(2 + 1)D-CAIPIRINHA accelerated MR spectroscopic imaging of the brain at 7T.

PURPOSE: To compare a new parallel imaging (PI) method for multislice proton magnetic resonance spectroscopic imaging (1 H-MRSI), termed (2 + 1)D-CAIPIRINHA, with two standard PI methods: 2D-GRAPPA and 2D-CAIPIRINHA at 7 Tesla (T). METHODS: (2 + 1)D-CAIPIRINHA is a combination of 2D-CAIPIRINHA and slice-CAIPIRINHA. Eight healthy volunteers were measured on a 7T MR scanner using a 32-channel head coil. The best undersampling patterns were estimated for all three PI methods. The artifact powers, g-factors, Cramér-Rao lower bounds (CRLB), and root mean square errors (RMSE) were compared quantitatively among the three PI methods. Metabolic maps and spectra were compared qualitatively. RESULTS: (2 + 1)D-CAIPIRINHA allows acceleration in three spatial dimensions in contrast to 2D-GRAPPA and 2D-CAIPIRINHA. Thus, this sequence significantly decreased the RMSE of the metabolic maps by 12.1 and 6.9%, on average, for 4 < R < 11, compared with 2D-GRAPPA and 2D-CAIPIRINHA, respectively. The artifact power was 22.6 and 8.4% lower, and the CRLB were 3.4 and 0.6% lower, respectively. CONCLUSION: (2 + 1)-CAIPIRINHA can be implemented for multislice MRSI in the brain, enabling higher accelerations than possible with two-dimensional (2D) parallel imaging methods. An eight-fold acceleration was still feasible in vivo with negligible PI artifacts with lipid decontamination, thus decreasing the measurement time from 120 to 15 min for a 64 × 64 × 4 matrix. Magn Reson Med 78:429-440, 2017. © 2016 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Diffusion-weighted imaging of breast tumours at 3 Tesla and 7 Tesla: a comparison.

OBJECTIVES: To compare bilateral diffusion-weighted MR imaging (DWI) at 3 T and 7 T in the same breast tumour patients. METHODS: Twenty-eight patients were included in this IRB-approved study (mean age 56 ± 16 years). Before contrast-enhanced imaging, bilateral DWI with b = 0 and 850 s/mm(2) was performed in 2:56 min (3 T) and 3:48 min (7 T), using readout-segmented echo planar imaging (rs-EPI) with a 1.4 × 1.4 mm(2) (3 T)/0.9 × 0.9 mm(2) (7 T) in-plane resolution. Apparent diffusion coefficients (ADC), signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were assessed. RESULTS: Twenty-eight lesions were detected (18 malignant, 10 benign). CNR and SNR were comparable at both field strengths (p > 0.3). Mean ADC values at 7 T were 4-22% lower than at 3 T (p ≤ 0.03). An ADC threshold of 1.275 × 10(-3) mm(2)/s resulted in a diagnostic specificity of 90% at both field strengths. The sensitivity was 94% and 100% at 3 T and 7 T, respectively. CONCLUSION: 7-T DWI of the breast can be performed with 2.4-fold higher spatial resolution than 3 T, without significant differences in SNR if compared to 3 T. KEY POINTS: • 7 T provides a 2.4-fold higher resolution in breast DWI than 3 T • 7 T DWI has a high diagnostic accuracy comparable to that at 3 T • At 7 T malignant lesions had 22 % lower ADC than at 3 T (p < 0.001).

Coil combination of multichannel MRSI data at 7 T: MUSICAL.

