Details of left ventricular radial wall motion supporting the ventricular theory of the third heart sound obtained by cardiac MR.

OBJECTIVE: Obtaining new details of radial motion of left ventricular (LV) segments using velocity-encoding cardiac MRI. METHODS: Cardiac MR examinations were performed on 14 healthy volunteers aged between 19 and 26 years. Cine images for navigator-gated phase contrast velocity mapping were acquired using a black blood segmented κ-space spoiled gradient echo sequence with a temporal resolution of 13.8 ms. Peak systolic and diastolic radial velocities as well as radial velocity curves were obtained for 16 ventricular segments. RESULTS: Significant differences among peak radial velocities of basal and mid-ventricular segments have been recorded. Particular patterns of segmental radial velocity curves were also noted. An additional wave of outward radial movement during the phase of rapid ventricular filling, corresponding to the expected timing of the third heart sound, appeared of particular interest. CONCLUSION: The technique has allowed visualization of new details of LV radial wall motion. In particular, higher peak systolic radial velocities of anterior and inferior segments are suggestive of a relatively higher dynamics of anteroposterior vs lateral radial motion in systole. Specific patterns of radial motion of other LV segments may provide additional insights into LV mechanics. ADVANCES IN KNOWLEDGE: The outward radial movement of LV segments impacted by the blood flow during rapid ventricular filling provides a potential substrate for the third heart sound. A biphasic radial expansion of the basal anteroseptal segment in early diastole is likely to be related to the simultaneous longitudinal LV displacement by the stretched great vessels following repolarization and their close apposition to this segment.

Effects of ventricular insertion sites on rotational motion of left ventricular segments studied by cardiac MR.

OBJECTIVE: Obtaining new details for rotational motion of left ventricular (LV) segments using velocity encoding cardiac MR and correlating the regional motion patterns to LV insertion sites. METHODS: Cardiac MR examinations were performed on 14 healthy volunteers aged between 19 and 26 years. Peak rotational velocities and circumferential velocity curves were obtained for 16 ventricular segments. RESULTS: Reduced peak clockwise velocities of anteroseptal segments (i.e. Segments 2 and 8) and peak counterclockwise velocities of inferoseptal segments (i.e. Segments 3 and 9) were the most prominent findings. The observations can be attributed to the LV insertion sites into the right ventricle, limiting the clockwise rotation of anteroseptal LV segments and the counterclockwise rotation of inferoseptal segments as viewed from the apex. Relatively lower clockwise velocities of Segment 5 and counterclockwise velocities of Segment 6 were also noted, suggesting a cardiac fixation point between these two segments, which is in close proximity to the lateral LV wall. CONCLUSION: Apart from showing different rotational patterns of LV base, mid ventricle and apex, the study showed significant differences in the rotational velocities of individual LV segments. Correlating regional wall motion with known orientation of myocardial aggregates has also provided new insights into the mechanisms of LV rotational motions during a cardiac cycle. ADVANCES IN KNOWLEDGE: LV insertion into the right ventricle limits the clockwise rotation of anteroseptal LV segments and the counterclockwise rotation of inferoseptal segments adjacent to the ventricular insertion sites. The pattern should be differentiated from wall motion abnormalities in cardiac pathology.

Quantitative MRI measurements of the Achilles tendon in spondyloarthritis using ultrashort echo times.

