Positional MR imaging of normal and injured knees.

OBJECTIVES: This study uses a practical positional MRI protocol to evaluate tibiofemoral translation and rotation in normal and injured knees. METHODS: Following ethics approval, positional knee MRI of both knees was performed at 35° flexion, extension, and hyperextension in 34 normal subjects (mean age 31.1 ± 10 years) and 51 knee injury patients (mean age 36.4 ± 11.5 years, ACL tear n = 23, non-ACL injury n = 28). At each position, tibiofemoral translation and rotation were measured. RESULTS: Normal knees showed 8.1 ± 3.3° external tibial rotation (i.e., compatible with physiological screw home mechanism) in hyperextension. The unaffected knee of ACL tear patients showed increased tibial anterior translation laterally (p = 0.005) and decreased external rotation (p = 0.002) in hyperextension compared to normal knees. ACL-tear knees had increased tibial anterior translation laterally (p < 0.001) and decreased external rotation (p < 0.001) compared to normal knees. Applying normal thresholds, fifteen (65%) of 23 ACL knees had excessive tibial anterior translation laterally while 17 (74%) had limited external rotation. None (0%) of 28 non-ACL-injured knees had excessive tibial anterior translation laterally while 13 (46%) had limited external rotation. Multidirectional malalignment was much more common in ACL-tear knees. CONCLUSIONS: Positional MRI shows (a) physiological tibiofemoral movement in normal knees, (b) aberrant tibiofemoral alignment in the unaffected knee of ACL tear patients, and (c) a high frequency of abnormal tibiofemoral malalignment in injured knees which was more frequent, more pronounced, more multidirectional, and of a different pattern in ACL-tear knees than non-ACL-injured knees. KEY POINTS: • Positional MRI shows physiological tibiofemoral translation and rotation in normal knees. • Positional MRI shows a different pattern of tibiofemoral alignment in the unaffected knee of ACL tear patients compared to normal control knees. • Positional MRI shows a high prevalence of abnormal tibiofemoral alignment in injured knees, which is more frequent and pronounced in ACL-tear knees than in ACL-intact injured knees.

MRI wrist in early rheumatoid arthritis: reduction in inflammation assessed quantitatively during treatment period correlates best with clinical improvement.

OBJECTIVE: To investigate (a) which MR features of inflammation (synovitis, tenosynovitis, perfusion) correlate with clinical/serological features in early rheumatoid arthritis (ERA) before, during and after 1 year of treatment and (b) whether quantitative or semi-quantitative measures of inflammation on magnetic resonance imaging (MRI) provides the highest correlation in this regard. METHOD: One hundred one ERA patients (76 females, 25 males, mean age, 53 ± 12 years) underwent clinical/serological testing and 3 T dynamic contrast-enhanced MRI of the most symptomatic wrist. Seventy-seven of the 101 patients completed 1 year of treatment, followed by repeat MR examination. Clinical/serological parameters were correlated with semi-quantitative/quantitative MR measures of inflammation at baseline, during and after 1 year of treatment. Spearman's correlation was applied. RESULTS: Quantitative measures of inflammation correlated better with clinical/serological parameters than semi-quantitative measures, with the highest correlations being for relative change during treatment. Pain reduction correlated with reduced tenosynovitis volume (r = 0.41). Reduction in disease activity correlated with reduction in synovitis volume (r = 0.66) or synovial perfusion parameters (r = 0.58). Decrease in early morning stiffness correlated with decrease in perfusion parameters (r = 0.46). Reduction in ESR and CRP correlated with decrease in synovial volume (r = 0.40 and r = 0.41, respectively). CONCLUSION: In ERA patients, quantitative assessment of inflammation on MRI correlated better with clinical parameters than semi-quantitative assessment. Relative change during treatment yielded the highest correlation. Decrease in tenosynovitis correlated best with reduction in pain while decrease in synovitis volume and perfusion correlated best with reduction in disease activity, early morning stiffness (perfusion), or serological parameters (synovitis volume).

ERAMRS: a new MR scoring system for early rheumatoid arthritis of the wrist.

