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Introduction: Progressive supranuclear palsy (PSP) involves midbrain structures, including the red nucleus (RN), an iron-rich region that appears as a high-contrast area on quantitative susceptibility mapping (QSM). RN may serve as a promising biomarker for differentiating parkinsonism. However, RN deformation in PSP remains elusive. This study aimed to evaluate RN deformation in PSP using coronal QSM images and compare them with those of Parkinson's disease (PD) and healthy controls (HC)., Methods: We evaluated the QSM images of 22 patients with PSP, 37 patients with PD, and 43 HC. We developed a grading system to assess RN deformation on coronal QSM images and classified them into three grades. The midbrain and RN volumes were extracted using distinct approaches, and their relationship with grading was investigated. For validation, coronal QSM images of 16 PSP patients from a different institution were assessed., Results: In PSP, 59 % of the patients displayed a flattened RN of grade 3, which we termed a Rice-Grain Appearance. The volume reductions in midbrain and RN were associated with deformation. Differentiation based on the presence of this appearance yielded a specificity of 1.000 (CI: 1.000-1.000) and sensitivity of 0.591 (0.385-0.796) for distinguishing PSP from others. Secondary dataset also showed that 56 % of patients with PSP were classified as grade 3., Conclusion: In coronal QSM images, the flattened RN shape appears to be specific to PSP compared to PD and HC and may serve as a marker to help differentiate PSP in future clinical settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Flip angle (FA) measurements using the actual flip angle imaging (AFI) method may induce significant errors in ultrahigh fields. We aimed to develop a method for detecting errors in FA measurements using phase information at 7 tesla. We performed computer simulations to elucidate the relationship between the FA calculation errors and the phase difference between the two AFI source images. We then examined whether a method based on the phase difference could detect FA calculation errors and determine the prescribed nominal FA of the scanner for accurate measurements in phantoms and healthy volunteers. The simulations confirmed that the calculated FA values erroneously decreased when the longitudinal magnetization and phase in one of the source images were inverted. Tests on phantoms and human subjects demonstrated that the phase difference information between the source images with a cut-off of 90° could readily detect FA calculation errors in the AFI method.

We investigated the spatial and temporal variations of flip-angle (FA) distributions in the human brain from multiple scans, using an eight-channel parallel transmission (pTx) system at 7T. Nine healthy volunteers were scanned in five sessions using three radiofrequency excitation techniques each time: circular polarization (CP), static pTx, and dynamic pTx. We calculated the coefficients of variation of the FA values within the brain area to evaluate the variations, and the maximum intersession differences in the FA values (D max ), comparing them between the three methods. The coefficients of variation decreased in the following order: CP, static pTx, and dynamic pTx (median: 20.1%, 13.6%, and 5.7%, respectively; p < 0.001). The average D max values were significantly higher for the static pTx (5.4°) than for the dynamic pTx (2.8°) and CP (1.7°) methods (p = 0.004 and 0.001, respectively). Compared to the CP method, the dynamic pTx method at 7T can efficiently minimize spatial variations in the FA distribution with a mild increase in temporal variations. The static pTx method exhibited a remarkably wide temporal variation.

Aim: It remains unclear whether elevated low-density lipoprotein cholesterol (LDL-C) is a risk factor for cerebral vascular disease. Familial hypercholesterolemia (FH) is the most appropriate model for understanding the effects of excess LDL-C because affected individuals have inherently high levels of circulating LDL-C. To clarify the effects of hypercholesterolemia on cerebral small vessel disease (SVD), we investigated cerebrovascular damage in detail due to elevated LDL-C using high resolution brain magnetic resonance imaging (MRI) in patients with FH., Methods: Twenty-eight patients with FH and 35 healthy controls underwent 7T brain MRI. The prevalence of SVD and arterial structural changes were determined in each group., Results: The prevalence of periventricular hyperintensity (PVH) was significantly higher (control, 0% vs. FH, 14.2%, p=0.021) and deep white matter intensity tended to be more frequent in FH patients than in controls. The prevalence of SVD in patients with forms of cerebral damage, such as lacunar infarction, PVH, deep white matter hyperintensities (DWMH), microbleeding, and brain atrophy, was significantly higher among FH patients (control, n=2, 5.7% vs. FH, n=7, 25.0%, p＜0.001, chi-square test). The tortuosity of major intracranial arteries and the signal intensity of lenticulostriate arteries were similar in the two groups. In FH patients, as the grade of PVH progressed, several atherosclerosis risk factors, such as body mass index, blood pressure, and triglyceride level, showed ever worsening values., Conclusion: These results obtained from FH patients revealed that persistently elevated LDL-C leads to cerebral PVH. It is necessary in the management of FH to pay attention not only to the development of coronary heart disease but also to the presence of cerebral SVD.

Purpose: The feasibility of steady-state sequences for 17 O imaging was evaluated based on a kinetic analysis of the brain parenchyma and cerebrospinal fluid (CSF)., Materials and Methods: The institutional review board approved this prospective study with written informed consent. Dynamic 2D or 3D steady-state sequences were performed in five and nine participants, respectively, with different parameters using a 3T scanner. During two consecutive dynamic scans, saline was intravenously administered for control purposes in the first scan, and 20% 17 O-labeled water (1 mL/Kg) was administered in the second scan. Signal changes relative to the baseline were calculated, and kinetic analyses of the curves were conducted for all voxels. Region of interest analysis was performed in the brain parenchyma, choroid plexus, and CSF spaces., Results: Average signal drops were significantly larger in the 17 O group than in the controls for most of the imaging parameters. Different kinetic parameters were observed between the brain parenchyma and CSF spaces. Average and maximum signal drops were significantly larger in the CSF spaces and choroid plexus than in the brain parenchyma. Bolus arrival, time to peak, and the first moment of dynamic curves of 17 O in the CSF space were delayed compared to that in the brain parenchyma. Significant differences between the ventricle and subarachnoid space were also noted., Conclusion: Steady-state sequences are feasible for indirect 17 O imaging with reasonable temporal resolution; this result is potentially important for the analysis of water kinetics and aquaporin function for several disorders.

Background: Respiration-induced phase shift affects B 0 /B 1 + mapping repeatability in parallel transmission (pTx) calibration for 7T brain MRI, but is improved by breath-holding (BH). However, BH cannot be applied during long scans., Purpose: To examine whether interleaved acquisition during calibration scanning could improve pTx repeatability and image homogeneity., Study Type: Prospective., Subjects: Nine healthy subjects., Field Strength/sequence: 7T MRI with a two-channel RF transmission system was used., Assessment: Calibration scanning for B 0 /B 1 + mapping was performed under sequential acquisition/free-breathing (Seq-FB), Seq-BH, and interleaved acquisition/FB (Int-FB) conditions. The B 0 map was calculated with two echo times, and the B 1 + map was obtained using the Bloch-Siegert method. Actual flip-angle imaging (AFI) and gradient echo (GRE) imaging were performed using pTx and quadrature-Tx (qTx). All scans were acquired in five sessions. Repeatability was evaluated using intersession standard deviation (SD) or coefficient of variance (CV), and in-plane homogeneity was evaluated using in-plane CV., Statistical Tests: A paired t-test with Bonferroni correction for multiple comparisons was used., Results: The intersession CV/SDs for the B 0 /B 1 + maps were significantly smaller in Int-FB than in Seq-FB (Bonferroni-corrected P < 0.05 for all). The intersession CVs for the AFI and GRE images were also significantly smaller in Int-FB, Seq-BH, and qTx than in Seq-FB (Bonferroni-corrected P < 0.05 for all). The in-plane CVs for the AFI and GRE images in Seq-FB, Int-FB, and Seq-BH were significantly smaller than in qTx (Bonferroni-corrected P < 0.01 for all)., Data Conclusion: Using interleaved acquisition during calibration scans of pTx for 7T brain MRI improved the repeatability of B 0 /B 1 + mapping, AFI, and GRE images, without BH., Level of Evidence: 1 Technical Efficacy Stage 1 J. Magn. Reson. Imaging 2017., (© 2017 International Society for Magnetic Resonance in Medicine.)

