Ultra-High-Resolution Time-of-Flight MR-Angiography for the Noninvasive Assessment of Intracranial Aneurysms, Alternative to Preinterventional DSA?

PURPOSE: The 3D time-of-flight (TOF) magnetic resonance angiography (MRA) at 3T shows high sensitivity for intracranial aneurysms but is inferior to three-dimensional digital subtraction angiography (3D-DSA) regarding aneurysm characteristics. We applied an ultra-high-resolution (UHR) TOF-MRA using compressed sensing reconstruction to investigate the diagnostic performance in preinterventional evaluation of intracranial aneurysms compared to conventional TOF-MRA and 3D-DSA. METHODS: In this study 17 patients with unruptured intracranial aneurysms were included. Aneurysm dimensions, configuration, image quality and sizing of endovascular devices were compared between conventional TOF-MRA at 3T and UHR-TOF with 3D-DSA as gold standard. Quantitatively, contrast-to-noise ratios (CNR) were compared between TOF-MRAs. RESULTS: On 3D-DSA, 25 aneurysms in 17 patients were detected. On conventional TOF, 23 aneurysms were detected (sensitivity: 92.6%). On UHR-TOF, 25 aneurysms were detected (sensitivity: 100%). Image quality was not significantly different between TOF and UHR-TOF (p = 0.17). Aneurysm dimension measurements were significantly different between conventional TOF (3.89 mm) and 3D-DSA (4.2 mm, p = 0.08) but not between UHR-TOF (4.12 mm) and 3D-DSA (p = 0.19). Irregularities and small vessels at the aneurysm neck were more frequently correctly depicted on UHR-TOF compared to conventional TOF. Comparison of the planned framing coil diameter and flow-diverter (FD) diameter revealed neither a statistically significant difference between TOF and 3D-DSA (coil p = 0.19, FD p = 0.45) nor between UHR-TOF and 3D-DSA (coil: p = 0.53, FD 0.33). The CNR was significantly higher in conventional TOF (p = 0.009). CONCLUSION: In this pilot study, ultra-high-resolution TOF-MRA visualized all aneurysms and accurately depicted aneurysm irregularities and vessels at the base of the aneurysm comparably to DSA, outperforming conventional TOF. UHR-TOF with compressed sensing reconstruction seems to represent a non-invasive alternative to pre-interventional DSA for intracranial aneurysms.

Impact of Chronic Prostatitis on the PI-RADS Score 3: Proposal for the Addition of a Novel Binary Suffix.

We examined the impact of chronic prostatitis on the diagnostic performance of multiparametric magnetic resonance imaging (mpMRI). In this retrospective study, 63 men underwent 3T mpMRI followed by MRI/ultrasound fusion biopsy to exclude/confirm clinically significant prostate cancer (csPCa). A total of 93 lesions were included for evaluation. Images were assessed by two radiologists. Prostatitis was graded visually on T2-weighted and contrast-enhanced sequences. The correlation of prostatitis features with the assigned Prostate Imaging Reporting and Data System (PI-RADS) and the presence of csPCa were assessed, and the clinical and functional imaging parameters for differentiating between prostatitis and significant tumors were examined. Histopathological analysis was used as the reference standard. The rate of PI-RADS 3 scores tended to be higher in the presence of radiologically severe prostatitis compared with no/discrete prostatitis (n = 52 vs. n = 9; p = 0.225). In severe prostatitis, csPCa was determined in only 7.7% (4/52) of PI-RADS 3 lesions. In severe chronic prostatitis, a binary prostatitis suffix (e.g., PI-RADS 3 i+ versus i-) within the radiological report may help assess the limitations of mpMRI interpretability because of severe prostatitis and avoid unnecessary biopsies. Mean apparent diffusion coefficient (ADCmean) was the best marker (cutoff 0.93 × 10-3 mm2/s) to differentiate between csPCa/non csPCa in severe prostatitis.

Impact of different phased-array coils on the quality of prostate magnetic resonance images.

PURPOSE: To evaluate the influence of body phased-array (BPA) receive coil setups on signal-to-noise ratio (SNR) and image quality (IQ) in prostate MRI. METHODS: This prospective study evaluated axial T2-weighted images (T2W-TSE) and DWI of the prostate in ten healthy volunteers with 18-channel (18CH), 30-channel and 60-channel (60CH) BPA receive coil setups. SNR and ADC values were assessed in the peripheral and transition zones (TZ). Two radiologists rated IQ features. Differences in qualitative and quantitative image features between BPA receive coil setups were compared. After correction for multiple comparisons, p-values <0.004 for quantitative and p-values <0.017 for qualitative image analysis were considered statistically significant. RESULTS: Significantly higher SNR was found in T2W-TSE images in the TZ using 60CH BPA compared to 18CH BPA coil setups (15.20 ± 4.22 vs. 7.68 ± 2.37; p = 0.001). There were no significant differences between all other quantitative (T2W-TSE, p = 0.007-0.308; DWI, p = 0.024-0.574) and qualitative image features (T2W-TSE, p = 0.083-1.0; DWI, p = 0.046-1.0). CONCLUSION: 60CH BPA receive coil setup showed marginal SNR improvement in T2W-TSE images. Good IQ could be achieved with 18CH BPA coil setups.

