SAR reduction in 7T C-spine imaging using a "dark modes" transmit array strategy.

PURPOSE: Local specific absorption rate (SAR) limits many applications of parallel transmit (pTx) in ultra high-field imaging. In this Note, we introduce the use of an array element, which is intentionally inefficient at generating spin excitation (a "dark mode") to attempt a partial cancellation of the electric field from those elements that do generate excitation. We show that adding dipole elements oriented orthogonal to their conventional orientation to a linear array of conventional loop elements can lower the local SAR hotspot in a C-spine array at 7 T. METHODS: We model electromagnetic fields in a head/torso model to calculate SAR and excitation B1 (+) patterns generated by conventional loop arrays and loop arrays with added electric dipole elements. We utilize the dark modes that are generated by the intentional and inefficient orientation of dipole elements in order to reduce peak 10g local SAR while maintaining excitation fidelity. RESULTS: For B1 (+) shimming in the spine, the addition of dipole elements did not significantly alter the B1 (+) spatial pattern but reduced local SAR by 36%. CONCLUSION: The dipole elements provide a sufficiently complimentary B1 (+) and electric field pattern to the loop array that can be exploited by the radiofrequency shimming algorithm to reduce local SAR.

Voxel-based relaxometry for cases of an unresolved epilepsy diagnosis.

PURPOSE: Voxel-based relaxometry (VBR) is a technique in which a voxel-level statistical comparison of quantitative MR T2 maps is performed to identify regions with significantly elevated T2 relaxation time. Our objective was to assess the performance of single-subject VBR at 3T as a diagnostic tool for patients whose diagnosis of epilepsy or seizure focus location is uncertain. METHODS: Fifty-nine patients with possible epilepsy or known epilepsy, but an unknown focus and forty-five healthy controls were studied. All subjects were scanned at 3T using a Carr-Purcell-Meiboom-Gill MR sequence. Single-subject VBR was performed at a significance level of α=0.001. Patients were classified based on whether the diagnosis of epilepsy was in question and whether there was a suspected focus. A VBR score was determined based on the presence of VBR abnormalities in any of 13 predefined regions per hemisphere. RESULTS: All patients exhibited significantly more median VBR abnormalities than controls (p<0.05). VBR abnormalities were seen in 69% and 89% of patients with a normal or questionably abnormal MR scan, respectively. Nineteen of the 27 patients with a suspected focus (70%) had VBR abnormalities in the suspected focus, with additional regions of involvement being elucidated. VBR also correctly predicted the seizure focus in 50% of patients whose seizure foci were confirmed based on follow-up history or clinical investigations. CONCLUSIONS: Single subject VBR can help identify potential seizure foci in patients whose seizure foci are uncertain.

Algebraic T2 estimation improves detection of right temporal lobe epilepsy by MR T2 relaxometry.

Seizure related abnormalities may be detected with T2 relaxometry, which involves quantitative estimation of T2 values. Accounting for the partial-volume effect of cerebrospinal fluid (CSF) is important, especially for voxel-based relaxometry, VBR. With a mono-exponential decay model, this can be accomplished by including a baseline constant. An algebraic calculation, which accommodates this constant, offers improved T2 estimation speed over the commonly used non-linear fitting approach. Our objective was to compare the algebraic approach against three fitting approaches for the detection of seizure related abnormalities. We tested the performance of the four methods in the presence of noise using simulated data as well as real data acquired at 3 T with a Carr-Purcell-Meiboom-Gill sequence from 45 healthy subjects and 24 patients with confirmed right temporal lobe epilepsy. A quantitative analysis was performed on spatially normalized data by measuring T2 in various regions and with a whole brain tissue segmentation analysis. The detection rate of hippocampal T2 changes in patients was assessed by comparing the regional T2 measurements from each patient against the control data with a z-score threshold of 2.33. The algebraic method yielded high sensitivity for detection of hippocampal abnormalities in the epileptic patients in regional assessment and in follow-up single-subject VBR. This can be attributed to the relatively small variance across healthy subjects and improved precision in the presence of CSF and noise in simulation. In conclusion, the algebraic method is better than fitting based on faster calculation speed and better sensitivity for detecting seizure-related T2 changes.

Hippocampal T2 abnormalities in healthy adults.

