were closely related to intrahepatic lipid changes. CONCLUSION: Comprehensive lifestyle intervention and meal replacement regimen have comparable effects on body and liver fat, as well as decrease in markers of hepatic inflammation among NASH patients.

Simultaneous detection of valine and lactate using MEGA-PRESS editing in pyogenic brain abscess.

Valine and lactate have been recognized as important metabolic markers to diagnose brain abscess by means of MRS. However, in vivo unambiguous detection and quantification is hampered by macromolecular contamination. In this work, MEGA-PRESS difference editing of valine and lactate is proposed. The method is validated in vitro and applied for quantitative in vivo experiments in one healthy subject and two brain abscess patients. It is demonstrated that with this technique the overlapping lipid signal can be reduced by more than an order of magnitude and thus the robustness of valine and lactate detection in vivo can be enhanced. Quantification of the two abscess MEGA-PRESS spectra yielded valine/lactate concentration ratios of 0.10 and 0.27. These ratios agreed with the concentration ratios determined from concomitantly acquired short-TE PRESS data and were in line with literature values. The quantification accuracy of lactate (as measured with Cramér-Rao lower bounds in LCModel processing) was better for MEGA-PRESS than for short-TE PRESS in all acquired in vivo datasets. The Cramér-Rao lower bounds of valine were only better for MEGA-PRESS in one of the two abscess cases, while in the other case coediting of isoleucine confounded the quantification in the MEGA-PRESS analysis. MEGA-PRESS and short-TE PRESS should be combined for unambiguous quantification of amino acids in abscess measurements. Simultaneous valine/lactate MEGA-PRESS editing might benefit the distinction of brain abscesses from tumors, and further categorization of bacteria with reasonable sensitivity and specificity.

Value of MRI and MRS fat measurements to complement conventional screening methods for childhood obesity.

PURPOSE: To evaluate a protocol combining abdominal fat-water magnetic resonance imaging (MRI) and liver single voxel magnetic resonance spectroscopy (MRS) for studies of childhood obesity. MATERIALS AND METHODS: Six obese male children and five age-matched normal-weight controls underwent abdominal fat-water Dixon MRI based on a gradient echo sequence with multiple echo times and single voxel liver MRS at a field strength of 3T. The MRI/MRS data were compared with data previously acquired from an obese adult cohort and with anthropometric and blood parameters that are typically acquired for screening in childhood obesity. RESULTS: There was a very strong correlation (r = 0.96) between the body mass index standard deviation score (BMI-SDS) and the subcutaneous fat volume fraction in the examined children, but only a moderate correlation (r = 0.62) between the BMI-SDS index and the intraabdominal fat volume fraction, which is much lower in the obese children (5.3 ± 1.1%) than in the obese adult cohort (19.4 ± 2.9%). Furthermore, a significant difference between the two child cohorts was observed in the intrahepatic lipid (IHL) content as obtained with MRS (P = 0.017). However, even the obese child cohort shows an IHL content that is 1-2 orders of magnitude lower (1.0 ± 0.5%) than in the obese adult cohort (17.0 ± 8.7%). CONCLUSION: The proposed method was successfully applied in children and may complement traditional clinical screening methods for childhood obesity such as anthropometry and laboratory tests to better characterize the obesity-associated metabolic risk.

Spectroscopic imaging with prospective motion correction and retrospective phase correction.

Motion-induced artifacts are much harder to recognize in magnetic resonance spectroscopic imaging than in imaging experiments and can therefore lead to erroneous interpretation. A method for prospective motion correction based on an optical tracking system has recently been proposed and has already been successfully applied to single voxel spectroscopy. In this work, the utility of prospective motion correction in combination with retrospective phase correction is evaluated for spectroscopic imaging in the human brain. Retrospective phase correction, based on the interleaved reference scan method, is used to correct for motion-induced frequency shifts and ensure correct phasing of the spectra across the whole spectroscopic imaging slice. It is demonstrated that the presented correction methodology can reduce motion-induced degradation of spectroscopic imaging data.