Morphological and functional assessment of the uterus: "one-stop shop imaging" using a compressed-sensing accelerated, free-breathing T1-VIBE sequence.

BACKGROUND: The combination of motion-insensitive, high-temporal, and spatial resolution imaging with evaluation of quantitative perfusion has the potential to increase the diagnostic capabilities of magnetic resonance imaging (MRI) in the female pelvis. PURPOSE: To compare a free-breathing compressed-sensing VIBE (fbVIBE) with flexible temporal resolution (range = 4.6-13.8 s) with breath-hold VIBE (bhVIBE) and to evaluate the potential value of quantifying uterine perfusion. MATERIAL AND METHODS: A total of 70 datasets from 60 patients (bhVIBE: n = 30; fbVIBE: n = 40) were evaluated by two radiologists. Only temporally resolved reconstruction (fbVIBE) was performed on 30 of the fbVIBE datasets. For a subset (n = 10) of the fbVIBE acquisitions, a time- and motion-resolved reconstruction (mrVIBE) was evaluated. Image quality (IQ), artifacts, diagnostic confidence (DC), and delineation of uterine structures (DoS) were graded on Likert scales (IQ/DC/DoS: 1 (non-diagnostic) to 5 (perfect); artifacts: 1 (no artifacts) to 5 (severe artifacts)). A Tofts model was applied for perfusion analysis. Ktrans was obtained in the myometrium (Mm), junctional zone (Jz), and cervix (Cx). RESULTS: The median IQ/DoS/DC scores of fbVIBE (4/5/5 κ >0.7-0.9) and bhVIBE (4/4/4; κ = 0.5-0.7; P > 0.05) were high, but Artifacts were graded low (fbVIBE/bhVIBE: 2/2; κ = 0.6/0.5; P > 0.05). Artifacts were only slightly improved by the additional motion-resolved reconstruction (fbVIBE/mrVIBE: 2/1.5; P = 0.08); fbVIBE was preferred in most cases (7/10). Significant differences of Ktrans values were found between Cx, Jz, and Mm (0.12/0.21/0.19; P < 0.05). CONCLUSION: The fbVIBE sequence allows functional and morphological assessment of the uterus at comparable IQ to bhVIBE.

Medication-Related Osteonecrosis of the Jaw-Comparison of Bone Imaging Using Ultrashort Echo-Time Magnetic Resonance Imaging and Cone-Beam Computed Tomography.

OBJECTIVE: The aim of this study was to compare bone imaging between ultrashort echo-time (UTE) magnetic resonance (MR) imaging and cone-beam computed tomography (CBCT) as the reference standard in patients with medication-related osteonecrosis of the jaw (MRONJ). MATERIALS AND METHODS: A 1-year retrospective, blinded, and randomized qualitative analysis of UTE MR images and CBCT from 19 patients with clinically diagnosed MRONJ was performed by 2 independent radiologists. Medication-related osteonecrosis of the jaw imaging hallmarks such as osteolysis, periosteal thickening, and medullary osteosclerosis were rated visually (0 and 1 to 3 for normal and mild to severe changes) for defined anatomic regions of the jaw. In addition, segmentation of these regions was performed on coregistered MR/CBCT images for the following quantitative comparison of signal intensity (SI) on MR and gray values (GVs) on CBCT images. Interreader/modality agreement (Cohen kappa), standard testing for significant differences of (non)parametric values, and Pearson correlation of signal intensity/GV were used for statistical analysis. RESULTS: The anterior corpus of the mandible was most often affected by MRONJ (P < 0.001). Overall, interreader agreement of qualitative MRONJ hallmark scores was almost perfect (κ = 0.81) and without significant differences between modalities (κ = 0.81 vs 0.82, CBCT vs MR, respectively). Intermodality agreement for qualitative gradings was substantial for both readers (κ = 0.77 and 0.70). Signal intensity/GV in MRONJ-affected areas differed significantly from healthy bone (P < 0.001) as well as correlation significantly between modalities (r = -0.77; P < 0.001). CONCLUSIONS: Qualitative assessment of MRONJ with radiation-free UTE MR imaging is comparable to reference standard CBCT. Quantitative measurements of both modalities significantly distinguish diseased from normal bone with strong correlations among the quantitative values in both modalities.

Early Prediction of Treatment Response of Neuroendocrine Hepatic Metastases after Peptide Receptor Radionuclide Therapy with 90Y-DOTATOC Using Diffusion Weighted and Dynamic Contrast-Enhanced MRI.

