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Objective: Using surface-based morphometry we aimed to provide a detailed examination of cortical alterations in medication-overuse headache (MOH), by disentangling between altered cortical thickness and gyrification (folding)., Background: In MOH, pain modulation is probably dysfunctional at the cortical and subcortical level, resulting in a disequilibrium between pain inhibition and facilitation. Both increased and decreased cortical volumes have been reported in individuals with MOH. There is however no detailed examination to date that distinguishes between altered cortical thickness and gyrification. Such distinction would help to identify the nature and timing of neurodevelopmental mechanisms at play in affected individuals., Methods: We investigated cortical thickness and gyrification in 29 patients with MOH according to International Headache Society criteria and 29 age- and gender-matched controls, using high-resolution structural MRIs of the brain analyzed with FreeSurfer. This is a secondary analysis of data from a previously published voxel-based morphometry study., Results: In patients with MOH compared to controls, reduced cortical thickness was observed in the left prefrontal cortex. We also observed higher local gyrification in one cluster extending from the fusiform cortex to adjacent medial temporal regions, and in another cluster in the right occipital pole. Higher gyrification in the right occipital pole predicted poor response after detoxification., Conclusions: Corroborating previous volumetric results, our study adds information on the putative neurobiological mechanisms involved in MOH, suggesting neurodevelopmental changes in MOH., (© 2016 American Headache Society.)

Self-control is key to success in life. Initial acts of self-control temporarily impair subsequent self-control performance. Why such self-control failures occur is unclear, with prominent models postulating a loss of a limited resource vs a loss of motivation, respectively. Here, we used functional magnetic resonance imaging to identify the neural correlates of motivation-induced benefits on self-control. Participants initially exerted or did not exert self-control. In a subsequent Stroop task, participants performed worse after exerting self-control, but not if they were motivated to perform well by monetary incentives. On the neural level, having exerted self-control resulted in decreased activation in the left inferior frontal gyrus. Increasing motivation resulted in a particularly strong activation of this area specifically after exerting self-control. Thus, after self-control exertion participants showed more prefrontal neural activity without improving performance beyond baseline level. These findings suggest that impaired performance after self-control exertion may not exclusively be due to a loss of motivation., (© The Author (2016). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.)

Traumatic spinal cord injury (SCI) has been shown to trigger structural atrophic changes within the spinal cord and brain. However, the relationship between structural changes and magnitude of neuropathic pain (NP) remains incompletely understood. Voxel-wise analysis of anatomical magnetic resonance imaging data provided information on cross-sectional cervical cord area and volumetric brain changes in 30 individuals with chronic traumatic SCI and 31 healthy controls. Participants were clinically assessed including neurological examination and pain questionnaire. Compared to controls, individuals with SCI exhibited decreased cord area, reduced grey matter (GM) volumes in anterior cingulate cortex (ACC), left insula, left secondary somatosensory cortex, bilateral thalamus, and decreased white matter volumes in pyramids and left internal capsule. The presence of NP was related with smaller cord area, increased GM in left ACC and right M1, and decreased GM in right primary somatosensory cortex and thalamus. Greater GM volume in M1 was associated with amount of NP. Below-level NP-associated structural changes in the spinal cord and brain can be discerned from trauma-induced consequences of SCI. The directionality of these relationships reveals specific changes across the neuroaxis (i.e., atrophic changes versus increases in volume) and may provide substrates of underlying neural mechanisms in the development of NP.

Objectives: To establish age- and sex-dependent values of magnetic resonance (MR) liver fat-signal fraction (FSF) in healthy volunteers with normal body-mass index (BMI)., Methods: 2-point mDIXON sequences (repetition time/echo time, 4.2msec/1.2msec, 3.1msec) at 3.0 Tesla MR were acquired in 80 healthy volunteers with normal BMI (18.2 to 25.7 kg/m2) between 20 and 62 years (10 men/10 women per decade). FSF was measured in 5 liver segments (segment II, III, VI, VII, VIII) based on mean signal intensities in regions of interest placed on mDIXON-based water and fat images. Multivariate general linear models were used to test for significant differences between BMI-corrected FSF among age subgroups. Pearson and Spearman correlations between FSF and several body measures were calculated., Results: Mean FSF (%) ± standard deviations significantly differed between women (3.91 ± 1.10) and men (4.69 ± 1.38) and varied with age for women/men (p-value: 0.002/0.027): 3.05 ± 0.49/3.74 ± 0.60 (age group 20-29), 3.75 ± 0.66/4.99 ± 1.30 (30-39), 4.76 ± 1.16/5.25 ± 1.97 (40-49) and 4.09 ± 1.26/4.79 ± 0.93 (50-62). FSF differences among age subgroups were significant for women only (p = 0.003)., Conclusions: MR-based liver fat content is higher in men and peaks in the fifth decade for both genders.