PURPOSE: To (i) devise a new semi-quantitative scoring system known as Early Rheumatoid Arthritis Magnetic Resonance Score (ERAMRS) to assess inflammation of the wrist on magnetic resonance imaging in early rheumatoid arthritis and to (ii) test ERAMRS and other MR scoring systems against everyday used clinical scorings. MATERIALS AND METHODS: One hundred six treatment-naïve patients (81 females, 25 males, mean age 53 ± 12 years) with early rheumatoid arthritis (ERA) underwent clinical/serological testing as well as 3-T MRI examination of the most symptomatic wrist. Clinical assessment included Disease Activity Score-28 and Health Assessment Questionnaire; erythrocyte sedimentation rate and C-reactive protein were measured. MR imaging data was scored in all patients using three devised MR semi-quantitative scoring systems, namely, the (a) ERAMRS system, (b) Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) system, and the (c) McQueen Score system. RESULTS: Synovitis was present in 106 (100%), tenosynovitis in 98 (92%), and bone marrow edema in 84 (79%) of 106 ERA wrists. ERAMRS had the highest correlation with clinical disease activity scores (r = 0.476, p < 0.001) and serological parameters (r = 0.562, p < 0.001). RAMRIS system had the lowest correlation (r = 0.369, p < 0.001 for clinical disease activity; r = 0.436, p < 0.001 for serological parameters). RAMRIS synovitis subscore had a lower correlation than ERAMRS for clinical disease activity (r = 0.410, p < 0.001) and for serological parameters (r = 0.456, p < 0.001). CONCLUSION: The ERAMRS system, designed to grade inflammation on wrist MRI in ERA, provided the best correlation with all clinical scoring systems and serological parameters, indicating its improved clinical relevance over other MR scoring systems. KEY POINTS: • We devised a clinically relevant, easy-to-use semi-quantitative scoring system for scoring inflammation on MRI of the wrist in patients with early rheumatoid arthritis. • ERAMRS system showed better correlation with all clinical and serological assessment of inflammation in patients with early rheumatoid arthritis indicating its improved clinical relevance over other MR scoring systems.

Observed changes in brown, white, hepatic and pancreatic fat after bariatric surgery: Evaluation with MRI.

OBJECTIVES: To study the change in brown and white adipose tissue (BAT and WAT), as well as fat content in the liver and pancreas, in patients with morbid obesity before and after bariatric surgery. METHODS: Twelve patients with morbid obesity (F=8, M=4, age: 45.4 years (38.4-51.2), BMI: 35.2 kg/m2 (32.5-38.6)) underwent pre-op MRI at baseline and two post-op scans at 6-month and 12-month intervals after bariatric surgery. Co-registered water, fat, fat-fraction and T2* image series were acquired. Supraclavicular BAT and abdominal WAT were measured using in-house algorithms. Intrahepatic triglyceride (IHTG) was measured using MR spectroscopy and pancreatic fat was measured using a region-of-interest approach. Fat contents were compared between baseline and the first and second 6-month intervals using non-parametric analysis of Friedman's test and Wilcoxon's signed-rank test. Level of significance was selected at p=0.017 (0.05/3). Threshold of non-alcoholic fatty liver disease was set at 5.56%. RESULTS: Results indicated that BMI (p=0.005), IHTG (p=0.005), and subcutaneous (p=0.005) and visceral adipose tissues (p=0.005) were significantly reduced 6 months after surgery. Pancreatic fat (p=0.009) was significantly reduced at 12 months. Most reduction became stable between the 6-month and 12-month interval. No significant difference was observed in BAT volume, fat-fraction and T2* values. CONCLUSION: The results of this study suggest that bariatric surgery effectively reduced weight, mainly as a result of the reduction of abdominal WAT. Liver and pancreatic fat were deceased below the threshold possibly due to the reduction of free fatty acid. BAT volume, fat-fraction and T2* showed no significant changes, probably because surgery itself might not have altered the metabolic profile of the patients. KEY POINTS: • No significant changes were observed in fat-fraction, T2* and volume of brown adipose tissue after bariatric surgery. • Non-alcoholic fatty liver disease was resolved after surgery. • Abdominal white fat and liver fat were significantly reduced 6 months after surgery and become stable between 6 and 12 months while pancreatic fat was significantly reduced between 0 and 12 months.

Achilles Tendon Xanthomas: Fat-Water Separation at Baseline and after Treatment.