The purpose of this study was to determine if parameters derived from diffusion-weighted (DW-) and dynamic contrast-enhanced (DCE-) magnetic resonance imaging (MRI) can help to assess early response to peptide receptor radionuclide therapy (PRRT) with 90Y-DOTATOC in neuroendocrine hepatic metastases (NET-HM). Twenty patients (10 male; 10 female; mean age: 59.2 years) with NET-HM were prospectively enrolled in this single-center imaging study. DW-MRI and DCE-MRI studies were performed just before and 48 hours after therapy with 90Y-DOTATOC. Abdominal SPECT/CT was performed 24 hours after therapy. This MRI imaging and therapy session was repeated after a mean interval of 10 weeks. Up to four lesions per patient were evaluated. Response to therapy was evaluated using metastasis sizes at the first and second therapy session as standard for comparison (regressive, stable, and progressive). DW-MRI analysis included the apparent diffusion coefficient (ADC) and parameters related to intravoxel incoherent motion (IVIM), namely, diffusion (D), perfusion fraction (f) and pseudo-diffusion (D ∗ ). DCE-MRI analysis comprised Ktrans, v e and k ep. For statistical analysis of group differences, one-way analysis of variance (ANOVA) and appropriate post hoc testing was performed. A total of 51 lesions were evaluated. Seven of 51 lesions (14%) showed size progression, 18/51 (35%) regression, and 26/51 (51%) remained stable. The lesion-to-spleen uptake ratio in SPECT showed a decrease between the two treatment sessions that was significantly stronger in regressive lesions compared with stable (p = 0.013) and progressive lesions (p = 0.021). ANOVA showed significant differences in mean ADC after 48 h (p = 0.026), with higher ADC values for regressive lesions. Regarding IVIM, highest values for D at baseline were seen in regressive lesions (p = 0.023). In DCE-MRI, a statistically significant increase in v e after 10 weeks (p = 0.046) was found in regressive lesions. No differences were observed for the transfer constants Ktrans and k ep. Diffusion restriction quantified as ADC was able to differentiate regressive from progressive NET-HMs as early as 48 hours after PRRT. DW-MRI therefore may complement scintigraphy/SPECT for early assessment of response to PRRT. Assessment of perfusion parameters using IVIM and DCE-MRI did not show an additional benefit.

Free-Breathing Dynamic Contrast-Enhanced Imaging of the Upper Abdomen Using a Cartesian Compressed-Sensing Sequence With Hard-Gated and Motion-State-Resolved Reconstruction.

OBJECTIVES: The aim of this study was to compare a compressed-sensing free-breathing VIBE (fbVIBE) with a conventional breath-hold VIBE (bhVIBE) for dynamic contrast-enhanced imaging of the upper abdomen. MATERIALS AND METHODS: In total, 70 datasets (bhVIBE, n = 30; fbVIBE n = 40; hard-gated [hg] reconstruction, n = 30; motion-state-resolved [mr] reconstruction, n = 10) were assessed by 2 experienced readers. Both sequences were performed on 1.5-T magnetic resonance imaging scanners. The prototypical fbVIBE sequence acquired a navigation signal along with the imaging data and supported 2 different reconstructions: an hg reconstruction that either accepted or rejected an echo train based on the navigation signal and an mr reconstruction that assigned echo trains to their determined motion states. The hg reconstruction to reduce respiratory motion artifacts was carried out inline on the scanner (duration: approximately 8 minutes on the scanner-integrated CPU). The mr reconstruction delivered better results, but the reconstruction time is multiplied by the number of selected motion states (6 in the current study). Comparable reconstruction times to hg reconstruction can only be achieved on GPU-supported scanners. Therefore, the acquired raw data were selectively reconstructed at a later timepoint (duration: approximately 45 minutes). Welch analysis of variance tests were applied to compare image quality (IQ), delineation of structures, artifacts, and diagnostic confidence, which were rated on Likert-type scales (IQ/delineation of structures/diagnostic confidence: 1 [nondiagnostic] to 5 [perfect]; artifacts: 1 [no artifacts] to 5 [severe artifacts]). Mann-Whitney U tests and Kruskal-Wallis H tests were used to compare the extent of artifacts in older (aged ≥70 years) and younger (aged <70 years) patients. Interobserver agreement was assessed using Cohen κ. RESULTS: Mean ratings for IQ/delineation of structures/diagnostic confidence of fb(hg)VIBE (4.2 ± 0.7/4.3 ± 0.8/4.3 ± 0.7; κ = 0.8/0.7/0.6) and fb(mr)VIBE (4.9 ± 0.3/4.9 ± 0.3/4.9 ± 0.3; κ = 0.3/1/0.9) were higher compared with those of bhVIBE (3.7 ± 0.8/3.8 ± 0.8/3.9 ± 0.9; κ = 0.9/0.9/0.9), whereas artifacts of fb(hg)VIBE/fb(mr)VIBE were rated lower (fb[hg]VIBE/fb[mr]VIBE/bhVIBE = 2.2 ± 0.9/1.3 ± 0.5/2.4 ± 0.9; κ = 0.6/0.6/0.9). The IQ of fb(hg)VIBE was rated significantly higher compared with that of bhVIBE (P = 0.03). All parameters were significantly improved by mr reconstruction compared with fb(hg)VIBE and bhVIBE (P < 0.001). In the fb(hg)VIBE cohort, an insignificant trend toward lower artifacts in the younger age group (≥70 years: 2.5 ± 0.9 vs <70 years: 1.9 ± 0.8) was found, whereas significant differences emerged in the bhVIBE cohort (≥70 years: 3 ± 0.9 vs <70 years: 2.1 ± 0.9; P = 0.02). CONCLUSIONS: Fast fbVIBE using hg and mr reconstructions is technically feasible with improved IQ compared with that of bhVIBE. Free-breathing VIBE may be useful for dynamic contrast-enhanced of the upper abdomen, particularly in older and/or severely ill patients with impaired breath-hold capabilities.