Unlabelled: The aim of this paper is to inform physicians, especially radiologists and cardiologists, about the technical and electrophysiological background of MR imaging of patients with implanted cardiac pacemakers (PM) and to provide dedicated clinical practice guidelines how to perform MR exams in this patient group. The presence of a conventional PM system is not any more considered an absolute contraindication for MR imaging. The prerequisites for MR imaging on pacemaker patients include the assessment of the individual risk/benefit ratio as well as to obtain full informed consent about the off label character of the procedure and all associated risks. Furthermore the use of special PM-related (e.g. re-programming of the PM) and MRI-related (e.g. limitation of whole body SAR to 2 W/kg) precautions is required and needs to be combined with adequate monitoring during MR imaging using continuous pulsoximetry. MR conditional PM devices are tested and approved for the use in the MR environment under certain conditions, including the field strength and gradient slew rate of the MR system, the maximum whole body SAR value and the presence of MR imaging exclusion zones. Safe MR imaging of patients with MR conditional PM requires the knowledge of the specific conditions of each PM system. If MR imaging within these specific conditions cannot be guaranteed in a given patient, the procedure guidelines for conventional PM should be used. The complexity of MR imaging of PM patients requires close cooperation of radiologists and cardiologists., Key Points: Conventional pacemaker systems are no longer an absolute but rather a relative contraindication for performing an MR examination. The procedural management of conventional pacemaker includes the assessment of the individual risk/benefit ratio, comprehensive patient informed consent about specific related risks and "off label" use, extensive PM- and MRI-related safety precautions as well as adequate monitoring techniques during the MR exam. Decisive for patient safety are precise understanding of, and compliance with, the terms of use for the specific MR-conditional pacemaker system. If the electrophysiological and MRI-specific conditions for use of MR-conditional pacemakers are not met or compliance with these conditions for use cannot be guaranteed, the device must be treated like a conventional pacemaker., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: To investigate the technical feasibility of whole-body intravoxel incoherent motion (IVIM) imaging., Materials and Methods: Whole-body MR images of eight healthy volunteers were acquired at 3T using a spin-echo echo-planar imaging sequence with eight b-values. Coronal parametrical whole-body maps of diffusion (D), pseudodiffusion (D*), and the perfusion fraction (Fp) were calculated. Image quality was rated qualitatively by two independent radiologists, and inter-reader reliability was tested with intra-class correlation coefficients (ICCs). Region of interest (ROI) analysis was performed in the brain, liver, kidney, and erector spinae muscle., Results: Depiction of anatomic structures was rated as good on D maps and good to fair on D* and Fp maps. Exemplary mean D (10(-3) mm(2)/s), D* (10(-3) mm(2)/s) and Fp (%) values (± standard deviation) of the renal cortex were as follows: 1.7 ± 0.2; 15.6 ± 6.5; 20.9 ± 4.4. Inter-observer agreement was "substantial" to "almost perfect" (ICC = 0.80 - 0.92). The coefficient of variation of D* was significantly lower with the proposed algorithm compared to the conventional algorithm (p < 0.001), indicating higher stability., Conclusion: The proposed IVIM protocol allows computation of parametrical maps with good to fair image quality. Potential future clinical applications may include characterization of widespread disease such as metastatic tumours or inflammatory myopathies., Key Points: • IVIM imaging allows estimation of tissue perfusion based on diffusion-weighted MRI. • In this study, a clinically suitable whole-body IVIM algorithm is presented. • Coronal parametrical whole-body maps showed good depiction of anatomic details. • Potential future applications include detection of widespread metastatic or inflammatory disease.