Purpose To investigate the fat-water content of Achilles tendon xanthomas at baseline and after treatment and to compare this assessment with that of ultrasonography (US) and other magnetic resonance (MR) imaging-based parameters. Materials and Methods Forty-eight Achilles tendons with clinically apparent xanthomas in 24 patients with familial hypercholesterolemia (FH) (six men, 18 women; mean age ± standard deviation, 58 years ± 9) were compared with 20 Achilles tendons in 10 control subjects without FH (two men, eight women; mean age, 62 years ± 7). US imaging measurements (thickness, width, cross-sectional area, echogenicity) and 3.0-T MR imaging measurements (thickness, width, cross-sectional area, volume, and fat-water separation) of the Achilles tendons were obtained at baseline and in patients with FH at 3 and 6 months after treatment with probucol, a cholesterol-lowering agent. Nonparametric tests compared baseline data, whereas repeated-measures analyses assessed treatment change. Results At baseline, all US and MR imaging-based parameters were higher in xanthoma tendons compared with those in control tendons (all P < .05). The mean relative water content per unit volume was 71% higher (42.0% ± 6.7) in xanthoma tendons than in control tendons (24.5% 6 5.8; P < .001). After 6 months of cholesterol-lowering treatment, only MR imaging measurements of tendon volume (P = .007), relative fat (P = .041), and relative water content (P < .001) showed significant changes. As relative tendon fat content decreased with treatment, relative water content increased. Conclusion Most of the enlargement of Achilles tendon xanthomas is due to an increase in water content rather than fat. For depicting treatment change, relative tendon water content was the most sensitive parameter, followed by tendon volume and relative tendon fat content. © RSNA, 2017 Online supplemental material is available for this article.

Quantification of brown and white adipose tissue based on Gaussian mixture model using water-fat and T2* MRI in adolescents.

PURPOSE: To develop a technique for the separation and quantification of brown adipose tissue (BAT) and white adipose tissue (WAT) using fat fraction and T2* intensity based on the Gaussian mixture model (GMM). MATERIALS AND METHODS: Chemical-shift water-fat and T2* images were acquired at the neck, supraclavicular, interscapular, and paravertebral regions in 24 volunteers (Obese: n = 12, female/male = 6/6, body mass index [BMI] = 31.3 ± 2.3 kg/m2 , age = 16.1 ± 0.6; Normal weight: n = 12, female/male = 6/6, BMI = 21.2 ± 2.4 kg/m2 , age = 12.9 ± 2.4) using a 3T scanner with the chemical-shift water-fat mDixon sequence. BAT and WAT were clustered based on the Gaussian mixture model using the expectation-maximization algorithm. Results and reproducibility were compared and assessed using independent t-tests and intraclass correlation coefficient. RESULTS: BAT in obese participants was predominately found at the supraclavicular region and in normal-weight participants it was more scattered and distributed in interscapular-supraclavicular, axillary, and spine regions. Absolute volume of BAT was higher in the obese group (Obese: 315.2 mL [±89.1], Normal weight: 248.5 mL [±86.4]), but BAT/WAT ratios were significantly higher (P = 0.029) in the normal group. T2* of BAT (P = 0.04) and volume of WAT (P < 0.001) were significantly lower in the normals. Within-group comparison between male and female indicated no significant differences were found in volume (P = 0.776 (normal), 0.501 [obese]), T2* (P = 0.908 [normal], 0.249 [obese]) and fat-fraction of BAT (P = 0.985 [normal], 0.108 [obese]). The intraclass correlation coefficient showed a good reproducibility in volume (BAT: 0.997, WAT: 0.948), T2* (BAT: 0.969, WAT: 0.983), and fat-fraction (BAT: 0.952, WAT: 0.517). CONCLUSION: BAT identified by this method was in agreement with other studies in terms of location, fat-fraction value, and T2* intensity. The proposed GMM-based segmentation could be a useful nonradiation imaging method for assessment of adipose tissue, in particular for serial follow-up of volume changes after drug or lifestyle interventions for obesity. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:758-768.

Ankle Traction During MRI of Talar Dome Osteochondral Lesions.