Development of an anthropomorphic spine phantom suitable for fusion of MR neurography with interventional flat-panel CT.

PURPOSE: To design a spine phantom suitable for fusion of MR neurography (MRN) with interventional flat panel computed tomography (FPCT) images from tissue-equivalent agarose gels and artificial nerves in MRI, including material with equal attenuation to bone in computed tomography (CT). METHODS: T1-/T2-relaxation times of target tissue were determined in vivo (n = 5) using MR mapping-techniques. Serial dilution of castor oil lipogels was performed ex vivo in order to define correct composition for tissue-equivalent relaxation times. Similarly, serial dilution series of calcium carbonate (CaCO3) and barium sulphate (BaSO4) in synthetic resin were used to adjust radiodensity of selected vertebral bodies (L1-L5) and sacrum in CT. Nerve tissue was simulated with agarose-impregnated polyethylene fibers. Spine phantom was assembled using respective components in anthropomorphic geometry. A fat-saturated, T2-weighted 3D SPACE STIR sequence was acquired for MRN and subsequently fused with an on-site FPCT scan of the phantom. RESULTS: In vivo T1-/T2-values for fat tissue were found to be at 394 ± 16 ms and 161 ± 16 ms, corresponding to a castor oil concentration of 50%. Analogously, bone marrow-equivalent values were measured at 822 ± 21 ms and 67 ± 6 ms, simulated with 40% castor oil. Cortical bone-like radiodensity of 1'115 ± 80 HU was achieved for artificial bone with 30% CaCO3 and 1.5% BaSO4. Simulated nerves were successfully depicted in MRN and fused with FPCT, combining optimal contrasts for nerves and bones on-site. CONCLUSIONS: The customized phantom showed analogous tissue contrasts to in vivo conditions in both MRN and FPCT, facilitating simulations of fusion-image guided spine interventions.

T1- and T2*-Mapping for Assessment of Tendon Tissue Biophysical Properties: A Phantom MRI Study.

OBJECTIVES: The aim of this study was to quantitatively assess changes in collagen structure using MR T1- and T2*-mapping in a novel controlled ex vivo tendon model setup. MATERIALS AND METHODS: Twenty-four cadaveric bovine flexor tendons underwent MRI at 3 T before and after chemical modifications, representing mechanical degeneration and augmentation. Collagen degradation (COL), augmenting collagen fiber cross-linking (CXL), and a control (phosphate-buffered saline [PBS]) were examined in experimental groups, using histopathology as standard of reference. Variable echo-time and variable-flip angle gradient-echo sequences were used for T2*- and T1-mapping, respectively. Standard T1- and T2-weighted spin-echo sequences were acquired for visual assessment of tendon texture. Tendons were assessed subsequently for their biomechanical properties and compared with quantitative MRI analysis. RESULTS: T1- and T2*-mapping was feasible and repeatable for untreated (mean, 545 milliseconds, 2.0 milliseconds) and treated tendons. Mean T1 and T2* values of COL, CXL, and PBS tendons were 1459, 934, and 1017 milliseconds, and 5.5, 3.6, and 2.5 milliseconds, respectively. T2* values were significantly different between enzymatically degraded tendons, cross-linked tendons, and controls, and were significantly correlated with mechanical tendon properties (r = -0.74, P < 0.01). T1 values and visual assessment could not differentiate CXL from PBS tendons. Photo-spectroscopy showed increased autofluorescence of cross-linked tendons, whereas histopathology verified degenerative lesions of enzymatically degraded tendons. CONCLUSIONS: T2*-mapping has the potential to detect and quantify subtle changes in tendon collagen structure not visible on conventional clinical MRI. Tendon T2* values might serve as a biomarker for biochemical alterations associated with tendon pathology.