OBJECTIVES: Tendon involvement is common in spondyloarthritis. The MRI signal from the Achilles tendon has been used to quantify mechanical tendinopathy; however, conventional MRI is limited by the short T(2) of normal tendon. Short and ultrashort echo time (UTE) MRI have the potential to better measure signal intensity reflecting changes in T(2) or gadolinium enhancement. Furthermore, UTE images could be used for normalisation to reduce variability. The aim of this work was to investigate such techniques in patients with spondyloarthritis (SpA). METHODS: The Achilles tendons of 14 healthy volunteers and 24 patients with symptomatic spondyloarthritis were studied. Combined UTE (TE=0.07 ms) and gradient echo (TE=4.9 ms) images were acquired before and after intravenous gadolinium together with pre-contrast gradient echo images (TE=2 ms). The signal intensity from a region of interest in the Achilles tendon above the calcaneus was measured. The relative enhancement at echo times of 0.07 ms (RE(0.1)) and 4.9 ms (RE(5)) were calculated. The ratios of the signal intensities from both 4.9 ms and 2 ms gradient echo images to the signal intensity from the UTE image were calculated (RTE(5) and RTE(2) respectively). RESULTS: Interobserver intraclass correlation coefficients were excellent (≥0.97). The contrast-to-noise ratio was higher for enhancement on UTE images than on gradient echo images. RE(0.1), RTE(5) and RTE(2) were significantly higher in SpA patients than controls. CONCLUSION: Signal intensity ratios using UTE images allow quantitative measurements to be made which are sensitive to tendon T(2) or contrast enhancement and which are increased in spondyloarthritis. They therefore have the potential for use as measures of tendon disease in spondyloarthritis.

Imaging of the Achilles tendon in spondyloarthritis: a comparison of ultrasound and conventional, short and ultrashort echo time MRI with and without intravenous contrast.

OBJECTIVES: To compare conventional MRI, ultrashort echo time MRI and ultrasound for assessing the extent of tendon abnormalities in spondyloarthritis. METHODS: 25 patients with spondyloarthritis and Achilles symptoms were studied with MRI and ultrasound. MR images of the Achilles tendon were acquired using T1-weighted spin echo, gradient echo and ultrashort echo time (UTE) sequences with echo times (TE) between 0.07 and 16 ms, before and after intravenous contrast medium. Greyscale and power Doppler ultrasound were also performed. The craniocaudal extent of imaging abnormalities measured by a consultant musculoskeletal radiologist was compared between the different techniques. RESULTS: Abnormalities were most extensive on spoiled gradient echo images with TE = 2 ms. Contrast enhancement after intravenous gadolinium was greatest on the UTE images (TE = 0.07 ms). Fewer abnormalities were demonstrated using unenhanced UTE. Abnormalities were more extensive on MRI than ultrasound. Contrast enhancement was more extensive than power Doppler signal. CONCLUSIONS: 3D spoiled gradient echo images with an echo time of 2 ms demonstrate more extensive tendon abnormalities than the other techniques in spondyloarthritis. Abnormalities of vascularity are best demonstrated on enhanced ultrashort echo time images.

Multiple inflow pulsed arterial spin-labeling reveals delays in the arterial arrival time in minor stroke and transient ischemic attack.

Our purpose was to use multiple inflow pulsed ASL to investigate whether hemodynamic AAT information is sensitive to hemispheric asymmetry in acute ischemia. The cohorts included 15 patients with acute minor stroke or TIA and 15 age-matched controls. Patients were scanned by using a stroke MR imaging protocol at a median time of 74 hours. DWI lesion volumes were small and functional impairment was low; however, perfusion abnormalities were evident. Prolonged AAT values were more likely to reside in the affected hemisphere (significant when compared with controls, P < .048). An advantage of this ASL technique is the ability to use AAT information in addition to CBF to characterize ischemia.

Quantifying sclerotic bone metastases with 2D ultra short TE MRI: a feasibility study.