We compared hippocampal abnormalities in 42 healthy adults identified by voxel-based relaxometry (VBR) and by visual inspection. Hippocampal abnormalities were seen in 8 (19.0%) and 10 (23.8%) of subjects by VBR and visual inspection, respectively (p>0.05). Notably, 50% of the abnormalities seen by visual inspection were likely false positive. This suggests that VBR is a more specific measure and should be considered in subjects with questionable hippocampal abnormalities.

Age effects on voxel-based relaxometry used for epileptic patients.

PURPOSE: T2 voxel-based relaxometry (VBR) is a technique that allows for a quantitative, unbiased analysis of T2 relaxation time across the whole brain. Previous studies have shown that this technique is effective for clinical analysis of single patients; however, the effects of age normal age-related changes on these data were unknown. Our study was therefore designed to assess the effect of normal aging on VBR data. METHODS: A linear regression with age as a predictor of T2 was run in both a (1) whole-brain voxel-based manner to determine regions which showed significant age-related change and subsequently (2) on a selection of regions-of-interest to allow for a more detailed analysis of the trends. RESULTS: T2 estimates showed a significant increase with age in the frontal lobe white matter and a significant decrease with age in the putamen with region-of-interest and voxel-based regressions (p<0.05). There was also a general trend for T2 to decrease in inferior temporal lobe grey matter in the voxel-based regression. CONCLUSIONS: Age causes changes in T2 relaxation time in healthy control subjects, with increases being observed in frontal lobe white matter and decreases in the putamen. These changes should be accounted for when interpreting single subject VBR data.

Atlas-based topographical scoring for magnetic resonance imaging of acute stroke.

BACKGROUND AND PURPOSE: The Alberta Stroke Program Early CT Score (ASPECTS), a 10-point scale, is a clinical tool for assessment of early ischemic changes after stroke based on the location and extent of a visible stroke lesion. It has been extended for use with MR diffusion-weighted imaging. The purpose of this work was to automate a MR topographical score (MR-TS) using a digital atlas to develop an objective tool for large-scale analyses and possibly reduce interrater variability and slice orientation differences. METHODS: We assessed 30 patients with acute ischemic stroke with a diffusion lesion who provided informed consent. Patients were imaged by CT and MRI within 24 hours of symptom onset. An MR-TS digital atlas was generated using the ASPECTS scoring sheet and anatomic MR data sets. Automated MR topographical scores (auto-MR-TS) were obtained based on the overlap of lesions on apparent diffusion coefficient maps with MR-TS atlas regions. Auto-MR-TS scores were then compared with scores derived manually (man-MR-TS) and with conventional CT ASPECTS scores. RESULTS: Of the 30 patients, 29 were assessed with auto-MR-TS. Auto-MR-TS was significantly lower than CT ASPECTS (P<0.001), but with a median difference of only 1 point. There was no significant difference between the auto-MR-TS and the man-MR-TS with a median difference of 0 points; 86% of patient scores differed by

Evolution of hyperacute stroke over 6 hours using serial MR perfusion and diffusion maps.

PURPOSE: To develop an appropriate method to evaluate the time-course of diffusion and perfusion changes in a clinically relevant animal model of ischemic stroke and to examine lesion progression on MR images. An exploration of acute stroke infarct expansion was performed in this study by using a new methodology for developing time-to-infarct maps based on the time at which each voxel becomes infarcted. This enabled definition of homogeneous regions from the heterogeneous stroke infarct. MATERIALS AND METHODS: Time-to-infarct maps were developed based on apparent diffusion coefficient (ADC) changes. These maps were validated and then applied to blood flow and time-to-peak maps to examine perfusion changes. RESULTS: ADC stroke infarct showed different evolution patterns depending on the time at which that region of tissue infarcted. Applying the time-to-infarct maps to the perfusion maps showed localized perfusion evolution characteristics. In some regions, perfusion was immediately affected and showed little change over the experiment; however, in some regions perfusion changes were more dynamic. CONCLUSION: Results were consistent with the diffusion-perfusion mismatch hypothesis. In addition, characteristics of collateral recruitment were identified, which has interesting stroke pathophysiology and treatment implications.

Single-subject voxel-based relaxometry for clinical assessment of temporal lobe epilepsy.