The goal of this study was to evaluate a new method of combining multi-channel (1)H MRSI data by direct use of a matching imaging scan as a reference, rather than computing sensitivity maps. Seven healthy volunteers were measured on a 7-T MR scanner using a head coil with a 32-channel array coil for receive-only and a volume coil for receive/transmit. The accuracy of prediction of the phase of the (1)H MRSI data with a fast imaging pre-scan was investigated with the volume coil. The array coil (1)H MRSI data were combined using matching imaging data as coil combination weights. The signal-to-noise ratio (SNR), spectral quality, metabolic map quality and Cramér-Rao lower bounds were then compared with the data obtained by two standard methods, i.e. using sensitivity maps and the first free induction decay (FID) data point. Additional noise decorrelation was performed to further optimize the SNR gain. The new combination method improved significantly the SNR (+29%), overall spectral quality and visual appearance of metabolic maps, and lowered the Cramér-Rao lower bounds (-34%), compared with the combination method based on the first FID data point. The results were similar to those obtained by the combination method using sensitivity maps, but the new method increased the SNR slightly (+1.7%), decreased the algorithm complexity, required no reference coil and pre-phased all spectra correctly prior to spectral processing. Noise decorrelation further increased the SNR by 13%. The proposed method is a fast, robust and simple way to improve the coil combination in (1)H MRSI of the human brain at 7 T, and could be extended to other (1)H MRSI techniques.

Fully adiabatic 31P 2D-CSI with reduced chemical shift displacement error at 7 T--GOIA-1D-ISIS/2D-CSI.

A fully adiabatic phosphorus (31P) two-dimensional (2D) chemical shift spectroscopic imaging sequence with reduced chemical shift displacement error for 7 T, based on 1D-image-selected in vivo spectroscopy, combined with 2D-chemical shift spectroscopic imaging selection, was developed. Slice-selective excitation was achieved by a spatially selective broadband GOIA-W(16,4) inversion pulse with an interleaved subtraction scheme before nonselective adiabatic excitation, and followed by 2D phase encoding. The use of GOIA-W(16,4) pulses (bandwidth 4.3-21.6 kHz for 10-50 mm slices) reduced the chemical shift displacement error in the slice direction ∼1.5-7.7 fold, compared to conventional 2D-chemical shift spectroscopic imaging with Sinc3 selective pulses (2.8 kHz). This reduction was experimentally demonstrated with measurements of an MR spectroscopy localization phantom and with experimental evaluation of pulse profiles. In vivo experiments in clinically acceptable measurement times were demonstrated in the calf muscle (nominal voxel volume, 5.65 ml in 6 min 53 s), brain (10 ml, 6 min 32 s), and liver (8.33 ml, 8 min 14 s) of healthy volunteers at 7 T. High reproducibility was found in the calf muscle at 7 T. In combination with adiabatic excitation, this sequence is insensitive to the B1 inhomogeneities associated with surface coils. This sequence, which is termed GOIA-1D-ISIS/2D-CSI (goISICS), has the potential to be applied in both clinical research and in the clinical routine.

High-resolution mapping of human brain metabolites by free induction decay (1)H MRSI at 7 T.

This work describes a new approach for high-spatial-resolution (1)H MRSI of the human brain at 7 T. (1)H MRSI at 7 T using conventional approaches, such as point-resolved spectroscopy and stimulated echo acquisition mode with volume head coils, is limited by technical difficulties, including chemical shift displacement errors, B(0)/B(1) inhomogeneities, a high specific absorption rate and decreased T(2) relaxation times. The method presented here is based on free induction decay acquisition with an ultrashort acquisition delay (TE*) of 1.3 ms. This allows full signal detection with negligible T(2) decay or J-modulation. Chemical shift displacement errors were reduced to below 5% per part per million in the in-slice direction and were eliminated in-plane. The B(1) sensitivity was reduced significantly and further corrected using flip angle maps. Specific absorption rate requirements were well below the limit (~20 % = 0.7 W/kg). The suppression of subcutaneous lipid signals was achieved by substantially improving the point-spread function. High-quality metabolic mapping of five important brain metabolites was achieved with high in-plane resolution (64 × 64 matrix with a 3.4 × 3.4 × 12 mm(3) nominal voxel size) in four healthy subjects. The ultrashort TE* increased the signal-to-noise ratio of J-coupled resonances, such as glutamate and myo-inositol, several-fold to enable the mapping of even these metabolites with high resolution. Four measurement repetitions in one healthy volunteer provided proof of the good reproducibility of this method. The high spatial resolution allowed the visualization of several anatomical structures on metabolic maps. Free induction decay MRSI is insensitive to T(2) decay, J-modulation, B(1) inhomogeneities and chemical shift displacement errors, and overcomes specific absorption rate restrictions at ultrahigh magnetic fields. This makes it a promising method for high-resolution (1)H MRSI at 7 T and above.