INTRODUCTION: Ultra Short TE MRI allows signal to be detected from tissues with a very short T2.The aims of this study were to optimize a 2D UTE MRI sequence for imaging and quantification of sclerotic bone metastases, establish T2* values of sclerotic components and investigate the feasibility of using the method to assess changes in T2* of sclerotic metastases and their relation to attenuation values in patients on treatment. METHODS: Twenty-two subjects were recruited in 3 cohorts. Cohort 1 was used to optimize the 2-D UTE sequence, cohort 2 was used to establish T2* measurements using a range of TEs and cohort 3 was used to assess T2* changes with treatment response and relate them to changes on electron density as measured by CT Hounsfield Units. RESULTS: Sagittal 2D UTE MRI of the lumbar spine is feasible demonstrating short T2 components in normal volunteers. In patients with bone metastases secondary to prostate carcinoma T2* can be measured and mean T2* of sclerotic metastases measured with TEs of 0.07, 0.27, 0.47 and 0.67 ms was 8.5 ms.T2* shortened by 20.0% in responders and increased by 24.4% in progressors. DISCUSSION: The significant linear relationship between percentage change in T2* as derived from UTE MRI and percentage change in HU from corresponding CT studies is indirect evidence that they are measuring effects of the same process.If the relationship between T2* and electron density holds true in further studies it offers potential for MR guided radiotherapy planning as well as attenuation correction for PET/MRI.

Reproducibility of 31P cardiac magnetic resonance spectroscopy at 3 T.

The purpose of this work was to take advantage of the new clinical field strength of 3 T to implement and optimize a chemical shift imaging (CSI) acquisition protocol to produce spectra of high quality with high specificity to the myocardium within a clinically feasible scan time. Further, an analysis method was implemented dependent purely on anatomical location of spectra, and as such free from any potential user bias caused by inference from spectral information. Twenty healthy male subjects were scanned on two separate occasions using the optimized CSI protocol at 3 T. Data were analyzed for intra- and inter-subject variability, as well as intra- and inter-observer variability. The average phosphocreatine (PCr)/adenosine triphosphate (ATP) value for scan 1 was 2.07 +/- 0.38 and for scan 2 was 2.14 +/- 0.46, showing no significant difference between scans. Intra-subject variability was 0.43 +/- 0.35 (percentage difference 20%) and the inter-subject coefficient of variation was 18%. The intra-observer variability, assessed as the absolute difference between analyses of the data by a single observer, was 0.14 +/- 0.24 with no significant difference between analyses. The inter-observer variability showed no significant differences between the PCr/ATP value measured by four different observers as demonstrated by an intra-class correlation coefficient of 0.763. The increased signal available at 3 T has improved spatial resolution and thereby increased myocardial specificity without any significant decrease in reproducibility over previous studies at 1.5 T. We present an acquisition protocol that routinely provides high quality spectra and a robust analysis method that is free from potential user bias.

Magnetic resonance imaging of facial muscles.

Facial and tongue muscles are commonly involved in patients with neuromuscular disorders. However, these muscles are not as easily accessible for biopsy and pathological examination as limb muscles. We have previously investigated myasthenia gravis patients with MuSK antibodies for facial and tongue muscle atrophy using different magnetic resonance imaging sequences, including ultrashort echo time techniques and image analysis tools that allowed us to obtain quantitative assessments of facial muscles. This imaging study had shown that facial muscle measurement is possible and that useful information can be obtained using a quantitative approach. In this paper we aim to review in detail the methods that we applied to our study, to enable clinicians to study these muscles within the domain of neuromuscular disease, oncological or head and neck specialties. Quantitative assessment of the facial musculature may be of value in improving the understanding of pathological processes occurring within facial muscles in certain neuromuscular disorders.

Assessment of left atrial volumes at 1.5 Tesla and 3 Tesla using FLASH and SSFP cine imaging.

PURPOSE: To investigate left atrial volumes and function and their variability in healthy volunteers using steady state free precession (SSFP) and fast low angle shot (FLASH) sequences at both 1.5 and 3 T using both the short-axis and biplane area-length methods. MATERIALS AND METHODS: Ten healthy volunteers underwent CMR at both 1.5 and 3 Tesla. The biplane area-length method utilized volumes from the horizontal and vertical long axis images. RESULTS: There were no significant differences between left atrial short-axis volumes or function between 1.5 and 3 T assessed using either FLASH or SSFP sequences. The biplane area-length method underestimated maximal left atrial volume using FLASH by 12 mL at 3 T (18%) and by 10 mL (14%) at 1.5 T (p = 0.003 and p = 0.05 respectively). Variability was larger for left atrial measurements using the biplane area-length method. CONCLUSION: Field strength had no effect on left atrial volume and function assessment using either FLASH or SSFP. The use of the short-axis method for the acquisition of left atrial parameters is more reproducible than the biplane area-length for serial measurements.