In cervical spondylotic myelopathy spinal cord motion is focally increased at the level of stenosis: a controlled cross-sectional study.

STUDY DESIGN: Level-, age-, and gender-matched controlled cross-sectional cohort study. OBJECTIVES: To investigate alterations of spinal cord (SC) motion within cervical spondylotic myelopathy (CSM) across the cervical spinal segments and its relation to cerebrospinal fluid (CSF)-flow, anatomic conditions, and clinical parameters. SETTING: University Hospital Balgrist, Zurich, Switzerland. METHODS: Overall, 12 patients suffering from CSM at level C5 and 12 controls underwent cardiac-gated 2D phase-contrast-MRI at level C2 and C5 and standard MRI sequences. Parameters of interest: Velocity measurements of SC and CSF (area under the curve = total displacement (normalization for duration of the heart cycle), total displacement ratio (C5/C2; intraindividual normalization for confounders)), spinal canal diameters, clinical motor- and sensory scores, and performance measures. RESULTS: Interrater reliability was excellent for SC motion at both levels and for CSF flow at C2, but not reliable for CSF flow at C5. Within controls, SC motion at C2 positively correlated with SC motion at C5 (p = 0.000); this correlation diminished in patients (p = 0.860). SC total displacement ratio was significantly increased in patients (p = 0.029) and correlated with clinical impairment (p = 0.017). Morphometric measures of the extent of stenosis were not related to SC motion or clinical symptoms. CONCLUSION: The findings revealed physiological interactions of CSF flow and SC motion across the cervical spine in healthy controls while being diminished in CSM patients. Findings of focally increased SC motion at the level of stenosis were related to clinical impairment and might be promising as a diagnostic and prognostic marker in CSM. SPONSORSHIP: CRPP Neurorehab of the University of Zurich, Switzerland.

Image Quality and Geometric Distortion of Modern Diffusion-Weighted Imaging Sequences in Magnetic Resonance Imaging of the Prostate.

PURPOSE: The aim of this study was to compare qualitative and quantitative image quality and geometric distortion of 4 magnetic resonance diffusion-weighted imaging (DWI) sequences of the prostate using comparable imaging parameters and similar acquisition times. METHODS AND MATERIALS: Axial T2-weighted turbo spin echo images and axial DWI echo-planar imaging (EPI) sequences, including single-shot spin-echo (ss-EPI), readout-segmented multishot (rs-EPI), selective excitation-reduced field of view (sTX-EPI), and prototype single-shot technique applying slice-specific shimming (iShim-EPI) sequences, were acquired at 3 T in 10 healthy volunteers (mean age, 26.1 ± 3.8 years; body mass index, 23.2 ± 3.0 kg/m). Two radiologists, blinded to the type of DWI, independently rated DWIs on a 5-point Likert scale regarding subjective image quality features (resolution, demarcation of prostate capsule, zonal anatomy). Interreader agreement was assessed using the intraclass correlation coefficient. Signal-to-noise ratio (SNR) and apparent diffusion coefficient (ADC) values were assessed separately in the peripheral and transitional zone. For the analysis of geometric distortion, the diameter of the prostate from left to right and from anterior to posterior was measured at the level of the verumontanum on b-1000 DWIs and on T2-weighted turbo spin echo images. Differences were compared using the Wilcoxon rank sum test for qualitative parameters, analysis of variance, and Friedman test for quantitative parameters. A P value of less than 0.05 was considered significant, with correction for multiple comparisons. RESULTS: Interreader agreement was good to excellent (intraclass correlation coefficient, 0.71-0.79) for all qualitative features. Subjective image quality regarding "resolution" was significantly better for ss-EPI than rs-EPI (mean Likert score, 4.25 vs 3.8; P = 0.031) and sTX-EPI (4.25 vs 3.3; P = 0.046) and for iShim-EPI as compared with rs-EPI (4.4 vs 3.8; P = 0.031) and sTX-EPI (4.4 vs 3.3; P = 0.047). There was no significant difference regarding capsule demarcation and zonal anatomy. Signal-to-noise ratio was significantly higher in iShim-EPI than sTX-EPI (SNR ± standard deviation [SD], 28.13 ± 8.21 vs 14.96 ± 2.4; P = 0.015). The ADC values were lower for the peripheral zone in the sTX-EPI than in the ss-EPI (ADC ± SD, 1002.94 ± 83.51 vs 1165.05 ± 115.64; P = 0.013) and the rs-EPI (1002.94 ± 83.51 vs 1244.40 ± 89.95; P = 0.0012) and in the transitional zone in the sTX-EPI compared with the rs-EPI (874.50 ± 200.72 vs 1261.47 ± 179.23; P = 0.0021). There were no statistically significant differences in geometric distortion between all DWI sequences. CONCLUSIONS: Single-shot spin-echo EPI and iShim-EPI showed a tendency toward superior image quality and SNR compared with rs-EPI and sTX-EPI with no significant differences in geometric distortion.