In vivo 31P spectroscopy by fully adiabatic extended image selected in vivo spectroscopy: a comparison between 3 T and 7 T.

An improved image selected in vivo spectroscopy (ISIS) sequence for localized (31)P magnetic resonance spectroscopy at 7 T was developed. To reduce errors in localization accuracy, adiabatic excitation, gradient offset independent adiabatic inversion pulses, and a special extended ISIS ordering scheme were used. The localization accuracy of extended ISIS was investigated in phantoms. The possible spectral quality and reproducibility in vivo was explored in a volunteer (brain, muscle, and liver). A comparison between 3 T and 7 T was performed in five volunteers. Adiabatic extended ISIS provided high spectral quality and accurate localization. The contamination in phantom experiments was only ∼5%, even if a pulse repetition time ∼ 1.2·T(1) was chosen to maximize the signal-to-noise ratio per unit time. High reproducibility was found in the calf muscle for 2.5 cm isotropic voxels at 7 T. When compared with 3 T, localized (31)P magnetic resonance spectroscopy in the human calf muscle at 7 T provided ∼3.2 times higher signal-to-noise ratio (as judged from phosphocreatine peak amplitude in frequency domain after matched filtering). At 7 T, extended ISIS allowed the performance of high-quality localized (31)P magnetic resonance spectroscopy in a short measurement time (∼3 to 4 min) and isotropic voxel sizes of ∼2.5 to 3 cm. With such short measurement times, localized (31)P magnetic resonance spectroscopy has the potential to be applied not only for clinical research but also for routine clinical practice.

Impaired insulin stimulation of muscular ATP production in patients with type 1 diabetes.

OBJECTIVE: in type 2 diabetic patients and their first-degree relatives, insulin resistance (IR) is associated with impairment of insulin-stimulated myocellular glucose-6-phosphate (g6p) and unidirectional flux through ATP synthase (fATP), suggesting the presence of inherited abnormal mitochondrial oxidative fitness. We hypothesized that patients with long-standing type 1 diabetes may also exhibit insulin resistance as well as lower fATP. DESIGN: this single-centre trial was registered at ClinicalTrials.gov (NCT00481598). SUBJECTS: we included eight nonobese type 1 diabetic patients (mean diabetes duration: 17 years) with near-target glycaemic control [haemoglobin A1c (HbA1c): 6.8 ± 0.4%] during treatment with continuous subcutaneous insulin infusion pumps and eight healthy volunteers (HbA1c: 5.4 ± 0.2%) of comparable age, body mass and level of physical activity. OUTCOME MEASURES: myocellular fATP, g6p and intramyocellular lipid content (IMCL) were measured with (1) H/(31) P magnetic resonance spectroscopy during fasting and hyperinsulinaemic-euglycaemic clamp tests. RESULTS: fasting fATP, g6p and IMCL did not differ between groups. During stimulation by insulin, type 1 diabetic patients exhibited approximately 50% (P < 0.001) lower whole-body glucose disposal along with approximately 42% (P = 0.003) lower intramyocellular g6p and approximately25% (P = 0.024) lower fATP. Insulin-stimulated fATP correlated positively with whole-body insulin sensitivity (R = 0.706, P = 0.002) and negatively with HbA1c (R = -0.675, P = 0.004). CONCLUSIONS: despite documented near-target glycaemic control for 1 year, nonobese patients with long-standing type 1 diabetes can exhibit insulin resistance. This associates with lower insulin-stimulated flux through muscular ATP synthase which could result from glucose toxicity.

Assessment of (31)P relaxation times in the human calf muscle: a comparison between 3 T and 7 T in vivo.