Between session reproducibility and between subject variability of diffusion MR and tractography measures.

As diffusion tractography is increasingly used to generate quantitative measures to address clinical questions, it is important to characterise the inter-session reproducibility and inter-subject variability of these measures. Here, we assess the reproducibility and variability of diffusion tractography measures using diffusion data from 8 subjects scanned 3 times. We used probabilistic tractography to define the cingulum bundle, pyramidal tracts, optic radiations and genu of the corpus callosum in each individual data set using three different methods of seed definition. Measures of mean fractional anisotropy (FA) and mean diffusivity (MD) along the tracts were more reproducible than measures of tract volume. Further, tracts defined using a two region of interest (ROI) approach were more reproducible than those defined using manually placed seed masks alone. For mean FA taken from tracts defined using the two ROI approach, inter-session coefficients of variation (CV) were all below 5% and inter-subject CVs were below 10%; for mean MD inter-session, CVs were all below 3% and inter-subject CVs were below 8%. We use the variability measures found here to calculate the sample sizes required to detect changes in FA, MD or tract volume of a given size, either between groups of subjects or within subjects over time. Finally, we compare tractography results using 60 diffusion encoding directions to those found using a subset of 12 directions; the number of diffusion directions did not have a significant effect on reproducibility, but tracts derived using fewer directions were consistently smaller than those derived using 60 direction data. We suggest that 12 direction data are sufficient for reproducibly defining the core of large bundles but may be less sensitive to smaller pathways.

Cardiovascular magnetic resonance imaging for non-invasive assessment of vascular function: validation against ultrasound.

Ultrasound is an established modality for quantification of vascular function in clinical studies of cardiovascular disease. We determined whether cardiovascular magnetic resonance imaging (CMR) can provide a comparable assessment of vascular function. In seventeen control subjects, we used CMR to quantify endothelium-dependent (flow mediated dilatation, FMD) and endothelium-independent dilatation of the brachial artery, brachial and carotid distensibility, aortic compliance, and pulse wave velocity. These were compared to brachial and carotid measurements obtained by established ultrasound protocols. Twelve of the volunteers then underwent repeated measurements with both modalities. There was good agreement between imaging modalities for measures of endothelial function and arterial structure in the same subjects (difference between CMR and ultrasound for FMD = 0.14 +/- 6.8%, and brachial artery area = - 0.7 +/- 2.2 mm2, correlation between modalities for FMD = 0.62, p = 0.01 and for area = 0.87, p = < 0.0001). Inter-study reproducibility was also similar (coefficient of variation (CV) for FMD: CMR = 0.3, ultrasound = 0.3, CV for brachial artery area: CMR = 0.1, ultrasound = 0.1). Comparability and reproducibility were not as strong for functional measures if repeated studies were several days apart (CV for FMD by ultrasound on the same day = 0.1 and several days apart = 0.4). CMR and ultrasound show good agreement for quantitative measures of vascular structure and function with good reproducibility for both modalities. The major advantage of CMR is that it allows one-stop integrated assessment of both peripheral and central measures of vascular function.

A consistent relationship between local white matter architecture and functional specialisation in medial frontal cortex.

Functionally significant landmarks in the brain do not necessarily align with local sulcal and gyral architecture in a manner that is consistent across individuals. However, the functional specialisation underlying these landmarks is strongly constrained by the connectional architecture of the region. Here, we explore this relationship in the supplementary motor area (SMA) and pre-SMA in the medial frontal cortex of the human brain. Using diffusion tensor, conventional and functional MR imaging, we find that the location of the functional boundary between SMA and preSMA is more consistent with respect to specific features of the local white matter as it approaches neocortex than with respect to the local gyral and sulcal anatomy in the region.