Cognitive brain responses during circadian wake-promotion: evidence for sleep-pressure-dependent hypothalamic activations.

The two-process model of sleep-wake regulation posits that sleep-wake-dependent homeostatic processes interact with the circadian timing system to affect human behavior. The circadian timing system is fundamental to maintaining stable cognitive performance, as it counteracts growing homeostatic sleep pressure during daytime. Using magnetic resonance imaging, we explored brain responses underlying working memory performance during the time of maximal circadian wake-promotion under varying sleep pressure conditions. Circadian wake-promoting strength was derived from the ability to sleep during an evening nap. Hypothalamic BOLD activity was positively linked to circadian wake-promoting strength under normal, but not under disproportionally high or low sleep pressure levels. Furthermore, higher hypothalamic activity under normal sleep pressure levels predicted better performance under sleep loss. Our results reappraise the two-process model by revealing a homeostatic-dose-dependent association between circadian wake-promotion and cognition-related hypothalamic activity.

Evaluation of Reproducibility of Diffusion Tensor Imaging in the Brachial Plexus at 3.0 T.

OBJECTIVE: The aim of this study was to evaluate the reproducibility of 3 T magnetic resonance imaging diffusion tensor imaging (DTI) of the brachial plexus in healthy subjects. METHODS: Ten healthy volunteers were included, and morphological and DTI sequences of the nerve roots of the brachial plexus from C5 to T1 of both sides were repeatedly acquired on a 3 T magnetic resonance system (MAGNETOM Skyra; Siemens Healthcare, Erlangen, Germany). A prototype diffusion-weighted single-shot echo-planar imaging sequence-enabling slice-specific shim adjustments was performed with b-values of 0 and 800 s/mm in 30 gradient directions, resulting in an acquisition time of about 6 minutes each in axial orientation. Between scans, subjects were moved and repositioned in the scanner, coils were reinserted, and new localizers were acquired. Image analysis was performed using MITK Diffusion software toolkit. Two independent readers performed diffusion data postprocessing, and regions of interest (ROIs) were set on the proximal postganglionic trunk at each spinal level, bilaterally to obtain values for fractional anisotropy (FA) and mean diffusivity (MD). Interreader and intrareader agreement as well as test-retest reproducibility of DTI metrics were assessed. RESULTS: Intraclass correlation coefficients (ICCs) for interreader and intrareader agreement did not differ significantly between measurements for FA and MD. In particular, ICCs for interreader agreement of FA ranged from 0.741 to 0.961 and that of MD ranged from 0.802 to 0.998, and ICCs for intrareader agreement of FA ranged from 0.759 to 0.949 and that of MD ranged from 0.796 to 0.998. The test-retest reproducibility of DTI metrics showed an overall moderate to strong correlation (r > 0.707), with few minor exceptions, for both FA and MD values. CONCLUSIONS: Diffusion tensor imaging metrics in the brachial plexus are reproducible. Future applications of DTI for a possible clinical use should be further investigated.

The Spatial Relationship between Apparent Diffusion Coefficient and Standardized Uptake Value of 18F-Fluorodeoxyglucose Has a Crucial Influence on the Numeric Correlation of Both Parameters in PET/MRI of Lung Tumors.

The minimum apparent diffusion coefficient (ADCmin) derived from diffusion-weighted MRI (DW-MRI) and the maximum standardized uptake value (SUVmax) of FDG-PET are markers of aggressiveness in lung cancer. The numeric correlation of the two parameters has been extensively studied, but their spatial interplay is not well understood. After FDG-PET and DW-MRI coregistration, values and location of ADCmin- and SUVmax-voxels were analyzed. The upper limit of the 95% confidence interval for registration accuracy of sequential PET/MRI was 12 mm, and the mean distance (D) between ADCmin- and SUVmax-voxels was 14.0 mm (average of two readers). Spatial mismatch (D > 12 mm) between ADCmin and SUVmax was found in 9/25 patients. A considerable number of mismatch cases (65%) was also seen in a control group that underwent simultaneous PET/MRI. In the entire patient cohort, no statistically significant correlation between SUVmax and ADCmin was seen, while a moderate negative linear relationship (r = -0.5) between SUVmax and ADCmin was observed in tumors with a spatial match (D ≤ 12 mm). In conclusion, spatial mismatch between ADCmin and SUVmax is found in a considerable percentage of patients. The spatial connection of the two parameters SUVmax and ADCmin has a crucial influence on their numeric correlation.

The Role of the Subgenual Anterior Cingulate Cortex and Amygdala in Environmental Sensitivity to Infant Crying.