Phosphorus ((31)P) T(1) and T(2) relaxation times in the resting human calf muscle were assessed by interleaved, surface coil localized inversion recovery and frequency-selective spin-echo at 3 and 7 T. The obtained T(1) (mean +/- SD) decreased significantly (P < 0.05) from 3 to 7 T for phosphomonoesters (PME) (8.1 +/- 1.7 s to 3.1 +/- 0.9 s), phosphodiesters (PDE) (8.6 +/- 1.2 s to 6.0 +/- 1.1 s), phosphocreatine (PCr) (6.7 +/- 0.4 s to 4.0 +/- 0.2 s), gamma-NTP (nucleotide triphosphate) (5.5 +/- 0.4 s to 3.3 +/- 0.2 s), alpha-NTP (3.4 +/- 0.3 s to 1.8 +/- 0.1 s), and beta-NTP (3.9 +/- 0.4 s to 1.8 +/- 0.1 s), but not for inorganic phosphate (Pi) (6.9 +/- 0.6 s to 6.3 +/- 1.0 s). The decrease in T(2) was significant for Pi (153 +/- 9 ms to 109 +/- 17 ms), PDE (414 +/- 128 ms to 314 +/- 35 ms), PCr (354 +/- 16 ms to 217 +/- 14 ms), and gamma-NTP (61.9 +/- 8.6 ms to 29.0 +/- 3.3 ms). This decrease in T(1) with increasing field strength of up to 62% can be explained by the increasing influence of chemical shift anisotropy on relaxation mechanisms and may allow shorter measurements at higher field strengths or up to 62% additional signal-to-noise ratio (SNR) per unit time. The fully relaxed SNR increased by +96%, while the linewidth increased from 6.5 +/- 1.2 Hz to 11.2 +/- 1.9 Hz or +72%. At 7 T (31)P-MRS in the human calf muscle offers more than twice as much SNR per unit time in reduced measurement time compared to 3 T. This will facilitate in vivo (31)P-MRS of the human muscle at 7 T.

Three-dimensional high-resolution magnetic resonance spectroscopic imaging for absolute quantification of 31P metabolites in human liver.

Liver dysfunction correlates with alterations of intracellular concentrations of (31)P metabolites. Localization and absolute quantification should help to trace regional hepatic metabolism. An improved protocol for the absolute quantification of (31)P metabolites in vivo in human liver was developed by employing three-dimensional (3D) k-space weighted spectroscopic imaging (MRSI) with B(1)-insensitive adiabatic excitation. The protocol allowed for high spatial resolution of 17.8 +/- 0.22 cm(3) in 34 min at 3 T. No pulse adjustment prior to MRSI measurement was necessary due to adiabatic excitation. The protocol geometry was identical for all measurements so that one calibration data set, acquired from phantom replacement measurement, was applied for all quantifications. The protocol was tested in 10 young, healthy volunteers, for whom 57 +/- 7 spectra were quantified. Concentrations per liter of liver volume (reproducibilities) were 2.24 +/- 0.10 mmol/L (1.8%) for phosphomonoesters (PME), 1.37 +/- 0.07 mmol/L (7.9%) for inorganic phosphate (Pi), 11.40 +/- 0.96 mmol/L (2.9%) for phosphodiesters (PDE), and 2.14 +/- 0.10 mmol/L (1.6%) for adenosine triphosphate (ATP), respectively. Taken together, this approach provides fast, simple, and reproducible high-resolution absolute quantification and detailed mapping of the spatial distribution of hepatic (31)P metabolites. This method allows for examination of regional deviations of energy metabolism in human liver diseases.

Quantitative ATP synthesis in human liver measured by localized 31P spectroscopy using the magnetization transfer experiment.