Background: Few studies have been reported for T 2 -weighted indirect 17 O imaging., Purpose/hypothesis: To evaluate the feasibility of steady-state sequences for indirect 17 O brain imaging., Study Type: Signal simulation, phantom measurements, and prospective animal experiments were performed in accordance with the institutional guidelines for animal experiments., Population/subjects/phantom/specimen/animal Model: Signal simulations of balanced steady-state free precession (bSSFP) were performed for concentrations of 17 O ranging from 0.037-1.600%. Phantom measurements with concentrations of 17 O water ranging from 0.037-1.566% were also conducted. Six healthy beagle dogs were scanned with intravenous administration of 20% 17 O-labeled water (1 mL/kg)., Field Strength/sequence: Dynamic 3D-bSSFP scans were performed at 3T MRI. 17 O-labeled water was injected 60 seconds after the scan start, and the total scan duration was 5 minutes., Assessment: Based on the result of signal simulation and phantom measurement, signal changes in the beagle dogs were measured and converted into 17 O concentrations., Statistical Tests: The 17 O concentrations were averaged for every 15 seconds, and compared to the baseline (30-45 sec) with Dunnett's multiple comparison tests., Results: Signal simulation revealed that the relationships between 17 O concentration and the natural logarithm of relative signals were linear. The intraclass correlation coefficient between relative signals in phantom measurement and signal simulations was 0.974. In the animal experiments, significant increases in 17 O concentration (P < 0.05) were observed 60 seconds after the injection of 17 O. At the end of scanning, mean respective 17 O concentrations of 0.084 ± 0.026%, 0.117 ± 0.038, 0.082 ± 0.037%, and 0.049 ± 0.004% were noted for the cerebral cortex, cerebellar cortex, cerebral white matter, and ventricle., Data Conclusion: Dynamic steady-state sequences were feasible for indirect 17 O imaging, and absolute quantification was possible. This method can be applied for the measurement of permeability and blood flow in the brain, and for kinetic analysis of cerebrospinal fluid., Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:1373-1379., (© 2017 International Society for Magnetic Resonance in Medicine.)

Background and Purpose: Magnetic resonance (MR) and contrast-enhanced ultrasound assess characteristics and neovascularization, respectively, of the carotid plaque. The purpose of the present study was to clarify how findings of contrast-enhanced ultrasound plaque imaging are related to those of 3-dimensional (3D) fast spin echo (FSE) T1-weighted MR plaque imaging (WI) in severe stenosis (≥70%) of the cervical carotid artery., Methods: Fifty-three patients underwent 3D FSE T1-WI and contrast-enhanced ultrasound. For each patient, the averaged contrast ratio on MR (CR MR ) was calculated by dividing the averaged internal carotid artery plaque signal intensity by the sternocleidomastoid muscle signal intensity; maximally enhanced intensities on the intraplaque and lumen time-intensity curves were obtained from contrast-enhanced ultrasound data, and the ratio of the maximal intensity of the intraplaque curve to that of the lumen curve was calculated and defined as contrast effect (CE US )., Results: A linear correlation (r = .702; P <.0001) was observed between CR MR and CE US . Receiver operating characteristic curve analyses to evaluate the ability of the CE US to differentiate each category of CR MR from the other 2 categories showed that the sensitivity was significantly lower for category II (1.30 ≤ CR MR  ≤ 1.60) than for category I (CR MR  < 1.30) or III (1.60 < CR MR ). The CE US was lower in plaques with higher CR MR than in those with lower CR MR in a subgroup of category III (P = .0196)., Conclusion: Findings of contrast-enhanced ultrasound plaque imaging are related to those of 3D FSE T1-WI MR plaque imaging according to the life history of arterial plaque and its neovascularization., (Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

The safety of metallic spinal implants in magnetic resonance imaging (MRI) performed using ultrahigh fields has not been established. Hence, we examined whether the displacement forces caused by a static magnetic field and the heating induced by radiofrequency radiation are substantial for spinal implants in a 7 T field. We investigated spinal rods of various lengths and materials, a screw, and a cross-linking bridge in accordance with the American Society for Testing and Materials guidelines. The displacement forces of the metallic implants in static 7 T and 3 T static magnetic fields were measured and compared. The temperature changes of the implants during 15-min-long fast spin-echo and balanced gradient-echo image acquisition sequences were measured in the 7 T field. The deflection angles of the metallic spinal materials in the 7 T field were 5.0-21.0° [median: 6.7°], significantly larger than those in the 3 T field (1.0-6.3° [2.2°]). Among the metallic rods, the cobalt-chrome rods had significantly larger deflection angles (17.8-21.0° [19.8°]) than the pure titanium and titanium alloy rods (5.0-7.7° [6.2°]). The temperature changes of the implants, including the cross-linked rods, were 0.7-1.0°C [0.8°C] and 0.6-1.0°C [0.7°C] during the fast spin-echo and balanced gradient-echo sequences, respectively; these changes were slightly larger than those of the controls (0.4-1.1°C [0.5°C] and 0.3-0.9°C [0.6°C], respectively). All of the metallic spinal implants exhibited small displacement forces and minimal heating, indicating that MRI examinations using 7 T fields may be performed safely on patients with these implants. © 2016 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 35:1831-1837, 2017., (© 2016 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society.)

Background: Magnetic resonance imaging is widely used to evaluate the intraplaque components of the cervical carotid artery. The non-gated T1-weighted spin-echo (SE) technique has been reported to have an excellent ability for discriminating stable and unstable plaques. However, the diagnostic performance of various SE-based techniques remains unclear. Hence, we compared plaque signals obtained by 3 kinds of SE-based methods with histological findings., Methods: We prospectively examined 40 patients who underwent carotid endarterectomy by using 1.5-T scanners and obtained 2-dimensional (2D) conventional spin-echo (CSE), 2D fast spin-echo (FSE), and 3-dimensional (3D)-FSE images with identical repetition times. We calculated contrast ratios (CRs) of the plaques against adjacent muscles and compared these values with the pathological classification of the specimens., Results: The CRs of type VII-VIII (calcific/fibrous), IV-V (lipid-rich/necrotic), and VI (complex/hemorrhagic) plaques were significantly different between all the methods (P <.001) and were discriminated from each other at sensitivities of 83%-100% and specificities of 94%-100%. The CRs of type IV-V plaques significantly differed between the methods (low to high, 2D-FSE, 2D-CSE, and 3D-FSE; P <.05); those of the type VI plaques were significantly lower with the 2D-FSE method than with the other methods (P <.01)., Conclusions: The SE-based T1-weighted images can readily discriminate plaque characteristics with high sensitivities and specificities, although the signal intensity of unstable plaques was significantly high on the 3D-FSE images and significantly low on the 2D-FSE images., (Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Purpose: The B0 and B1+ maps required for calculation of the radiofrequency (RF) pulse of parallel transmission (pTx) are obtained in calibration scans; however, they may be affected by respiratory motion. We aimed to compare the reproducibility of B0 and B1+ maps and gradient echo (GRE) images of the brain scanned with pTx at 7T between free-breathing (FB) and breath-holding (BH) conditions during the calibration scan., Methods: Nine healthy volunteers were scanned by 7T MRI using a two-channel quadrature head coil. In the pTx calibration scans performed with FB and BH, the B0 map was obtained from two different TE images and the B1+ map was calculated by the Bloch-Siegert method. A GRE image (gradient-recalled-acquisition in steady state) was also obtained with RF shimming and RF design of pTx with spoke method, as well as quadrature transmission (qTx). All the scans were repeated over five sessions. The reproducibility of the B0 and B1+ maps and GRE image was evaluated with region-of-interest measurements using inter-session standard deviation (SD) and coefficient of variation (CV) values. Intensity homogeneity of GRE images was also assessed with in-plane CV., Results: Inter-session SDs of B0 and B1+ maps were significantly smaller in BH (P < 0.01). Inter-session CVs of GRE images were significantly smaller in qTx than BH and FB (P < 0.01, both); however, the CVs of BH were significantly smaller (P < 0.01). In-plane CVs of FB and BH with RF shimming were not significantly different with qTx; however, CVs of FB and BH with RF design were significantly smaller than those of qTx (P < 0.05 and P < 0.01, respectively)., Conclusion: BH could improve the reproducibility of B0 and B1+ maps in pTx calibration scans and GRE images. These results might facilitate the development of pTx in human brain at 7T.

