Mechanical implications of in vivo human diaphragm shape.

Using magnetic resonance imaging, we measured the three-dimensional form of the diaphragm in vivo in four supine relaxed subjects at functional residual capacity and calculated its total surface area, the right and left surface areas in the zone of apposition, and the principal radii of curvature as a function of height. The area of apposition comprised 45 +/- 1.5% (SE) of the total surface area of the diaphragm. Available data on the area of the central tendon indicate that a considerable part of the muscular part of the diaphragm is lung apposed. The curvature was linearly related to height over 7 cm of the posterior half of each hemidiaphragm. From the linear portion of this graph and assuming a vertical gradient of transdiaphragmatic pressure of 0.75 cmH2O/cm, we applied the Laplace law and calculated tensions of 54 and 32 g/cm for right and left sides, respectively. We conclude that the shape of at least part of the posterior half of the relaxed human diaphragm in the supine position at functional residual capacity can be explained by the Laplace law, suggesting that both the lung and abdominal contents behave sufficiently as fluids so that they do not impose their shape on the diaphragm. Because diaphragm muscle is partly lung apposed, it is unlikely that the diaphragm functions simply as a piston.

MRI signal void due to in-plane motion is all-or-none.

The process of MRI signal attenuation due to in-plane intravoxel velocity inhomogeneity is described. Given rigid rotation or linear shear, velocity phase-sensitivity will induce a phase distribution that varies linearly with position, which is exactly equivalent to the effect of a spatial phase encoding gradient pulse. It follows that the effect of such motion on the raw MRI signal is to displace it a fixed distance in kappa-space. Attenuation becomes marked when the center of the spin-echo reaches an edge of kappa-space, which happens when intravoxel phase shifts reach pi radian/voxel. Because spin echoes are typically peaked sharply at center, this attenuation usually is abrupt. Analytic and numerical simulations of linear and nonlinear velocity fields confirm abrupt MRI attenuation where phase dispersion exceeds pi radian/voxel. Examples of this phenomenon include the abrupt loss of blood signal adjacent the vessel wall in laminar flow, abrupt loss of subendocardial signal in early diastole, and sudden disappearance due to rotation of a kidney during a measurement of diffusion.

Time of flight quantification of coronary flow with echo-planar MRI.

Detection and quantification of flow of the left anterior descending (LAD) coronary artery in healthy volunteers are demonstrated using echo-planar imaging (EPI). A time-of-flight (TOF) model was used to derive coronary flow velocities from wash-in curves, free of cardiac wall motion contamination. Short-axis cardiac studies were performed using a gated, gradient echo EPI technique to limit the effect of cardiac wall motion on coronary vessel imaging. A series of 10 to 20 single or multislice images were acquired within a single breath-hold. Real-time cine series showed the LAD coronary artery with a detectability of 91% (n = 23) and revealed beat-to-beat variability in vessel position of a magnitude equal to or greater than its diameter. Flow velocity was measured in the proximal portion of the artery at rest and during exercise. The data demonstrated the known phasic pattern of LAD flow: Vsystole < or = 5 cm/s and peak Vdiastole = 14 +/- 3 cm/s (n = 11, V = mean laminar flow velocity). During isometric exercise, a LAD flow velocity increase (52 +/- 24%) was detected in eight of nine subjects. The capacity of the EPI TOF method to detect flow velocity changes should prove clinically useful for future assessment of coronary flow reserve.

Brain parenchyma motion: measurement with cine echo-planar MR imaging.

With echo-planar magnetic resonance (MR) imaging, the authors measured the intrinsic pulsatile motion of brain parenchyma. Phase-sensitive, electrocardiography-gated, two-dimensional cine images were acquired throughout the cardiac cycle by using a spin-echo, blipped echo-planar MR pulse sequence. Transverse and coronal planes were obtained in 14 healthy volunteers. Corrections were made for gross head motion. Brain motion consisted of a rapid displacement in systole, with a slow diastolic recovery. The motion occurred chiefly in the cephalocaudal and lateral directions; the anteroposterior motions were relatively small. Cephalocaudal velocities increase with proximity to the foramen magnum. The lateral motion is mainly a compressive motion of the thalami. Brain parenchymal velocities were as high as 2 mm/sec caudally in the brain stem and 1.5 mm/sec medially in the thalami. Net parenchymal excursions were at most 0.5 mm. Phase-based echo-planar velocity measurements agreed well with echo-planar Fourier velocity zeugmatography measurements and were consistent with reported values. Velocity mapping with echo-planar imaging offers a rapid and flexible method of assessing the pulsation velocities of the human brain.

Single-shot magnetic resonance imaging: applications to angiography.