OBJECTIVE: The objective of our study was to assess the impact of axial traction during MRI of talar dome osteochondral lesions using a small-FOV coil. SUBJECTS AND METHODS: A prospective study of 33 patients undergoing high-resolution MRI of the ankle using a microscopy coil with and without axial traction was performed. Two radiologists independently measured the tibiotalar joint space width and semiquantitatively graded intraarticular joint fluid dispersion, cartilage surface visibility of the osteochondral lesion, and cartilage surface visibility elsewhere in the tibiotalar joint before and after traction. Patients were instructed to report any discomfort during ankle traction. RESULTS: None of the patients reported discomfort or other symptoms during ankle traction. The tibiotalar joint space significantly increased (increase in cartilage-cartilage distance, 0.5-0.7 mm; all, p < 0.05) after traction compared with before traction. The degree of intraarticular joint fluid dispersion and the cartilage surface visibility at the osteochondral lesion and elsewhere in the tibiotalar joint improved after traction (all, p < 0.05). CONCLUSION: Traction MRI of the ankle is safe and technically feasible. This study is the first to date to investigate the effect of ankle traction on the MRI assessment of talar dome osteochondral lesions. Traction improves cartilage surface visibility of talar dome osteochondral lesions.

Wrist Traction During MR Arthrography Improves Detection of Triangular Fibrocartilage Complex and Intrinsic Ligament Tears and Visibility of Articular Cartilage.

OBJECTIVE: The purpose of this study was to assess the effects of traction during MR arthrography of the wrist on joint space widening, cartilage visibility, and detection of tears of the triangular fibrocartilage complex (TFCC) and intrinsic ligaments. SUBJECTS AND METHODS: A prospective study included 40 wrists in 39 patients (25 men, 14 women; mean age, 35 years). MR arthrography was performed with a 3-T MRI system with and without axial traction. Two radiologists independently measured wrist and carpal joint space widths and semiquantitatively graded articular cartilage visibility. Using conventional arthrography as the reference standard and working in consensus, they assessed for the presence of tears of the TFCC, lunotriquetral ligament (LTL), and scapholunate ligament (SLL). Visibility of a tear before traction was compared with visibility after traction. RESULTS: With traction, all joint spaces in the wrist and carpus were significantly widened (change, 0.15-1.01 mm; all p < 0.006). Subjective cartilage visibility of all joint spaces improved after traction (all p ≤ 0.048) except for that of the radioscaphoid space, which was well visualized even before traction. Conventional arthrography depicted 24 TFCC tears, seven LTL tears, and three SLL tears. The accuracy of tear detection improved after traction for the TFCC (98% after traction vs 83% before traction), the LTL (100% vs 88%), and the SLL (100% vs 95%). Tear visibility improved after traction for 54% of TFCC tears, 71% of LTL tears, and 66% of SLL tears. CONCLUSION: Wrist MR arthrography with axial traction significantly improved the visibility of articular cartilage and the detection and visibility of tears of the TFCC and intrinsic ligaments. The results favor more widespread use of traction during MR arthrography of the wrist.

Dynamic contrast-enhanced imaging of the wrist in rheumatoid arthritis: dedicated low-field (0.25-T) versus high-field (3.0-T) MRI.

OBJECTIVE: To compare the assessment of wrist synovitis severity, synovial volume and synovial perfusion parameters on a dedicated low-field (0.25-T) to that of a high-field (3-T) whole-body MR system in patients with rheumatoid arthritis (RA). METHODS: Twenty-one patients (mean age 50.0 ± 9.8 years) with active RA were recruited prospectively. Dynamic contrast-enhanced MRI examination of the most severely affected wrist was performed at both 0.25 T and 3 T. Three MRI-derived parameters, synovitis severity (RAMRIS grade), synovial volume (ml(3)) and synovial perfusion indices (maximum enhancement and enhancement slope), were compared. RESULTS: Comparing 0.25- and 3-T MRI, there was excellent agreement for semiquantitative assessment (r: 0.80, p < 0.00001) of synovitis (RAMRIS) as well as quantitative assessment (r: 0.94, p < 0.00001) of synovial volume. Good agreement for synovial Emax (r: 0.6, p = 0.002) and fair agreement (r: 0.5, p = 0.02) for synovial Eslope was found. CONCLUSIONS: Imaging of the RA wrist at 0.25 T yields excellent correlation with 3 T with regard to the synovitis activity score (RAMRIS) and synovial volume measurement. Fair to good correlation between low- (0.25-T) and high-field (3-T) MR systems was found for perfusion parameters, being better for Emax than for Eslope.

Non-alcoholic fatty liver disease: spectral patterns observed from an in vivo phosphorus magnetic resonance spectroscopy study.