Conscious sedation with propofol sometimes causes amnesia while keeping the patient awake. However, it remains unknown how propofol compromises the memory function. Therefore, we investigated the changes in brain activation induced by visual stimulation during and after conscious sedation with propofol using serial functional MRI. Healthy volunteers received a target-controlled infusion of propofol, and underwent functional MRI scans with a block-design paradigm of visual stimulus before, during, and after conscious sedation. Random-effect model analyses were performed using Statistical Parametric Mapping software. Among the areas showing significant activation in response to the visual stimulus, the visual cortex and fusiform gyrus were significantly suppressed in the sedation session and tended to recover in the early-recovery session of ∼20 min (P<0.001, uncorrected). In contrast, decreased activations of the hippocampus, thalamus, inferior frontal cortex (ventrolateral prefrontal cortex), and cerebellum were maintained during the sedation and early-recovery sessions (P<0.001, uncorrected) and were recovered in the late-recovery session of ∼40 min. Temporal changes in the signals from these areas varied in a manner comparable to that described by the random-effect model analysis (P<0.05, corrected). In conclusion, conscious sedation with propofol may cause prolonged suppression of the activation of memory-related structures, such as the hippocampus, during the early-recovery period, which may lead to transient amnesia.

Background: Proton beam therapy (PBT) achieves good local control for hepatocellular carcinoma (HCC), and toxicity tends to be lower than for photon radiotherapy. Focal liver parenchymal damage in radiotherapy is described as the focal liver reaction (FLR); the threshold doses (TDs) for FLR in the background liver have been analyzed in stereotactic ablative body radiotherapy and brachytherapy. To develop a safer approach for PBT, both TD and liver volume changes are considered clinically important in predicting the extent of damage before treatment, and subsequently in reducing background liver damage. We investigated appearance time, TDs and volume changes regarding FLR after PBT for HCC., Material and Methods: Patients who were treated using PBT and were followed up using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA MRI) after PBT were enrolled. Sixty-eight lesions in 58 patients were eligible for analysis. MRI was acquired at the end of treatment, and at 1, 2, 3 and 6 months after PBT. We defined the FLR as a clearly depicted hypointense area on the hepatobiliary phase of Gd-EOB-DTPA MRI, and we monitored TDs and volume changes in the FLR area and the residual liver outside of the FLR area., Results: FLR was depicted in all lesions at 3 months after PBT. In FLR expressed as the 2-Gy equivalent dose (α/β = 3 Gy), TDs did not differ significantly (27.0±6.4 CGE [10 fractions [Fr] vs. 30.5±7.3 CGE [20 Fr]). There were also no correlations between the TDs and clinical factors, and no significant differences between Child-Pugh A and B scores. The volume of the FLR area decreased and the residual liver volume increased, particularly during the initial 3 months., Conclusion: This study established the FLR dose for liver with HCC, which might be useful in the prediction of remnant liver volume for PBT., Competing Interests: The authors declare that they have no competing interests.

The aim of the present study was to determine whether preoperative three-dimensional (3D) fast spin-echo (FSE) T1-weighted magnetic resonance (MR) plaque imaging for severely stenotic cervical carotid arteries could accurately predict the development of artery-to-artery emboli during exposure of the carotid arteries in carotid endarterectomy (CEA). Seventy-five patients underwent preoperative MR plaque imaging and CEA under transcranial Doppler ultrasonography of the ipsilateral middle cerebral artery. On reformatted axial MR image slices showing the maximum plaque occupation rate (POR) and maximum plaque intensity for each patient, the contrast ratio (CR) was calculated by dividing the internal carotid artery plaque signal intensity by the sternocleidomastoid muscle signal intensity. For all patients, the area under the receiver operating characteristic curve (AUC)-used to discriminate between the presence and absence of microembolic signals-was significantly greater for the CR on the axial image with maximum plaque intensity (CR max intensity ) (0.941) than for that with the maximum POR (0.885) ( p < 0.05). For 32 patients in whom both the maximum POR and the maximum plaque density were identified, the AUCs for the CR were 1.000. Preoperative 3D FSE T1-weighted MR plaque imaging accurately predicts the development of artery-to-artery emboli during exposure of the carotid arteries in CEA., Competing Interests: The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

The purposes of this study are to establish oxygen extraction fraction (OEF) measurements using quantitative susceptibility mapping (QSM) of magnetic resonance imaging (MRI), and to compare QSM-OEF data with the gold standard (15)O positron emission tomography (PET). Twenty-six patients with chronic unilateral internal carotid artery or middle cerebral artery stenosis or occlusion, and 15 normal subjects were included. MRI scans were conducted using a 3.0 Tesla scanner with a three-dimensional spoiled gradient recalled sequence. QSM images were created using the morphology-enabled dipole inversion method, and OEF maps were generated from QSM images using extraction of venous susceptibility induced by deoxygenated hemoglobin. Significant correlation of relative OEF ratio to contra-lateral hemisphere between QSM-OEF and PET-OEF was observed (r = 0.62, p < 0.001). The local (intra-section) correlation was also significant (r = 0.52, p < 0.001) in patients with increased PET-OEF. The sensitivity and specificity of OEF increase in QSM was 0.63 (5/8) and 0.89 (16/18), respectively, in comparison with PET. In conclusion, good correlation was achieved between QSM-OEF and PET-OEF in the identification of elevated OEF in affected hemispheres of patients with unilateral chronic steno-occlusive disease., (© The Author(s) 2015.)

The ventral tegmental area (VTA), one of the neuromelanin-containing dopaminergic nuclei in the midbrain, is closely related to the pathogenesis of schizophrenia, but its imaging findings remain unclear. Here, we investigated whether neuromelanin-sensitive MRI can detect alterations in the signals of the VTA of patients with schizophrenia. Neuromelanin-sensitive T1-weighted images at 3 T were obtained in 14 patients with schizophrenia and 22 healthy individuals. After signal inhomogeneity correction, brain signal rescaling of the images, and spatial normalization, signal intensity of the VTA and substantia nigra pars compacta (SNc) was automatically measured using the regions-of-interest constructed from the images of the healthy individuals. The normalized signal intensity of the VTA in patients with schizophrenia (median ± quartile deviation, 998 ± 10) was significantly decreased compared with that in healthy controls (1018 ± 15) (P=0.010), whereas that of the SNc was not significantly different between the groups (1093 ± 6 and 1098 ± 10, respectively, P=0.84). The VTA/SNc ratio was also significantly lower in patients with schizophrenia (0.916 ± 0.007) than in the control participants (0.934 ± 0.010) (P=0.010). In addition, the scores of the Scale for the Assessment of Positive Symptoms showed an independent negative correlation with VTA signaling (r=-0.69, P=0.012). Neuromelanin-sensitive MRI enables direct visualization of the selective signal attenuation in the VTA, which was correlated with positive symptoms, in patients with schizophrenia.