Newborns and infants communicate their needs and physiological states through crying and emotional facial expressions. Little is known about individual differences in responding to infant crying. Several theories suggest that people vary in their environmental sensitivity with some responding generally more and some generally less to environmental stimuli. Such differences in environmental sensitivity have been associated with personality traits, including neuroticism. This study investigated whether neuroticism impacts neuronal, physiological, and emotional responses to infant crying by investigating blood-oxygenation-level dependent (BOLD) responses using functional magnetic resonance imaging (fMRI) in a large sample of healthy women (N = 102) with simultaneous skin conductance recordings. Participants were repeatedly exposed to a video clip that showed crying infants and emotional responses (valence, arousal, and irritation) were assessed after every video clip presentation. Increased BOLD signal during the perception of crying infants was found in brain regions that are associated with emotional responding, the amygdala and anterior insula. Significant BOLD signal decrements (i.e., habituation) were found in the fusiform gyrus, middle temporal gyrus, superior temporal gyrus, Broca's homologue on the right hemisphere, (laterobasal) amygdala, and hippocampus. Individuals with high neuroticism showed stronger activation in the amygdala and subgenual anterior cingulate cortex (sgACC) when exposed to infant crying compared to individuals with low neuroticism. In contrast to our prediction we found no evidence that neuroticism impacts fMRI-based measures of habituation. Individuals with high neuroticism showed elevated skin conductance responses, experienced more irritation, and perceived infant crying as more unpleasant. The results support the hypothesis that individuals high in neuroticism are more emotionally responsive, experience more negative emotions, and may show enhanced cognitive control during the exposure to infant distress, which may impact infant-directed behavior.

Diffusion Tensor Imaging of Lumbar Nerve Roots: Comparison Between Fast Readout-Segmented and Selective-Excitation Acquisitions.

OBJECTIVES: The aim of this study was to compare the quality of recently emerged advanced diffusion tensor imaging (DTI) techniques with conventional single-shot echo-planar imaging (EPI) in a functional assessment of lumbar nerve roots. MATERIALS AND METHODS: The institutional review board approved the study including 12 healthy volunteers. Diffusion tensor imaging was performed at 3 T (MAGNETOM Skyra; Siemens Healthcare) with b-values of 0 and 700 s/mm and an isotropic spatial resolution for subsequent multiplanar reformatting. The nerve roots L2 to S1 were imaged in coronal orientation with readout-segmented EPI (rs-DTI) and selective-excitation EPI (sTX-DTI) with an acquisition time of 5 minutes each, and in axial orientation with single-shot EPI (ss-DTI) with an acquisition time of 12 minutes (scan parameters as in recent literature). Two independent readers qualitatively and quantitatively assessed image quality. RESULTS: The interobserver reliability ranged from "substantial" to "almost perfect" for all examined parameter and all 3 sequences (κ = 0.70-0.94). Overall image quality was rated higher, and artifact levels were scored lower for rs-DTI and sTX-DTI than for ss-DTI (P = 0.007-0.027), while fractional anisotropy and signal-to-noise ratio values were similar for all sequences (P ≥ 0.306 and P ≥ 0.100, respectively). Contrast-to-noise ratios were significantly higher for rs-DTI and ss-DTI than for sTX-DTI (P = 0.004-0.013). CONCLUSIONS: Despite shorter acquisition times, rs-DTI and sTX-DTI produced images of higher quality with smaller geometrical distortions than the current standard of reference, ss-DTI. Thus, DTI acquisitions in the coronal plane, requiring fewer slices for full coverage of exiting nerve roots, may allow for functional neurography in scan times suitable for routine clinical practice.

Fighting Sleep at Night: Brain Correlates and Vulnerability to Sleep Loss.

OBJECTIVE: Even though wakefulness at night leads to profound performance deterioration and is regularly experienced by shift workers, its cerebral correlates remain virtually unexplored. METHODS: We assessed brain activity in young healthy adults during a vigilant attention task under high and low sleep pressure during night-time, coinciding with strongest circadian sleep drive. We examined sleep-loss-related attentional vulnerability by considering a PERIOD3 polymorphism presumably impacting on sleep homeostasis. RESULTS: Our results link higher sleep-loss-related attentional vulnerability to cortical and subcortical deactivation patterns during slow reaction times (i.e., suboptimal vigilant attention). Concomitantly, thalamic regions were progressively less recruited with time-on-task and functionally less connected to task-related and arousal-promoting brain regions in those volunteers showing higher attentional instability in their behavior. The data further suggest that the latter is linked to shifts into a task-inactive default-mode network in between task-relevant stimulus occurrence. INTERPRETATION: We provide a multifaceted view on cerebral correlates of sleep loss at night and propose that genetic predisposition entails differential cerebral coping mechanisms, potentially compromising adequate performance during night work.

Fairly direct hit! Advances in imaging of shotgun projectiles in MRI.