BACKGROUND & AIMS: Liver biopsy is the gold standard for diagnosing non-alcoholic fatty liver disease (NAFLD) but with practical constraints. Phosphorus magnetic resonance spectroscopy ((31)P-MRS) allows in vivo assessment of hepatocellular metabolism and has shown potential for biochemical differentiation in diffuse liver disease. Our aims were to describe spectroscopic signatures in biopsy-proven NAFLD and to determine diagnostic performance of (31)P-MRS for non-alcoholic steatohepatitis (NASH). METHODS: (31)P-MRS was performed in 151 subjects, comprised of healthy controls (n=19) and NAFLD patients with non-NASH (n=37) and NASH (n=95). Signal intensity ratios for phosphomonoesters (PME) including phosphoethanolamine (PE), phosphodiesters (PDE) including glycerophosphocholine (GPC), total nucleotide triphosphate (NTP) including α-NTP, and inorganic phosphate (Pi), expressed relative to total phosphate (TP) or [PME+PDE] and converted to percentage, were obtained. RESULTS: Compared to controls, both NAFLD groups had increased PDE/TP (p<0.001) and decreased Pi/TP (p=0.011). Non-NASH patients showed decreased PE/[PME+PDE] (p=0.048), increased GPC/[PME+PDE] (p<0.001), and normal NTP/TP and α-NTP/TP. Whereas, NASH patients had normal PE/[PME+PDE] and GPC/[PME+PDE], but decreased NTP/TP (p=0.004) and α-NTP/TP (p<0.001). The latter was significantly different between non-NASH and NASH (p=0.047) and selected as discriminating parameter, with area under the receiver-operating characteristics curve of 0.71 (95% confidence interval, 0.62-0.79). An α-NTP/TP cutoff of 16.36% gave 91% sensitivity and cutoff of 10.57% gave 91% specificity for NASH. CONCLUSIONS: (31)P-MRS shows distinct biochemical changes in different NAFLD states, and has fair diagnostic accuracy for NASH.

Head and neck squamous cell carcinoma: diagnostic performance of diffusion-weighted MR imaging for the prediction of treatment response.

PURPOSE: To determine the diagnostic performance of diffusion-weighted (DW) imaging for the prediction of treatment failure in primary head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS: The study was approved by the local institutional ethics committee and conducted with informed written consent in patients with primary HNSCC treated with radiation therapy and chemotherapy. DW imaging of the primary tumor was performed before treatment in 37 patients and was repeated within 2 weeks of treatment in 30 patients. Histograms of apparent diffusion coefficients (ADCs) were analyzed, and mean ADC, kurtosis, skewness, and their respective percentage change were correlated for local failure and local control at 2 years by using the Student t test. Univariate and multivariate analyses of the ADC parameters, T stage, and tumor volume were performed by using logistic regression for prediction of local failure. RESULTS: Local failure occurred in 16 of 37 (43%) patients and local control occurred in 21 of 37 (57%) patients. Pretreatment ADC parameters showed no correlation with local failure. There was significant intratreatment increase in mean ADC and a decrease in skewness and kurtosis (P < .001, P < .001, P = .024, respectively) for the whole group of patients when compared with those before treatment. During treatment, primary tumors showed a significantly lower increase in percentage change of mean ADC, higher skewness, and higher kurtosis for local failure than for local control (P = .016, .015, and .040, respectively). These ADC parameters also were significant for predicting local failure with use of univariate but not multivariate analysis. CONCLUSION: Early intratreatment DW imaging has the potential to allow prediction of treatment response at the primary site in patients with HNSCC.

Air pressure-induced susceptibility changes in vascular reactivity studies using BOLD MRI.

PURPOSE: To investigate whether compressed air during air-cuff inflation in vascular reactivity studies could induce aberrant blood oxygenation level-dependent (BOLD) signal change. MATERIALS AND METHODS: Magnetic resonance imaging (MRI) experiments were performed on a whole-body 3 T scanner. The pattern of T2* signal change measured from a phantom simulating the lower limb was assessed while a thigh cuff was inflated and deflated. MR spectroscopy was performed on a head phantom wrapped using a hand-cuff to determine the relationship between water peak linewidth and applied cuff pressure. Calf muscles from 14 normal subjects were examined to identify aberrant T2* signal changes in the occluded and nonoccluded legs. RESULTS: A sudden T2* signal drop was observed in the phantom on initiation of cuff inflation with subsequent signal change being dependent on cuff pressure. Water peak linewidth increased linearly with cuff pressure (r(2) = 0.94). Aberrant T2* signal changes were observed in both the occluded and nonoccluded legs. CONCLUSION: Compressed air due to cuff inflation directly affects local magnetic field susceptibility. The T2* sequence is sensitive to local field disturbances induced by an inflated cuff. Muscle BOLD results are affected by high-pressure air, with a sudden drop in T2* signal being a characteristic feature of this induced effect.