Purpose: We examined safety issues related to the presence of various metallic dental materials in magnetic resonance (MR) imaging at 7 tesla., Methods: A 7T MR imaging scanner was used to examine 18 kinds of materials, including 8 metals used in dental restorations, 6 osseointegrated dental implants, 2 abutments for dental implants, and 2 magnetic attachment keepers. We assessed translational attraction forces between the static magnetic field and materials via deflection angles read on a tailor-made instrument and compared with those at 3T. Heating effects from radiofrequency during image acquisitions using 6 different sequences were examined by measuring associated temperature changes in agarose-gel phantoms with a fiber-optic thermometer., Results: Deflection angles of the metallic dental materials were significantly larger at 7T than 3T. Among full metal crowns (FMCs), deflection angles were 18.0° for cobalt-chromium (Co-Cr) alloys, 13.5° for nickel-chromium (Ni-Cr) alloys, and 0° for other materials. Deflection angles of the dental implants and abutments were minimal, ranging from 5.0 to 6.5°, whereas the magnetic attachment keepers were strongly attracted to the field, having deflection angles of 90° or more. Increases in temperature of the FMCs were significant but less than 1°C in every sequence. The dental implant of 50-mm length showed significant but mild temperature increases (up to 1.5°C) when compared with other dental implants and abutments, particularly on sequences with high specific absorption rate values., Conclusion: Although most metallic dental materials showed no apparent translational attraction or heating at 7T, substantial attraction forces on the magnetic attachment keepers suggested potential risks to patients and research participants undergoing MR imaging examinations.

Purpose: To investigate temporal changes in brain metabolites during the first year of life in preterm infants using multivoxel proton magnetic resonance spectroscopy ((1)H-MRS)., Methods: Seventeen infants born at 29 (25-33) gestational week (median, range) weighing 1104 (628-1836) g underwent 1.5-T multivoxel (1)H-MRS at 42 postconceptional week (PCW) and at 3, 6, 9, and 12 months after. We measured N-acetyl aspartate (NAA)/creatine (Cr), choline (Cho)/Cr, myo-inositol (Ins)/Cr, NAA/Cho, and Ins/Cho ratios in the frontal lobe (FL) and basal ganglia and thalamus (BG + Th). Linear regression analyses were performed to identify longitudinal changes in infants showing normal imaging findings and normal development. We also evaluated ratios of subjects with abnormal imaging findings and/or development using the 95% confidence intervals (CIs) of regression equations in normal subjects., Results: In the 13 infants with normal development, NAA/Cr and NAA/Cho ratios showed significant positive correlations with PCWs in the FL (r = 0.64 and 0.83, respectively, both P < 0.01) and BG + Th (r = 0.79 and 0.87, respectively, both P < 0.01), while Cho/Cr and Ins/Cr ratios revealed significant negative correlations with PCWs in the FL (r =-0.69 and -0.58, respectively, both P < 0.01) and BG + Th (r =-0.74 and -0.72, respectively, both P < 0.01). Ins/Cho ratios in the FL did not significantly correlate with PCWs (r =-0.19, P = 0.18), while those in the BG + Th showed significant negative correlation with PCWs (r =-0.44, P < 0.01). The metrics in the abnormal group were within the normal group 95% CIs in all periods except a few exceptions., Conclusions: Longitudinal multivoxel MRS is able to detect temporal changes in major brain metabolites during the first year of life in preterm infants.

Neuropsychiatric systemic lupus erythematosus (NPSLE) is speculated to be caused by disturbed microcirculation of the central nervous system. However, characteristic imaging findings of NPSLE have not been established. Hence, we investigated whether high-resolution images obtained using ultrahigh field MRI at 7 T can detect microcerebrovascular lesions in patients with NPSLE that have never been detected by conventional MRI. We prospectively examined 20 patients with SLE, including five with NPSLE, using a 7 T MRI scanner. High-resolution two-dimensional T2-weighted images and high-resolution three-dimensional T1-weighted images (T1WIs) before and after the administration of contrast agents were obtained. On the high-resolution T1WIs obtained at 7 T, minute punctate/linear hyperintense lesions in subcortical and/or cortical areas were found in four (80%) NPSLE patients and one (7%) non-NPSLE patient. Further, the minute punctate enhanced lesions in these areas were found on contrast-enhanced T1WIs in only three (60%) NPSLE patients. These findings suggesting microvascular thrombi or inflammation were significantly more frequent in NPSLE than in non-NPSLE patients (P=0.001). In contrast, other imaging findings, laboratory findings, and clinical characteristics were not different between the two groups. High-resolution T1WIs obtained at 7 T can detect minute lesions, indicating intracerebral microvascular lesions in patients with NPSLE.

Purpose: We investigated sensations experienced by a large number of subjects during magnetic resonance (MR) imaging examinations using a 7-tesla scanner and slow table-feed speed., Methods: After examinations at 7T, 504 of 508 consecutive subjects completed questionnaires using an 11-point scale to rate 14 potential sensations and symptoms during table movement and stationary positioning of the table. We compared scores among the sensations and between table conditions and the mean values of the scores with those reported in previous studies and examined correlations between the scores and subject characteristics., Results: Vertigo and feelings of curving or leaning in the right or left direction during table movement were experienced frequently and markedly compared to other sensations and sensations experienced when the table was stationary (P < 0.01) and were correlated with subject age and examination time (P < 0.05). However, moderate to severe (scores of 5 to 10) vertigo and a curving/leaning feeling during table movement were noted in only 10.5% (vertigo) and 10.9% (curving/leaning) of subjects, and the mean vertigo score, 1.26, appeared to be substantially lower than that reported in a previous study. Reports of a metallic taste, nausea, and light flashes were significantly rarer and weaker than other sensations (P < 0.05)., Conclusion: Vertigo and feelings of curving during table movement were the most frequent sensations reported during MR imaging examination at 7T. However, the occurrence and severity were low and mild, presumably because of the slow table-feed speed, which suggests that most patients and volunteers found discomfort at 7T acceptable.

Purpose: The purpose of this study was to investigate whether the signal intensity of the substantia nigra pars compacta (SNc) and locus coeruleus (LC) on neuromelanin-sensitive magnetic resonance imaging (MRI) can discriminate early-stage parkinsonism disorders, for which differential diagnosis is generally difficult., Methods: Neuromelanin-sensitive MRI at 3 T was performed in 53 patients with early parkinsonism and 22 healthy controls. After an observation period of >1.5 year, the patients were clinically diagnosed with Parkinson's disease (PD; n = 30), multiple system atrophy with predominant parkinsonism (MSA-P; n = 10), or progressive supranuclear palsy syndrome (PSPS; n = 13). The signal intensity of the lateral, central, and medial parts of the SNc and the LC were measured and the contrast ratios (CR) against adjacent white-matter structures was calculated., Results: The CR of the lateral SNc was lower in the PD and MSA-P groups than in the PSPS and control groups (p = 0.0001-0.05). The CR of the LC was lower in the PD group than in the other groups (p = 0.0001-0.05). Sensitivity and specificity of the CRs for discriminating PD from MSA-P was 60% and 90%, respectively, those for PD/PSPS were 63-88% and 77-92%, respectively, and those for MSA-P/PSPS were 80% and 85%, respectively. These properties were comparable or better to MIBG scintigraphy., Conclusions: Neuromelanin-sensitive MRI can depict differences in signal intensity of the lateral SNc and the LC among the parkinsonism disorders at their early stages., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: To determine whether voxel-based morphometry of the cerebrospinal fluid (CSF) space can accurately differentiate iNPH from other related neurological disorders., Methods: Nineteen patients with surgically proven iNPH and 24 patients with Alzheimer's disease (AD), 18 patients with Parkinson's disease (PD), and 14 healthy elderlies were examined. Regions of interest (ROIs) in the ventricular/sylvian (VS) and high convexity/midline (HCM) areas were used in VBM, and differences in CSF volume within these ROIs among the 4 groups were examined., Results: The relative CSF volume in the VS-ROI in the iNPH group (.64) was significantly higher than that in the AD, PD, and healthy control groups (.26, .29, and .17, respectively; P < .001), whereas the relative CSF volume in the HCM-ROI was significantly reduced in the iNPH (.10) than in the other (.17, .16, and .16, respectively) groups (P < .001). Furthermore, the ratio of the 2 areas (VS/HCM) was markedly higher in the iNPH (6.87) than in the other (1.65, 1.74, .97, respectively) groups (P < .001), with sensitivity and specificity of .89 and 1.00, respectively., Conclusions: The VBM-based CSF space analysis can detect disproportionate changes in CSF space and differentiate iNPH patients from those with AD or PD and healthy elderlies accurately., (Copyright © 2013 by the American Society of Neuroimaging.)