Objective: To evaluate metal artifacts induced by biodegradable magnesium--a new class of degradable biomaterial that is beginning to enter the orthopedic routine--on CT and MRI compared to standard titanium and steel controls., Methods: Different pins made of titanium, stainless steel, and biodegradable magnesium alloys were scanned using a second-generation dual-energy multidetector CT and a 1.5-T MR scanner. In CT, quantitative assessment of artifacts was performed by two independent readers by measuring the noise in standardized regions of interest close to the pins. In MRI, the artifact diameter was measured. Interobserver agreement was evaluated using intraclass correlation coefficients. Artifacts were compared using Mann Whitney U tests., Results: In comparison to stainless steel, biodegradable magnesium alloys induced significantly fewer artifacts in both 1.5-T MRI (p = 0.019-0.021) and CT (p = 0.003-0.006). Compared to titanium, magnesium induced significantly less artifact-related noise in CT (p = 0.003-0.008). Although artifacts were less on MRI for biodegradable magnesium compared to titanium, this result was not statistically significant., Conclusion: Biodegradable magnesium alloys induce substantially fewer artifacts in CT compared to standard titanium and stainless steel, and fewer artifacts in MRI for the comparison with stainless steel.

Besides the benefit of combining electroencephalography (EEG) and magnetic resonance imaging (MRI), much effort has been spent to develop algorithms aimed at successfully cleaning the EEG data from MRI-related gradient and ballistocardiological artifacts. However, there are also studies showing a negative influence of the EEG on MRI data quality. Therefore, in the present study, we focused for the first time on the influence of the EEG on morphometric measurements of T1-weighted MRI data (voxel- and surfaced-based morphometry). Here, we demonstrate a strong influence of the EEG on cortical thickness, surface area, and volume as well as subcortical volumes due to local EEG-related inhomogeneities of the static magnetic (B0) and the gradient field (B1). In a second step, we analyzed the signal-to-noise ratios for both the anatomical and the functional data when recorded simultaneously with EEG and MRI and compared them to the ratios of the MRI data without simultaneous EEG measurements. These analyses revealed consistently lower signal-to-noise ratios for anatomical as well as functional MRI data during simultaneous EEG registration. In contrast, further analyses of T2*-weighted images provided reliable results independent of whether including the individuals' T1-weighted image with or without the EEG cap in the fMRI preprocessing stream. Based on our findings, we strongly recommend against using the structural images obtained during simultaneous EEG-MRI recordings for further anatomical data analysis., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The biomarker potential of the inhibitory neurotransmitter γ-aminobutyric acid (GABA) for the in vivo characterization of preclinical stages in Alzheimer's disease has not yet been explored. We measured GABA, glutamate + glutamine (Glx), and N-acetyl-aspartate (NAA) levels by single-voxel MEGA-PRESS magnetic resonance spectroscopy in the posterior cingulate cortex of 21 elderly subjects and 15 patients with amnestic mild cognitive impairment. Participants underwent Pittsburgh Compound B positron emission tomography, apolipoprotein E (APOE) genotyping, and neuropsychological examination. GABA, Glx, and NAA levels were significantly lower in patients. NAA was lower in Pittsburgh Compound B-positive subjects and APOE ε4 allele carriers. GABA, Glx, and NAA levels were positively correlated to CERAD word learning scores. Reductions in GABA, Glx, and NAA levels may serve as metabolic biomarkers for cognitive impairment in amnestic mild cognitive impairment. Because GABA and Glx do not seem to reflect amyloid β deposition or APOE genotype, they are less likely biomarker candidates for preclinical Alzheimer's disease., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Introduction: Diffusion kurtosis imaging (DKI) is based on a non-Gaussian diffusion model that should inherently better account for restricted water diffusion within the complex microstructure of most tissues than the conventional diffusion-weighted imaging (DWI), which presumes Gaussian distributed water molecule displacement probability. The aim of this investigation was to test the technical feasibility of in vivo whole-body DKI, probe for organ-specific differences, and compare whole-body DKI and DWI results., Materials and Methods: Eight healthy subjects underwent whole-body DWI on a clinical 3.0 T magnetic resonance imaging system. Echo-planar images in the axial orientation were acquired at b-values of 0, 150, 300, 500, and 800 mm²/s. Parametrical whole-body maps of the diffusion coefficient (D), the kurtosis (K), and the traditional apparent diffusion coefficient (ADC) were generated. Goodness of fit was compared between DKI and DWI fits using the sums of squared residuals. Data groups were tested for significant differences of the mean by paired Student t tests., Results: Good-quality parametrical whole-body maps of D, K, and ADC could be computed. Compared with ADC values, D values were significantly higher in the cerebral gray matter (by 30%) and white matter (27%), renal cortex (23%) and medulla (21%), spleen (101%), as well as erector spinae muscle (34%) (each P value <0.001). No significant differences between D and ADC were found in the cerebrospinal fluid (P = 0.08) and in the liver (P = 0.13). Curves of DKI fitted the measurement points significantly better than DWI curves did in most organs., Conclusions: Whole-body DKI is technically feasible and may reflect tissue microstructure more meaningfully than whole-body DWI.