Changes in connectivity profiles define functionally distinct regions in human medial frontal cortex.

A fundamental issue in neuroscience is the relation between structure and function. However, gross landmarks do not correspond well to microstructural borders and cytoarchitecture cannot be visualized in a living brain used for functional studies. Here, we used diffusion-weighted and functional MRI to test structure-function relations directly. Distinct neocortical regions were defined as volumes having similar connectivity profiles and borders identified where connectivity changed. Without using prior information, we found an abrupt profile change where the border between supplementary motor area (SMA) and pre-SMA is expected. Consistent with this anatomical assignment, putative SMA and pre-SMA connected to motor and prefrontal regions, respectively. Excellent spatial correlations were found between volumes defined by using connectivity alone and volumes activated during tasks designed to involve SMA or pre-SMA selectively. This finding demonstrates a strong relationship between structure and function in medial frontal cortex and offers a strategy for testing such correspondences elsewhere in the brain.

Contrast enhancement of short T2 tissues using ultrashort TE (UTE) pulse sequences.

AIM: To review the effects of contrast administration on tissues with short T2s using a pulse ultrashort echo time (UTE) sequence. MATERIALS AND METHODS: Pulse sequences were implemented with echo times of 0.08 ms and three later gradient echoes. A fat-suppression option was used and later echo images were subtracted from the first echo image. Contrast enhancement with gadodiamide (0.3 mmol/kg) was used for serial studies in a volunteer. The images of 10 patients were reviewed for evidence of contrast enhancement in short T2 tissues. RESULTS: Contrast enhancement was seen in normal meninges, falx, tendons, ligaments, menisci, periosteum and cortical bone. In addition more extensive enhancement than with conventional pulse sequences was seen in meningeal disease, intervertebral disc disease, periligamentous scar tissue and periosteum after fracture. Subtraction of an image taken with a longer TE from the first image was of value in differentiating enhancement in short T2 tissues from that in long T2 tissues or blood. CONCLUSION: Contrast enhancement can be identified in tissues with short T2s using UTE pulse sequences in health and disease.

Magnetic resonance imaging of the Achilles tendon using ultrashort TE (UTE) pulse sequences.

AIM: To assess the potential value of imaging the Achilles tendon with ultrashort echo time (UTE) pulse sequences. MATERIALS AND METHODS: Four normal controls and four patients with chronic Achilles tendinopathy were examined in the sagittal and transverse planes. Three of the patients were examined before and after intravenous gadodiamide. RESULTS: The fascicular pattern was clearly demonstrated within the tendon and detail of the three distinct fibrocartilaginous components of an "enthesis organ" was well seen. T2* measurements showed two short T2* components. Increase in long T2 components with reduction in short T2 components was seen in tendinopathy. Contrast enhancement was much more extensive than with conventional sequences in two cases of tendinopathy but in a third case, there was a region of reduced enhancement. CONCLUSION: UTE pulse sequences provide anatomical detail not apparent with conventional sequences, demonstrate differences in T2* and show patterns of both increased and decreased enhancement in tendinopathy.

MRI of the brain with ultra-short echo-time pulse sequences.

As well as the long-T2 relaxation components normally detected with conventional imaging techniques, the brain has short-T2 components. We wished to use ultra-short (0.08 ms) echo time (UTE) pulse sequences to assess the feasibility of imaging these in normal subjects and patients. UTE sequences were employed, with or without fat suppression, 90 degree long-T2 suppression pulses, and selective nulling of long-T2 components using an inversion pulse. Subtraction of later echoes from the first was also used to reduce the signal from long-T2 components. We studied dive normal subjects and 15 patients with various diseases. Short-T2 components were demonstrated in grey and white matter. Increased signal from these components was seen in meningeal disease, probable calcification, presumed cavernomas, melanoma metastases and probable gliosis. Reduced signal was seen in some tumours, infarcts, mild multifocal vascular disease and vasogenic oedema. Further development and evaluation of these pulse sequences is warranted.