Background: Atherosclerotic lesions in intracranial arteries are a leading cause of ischemic stroke. Magnetic resonance angiography (MRA) is often used to assess atherosclerotic changes by detecting luminal narrowing, whereas it cannot directly visualize atherosclerotic lesions. Here, we used a 3-dimensional vessel wall imaging (3D-VWI) technique to evaluate intracranial arterial wall changes in acute stroke., Methods: Eighteen consecutive patients with acute noncardioembolic stroke in the middle cerebral artery (MCA) territory who were prospectively examined with a 1.5-T magnetic resonance scanner were studied. T1-weighted (T1-W) 3D-VWI was obtained using a flow-sensitized 3D fast-spin echo technique. Wall thickening of MCA that suggests atherosclerotic plaques was visually evaluated and the contrast ratio (CR) of signal intensity of the lesions to that of the corpus callosum was calculated and compared with stenotic changes by MRA., Results: Wall thickenings of the MCA ipsilateral and contralateral to the lesion were observed in almost all patients on 3D-VWI (94.4% and 94.4%, respectively), whereas MRA showed stenotic changes of 50% only in 1 patient (5.9%; P < .001). The CR of the thickened wall in the ipsilateral MCA was significantly higher than that in the contralateral MCA (median, .53 and .45, respectively; P = .028), suggesting of unstable plaques consisting of hemorrhage or lipid., Conclusions: The T1-W 3D-VWI can provide direct visualization of atherosclerotic lesions of the intracranial arteries in stroke patients, and it can detect signal change suggestive of unstable plaque., (Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the performance and efficacy for intensity inhomogeneity correction of various sequences of the human brain in 7T MRI using the extended version of the unified segmentation algorithm., Materials: Ten healthy volunteers were scanned with four different sequences (2D spin echo [SE], 3D fast SE, 2D fast spoiled gradient echo, and 3D time-of-flight) by using a 7T MRI system. Intensity inhomogeneity correction was performed using the "New Segment" module in SPM8 with four different values (120, 90, 60, and 30 mm) of full width at half maximum (FWHM) in Gaussian smoothness. The uniformity in signals in the entire white matter was evaluated using the coefficient of variation (CV); mean signal intensities between the subcortical and deep white matter were compared, and contrast between subcortical white matter and gray matter was measured. The length of the lenticulostriate (LSA) was measured on maximum intensity projection (MIP) images in the original and corrected images., Results: In all sequences, the CV decreased as the FWHM value decreased. The differences of mean signal intensities between subcortical and deep white matter also decreased with smaller FWHM values. The contrast between white and gray matter was maintained at all FWHM values. LSA length was significantly greater in corrected MIP than in the original MIP images., Conclusions: Intensity inhomogeneity in 7T MRI can be successfully corrected using SPM8 for various scan sequences.

Perfusion computed tomography and perfusion-weighted magnetic resonance imaging are used to evaluate the extent of the area with ischemic penumbra; however, different parameters, algorithms, and software packages show significant discrepancies in the size of perfusion abnormalities, which should be minimized. Recently, cross-validation studies were performed using digital phantoms and have elucidated the precision and reliability of various penumbral imaging techniques. These research initiatives can promote further multicenter trials on recanalization therapies by providing accurate inclusion/exclusion criteria for appropriate patient selection., (Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Introduction: Neuromelanin-sensitive MRI has been reported to be used in the diagnosis of Parkinson's disease (PD), which results from loss of dopamine-producing cells in the substantia nigra pars compacta (SNc). In this study, we aimed to apply a 3D turbo field echo (TFE) sequence for neuromelanin-sensitive MRI and to evaluate the diagnostic performance of semi-automated method for measurement of SNc volume in patients with PD., Methods: We examined 18 PD patients and 27 healthy volunteers (control subjects). A 3D TFE technique with off-resonance magnetization transfer pulse was used for neuromelanin-sensitive MRI on a 3T scanner. The SNc volume was semi-automatically measured using a region-growing technique at various thresholds (ranging from 1.66 to 2.48), with the signals measured relative to that for the superior cerebellar peduncle. Receiver operating characteristic (ROC) analysis was performed at all thresholds. Intra-rater reproducibility was evaluated by intraclass correlation coefficient (ICC)., Results: The average SNc volume in the PD group was significantly smaller than that in the control group at all the thresholds (P < 0.01, student t test). At higher thresholds (>2.0), the area under the curve of ROC (Az) increased (0.88). In addition, we observed balanced sensitivity and specificity (0.83 and 0.85, respectively). At lower thresholds, sensitivity tended to increase but specificity reduced in comparison with that at higher thresholds. ICC was larger than 0.9 when the threshold was over 1.86., Conclusions: Our method can distinguish the PD group from the control group with high sensitivity and specificity, especially for early stage of PD.

Purpose: To design a digital phantom data set for computed tomography (CT) perfusion and perfusion-weighted imaging on the basis of the widely accepted tracer kinetic theory in which the true values of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and tracer arrival delay are known and to evaluate the accuracy and reliability of postprocessing programs using this digital phantom., Materials and Methods: A phantom data set was created by generating concentration-time curves reflecting true values for CBF (2.5-87.5 mL/100 g per minute), CBV (1.0-5.0 mL/100 g), MTT (3.4-24 seconds), and tracer delays (0-3.0 seconds). These curves were embedded in human brain images. The data were analyzed by using 13 algorithms each for CT and magnetic resonance (MR), including five commercial vendors and five academic programs. Accuracy was assessed by using the Pearson correlation coefficient (r) for true values. Delay-, MTT-, or CBV-dependent errors and correlations between time to maximum of residue function (Tmax) were also evaluated., Results: In CT, CBV was generally well reproduced (r > 0.9 in 12 algorithms), but not CBF and MTT (r > 0.9 in seven and four algorithms, respectively). In MR, good correlation (r > 0.9) was observed in one-half of commercial programs, while all academic algorithms showed good correlations for all parameters. Most algorithms had delay-dependent errors, especially for commercial software, as well as CBV dependency for CBF or MTT calculation and MTT dependency for CBV calculation. Correlation was good in Tmax except for one algorithm., Conclusion: The digital phantom readily evaluated the accuracy and characteristics of the CT and MR perfusion analysis software. All commercial programs had delay-induced errors and/or insufficient correlations with true values, while academic programs for MR showed good correlations with true values., Supplemental Material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12112618/-/DC1., (RSNA, 2012)

Introduction: Several magnetic resonance (MR) imaging techniques are used to examine atherosclerotic plaque of carotid arteries; however, the best technique for visualizing intraplaque characteristics has yet to be determined. Here, we directly compared four kinds of T1-weighted (T1W) imaging techniques with pathological findings in patients with carotid stenosis., Methods: A total of 31 patients who were candidates for carotid endarterectomy were prospectively examined using a 1.5-T MRI scanner, which produced four kinds of T1W images, including non-gated spin echo (SE), cardiac-gated black-blood (BB) fast-SE (FSE), magnetization-prepared rapid acquisition with gradient echo (MPRAGE), and source image of three-dimensional time-of-flight MR angiography (SI-MRA). The signal intensity of the carotid plaque was manually measured, and the contrast ratio (CR) against the adjacent muscle was calculated. CRs from the four imaging techniques were compared to each other and correlated with histopathological specimens., Results: CRs of the carotid plaques mainly containing fibrous tissue, lipid/necrosis, and hemorrhage were significantly different with little overlaps (range: 0.92-1.15, 1.22-1.52, and 1.55-2.30, respectively) on non-gated SE. However, BB-FSE showed remarkable overlaps among the three groups (0.89-1.10, 1.07-1.23, and 1.01-1.42, respectively). MPRAGE could discriminate fibrous plaques from hemorrhagic plaques but not from lipid/necrosis-rich plaques: (0.77-1.07, 1.45-2.43, and 0.85-1.42, respectively). SI-MRA showed the same tendencies (1.01-1.39, 1.45-2.57, and 1.12-1.39, respectively)., Conclusion: Among T1W MR imaging techniques, non-gated SE images can more accurately characterize intraplaque components in patients who underwent CEA when compared with cardiac-gated BB-FSE, MPRAGE, and SI-MRA images.