Joint restoration of bi-contrast MRI data for spatial intensity non-uniformities.

The reconstruction of MRI data assumes a uniform radiofrequency field. However, in practice the radio-frequency field is inhomogeneous and leads to non-biological intensity non-uniformities across an image. This artifact can complicate further automated analysis of the data. In general, an acquisition protocol provides images of the same anatomic region with multiple contrasts representing similar underlying information, but suffering from different intensity non-uniformities. A method is presented for the joint intensity uniformity restoration of two such images. The effect of the intensity distortion on the auto-co-occurrence statistics of each of the two images as well as in their joint-co-occurrence statistics is modeled and used for their restoration with Wiener filtering. Several regularity constrains for the anatomy and for the non-uniformity are also imposed. Moreover, the method considers an inevitable difference between the signal regions of the two images. The joint treatment of the images can improve the accuracy and the efficiency of the restoration as well as decrease the requirements for additional calibration scans. The effectiveness of the method has been demonstrated extensively with both phantom and real brain anatomic data as well as with real DIXON pairs of fat and water abdominal data.

Correction of frequency drifts induced by gradient heating in 1H spectra using interleaved reference spectroscopy.

PURPOSE: To evaluate the impact of heating-induced frequency drifts on single-voxel spectroscopy and to demonstrate correction strategies based on the interleaved reference scan technique. MATERIALS AND METHODS: Frequency drifts induced by gradient heating are assessed for two clinical 3 Tesla (T) whole body MR systems. The interleaved reference scan (IRS) method is used for correcting these frequency drifts in 1H spectra in vitro and in vivo. For severely drift-affected spectroscopy experiments, a feedback-based version of the IRS sequence is proposed, which adds the functionality of a frequency lock to prevent a degradation of the water suppression. RESULTS: It is shown that the line widths of the spectral resonances can be largely reduced with the interleaved reference scan method, resulting in considerably improved peak resolution and signal-to-noise ratio. The feedback-based IRS method additionally allows for stable water suppression, even in the presence of very strong frequency drifts. CONCLUSION: If spectroscopy scans are combined with imaging scans with a high gradient duty cycle such as diffusion-weighted imaging or functional MRI, a drift correction with IRS can considerably improve the validity of data analysis in research studies.

Volumetric analysis of MRI data monitoring the treatment of polycystic kidney disease in a mouse model.

OBJECT: The human condition autosomal dominant polycystic kidney disease (ADPKD) is characterized by the growth of cysts in the kidneys that increase renal volume and lead to kidney failure. Mice studies are performed for treatment development monitored with imaging. The analysis of the imaging data is typically manual, which is costly and potentially biased. This paper presents a reliable and reproducible method for the automated segmentation of polycystic mouse kidneys. MATERIALS AND METHODS: Treated and untreated mice have been imaged longitudinally with high field anatomic MRI. The region of interest (ROI) of the kidneys in the images is identified and restored for artifacts. It is then analyzed statistically and geometric models are estimated for each kidney. The statistical and geometric information are provided to the graph cuts algorithm that delineates the kidneys. RESULTS: The accuracy of the analysis has been demonstrated by showing consistency with results obtained with previous methods as well as by comparing with manual segmentations. CONCLUSION: The method developed can accelerate and improve the accuracy of kidney volumetry in preclinical treatment trials for ADPKD.

A phase IA, open-label, dose-escalating study of PTK787/ZK 222584 administered orally on a continuous dosing schedule in patients with advanced cancer.