Heuristic linear mapping of physiological parameters in dynamic contrast-enhanced MRI without T1 measurement and contrast agent concentration.

PURPOSE: To present a novel heuristic linear mapping method to individually estimate physiological parameters for Tofts model without T(1) measurement and contrast agent concentration. MATERIALS AND METHODS: A linear relationship was used for k(ep) mapping through a heuristic time intensity curve (TIC) shape factor (TSF). K(trans) maps were subsequently estimated using k(ep) maps and another approximate linear model derived from the Tofts model. Twenty-seven patients with head-and-neck squamous cell carcinoma received dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Physiological parameters maps were obtained using this heuristic linear mapping method and compared to the maps obtained by the normal nonlinear least-square fitting with T(1) measurement. RESULTS: High linearity (R(2) >0.95) between k(ep) and TSF was found in all patients for k(ep) <5/min. This linearity is robust for TSF timepoint selection. The k(ep) maps generated by this linear fitting were highly consistent with those by the normal nonlinear approach (P > 0.05). The K(trans) maps were consistent with the normally derived maps in pattern distribution but the absolute value might be scaled due to the assumption of the reference K(trans) value. CONCLUSION: This novel method generates reliable and consistent physiological parameter maps with significantly lower computation complexity than the multiparameter nonlinear fitting. The DCE-MRI scan time can be greatly shortened without T(1) mapping.

Bone marrow fat content in the elderly: a reversal of sex difference seen in younger subjects.

PURPOSE: To investigate vertebral bone marrow fat content in elderly subjects related to sex, age, and bone mineral density (BMD) and relate these findings to published data in younger subjects. MATERIALS AND METHODS: A total of 259 healthy subjects (145 females, 114 males; age range, 62-90 years) underwent proton ((1) H) MR spectroscopy of L3 vertebral body and BMD of the lumbar spine with results stratified according to age. Ninety age- and BMD-matched subjects were selected to determine sex differences in marrow fat content and BMD. RESULTS: In females, vertebral marrow fat content rose sharply between 55 and 65 years of age while in males vertebral marrow fat content rose gradually throughout life. Vertebral marrow fat content in females more than 60 years was approximately 10% higher in females than males, i.e., a reversal of sex difference reported in marrow fat content for subjects less than 60 years. CONCLUSION: Marrow fat content increases sharply in female subjects between 55 and 65 years of age while male subjects continue to increase marrow fat at a more gradual steady rate. Females older than 60 years have a higher marrow fat content than males. This increased deposition in marrow fat concurs with recognized changes in extraosseous fat distribution in postmenopausal females.

Prediction of bone loss in elderly female subjects by MR perfusion imaging and spectroscopy.

OBJECTIVE: To determine whether MR perfusion indices or marrow fat content at baseline can predict areal bone mineral density (BMDa) loss. METHODS: Repeat dual x-ray absorptiometry (DXA) of the hip was performed in female subjects at 2 years (n = 52) and 4 years (n = 45) following baseline MR perfusion imaging and spectroscopy of the hip. RESULTS: Percentage reduction in femoral neck BMDa at 4 years post-baseline was greater in subjects with below median acetabulum enhancement slope (E(slope)) (-5.6 ± 1.2 Vs -1.1 ± 1.2 (mean ± standard error) p = 0.014) or muscle maximum enhancement (E(max)) (-5.7 ± 1.2 Vs -0.23 ± 1.2, p = 0.009) after adjusting for baseline co-variables. Baseline MR parameters correlated with reduction in BMDa at 4 years (acetabulum E(slope) r = 0.517, p = 0.0003; muscle E(max) r = 0.306, p = 0.043) as well as traditionally applied clinical risk factors. Acetabulum E(slope), femoral neck E(max) and marrow fat content at baseline had sensitivities of 89%, 81% and 72% respectively at distinguishing between fast (>1%/annum) (n = 18) and slow (<1%/annum) (n = 27) BMD losers. CONCLUSION: Elderly female subjects with reduced perfusion indices at baseline had increased femoral neck bone loss at 4 years. Selected perfusion indices and marrow fat content have a moderate to high sensitivity in discriminating between fast and slow bone losers.