The five questions answered in this article revolve around the different parameters resulting from perfusion imaging processing, and this clarifies the frequently confusing terminology used to describe these parameters. More specifically, the article discusses the different imaging techniques and main mathematical models behind perfusion imaging, reviews the perfusion attributes of brain tissue, and proposes a standardized parameter terminology to facilitate understanding and avoid common misinterpretations.

Introduction: Cilostazol, an antiplatelet agent, is reported to induce the regression of atherosclerotic changes. However, its effects on carotid plaques are unknown. Hence, we quantitatively investigated the changes that occur within carotid plaques during cilostazol administration using three-dimensional (3D) ultrasonography (US) and non-gated magnetic resonance (MR) plaque imaging., Methods: We prospectively examined 16 consecutive patients with carotid stenosis. 3D-US and T1-weighted MR plaque imaging were performed at baseline and 6 months after initiating cilostazol therapy (200 mg/day). We measured the volume and grayscale median (GSM) of the plaques from 3D-US data. We also calculated the contrast ratio (CR) of the carotid plaque against the adjacent muscle and areas of the intraplaque components: fibrous tissue, lipid, and hemorrhage components., Results: The plaque volume on US decreased significantly (median at baseline and 6 months, 0.23 and 0.21 cm(3), respectively; p = 0.03). In the group exhibiting a plaque volume reduction of more than 10%, GSM on US increased significantly (24.8 and 71.5, respectively; p = 0.04) and CR on MRI decreased significantly (1.13 and 1.04, respectively; p = 0.02). In this group, in addition, the percent area of the fibrous component on MRI increased significantly (68.6% and 79.4%, respectively; p = 0.02), while those of the lipid and hemorrhagic components decreased (24.9% and 20.5%, respectively; p = 0.12) (1.0% and 0.0%, respectively; p = 0.04). There were no substantial changes in intraplaque characteristics in either US or MRI in the other group., Conclusions: 3D-US and MR plaque imaging can quantitatively detect changes in the size and composition of carotid plaques during cilostazol therapy.

The introduction of ultrahigh-field MRI at 7 tesla (7T) has increased the interest in the use of neuroimaging techniques in clinical research. The high signal-to-noise ratio and profound susceptibility effect at 7T can remarkably improve the spatial resolution and image contrast of structural imaging, susceptibility imaging, and functional imaging techniques, whereas the heating effects of the radio frequency and the inhomogeneities of the local magnetic field can have substantial negative effects on parameter setting, acquisition time, and image quality. T1 prolongation at 7T can improve the enhancement effects of gadolinium agents and the inflow effects on MR angiography and arterial spin labeling. Ultrahigh-field MRI is expected to have a high clinical impact in the near future; however, further technological advances tailored to ultrahigh-field systems as well as the accumulation of scientific evidence will be needed to establish its clinical significance.

A delay-insensitive probabilistic method for estimating hemodynamic parameters, delays, theoretical residue functions, and concentration time curves by computed tomography (CT) and magnetic resonance (MR) perfusion weighted imaging is presented. Only a mild stationarity hypothesis is made beyond the standard perfusion model. New microvascular parameters with simple hemodynamic interpretation are naturally introduced. Simulations on standard digital phantoms show that the method outperforms the oscillating singular value decomposition (oSVD) method in terms of goodness-of-fit, linearity, statistical and systematic errors on all parameters, especially at low signal-to-noise ratios (SNRs). Delay is always estimated sharply with user-supplied resolution and is purely arterial, by contrast to oSVD time-to-maximum TMAX that is very noisy and biased by mean transit time (MTT), blood volume, and SNR. Residue functions and signals estimates do not suffer overfitting anymore. One CT acute stroke case confirms simulation results and highlights the ability of the method to reliably estimate MTT when SNR is low. Delays look promising for delineating the arterial occlusion territory and collateral circulation.

Purpose: To develop a map to detect changes in oxygen extraction fraction (OEF) utilizing susceptibility-weighted (SW) phase images and to correlate such changes in OEF with those in cerebral blood flow (CBF)., Materials and Methods: The study protocol was approved by the institutional review board, and written informed consent was obtained from all subjects. Eight healthy volunteers (mean age ± standard deviation, 29.8 years ± 4.6) were included in the study. Subjects were evaluated by using SW imaging, and the change in OEF was calculated by subtracting the image at baseline from one of the images obtained during six different conditions, including two at resting state, three different types of respiratory challenges, and one drug challenge with acetazolamide. Arterial spin labeling was carried out to measure CBF, while SW imaging was used to generate maps of change in OEF in response to a given condition. Statistical tests included one-way analysis of variance and Dunnett multiple comparisons to compare among the six conditions the magnitude of change from baseline for both OEF and CBF, by using the OEF change at resting state (resting 1) as the control., Results: Hyperventilation caused a statistically significant decrease in CBF (-29.3%, P < .001) and an increase in OEF (+5.2%, P < .001) compared with the control, resting 1 (+2.2%, -0.7%, respectively). Acetazolamide caused a significant increase in CBF (+39.7%, P < .001) and a decrease in OEF (-3.4%, P = .040). Carbogen also induced a CBF increase (+16.2%); however, the change was not significant (P = .090), even though OEF decreased significantly (-4.2%, P = .003). Oxygen administration resulted in a significant CBF decrease (-27.2%, P < .001), whereas OEF showed no significant difference (-0.6%, P > .99)., Conclusion: Maps of changes in OEF generated from SW phase images revealed changes in OEF corresponding to anticipated changes in CBF induced by various conditions; SW phase imaging might, in the future, be applied to evaluate cerebrovascular and other cerebral disorders in which changes in oxygen metabolism are important for planning therapeutic strategies., (© RSNA, 2011.)

By optimizing thresholds, we identified the perfusion-weighted magnetic resonance imaging (PWI) parameters that accurately predict final infarct volume and neurologic outcome in a primate model of permanent middle cerebral artery (MCA) occlusion. Ten cynomolgus monkeys underwent PWI and diffusion-weighted imaging (DWI) at 3 and 47 hours, respectively, after right MCA occlusion using platinum coils, and were killed at 48 hours. Volumes of the hypoperfused areas on PWI were automatically measured using different thresholds and 11 parametric maps to determine the optimum threshold (at which least difference was found between the average volumes on PWI and those determined using specimens or DWI). In the case of arrival time (AT), cerebral blood volume (CBV), time to peak (TTP), time to maximum (T(max)), and cerebral blood flow (CBF) determined using deconvolution techniques, the volume of the hypoperfused area significantly correlated with the infarct volumes and the neurologic deficit scores with small variations, whereas in the case of mean transit time and nondeconvolution CBF, relatively poor correlations with large variations were seen. At optimum threshold, AT, CBV, TTP, T(max), and deconvolution CBF can accurately predict the final infarct volume and neurologic outcome in monkeys with permanent MCA occlusion.

Purpose: Susceptibility-weighted (SW) imaging is a magnetic resonance (MR) imaging technique reported effective in visualizing multiple sclerosis (MS) plaques, but its capacity to distinguish active plaques remains unclear. We evaluated active plaque detection by SW compared with contrast-enhanced MR imaging., Methods: We prospectively examined 11 patients using a 3-tesla scanner. Two neuroradiologists independently evaluated signal changes of plaques and accompanying low signal rims in 74 plaques on various SW images (magnitude, phase, and minimum intensity projection [minIP]), and on contrast-enhanced T(1)-weighted images (T(1)WI). We correlated signal alterations on various SW images and contrast enhancement on T(1)WI using Fisher's exact test and calculated sensitivity and specificity for predicting gadolinium enhancement., Results: Only changes in plaque signal on SW magnitude images correlated significantly with contrast enhancement of the plaques (P=0.008), and high signal intensity had 0.556 sensitivity and 0.787 specificity for predicting contrast-enhanced plaques. Furthermore, plaques with rims of low signal showed sensitivity of 0.296 and specificity of 0.957., Conclusions: Susceptibility-weighted magnitude, but not phase or minIP, images can predict MS plaques with contrast enhancement with high specificity.