BACKGROUND: PTK787/ZK 222584 (PTK/ZK) offers a novel approach to inhibit tumour angiogenesis. PATIENTS AND METHODS: This study characterized the safety, tolerability, biological activity and pharmacokinetic profile of PTK/ZK, while determining the optimum dose. Seventy-one patients with advanced cancer were enrolled to receive once daily dosing. Pharmacokinetic, dynamic contrast enhanced magnetic resonance imaging and safety assessments were performed, along with measurement of soluble markers. Patients were treated until they had unacceptable toxicity and/or disease progression. RESULTS: Twenty-nine patients were assessable for maximum tolerated dose (MTD) determination, but no MTD was established; only two patients experienced dose limiting toxicities. PTK/ZK was well tolerated with only nine patients experiencing serious adverse events suspected to be PTK/ZK related, but no objective tumour response was observed; 34% had stable disease and 48% had progressive disease. In addition, PTK/ZK was rapidly absorbed with a maximum concentration occurring 2 hours post-dosing. Vascular endothelial growth factor and basic fibroblastic growth factor were good predictors of best tumour response, as was the MRI bidirectional transfer constant on day 2 of treatment. CONCLUSION: An MTD was not reached in this study but, based on these data and findings from other studies, 1200 mg was found to be the optimum dose of PTK/ZK for patients with advanced cancer.

Valproate-induced metabolic changes in patients with epilepsy: assessment with H-MRS.

PURPOSE: Valproate (VPA) interferes with mitochondrial metabolism causing hyperammonemia, thereby shifting the balance reaction of glutamine (Gln)/glutamate (Glu) toward Gln. In this study we wanted to determine whether metabolic changes could be reproduced in VPA-treated patients with epilepsy and whether the results differed from those known in chronic hepatic encephalopathy (CHE). METHODS: Seven patients with epilepsy pretreated with VPA and seven healthy volunteers were investigated on a 3T-scanner. We performed proton magnetic resonance spectroscopy ((1)H-MRS) using a short echo time point-resolved spectroscopy (PRESS) in the parietal and occipital lobe, respectively. Spectral analysis was performed by LCModel, allowing a separation of Glu and Gln at 3T. Absolute values of myo-Inositol (mI), choline (Cho), creatine (Cr), N-acetyl-aspartate (NAA), glutamine (Gln), glutamate (Glu), and the sum of Gln and Glu (Glx) were calculated. RESULTS: In the parietal lobe, mI was significantly decreased in the patients' group compared to the healthy volunteers. After separation of the signals of Gln and Glu, a significant increase of Gln was observed in the parietal lobe in the patients' group. No significant differences in the occipital spectra could be observed between the groups. DISCUSSION: In VPA-treated patients the alteration of the Glu/Gln ratio differs from that in patients with CHE, where Glx is markedly increased because of an increase in Gln. The expected shift from the biochemical balance reaction of Gln/Glu induced by VPA could be reproduced for the parietal lobe. Significantly reduced mI in the parietal lobe of VPA-treated patients most likely reflects an osmolytic compensation for high Gln.

Monitoring kidney and renal cyst volumes applying MR approaches on a rapamycin treated mouse model of ADPKD.

OBJECT: The aim of our study was to determine total cystic volume in a mouse model of PKD using MR imaging to monitor therapeutic effects in vivo. MATERIALS AND METHODS: We imaged eight female pcy-mice in two groups: four belonged to an untreated control group and four were treated with the anticystic agent rapamycin, which has proven to be effective in reducing cystogenesis in animal models. The mice were imaged using a 9.4 Tesla animal scanner. MRI measurements were taken at six time points during the therapy. Total renal volumes and total cyst volumes were calculated using a thresholding approach. RESULTS: During the course of the treatment, the total cyst volume increased significantly faster than the total renal volume in the untreated group, indicating that growth of the total renal volume in the untreated group was primarily due to the growth of the cysts, rather than the parenchyma. The measured total renal volume in the control (placebo) group was significantly higher than the volume in the treated group. CONCLUSION: Using MRI, we were able to monitor the cystic volume in a mouse model of PKD to assess the therapeutic effect of anticystic treatment.

Spectroscopic findings in attention-deficit/hyperactivity disorder: review and meta-analysis.