The liver plays a central role in intermediate metabolism. Accumulation of liver fat (steatosis) predisposes to various liver diseases. Steatosis and abnormal muscle energy metabolism are found in insulin-resistant and type-2 diabetic states. To examine hepatic energy metabolism, we measured hepatocellular lipid content, using proton MRS, and rates of hepatic ATP synthesis in vivo, using the 31P magnetization transfer experiment. A suitable localization scheme was developed and applied to the measurements of longitudinal relaxation times (T1) in six healthy volunteers and the ATP-synthesis experiment in nine healthy volunteers. Liver 31P spectra were modelled and quantified successfully using a time domain fit and the AMARES (advanced method for accurate, robust and efficient spectral fitting of MRS data with use of prior knowledge) algorithm describing the essential components of the dataset. The measured T1 relaxation times are comparable to values reported previously at lower field strengths. All nine subjects in whom saturation transfer was measured had low hepatocellular lipid content (1.5 +/- 0.2% MR signal; mean +/- SEM). The exchange rate constant (k) obtained was 0.30 +/- 0.02 s(-1), and the rate of ATP synthesis was 29.5 +/- 1.8 mM/min. The measured rate of ATP synthesis is about three times higher than in human skeletal muscle and human visual cortex, but only about half of that measured in perfused rat liver. In conclusion, 31P MRS at 3 T provides sufficient sensitivity to detect magnetization transfer effects and can therefore be used to assess ATP synthesis in human liver.

Metabolic changes in the normal ageing brain: consistent findings from short and long echo time proton spectroscopy.

OBJECTIVES: Sixty three healthy subjects were measured to assess dependence of brain metabolites on age using short- and long echo time spectroscopy in different brain regions. MATERIAL AND METHODS: Younger and elderly humans were measured with long echo time (TE=135ms) 3D-MR-spectroscopic imaging (MRSI) (10 subjects) and with ultra-short echo (TE=11ms) time 2D-MRSI (7 subjects). In addition, results from single voxel (1)H-spectroscopy (TE=20ms) of two cohorts of 46 healthy subjects were retrospectively correlated with age. RESULTS: 3D-MR SI revealed reduced NAA/Cr in the older group in the frontal lobe (-22%; p<0.01), parietal lobe (-28%; p<0.01) and semiovale (-9%; p<0.01) compared to the younger group. Cho/Cr was elevated in the semiovale (+35%; p<0.01) and in the n. lentiformis (+42%; p<0.01) in the older group. NAA/Cho was reduced in all regions measured, except the thalamus, in the older group compared to the younger group (from -21 to -49%; p<0.01). 2D-MRSI revealed decreased total NAA (-3.1% per decade; p<0.01) and NAA/Cr (-3.8% per decade; p<0.01), increased total Cho (+3.6% per decade; p<0.01) and Cho/Cr (+4.6% per decade; p<0.01) and increased total myo-Inositol (mI, +4.7% per decade; p<0.01) and mI/Cr (+5.4% per decade; p<0.01) and decreased NAA/Cho (-8% per decade; p<0.01) in semiovale WM. Results from single voxel spectroscopy revealed a significantly negative correlation of NAA/Cho in frontal (-13% per decade; p<0.01) and in temporal lobe (-7.4% per decade; p<0.01) as well as increased total Cr (10% per decade; p<0.01) in frontal lobe. Other results from single voxel measurements were not significant, but trends were comparable to that from multivoxel spectroscopy. CONCLUSION: Age-related changes measured with long echo time and short echo time 1H-MRS were comparable and cannot, therefore, be caused by different T2 relaxation times in young and old subjects, as suggested previously.

Disease due to Mycobacterium kansasii in the Czech Republic: 1984-89.

SETTING: Endemic area of North Moravia, Czech Republic. OBJECTIVE: Evaluate the incidence of human disease due to Mycobacterium kansasii. The follow-up of some bacteriological and clinical features. DESIGN: A retrospective analysis of M. kansasii patients. RESULTS: M. kansasii was isolated from the sputum, tissue and other specimens obtained from 650 persons during the period 1984-89. In only 471 of them was this mycobacterium deemed to be the causative agent, predominantly of lung disease. The most typical radiographic finding in these patients was lung infiltration and/or thin-walled cavity. CONCLUSION: As in previous years the highest incidence of disease remains in an endemic area of North Moravia. The effects of treatment in follow-up patients were influenced not only by the antituberculosis regimen but also by a high frequency of associated diseases. Sputum conversion within 30 days was not affected by the presence or absence of a cavity. Authors consider water to be the source of infection.