We performed magnetic resonance angiography (MRA) and susceptibility-weighted imaging (SWI) to observe cerebral changes during a migraine attack in a 28-year-old man. MRA revealed regional arterial spasm, and findings of SWI were consistent with decreased blood flow and/or venous dilatation. Because these noninvasive techniques can be performed repeatedly at short intervals, they can be useful for evaluating hemodynamic changes during and after migraine attacks.

Introduction: Chronic neuropsychiatric symptoms after carbon monoxide (CO) poisoning are caused by demyelination of cerebral white matter fibers. We examined whether diffusion tensor imaging can sensitively represent damage to fibers of the centrum semiovale in the subacute phase after CO intoxication., Methods: Subjects comprised 13 adult patients with CO poisoning, classified into three groups according to clinical behaviors: group A, patients with transit acute symptoms only; group P, patients with persistent neurological symptoms; and group D, patients with "delayed neuropsychiatric sequelae" occurring after a lucid interval. Median fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the centrum semiovale bilaterally at 2 weeks were compared between these groups and a control group of ten healthy volunteers. Myelin basic protein (MBP) concentration in cerebrospinal fluid was examined at 2 weeks to evaluate the degree of demyelination in patients., Results: MBP concentration was abnormal or detectable for all group P and group D patients but was undetectable for all patients assigned to group A. Low FA values in groups P and D displaying chronic neurological symptoms clearly differed from those in controls and group A without chronic neurological symptoms, but ADC showed no significant differences between patient groups., Conclusions: MBP concentration at 2 weeks after CO inhalation confirmed a certain extent of demyelination in the central nervous system of patients who would develop chronic neurological symptoms. In these patients, FA sensitively represented damage to white matter fibers in the centrum semiovale in the subacute phase after CO intoxication.

Introduction: We attempted to detect alterations in the cerebrospinal fluid (CSF) space in patients with idiopathic normal pressure hydrocephalus (iNPH) using voxel-based morphometry (VBM)., Methods: We obtained sagittal volume images of the entire head by three-dimensional T1-weighted magnetic resonance imaging and compared the regional distribution of CSF in 12 patients with iNPH, 14 patients with Alzheimer's disease (AD), and 17 healthy individuals using VBM with automatically extracted CSF objects., Results: VBM demonstrated significant widening at the lateral ventricles and Sylvian fissures and narrowing of the CSF space at the high convexity/midline areas in iNPH patients, compared to the AD patients and healthy controls (p < 0.05, after correction with a false-discovery rate). In addition, the ratio of the CSF volume in the lateral ventricle/Sylvian fissure area to that in the high convexity/midline area in iNPH patients (3.9 +/- 1.2) was remarkably greater than that in AD patients (1.2 +/- 0.3) and controls (0.9 +/- 0.3; one-way ANOVA, p < 0.001; post hoc Tukey's test, p < 0.001); we could discriminate iNPH patients from those in the other two groups without any overlap, when using a cutoff level of 1.9., Conclusion: VBM using CSF objects can be used to delineate the characteristic alteration of the CSF space in iNPH patients, which has been evaluated by visual interpretation.

Structural magnetic resonance imaging has potential pitfalls that can interfere with the accurate interpretation of common central nervous system disorders. With regard to asymptomatic brain lesions in the elderly, lacunar infarction is differentiated from white matter hyperintensity and dilated perivascular space by using an appropriate combination of imaging techniques and interpretation criteria in the Guidelines for Detection of Asymptomatic Brain Diseases. Compared with non-contrast computed tomography (CT), diffusion-weighted imaging (DWI) can clearly depict early ischemic changes in patients with acute ischemic stroke; however, in order to ensure that normal structures are not misinterpreted as lesions and faint lesions are not overlooked, the display conditions, i.e., the window level and width, of DWI should be standardized. Further, when the findings of CT and DWI show a substantial discrepancy in terms of early ischemic changes, it has not been confirmed whether DWI or CT is more reliable for determining the thrombolytic therapy to be employed. Proton-density weighted imaging and fluid-attenuated inversion recovery imaging can detect subtle subarachnoid hemorrhage (SAH) that is unclear on non-contrast CT images. However, these 2 techniques may cause artifacts in which the signal intensity of the subarachnoid space is increased and a false diagnosis of SAH can be obtained under certain inappropriate scanning parameters, which should be avoided.

Introduction: Magnetic resonance (MR) plaque imaging for carotid arteries is usually performed by using an electrocardiograph (ECG)-gating technique to eliminate pulsation-related artifacts, which can affect the plaque signals because of varied repetition time (TR) among patients. Hence, we investigated whether differences in TR causes signal alterations of the carotid plaque by using a non-gated plaque imaging technique., Methods: We prospectively examined 19 patients with carotid stenosis by using a T1-weighted self-navigated radial-scan technique with TRs of 500, 700, and 900 ms. The signal intensity of the carotid plaque was measured, and the contrast ratio (CR) relative to the adjacent muscle was calculated., Results: CRs of the carotid plaques were 1.39 +/- 0.39, 1.29 +/- 0.29, and 1.23 +/- 0.24 with TRs of 500, 700, and 900 ms, respectively, and were significantly different. Among the plaques, those with a hyperintensity signal (CR > 1.5) and moderate-intensity signal (CR 1.2-1.5) at 500 ms showed a TR-dependent signal decrease (hyperintensity plaques, 1.82 +/- 0.26; 1.61 +/- 0.19; and 1.48 +/- 0.17; moderate-intensity plaques, 1.33 +/- 0.08; 1.26 +/- 0.08; and 1.19 +/- 0.07), while those with an isointensity signal (CR < 1.2) remained unchanged regardless of TR (0.96 +/- 0.12, 0.96 +/- 0.11, and 0.97 +/- 0.13)., Conclusion: The signal intensity of the carotid plaque on T1-weighted imaging significantly varies among different TRs and tends to decrease with longer TR. MR plaque imaging with short and constant TR settings that the ECG-gating method cannot realize would be preferable for evaluating plaque characteristics.

Purpose: To evaluate the efficacy of susceptibility-weighted (SW) magnetic resonance (MR) imaging for the assessment of the posttreatment change in oxygen saturation in the draining vein in patients with spinal arteriovenous malformation (AVM)., Materials and Methods: The study protocol was approved by the institutional review board, and written informed consent was obtained from all subjects. SW imaging was performed in 11 patients with spinal AVM before and after surgical or endovascular treatment. Eleven healthy subjects were included as a control group. A four-grade response scale was used for the visual assessment of the anterior spinal vein (ASV). For quantitative analysis, the phase value of the ASV was measured and oxygen saturation was calculated. Nonparametric multigroup comparison for visual assessment and one-way analysis of variance for quantitative measurement of oxygen saturation were used as statistical tests for comparison among three groups (pretreatment patients, posttreatment patients, and control subjects)., Results: Complete shunt occlusion in all patients was confirmed by using conventional angiography. For visual assessment, the average score of the pretreatment group was significantly less than that of the posttreatment and control groups. For quantitative analysis, the average oxygen saturation of the pretreatment group was significantly higher than that of the posttreatment and control groups, while no significant difference was observed between the posttreatment and control groups., Conclusion: After treatment, normalization of increased oxygen saturation was noninvasively observed by using SW imaging in patients with spinal AVM. SW imaging can be a useful tool for the assessment of treatment efficacy in patients with spinal AVM. (c) RSNA, 2010.