Quantitative imaging of magnetization transfer using multiple selective pulses.

New spectroscopic and imaging methods have been developed for quantitatively measuring magnetization transfer (MT). These methods use trains of radiofrequency (rf) pulses with pulse separations much longer than 1/k(mf) and pulse durations much shorter than 1/k(mf), where k(mf) is the rate of MT from the immobile (macromolecular) protons to the mobile (free water) protons. Signal sensitivity to MT occurs when these pulses affect the mobile and immobile proton pools to different degrees. The signal from water may be quantitatively related to the macromolecular content of the sample using theory. The method has been used to make quantitative measurements of macromolecular content in cross-linked bovine serum albumin and employed in conjunction with echoplanar imaging to produce maps of the spatial distribution of the macromolecular content.

Measurements of the temporal fMRI response of the human auditory cortex to trains of tones.

Averaged single trials (AST) allowed the functional magnetic resonance imaging (fMRI) response to auditory stimuli to be measured at high temporal (1 s) and spatial (0.1 cm3) resolution. Using this paradigm we investigated the transient signal response to 100-ms tone bursts in trains of between 100 ms and 25.5 s in total duration. We have demonstrated that the fMRI response to such auditory stimuli is approximately linear for trains of 6 s and longer, but that shorter stimuli produce signals that are larger than might be expected from the response to the longer stimuli. This nonlinear behavior can be modeled if an adaptive response to each stimulus is assumed. A study using a novel paradigm was also performed in order to study the influence of scanner noise during fMRI experiments on the auditory system response to tones. This study demonstrated that the temporal response to 700-ms tone stimuli is modified when performed in the presence of scanner gradient noise, the modification being a small but significant increase (P < 0.05) in the magnitude of the response. Finally the ability to measure the onset of functional activation using the AST method was examined. It was found, with the aid of computer simulation that a sampling rate of one image per second is adequate to distinguish temporal responses. Using the data acquired in this study, onset times were calculated for the auditory cortex, and these results are consistent with current models of functional activation.

Measurement of the point spread function in MRI using constant time imaging.

The point spread function is a fundamental property of magnetic resonance imaging methods that affects image quality and spatial resolution. The point spread function is difficult to measure precisely in magnetic resonance even with the use of carefully designed phantoms, and it is difficult to calculate this function for complex sequences such as echo-planar imaging. This report describes a method that measures the point spread function with high spatial resolution at each pixel in samples of uniform intensity distribution. This method uses additional phase encoding gradients before the echo-planar acquisition that are constant in length but vary in amplitude. The additional gradients are applied to image the contents within each individual voxel. This method has been used to measure the point spread function for echo-planar imaging to demonstrate the effects of limited k-space sampling and transverse relaxation, as well as the effects of object motion. By considering the displacement of the point spread function, local distortions due to susceptibility and chemical shift effects have been quantified and corrected. The method allows rapid assessment of the point spread function in echo-planar imaging, in vivo, and may also be applied to other rapid imaging sequences that can be modified to include these additional phase encoding gradients.

Diffusion-weighted multiple shot echo planar imaging of humans without navigation.

A new method is proposed for reducing the artifacts produced in diffusion-weighted imaging. When data are acquired using multiple shot echo planar acquisitions, conventional reconstruction methods produce artifactual images as a consequence of diffusion weighting and small amounts of bulk motion of the subject. If the amount of motion can be determined, it is possible to correct the data before reconstruction, which removes the artifact. A method for estimating the motion from the acquired data has been developed and evaluated. This method assumes that ghost image effects will be minimized when motion has been correctly compensated. By considering the amount of signal in the background of the image, appropriate corrections to the data can be made, and the accuracy of the motion compensation may be estimated. This technique has been evaluated by computer simulation, and its performance has been demonstrated in a phantom and humans with both two- and four-shot echo planar acquisitions and using both "mosaic" and "interleaved" sampling schemes.