Implications of Abdominal Adipose Tissue Distribution on Nonalcoholic Fatty Liver Disease and Metabolic Syndrome: A Chinese General Population Study.

INTRODUCTION: Visceral adipose tissue (VAT) has been found to play a critical role in the development of metabolic syndrome and nonalcoholic fatty liver disease (NAFLD) independent of generalized obesity. METHODS: In this secondary study of prospectively acquired data, 625 participants underwent magnetic resonance spectroscopy and chemical shift fat-water separation MRI (2-point Dixon) of the liver and whole abdomen, respectively, in a 3 Tesla magnet. Whole abdominal VAT and subcutaneous adipose tissue (SAT) were extracted from the 2-point Dixon image series using an automated method. Clinical/anthropometric/blood biochemistry parameters were measured. Using region-specific body mass index, participants were classified into 3 paired subgroups (lean, overweight, and obese) and presence of NAFLD (liver fat content ≥ 5.5%). RESULTS: All relevant clinical/anthropometric/blood biochemistry characteristics and liver enzymes were statistically significant between groups (P < 0.001). NAFLD was found in 12.1%, 43.8%, and 68.3% and metabolic syndrome in 51.1%, 61.9%, and 65% of the lean, overweight, and obese, respectively. Odds ratio for metabolic syndrome and NAFLD was increased by 2.73 (95% confidence interval [CI] 2.18-3.40) and 2.53 (95% CI 2.04-3.12), respectively, for 1SD increase in VAT volume while prevalence of metabolic syndrome was increased by 2.26 (95% CI 1.83-2.79) for 1SD increase in liver fat content (%). VAT/SAT ratio in the lean with fatty liver showed the highest ratio (0.54) among all the subgroups, without a significant difference between the lean and obese with NAFLD (P = 0.127). DISCUSSION: Increased VAT volume/disproportional distribution of VAT/SAT may be vital drivers to the development of metabolic syndrome and NAFLD irrespective of body mass index category.

Reduced bone perfusion in osteoporosis: likely causes in an ovariectomy rat model.

PURPOSE: To investigate the cause of reduced vertebral perfusion in a rat ovariectomy model. MATERIALS AND METHODS: Experimental protocol was approved by the local Animal Experiment Ethics Committee. Twenty-two Sprague-Dawley rats were studied. Computed tomographic bone densitometry and magnetic resonance perfusion imaging were performed at baseline and 2, 4, and 8 weeks after ovariectomy (n = 11) or sham surgery (n = 11). Perfusion parameters analyzed were maximum enhancement (E(max)) and enhancement slope (E(slope)). After the animals were sacrificed, the aorta and femoral artery were analyzed for vessel reactivity, and the lumbar vertebrae were analyzed for marrow content. RESULTS: In control rats, bone mineral density (BMD), E(max), and E(slope) remained constant. In ovariectomy rats, a comparable reduction in BMD and the perfusion parameters at two weeks post-ovariectomy (BMD, 9.3%; E(max), 11.6%; E(slope), 9%) was seen 2 weeks after ovariectomy, and further reductions were seen 4 weeks (BMD, 17.5%; E(max), 15.6%; E(slope), 33%) and 8 weeks (BMD, 18.8%; E(max), 14.2%; E(slope), 33%) after ovariectomy. Endothelial dysfunction was observed in both the aorta and femoral artery of the ovariectomy group but not of the control group. Increased marrow fat area was seen in the ovariectomy group (52.9% vs 21.6%; P < .01) owing to an increase in fat cell number. Decreased erythropoetic marrow area (32.5% vs 48.6%; P < .05) was also observed in the ovariectomy group. CONCLUSION: Reduced bone perfusion occurs in synchrony with reduced BMD. The most likely causes of reduced bone perfusion are a reduction in the amount of erythropoetic marrow and endothelial dysfunction after ovariectomy. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09090608/-/DC1.