OBJECTIVES: The last decade has seen an increasing interest in the method of magnet resonance spectroscopy (MRS) since this is the only research tool that allows a non-invasive in vivo assessment of neurochemical aspects of ADHD without employing ionising radiation. In this paper we review published MRS results with respect to childhood, adolescence and adult ADHD. METHOD: We searched the Medline (Pub Med) database using the key words ADHD, attention-deficit/hyperactivity disorder, magnet resonance spectroscopy, MRS and spectroscopy. Citations of identified articles were also searched for relevant studies. Meta-analyses were performed for the measured metabolites and regions of assessment. RESULTS: Sixteen studies could be identified that used MRS to investigate the neurobiology of ADHD. Two regions could be identified as the focus of spectroscopic investigations--the frontal lobe including anterior cingulate cortex and parts of prefrontal cortex and the basal ganglia, mostly striatum, alongside the fronto-striato-thalamo-frontal circuits. As for metabolites, in the majority of studies the ratios to creatine and not absolute concentrations of metabolites were estimated. Choline compounds, N-acetyl-aspartate and glutamate/glutamine (to creatine ratios) could be identified as being altered in several studies in ADHD. The meta-analysis showed increased choline compounds in several researched regions. DISCUSSION: MRS is a promising tool for the non-invasive in vivo assessment of the cerebral neurochemistry in ADHD. More regions of interest (ROI) like amygdala, hippocampus, thalamus and cerebellum should be assessed in future studies. Further methodological improvements of MRS are desirable in order to assess the absolute metabolite concentration of several ROIs at the same time. Such developments will open novel perspectives in spectroscopic investigations of ADHD.

Analysis of MR images of mice in preclinical treatment monitoring of polycystic kidney disease.

A common cause of kidney failure is autosomal dominant polycystic kidney disease (ADPKD). It is characterized by the growth of cysts in the kidneys and hence the growth of the entire kidneys with eventual failure in most cases by age 50. No preventive treatment for this condition is available. Preclinical drug treatment studies use an in vivo mouse model of the condition. The analysis of mice imaging data for such studies typically requires extensive manual interaction, which is subjective and not reproducible. In this work both untreated and treated mice have been imaged with a high field, 9.4T, MRI animal scanner and a reliable algorithm for the automated segmentation of the mouse kidneys has been developed. The algorithm first detects the region of interest (ROI) in the image surrounding the kidneys. A parameterized geometric shape for a kidney is registered to the ROI of each kidney. The registered shapes are incorporated as priors to the graph cuts algorithm used to extract the kidneys. The accuracy of the automated segmentation has been demonstrated by comparing it with a manual segmentation. The processing results are also consistent with the literature for previous techniques.

Mapping of temporal and parietal cortex in progressive nonfluent aphasia and Alzheimer's disease using chemical shift imaging, voxel-based morphometry and positron emission tomography.

Little and controversial evidence is available from neuroimaging studies in progressive nonfluent aphasia (PNA). The goal of this study was to combine information from different imaging modalities in PNA compared with Alzheimer's disease (AD). Chemical shift imaging (CSI), voxel-based morphometry (VBM) and fluorodeoxyglucose positron emission tomography (FDG-PET) were used in 5 PNA, 10 AD patients and 10 normal subjects. Group comparisons revealed left anterior lateral temporal abnormalities (BA20/21) in PNA using CSI, VBM and PET in comparison to normal subjects. AD patients showed more limited hypometabolism within the same area. In addition left lateral parietal (BA40) abnormalities were demonstrated in our PNA as well as our AD group using PET and VBM (AD group only). Combining information from all imaging modalities on a single case basis revealed pathology within the left anterior lateral temporal and lateral parietal lobe both in PNA and AD. PNA and AD patients differed significantly, however, with respect to the frequency of medial temporal lobe and posterior cingulate/precuneus involvement. Although our results might not be generalizable to all subgroups of PNA, we conclude that medial temporal and posterior cingulate/precuneus cortex pathology as assessed by CSI and VBM or PET distinguish PNA from AD, whereas lateral temporal and parietal areas are involved in both conditions.