[Tuberculosis of the cervico-facial lymph nodes in childhood]. / Tuberkulóza cervikofaciálních mízních uzlin v detském veku.

The authors proved a tuberculosis origin of lymphadenitis of the cervicofacial area in 16 of 63 children operated on account of this suspected diagnosis. In all instances it was verified by bioptic examination of the removed lymph nodes. However, in no instance acid resistant rods were detected in the microscopic sections. Only in two bacteriological evidence was provided of the presence of mycobacteria tuberculosis in the preoperative punctate from colliquated lymph nodes but not in material obtained from the nodes. The attempt at typing of the causative agent was, however, not successful. In the submitted work the authors paid attention to some aspects of this disease in children, its problems in the area of the parotid gland.

[Cytodiagnosis of pleural exudates with electron microscopy. I. Activated pleural mesothelium]. / Cytodiagnostika pleurálních výpotku v elektronové mikroskopii. I. Aktivované pleurální mezotelie.

Detailed examination of 48 pleural exudations showed that a sequence of morphological changes [desquamation, proliferation, activation, degeneration] was a uniform response of mesothelium to various pathological stimuli. Desquamated mesothelial cells grow round and bigger, their nuclei increase, multiply, become irregular and get a coarse chromatin pattern. Their cytoplasm is less often homogeneous, a bit basophil and mostly vacuolized to some extent; fusion of vacuoles can lead to a signet-ring appearance. Provided that highly activated mesothelial cells phagocytize foreign corpuscular material, they cannot be distinguished from the macrophages. Their cytoplasmic organelles multiply progressively. More frequent lysosomes occur sometimes with dense lamellated myelin-like bodies. Glycogen particles increase in number substantially in peripheric cytoplasmic zone. Tonofilaments are very conspicuous, arranged round the nucleus, but disappear during progressive mesothelial activation and degradation. Numerous microvilli are gradually reduced in number, change into voluminous plasmatic blebs, and finally, mesothelial surface grow irregular or smooth. In dubious cases, electron microscopy [transmissive and scanning] gives more precise features of organelles and surface structures in activated mesothelial cells and helps to differentiate them from other exudation cells especially the neoplastic ones.

[Cytodiagnosis of pleural exudates with electron microscopy. II. Tumorous exudates of glandular origin]. / Cytodiagnostika pleurálních výpotku v elektronové mikroskopii. II. Nádorové výpotky zlázového puvodu.

Detailed examination of 26 pleural exudations by transmissive and scanning electron microscopy gave new cytodiagnostical possibilities. In addition to confirming the light-microscopical criteria of malignancy transmissive electron microscopy characterized the cells of adenocarcinoma by microvilli with common structure, various length, irregular orientation and crossing over or branching. They tend to be a bit widened at their base or top and to cover all the surface of cells. Microvilli in the neighbouring parts of cells are less numerous, irregularly oriented, shortened and interdigitating. Not even here is the surface of carcinoma cells quite smoth in contrast to neighbouring mesotelial cells. Scanning electron-microscopical examination being neither technologically sophisticated nor time consuming enables a scope on cellular surfaces uniformly covered by countless microvilli densely distributed.

[The diagnostic significance of cytological and histological examination of secretions, washout materials, catheterization and brush biopsy materials in the diagnosis of malignant bronchopulmonary diseases]. / Diagnostický význam cytologických a histologických vysetrení sekretu, výplachu, katetrizacních a sterových biopsií v diagnostice maligních bronchopulmonálních onemocnení

Referring to their group of 325 patients examined by means of all-around endobronchial biopsy material withdrawal the authors present the results of cytological and histological diagnosis. Endobronchially material obtained by direct aspiration of bronchial secretions, by wash-outs, and by catheterization and brush biopsy represents, particularly in peripheral localizations, a significant and often decisive contribution to the objectivization of malignant affections. The authors present and discuss morphological criteria of malignity derived from endobronchially obtained material processed by the method of cytoblocks stressing, at the same time, the possibility of an accurate localization of the pathological process down to the particular segment involved.