Recently developed technologies that allow the collection of magnetic resonance imaging (MRI) in as little as 26 msec have been explored in their application to angiography. Advantages are demonstrated in scan time reduction, insensitivity to patient motion (especially in abdominal applications), flow quantification, and temporal resolution. We demonstrate that because such single-shot techniques are inherently resistant to flow dephasing during acquisition that allow for sustained high signal intensities to be achieved when images must be combined through the cardiac cycle. Such high temporal resolution scans may be utilized for the collection of time-resolved angiograms. With these techniques we demonstrate the collection of complete MR angiograms in the course of reasonable 10-25 sec breath holds. The relative simplicity of the technique, coupled with its overall short acquisition time, allows us to incorporate angiography into other imaging protocols without adding significant time burdens. Results to date are promising for further improvements in spatial resolution, without extension of scan time.

Oscillatory motion of the normal cervical spinal cord.

PURPOSE: To determine the normal pattern of cervical spinal cord motion with measurement of cervical spinal cord velocity by means of phase-contrast magnetic resonance (MR) imaging. MATERIALS AND METHODS: Spinal cord velocity was measured in 11 healthy subjects with a modified gradient-echo pulse sequence on a conventional 1.5-T MR imaging system that generated phase images sensitive to slow motion. Prospective electrocardiogram gating was used to assess velocity as a function of the cardiac cycle. The accuracy of velocity measurements was estimated with images of a phantom moving at constant velocity. RESULTS: The cervical spinal cord moves with an oscillatory pattern in the craniocaudal direction. The maximum velocity (7.0 mm/sec +/- 1.4 [standard deviation]) in the caudal direction occurred approximately 109 msec +/- 20 after electrical cardiac systole. The maximum velocities in subsequent oscillations decreased toward zero before the next cardiac systole. CONCLUSION: The cervical spinal cord oscillates in a craniocaudal direction after each cardiac systole.

Cardiac susceptibility artifacts arising from the heart-lung interface.

Cardiac MRI studies often show susceptibility artifacts along the inferoapical myocardial margin in both human and in vivo animal experiments at field strengths of 1.5T and greater. This study was designed to determine the cause of these artifacts in porcine myocardium at 3T. Gradient echo images were obtained under various anatomic and physiologic conditions to systematically study potential sources of local susceptibility gradients. Lung resection in the open-chested, euthanized swine was the only intervention that eliminated the artifact. The data suggest that in the porcine model, the heart-lung interface is the primary cause of these artifacts. Magn Reson Med 45:341-345, 2001.

Motionless movies of myocardial strain-rates using stimulated echoes.

We present methods to acquire and analyze NMR movies of myocardial strain rates in which cardiac motion is suppressed and the histories of strain rates are accurately defined for each voxel of myocardial tissue. By means of stimulated echoes, the myocardial strain-rate tensor is phase-encoded at progressive delays in the cardiac cycle while the slice-select and spatial encoding of the image acquisition are performed at a constant cardiac delay. In these data, every image shows the identical myocardial tissue, and the anatomic configuration of the heart appears motionless. The myocardial strain-rate data, however, indicate the state of motion which existed in this slice at the time of the velocity phase-encoding, and these data evolve with the progressive delay as a movie. Using echo-planar MRI, motionless movies of myocardial strain rate of four to eight cardiac delays are obtained in a breath-hold. As an application, a quantitative characterization of cardiac mechanical synchrony is accomplished by principal component analysis (PCA) of the time series of strain rates.

Myocardial intensity changes associated with flow stimulation in blood oxygenation sensitive magnetic resonance imaging.

Functional magnetic resonance imaging exploits deoxygenated blood as an endogenous source for contrast in assessing local changes in tissue perfusion. Intrinsic changes in myocardial signal intensity were measured during dipyridamole induced coronary vasodilatation with T2*-weighted echo planar MRI in healthy volunteers. Concurrently, changes in flow velocity in the left anterior descending coronary artery were measured using a time-of-flight method. Dipyridamole infusion produced 14 +/- 6% increase in myocardial signal intensity (n = 7). Temporal profile of the myocardial signal intensity changes correlated well with the augmentation of coronary flow velocity. The data are consistent with the concept that changes in myocardial deoxyhemoglobin content due to altered flow result in changes in magnetic susceptibility that can be detected on T2*-weighted MR images.

Intramural mechanics in hypertrophic cardiomyopathy: functional mapping with strain-rate MR imaging.

PURPOSE: To characterize systolic and diastolic intramural mechanics in hypertrophic cardiomyopathy (HCM) with a new metric of contractile activity. MATERIALS AND METHODS: Eleven healthy subjects and eight patients with HCM underwent velocity-encoded echo-planar magnetic resonance (MR) imaging (6-8-frame gated breath-hold movies, 3 x 3-mm resolution). A scalar strain rate (SR) parameter was compared with wall thickness and symptoms. RESULTS: The normal pattern of SR included regional uniformity, a monotonically increasing subepicardial to subendocardial gradient, and minimum transmural shear rate. In HCM, heterogeneity of SRs increased in diastole. Regional diastolic SR correlated with regional wall thickness (r = .785, P = .0001). Interobserver global SR assignment agreed in seven of eight patients. All four patients with New York Heart Association class 1 disease had a low global SR deficit score, whereas three of four patients with class 2 or 3 disease had a high SR deficit score (Spearman r = .775, P = .187). CONCLUSION: SR characterization may provide an objective measure of disease course in HCM.