Introduction: Fast spin-echo (FSE) T1-weighted (T1W) magnetic resonance imaging (MRI) at 3T, which is sensitive to neuromelanin-related contrast, can quantitatively detect signal alterations in the locus ceruleus (LC) and the substantia nigra pars compacta (SNc) of depressive and schizophrenic patients; however, its qualitative diagnostic performance remains unknown. We investigated whether visual interpretation of semiquantitative color maps can be used for discriminating between depressive and schizophrenic patients and healthy individuals., Methods: We retrospectively examined 23 patients with major depression, 23 patients with schizophrenia, and 23 age-matched healthy controls by using a FSE-T1W MRI technique. Semiquantitative color maps of sections through the LC and SNc were visually interpreted by nine raters using a continuous confidence rating scale for receiver operating characteristic (ROC) analysis., Results: The area under the ROC curve (Az), which reflects the performance in differentiating between depressive patients and controls, was 0.88, and the sensitivity and specificity at the maximum likelihood were 76% and 83%, respectively. In contrast, the Az value, sensitivity, and specificity values between schizophrenics and controls and between depressives and schizophrenics were 0.66 and 0.69, 42% and 48%, and 82% and 84%, respectively., Conclusion: Semiquantitative, color-coded FSE-T1W MRI at 3T can be used for visually differentiating depressive patients from healthy individuals with a substantially high likelihood, but this technique cannot be applied to distinguish schizophrenic patients from the other two groups.

Purpose: To evaluate the visualization of the spinal veins using susceptibility-weighted imaging (SWI)., Materials and Methods: A 1.5-T magnet equipped with a spine matrix coil was used. Axial SWI scans of 20 healthy volunteers were obtained with a three-dimensional fast low-angle shot (3D-FLASH) sequence. Maximum intensity projection (MIP) of the phase images were reconstructed and five MIP images (at the levels of T11, T11/12, T12, T12/L1, and L1) were selected for the evaluation. The anterior median vein (AMV), posterior median vein (PMV), anterior radiculomedullary vein (ARV), posterior radiculomedullary vein (PRV), and sulcal vein (SV) were evaluated using a 4-grade scale (0, none; 1, weak; 2, moderate; and 3, prominent)., Results: The AMV was detected in all the subjects (100%). The detection rates of the other veins were lower: PMV, 65%; right ARV, 45%; left ARV, 15%; right PRV, 10%; left PRV, 30%; and SV, 0%. The average scores for AMV, PMV, right ARV, left ARV, right PRV, left PRV, and SV were 0.98, 0.24, 0.20, 0.08, 0.08, 0.14, and 0, respectively., Conclusion: SWI of the spine is feasible. The extrinsic spinal veins can be visualized by SWI without using contrast materials., ((c) 2009 Wiley-Liss, Inc.)

A 40-year-old man, who had been diagnosed with stage 2 pulmonary sarcoidosis, was referred to our hospital for further evaluation of dyspnea and cardiac function. The echocardiogram displayed thinning of the basal interventricular septum (IVS) and a reduced ejection fraction of 21%. Contrast-enhanced cardiac high resolution MRI (3 tesla) showed patchy subepicardial late gadolinium enhancement in the IVS, and anterior and lateral walls. There was no abnormality in the coronary angiography and the cardiac biopsy showed several small and well-defined noncaseating epithelioid granulomas. The granulomas contained multinucleated giant cells and asteroid bodies (a typical finding of sarcoidosis). Late gadolinium enhancement in high resolution MRI provided information on the pathophysiological condition of cardiac sarcoidosis very clearly, because 3 of 5 samples of endomyocardial biopsy from the septal wall of the right ventricle where late gadolinium enhancement was detected had positive findings for cardiac sarcoidosis (very high rate). These findings indicate that high resolution late gadolinium enhanced MRI might be very useful as a guide for endomyocardial biopsy in patients with cardiac sarcoidosis.

By using high-resolution, conventional, and neuromelanin-sensitive magnetic resonance imaging techniques, we reviewed the normal anatomy of the nuclei consisting of monoamine neurons such as dopaminergic, noradrenergic, and serotoninergic neurons and noted the changes in these nuclei that occur in some degenerative and psychiatric disorders. Multimodal MR images can directly or indirectly help in identifying the substantia nigra, locus ceruleus, and raphe nuclei that contain monoamine neurons. Neuromelanin-sensitive magnetic resonance imaging can detect signal alterations in the substantia nigra pars compacta and/or locus ceruleus that occur in Parkinson's disease and psychiatric disorders such as depression and schizophrenia. This technique seems to be promising for the noninvasive evaluation of the pathological or functional changes in the monoamine system that occur in degenerative and psychiatric disorders.

Introduction: We attempted to determine the most appropriate combination of magnetic resonance (MR) images that can accurately detect and discriminate between asymptomatic infarction and deep white matter hyperintensity (DWMH); these lesions have different clinical implications and are occasionally confused., Materials and Methods: We performed an observer performance analysis using cerebral MR images of 45 individuals with or without asymptomatic small white matter infarction and/or mild DWMH who participated in a physical checkup program at four institutions. Six observers interpreted whether infarction and/or DWMH existed in combinations of two or three image types of the T1-weighted images (T1WI), T2-weighted images (T2WI), and fluid-attenuated inversion recovery (FLAIR) images. The observers' performance was evaluated with a receiver operating characteristic (ROC) analysis., Results: The averaged area under the ROC curve (Az) for detecting a infarction was significantly larger in the combination of all the three image types (0.95) than that in any combinations of the two image types (T1WI and FLAIR images, 0.87; T2WI and FLAIR images, 0.85; T1WI and T2WI, 0.86). The Az for detecting DWMH was significantly smaller in the combination of T1WI and T2WI (0.79) than that in other image combinations (T1WI and FLAIR, 0.89; T2WI and FLAIR, 0.91; T1WI, T2WI, and FLAIR, 0.90)., Conclusion: The combination of T1WI, T2WI, and FLAIR images is required to accurately detect both small white matter infarction and mild DWMH.

Background: We investigated alterations in the substantia nigra pars compacta (SNc) and locus ceruleus (LC) in schizophrenic and depressive patients by using a neuromelanin-sensitive magnetic resonance imaging (MRI) technique that enables direct visualization of these nuclei and examined whether this technique could distinguish between these disorders and healthy subjects., Methods: Using a neuromelanin-sensitive T1-weighted MRI technique, we examined 20 schizophrenia patients, 18 depressive patients, and 34 healthy control subjects. The signal intensities of the areas corresponding to the SNc and LC were measured, and the contrast ratios (CR) to the adjacent white matter were calculated., Results: The CR of the SNc was significantly higher in schizophrenic patients (22.6 +/- 5.6) than in depressive patients (19.2 +/- 4.7) and healthy control subjects (19.6 +/- 3.8), whereas the CR of the LC in depressive patients (7.7 +/- 2.4) was significantly lower than that in healthy control subjects (11.0 +/- 3.9) and schizophrenic patients (10.0 +/- 3.1). Further, the difference in the CR between the SNc and LC was significantly greater in schizophrenic patients (12.6 +/- 6.7) than in control subjects (8.6 +/- 4.1)., Conclusions: Neuromelanin-sensitive MRI enables visualization of alterations in the SNc and LC that are observed in schizophrenia and depression.

Introduction: The aim of this study was to determine the performance of axial and coronal magnetic resonance imaging (MRI) in detecting the narrowing of the cerebrospinal fluid (CSF) space at the high convexity and high midline areas, which is speculated to be one of the clinical characteristics of idiopathic normal pressure hydrocephalus (iNPH)., Methods: We retrospectively examined axial and coronal T1-weighted images of 14 iNPH patients and 12 age-matched controls. The narrowness of the CSF space at the high convexity/midline was blindly evaluated by five raters using a continuous confidence rating scale for receiver operating characteristic (ROC) analysis., Results: Axial and coronal imaging accurately determined the presence of the narrow cisterns/sulci at the high convexity/midline and was capable of predicting probable/definite iNPH with a high degree of accuracy. there were also no significant differences in the detection of this finding between the axial and coronal images., Conclusion: Both axial and coronal T1-weighted MRI can detect the narrow CSF space at the high convexity/midline accurately and may therefore facilitate clinicians in choosing a management strategy for iNPH patients.