Evolution of radiation-induced brain injury: MR imaging-based study.

PURPOSE: To evaluate the temporal lobes in patients previously treated for nasopharyngeal carcinoma to provide a better understanding of delayed radiation-induced injury in the brain unaffected by the underlying tumor. MATERIALS AND METHODS: Retrospective analysis of the patient data was approved by the local ethics committee. Informed consent was waived. Magnetic resonance (MR) imaging results in patients with temporal lobe injury (TLI) after receiving radiation for nasopharyngeal carcinoma were analyzed. The appearance and change over time of white matter lesions (WMLs), contrast material-enhanced lesions, and cysts were assessed. The Mann-Whitney U test was used to compare interval time, and the chi(2) and Fisher exact tests were used to compare the pattern of TLI changes. RESULTS: The study group was 124 patients (95 men, 29 women; mean age, 51.4 years) with 192 injured temporal lobes; 62 of these patients with 103 injured temporal lobes underwent follow-up MR imaging at least once (range, one to five examinations). A total of 332 injured temporal lobes were revealed. WMLs, contrast-enhanced lesions, and cysts were present on 332 (100%), 274 (82.5%), and 42 (12.7%) studies, respectively. All contrast-enhanced lesions more than 2 cm in size showed necrosis, and those 3 cm or greater formed a rim-enhanced necrotic mass. WMLs were the only lesion to occur alone, contrast-enhanced lesions were always accompanied by WMLs, and cysts were always accompanied by WMLs and contrast-enhanced lesions. Detection of cysts was significantly later than detection of WMLs and contrast-enhanced lesions (P <.01). Regression or resolution was found in 27 (28%) of 96 WMLs, 37 (39%) of 94 contrast-enhanced lesions, and one (7%) of 15 cysts. CONCLUSION: TLI from radiation is not always an irreversible and progressive process but is one that can regress or resolve at MR imaging. In the evolution of radiation injury, WMLs are seen first and are followed by contrast-enhanced lesions, which have an increasing tendency to become necrotic with increasing size. Cysts are the least frequent manifestation and arise in the late stage of TLI.

Concatenated and parallel optimization for the estimation of T1 map in FLASH MRI with multiple flip angles.

Most traditional methods for T(1) map estimation in MRI with fast low-angle-shot sequences are aimed at high efficiency by compromising the fitting accuracy. In this paper, the fundamental problem of parameter estimation in fast low-angle-shot MRI was re-examined, and an accurate and fast optimization approach, named concatenated optimization for parameter estimation, was proposed for the regression of data points acquired with multiple flip angles. The initial estimation of T(1) was obtained from the linear regression, followed by the constrained nonlinear regression based on the initial estimates. This heterogeneous initialization strategy improves the fitting accuracy and reduces the computational time. A computationally efficient implementation of concatenated optimization for parameter estimation was achieved based on the graphic processing unit, named as concatenated optimization for parameter estimation graphic processing unit. In experimental comparison with Fram's method and the Fitter Tool in Jim, the proposed methods are capable of achieving significantly higher efficiency and more accurate estimations.

Chemical shift imaging in the head and neck at 3T: initial results.

PURPOSE: To determine the optimal method to correct air and tissue susceptibility differences in the head and neck to allow proton ((1)H) chemical shift imaging (CSI) to be performed at 3T. MATERIALS AND METHODS: Shimming protocols (iterative, first-order, and second-order) and perfluorocarbon (PFC) pads were evaluated using water peak linewidth measurements obtained from single-voxel magnetic resonance spectroscopy (MRS) on a head and neck phantom. After optimization of the technique, CSI was then tested on 14 patients with head and neck tumors. RESULTS: Second-order shimming (water peak linewidth, 4.6 Hz) performed significantly (P < 0.001) better than first-order (16.5 Hz) and iterative shimming (18 Hz) and the water peak linewidth was significantly reduced using PFC pads (P < 0.001). Using second-order shimming and PFC pads, CSI was successful in 10 patients with nodal metastases (n = 8) and benign tumors (n = 2) and unsuccessful in four patients with primary tumors along the aerodigestive tract. CONCLUSION: Proton CSI can be successfully performed in the head and neck using second-order shimming and PFC pads to correct air and tissue susceptibility differences. CSI was more successfully performed on nodal metastases, while CSI for primary tumors along the aerodigestive tract remains a challenge.