PURPOSE: T2 relaxometry, quantitative assessment of T2 relaxation time in magnetic resonance (MR) data, typically uses manually drawn regions of interest (ROIs). This approach is limited by its subjectivity and its restricted scope of investigation. A recently developed approach called voxel-based relaxometry (VBR) provides an unbiased statistical analysis of the whole brain. Our objective was to assess the clinical utility of single-subject VBR for patients with temporal lobe epilepsy (TLE). METHODS: Forty-five patients with TLE confirmed by history, EEG, and structural MRI and 25 control subjects were scanned at 3T using a modified Carr-Purcell-Meiboom-Gill MR sequence. ROIs were drawn for each patient and control subject, and measurements were made on unregistered T2 maps. VBR was performed on a single-subject basis at a significance level of alpha=0.05. Patients were grouped according to seizure focus (left mesial, right mesial, other), and whether structural MR imaging was normal or abnormal. RESULTS: Up to 85% of patients in the temporal lobe groups demonstrated T2 abnormalities. VBR detected abnormalities either in equal numbers or in more patients (up to 23% more) than ROI analysis for each group. The number of detected abnormalities per patient was higher using VBR (3.38 versus 2.04, p<0.05). VBR also identified abnormalities that were missed by ROI analysis. The rate of VBR detection of abnormalities was higher for patients than controls (76% versus 36%). CONCLUSIONS: VBR can be performed on single subjects with TLE and it detects considerably more abnormalities than ROI analysis. VBR may be a clinically useful tool for the detection of T2 abnormalities at the seizure focus and sites remote from it.

Improved dynamic susceptibility contrast (DSC)-MR perfusion estimates by motion correction.

PURPOSE: To investigate the effect of patient motion on quantitative cerebral blood flow (CBF) maps in ischemic stroke patients and to evaluate the efficacy of a motion-correction scheme. MATERIALS AND METHODS: Perfusion data from 25 ischemic stroke patients were selected for analysis. Two motion profiles were applied to a digital anthropomorphic brain phantom to estimate accuracy. CBF images were generated for motion-corrupted and motion-corrected data. To correct for motion, rigid-body registration was performed. The realignment parameters and mean CBF in regions of interest were recorded. RESULTS: All patient data with motion exhibited visibly reduced intervolume misalignment after motion correction. Improved flow delineation between different tissues and a more clearly defined ischemic lesion (IL) were achieved in the motion-corrected CBF. A significant difference occurred in the IL (P < 0.05) for patients with severe motion with an average difference between corrupted and corrected data of 4.8 mL/minute/100 g. The phantom data supported the patient results with better CBF accuracy after motion correction and high registration accuracy (<1 mm translational and <1 degrees rotational error). CONCLUSION: Motion degrades flow differentiation between adjacent tissues in CBF maps and can cause ischemic severity to be underestimated. A registration motion correction scheme improves dynamic susceptibility contrast (DSC)-MR perfusion estimates.

3-Tesla versus 1.5-Tesla magnetic resonance diffusion and perfusion imaging in hyperacute ischemic stroke.

BACKGROUND: Clinical 3-tesla magnetic resonance imaging systems are becoming widespread. No studies have examined differences between 1.5-tesla and 3-tesla imaging for the assessment of hyperacute ischemic stroke (<6 h from symptom onset). Our objective was to compare 1.5-tesla and 3-tesla diffusion and perfusion imaging for hyperacute stroke using optimized protocols. METHODS: Three patients or their surrogate provided informed consent. Diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) was performed sequentially at 1.5 T and 3 T. DWI, apparent diffusion coefficient (ADC) maps and relative time-to-peak (TTP) maps were registered and assessed. DWI contrast-to-noise ratio (CNR) and ADC contrast were measured and compared. The infarct lesion volume (ILV) and thresholded ischemic volume (TIV) were estimated on the ADC and TTP maps, respectively, with the penumbral volume being defined as the difference between these volumes. RESULTS: Qualitatively, the 3-tesla TTP images exhibited greater feature detail. Quantitatively, the DWI CNR and ILV were similar at both field strengths, the ADC contrast was greater at 3 T and the TIV and penumbral volumes were much smaller at 3 T. CONCLUSIONS: Overall, the 3-tesla diffusion and perfusion images were at least as good and in some ways superior to the 1.5-tesla images for assessing hyperacute stroke. The TTP maps showed greater feature detail at 3 T. The ischemic and penumbra volumes were much greater at 1.5 T, indicating a potential difference in the diagnostic utility of the PWI-DWI mismatch between field strengths.