OBJECTIVES: To investigate the magnetic properties of different types of projectiles and qualify the metal artefact reduction technique for diagnostic and/or forensic MRI. MATERIALS AND METHODS: Ten different projectiles embedded in ordnance gelatine blocks underwent an in vitro 1.5-T MR study with seven sequences including a recently developed metal artefact reduction sequence (Advanced WARP) combining VAT (view-angle-tilting) and SEMAC (slice-encoding metal-artefact-correction). Resulting image quality (five-point scale: 1=best; 5=worst) was scored. Quantifiable magnetic characteristics were correlated with qualitative rating of the MR sequences and torque dislodgment. RESULTS: Metal artefact reduction sequence (median: 2.5) significantly (p < 0.001) improves depiction of projectiles in comparison to all other MR pulse sequences (median: 4.75). Images from diamagnetic composed bullets (median: 2) are much less disturbed compared to magnetic attracted ones (median: 5). Correlation (0.623) between deflection angle measurement (ferromagnetic mean 84.2°; paramagnetic 62°; diamagnetic mean 0°) and median qualitative image quality was highly significant (p = 0.027). Torque dislodgement was distinct for elongated magnetic attracted projectiles. CONCLUSIONS: Significant improvement of MR imaging of projectiles using metal artefact reduction techniques has important implications for diagnostic/forensic work-up. The correlations between magnetic attraction force, deflection-angle results and image properties demonstrate that the MR safety of projectiles can be estimated with one of these methods. KEY POINTS: • Metal artefact reduction sequence improves overall image quality of bullets (p < 0.001). • Deflection angle assessment significantly predicts image quality of bullets (p = 0.027). • Classification of projectiles' magnetic properties based on artefacts' characteristics is possible. • Classifying of bullets has important implications in diagnostic and forensic imaging. • Identification of projectiles' magnetic attributes improves estimation of patients' injury risk.

Who gets afraid in the MRI-scanner? Neurogenetics of state-anxiety changes during an fMRI experiment.

Experiments using functional magnetic resonance imaging (fMRI) play a fundamental role in affective neuroscience. When placed in an MR scanner, some volunteers feel safe and relaxed in this situation, while others experience uneasiness and fear. Little is known about the basis and consequences of such inter-individually different responses to the general experimental fMRI setting. In this study emotional stimuli were presented during fMRI and subjects' state-anxiety was assessed at the onset and end of the experiment while they were within the scanner. We show that Val/Val but neither Met/Met nor Val/Met carriers of the catechol-O-methyltransferase (COMT) Val(158)Met polymorphism-a prime candidate for anxiety vulnerability-became significantly more anxious during the fMRI experiment (N=97 females: 24 Val/Val, 51 Val/Met, and 22 Met/Met). Met carriers demonstrated brain responses with increased stability over time in the right parietal cortex and significantly better cognitive performances likely mediated by lower levels of anxiety. Val/Val, Val/Met and Met/Met did not significantly differ in state-anxiety at the beginning of the experiment. The exposure of a control group (N=56 females) to the same experiment outside the scanner did not cause a significant increase in state-anxiety, suggesting that the increase we observe in the fMRI experiment may be specific to the fMRI setting. Our findings reveal that genetics may play an important role in shaping inter-individual different emotional, cognitive and neuronal responses during fMRI experiments.

Response inhibition in pedophilia: an FMRI pilot study.

BACKGROUND: The failure to inhibit pleasurable but inappropriate urges is associated with frontal lobe pathology and has been suggested as a possible cause of pedophilic behavior. However, imaging and neuropsychological findings about frontal pathology in pedophilia are heterogeneous. In our study we therefore address inhibition behaviorally and by means of functional imaging, aiming to assess how inhibition in pedophilia is related to a differential recruitment of frontal brain areas. METHOD: Eleven pedophilic subjects and 7 nonpedophilic controls underwent fMRI while performing a go/no-go task composed of neutral letters. RESULTS: Pedophilic subjects showed a slower reaction time and less accurate visual target discrimination. fMRI voxel-level ANOVA revealed as a main effect of the go/no-go task an activation of prefrontal and parietal brain regions in the no-go condition, while the left anterior cingulate, precuneus and gyrus angularis became more activated in the go condition. In addition, a group × task interaction was found in the left precuneus and gyrus angularis. This interaction was based on an attenuated deactivation of these brain regions in the pedophilic group during performance of the no-go condition. The positive correlation between blood oxygen level-dependent imaging signal and reaction time in these brain areas indicates that attenuated deactivation is related to the behavioral findings. CONCLUSION: Slower reaction time and less accurate visual target discrimination in pedophilia was accompanied by attenuated deactivation of brain areas belonging to the default mode network. Our findings thus support the notion that behavioral differences might also derive from self-related processes and not necessarily from frontal lobe pathology.