Dynamic magnetic resonance imaging of human brain activity during primary sensory stimulation.

Neuronal activity causes local changes in cerebral blood flow, blood volume, and blood oxygenation. Magnetic resonance imaging (MRI) techniques sensitive to changes in cerebral blood flow and blood oxygenation were developed by high-speed echo planar imaging. These techniques were used to obtain completely noninvasive tomographic maps of human brain activity, by using visual and motor stimulus paradigms. Changes in blood oxygenation were detected by using a gradient echo (GE) imaging sequence sensitive to the paramagnetic state of deoxygenated hemoglobin. Blood flow changes were evaluated by a spin-echo inversion recovery (IR), tissue relaxation parameter T1-sensitive pulse sequence. A series of images were acquired continuously with the same imaging pulse sequence (either GE or IR) during task activation. Cine display of subtraction images (activated minus baseline) directly demonstrates activity-induced changes in brain MR signal observed at a temporal resolution of seconds. During 8-Hz patterned-flash photic stimulation, a significant increase in signal intensity (paired t test; P less than 0.001) of 1.8% +/- 0.8% (GE) and 1.8% +/- 0.9% (IR) was observed in the primary visual cortex (V1) of seven normal volunteers. The mean rise-time constant of the signal change was 4.4 +/- 2.2 s for the GE images and 8.9 +/- 2.8 s for the IR images. The stimulation frequency dependence of visual activation agrees with previous positron emission tomography observations, with the largest MR signal response occurring at 8 Hz. Similar signal changes were observed within the human primary motor cortex (M1) during a hand squeezing task and in animal models of increased blood flow by hypercapnia. By using intrinsic blood-tissue contrast, functional MRI opens a spatial-temporal window onto individual brain physiology.

Measurement of human myocardial perfusion by double-gated flow alternating inversion recovery EPI.

This paper presents a flow-sensitive alternating inversion recovery (FAIR) method for measuring human myocardial perfusion at 1.5 T. Slice-selective/non-selective IR images were collected using a double-gated IR echoplanar imaging sequence. Myocardial perfusion was calculated after T1 fitting and extrapolation of the mean signal difference SI(Sel - SI(NSel). The accuracy of the method was tested in a porcine model using graded intravenous adenosine dose challenge. Comparison with radiolabeled microsphere measurements showed a good correlation (r = 0.84; mean error = 20%, n = 6) over the range of flows tested (0.9-7 ml/g/min). Applied in humans, this method allowed for the measurement of resting myocardial flow (1.04+/-0.37 ml/g/min, n = 11). The noise in our human measurements (SE(flow) = 0.2 ml/g/min) appears to come primarily from residual respiratory motion. Although the current signal-to-noise ratio limits our ability to measure small fluctuations in resting flow accurately, the results indicate that this noninvasive method has great promise for the quantitative assessment of myocardial flow reserve in humans.

Lung function and clinical findings in a cross-sectional study of arc welders. An epidemiological study.

An epidemiological, cross-sectional study was conducted in order to assess non-neoplasic effects on the lung due to chronic exposure to arc welding fumes and gases. The study involved 346 arc welders and 214 control workers from a factory producing industrial vehicles. These workers (welders and controls) had never been exposed to asbestos. Respiratory impairments were evaluated by using a standardized questionnaire, a clinical examination, chest radiophotography and several lung function tests (spirometry, bronchial challenge test to acetylcholine, CO transfer tests according to the breath-holding and the steady-state methods, N2 washout test). The only significant differences between the welders overall compared to the controls were a slightly higher bronchial hyper-reactivity to acetylcholine and a lower lung diffusing capacity for CO in the welders. However, non-specific, radiologic abnormalities (reticulation, micronodulation) and obstructive signs were more frequent in the most exposed welders (welding inside tanks) than in welders working in well ventilated workplaces. The nature of the metal welded (mild-steel, stainless steel, aluminium) did not seem to have an influence on respiratory impairments. In the mild-steel welders, respiratory symptoms (dyspnoea, recurrent bronchitis) and obstructive signs were more frequent in the welders using a manual process than in the welders involved with the semi-automatic process (MIG). For all the workers (welders and controls), smoking had a markedly adverse effect on respiratory symptoms and lung function. Moreover, smoking seemed to interact with welding since CO lung transfer was more impaired in smoking welders than in smoking controls.