Eight decades after Penfield's discovery of the homunculus only sparse evidence exists on the cortical representation of the lumbar spine. The aim of our investigation was the description of the lumbar spine's cortical representation in healthy subjects during the application of measured manual pressure. Twenty participants in the prone position were investigated during functional magnetic resonance imaging (fMRI). An experienced manual therapist applied non-painful, posterior-to-anterior (PA) pressure on three lumbar spinous processes (L1, L3, and L5). The pressure (30 N) was monitored and controlled by sensors. The randomized stimulation protocol consisted of 68 pressure stimuli of 5 s duration. Blood oxygenation level dependent (BOLD) responses were analyzed in relation to the lumbar stimulations. The results demonstrate that controlled PA pressure on the lumbar spine induced significant activation patterns. The major new finding was a strong and consistent activation bilaterally in the somatosensory cortices (S1 and S2). In addition, bilateral activation was located medially in the anterior cerebellum. The activation pattern also included other cortical areas probably related to anticipatory postural adjustments. These revealed stable somatosensory maps of the lumbar spine in healthy subjects can subsequently be used as a baseline to investigate cortical and subcortical reorganization in low back pain patients., (Copyright © 2014 Wiley Periodicals, Inc.)

Background: In accordance with the Theory of Structural Dissociation of the Personality (TSDP), studies of dissociative identity disorder (DID) have documented that two prototypical dissociative subsystems of the personality, the "Emotional Part" (EP) and the "Apparently Normal Part" (ANP), have different biopsychosocial reactions to supraliminal and subliminal trauma-related cues and that these reactions cannot be mimicked by fantasy prone healthy controls nor by actors., Methods: Arterial spin labeling perfusion MRI was used to test the hypotheses that ANP and EP in DID have different perfusion patterns in response to rest instructions, and that perfusion is different in actors who were instructed to simulate ANP and EP. In a follow-up study, regional cerebral blood flow of DID patients was compared with the activation pattern of healthy non-simulating controls., Results: Compared to EP, ANP showed elevated perfusion in bilateral thalamus. Compared to ANP, EP had increased perfusion in the dorsomedial prefrontal cortex, primary somatosensory cortex, and motor-related areas. Perfusion patterns for simulated ANP and EP were different. Fitting their reported role-play strategies, the actors activated brain structures involved in visual mental imagery and empathizing feelings. The follow-up study demonstrated elevated perfusion in the left temporal lobe in DID patients, whereas non-simulating healthy controls had increased activity in areas which mediate the mental construction of past and future episodic events., Conclusion: DID involves dissociative part-dependent resting-state differences. Compared to ANP, EP activated brain structures involved in self-referencing and sensorimotor actions more. Actors had different perfusion patterns compared to genuine ANP and EP. Comparisons of neural activity for individuals with DID and non-DID simulating controls suggest that the resting-state features of ANP and EP in DID are not due to imagination. The findings are consistent with TSDP and inconsistent with the idea that DID is caused by suggestion, fantasy proneness, and role-playing.

Imaging studies have identified a wide network of brain areas activated by nociceptive stimuli and revealed differences in somatotopic representation of highly distinct stimulation sites (foot vs. hand) in the primary (S1) and secondary (S2) somatosensory cortices. Somatotopic organization between adjacent dermatomes and differences in cortical coding of similarly perceived nociceptive stimulation are less well studied. Here, cortical processing following contact heat nociceptive stimulation of cervical (C4, C6, and C8) and trunk (T10) dermatomes were recorded in 20 healthy subjects using functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). Stimulation of T10 compared with the C6 and C8 revealed significant higher response intensity in the left S1 (contralateral) and the right S2 (ipsilateral) even when the perceived pain was equal between stimulation sites. Accordingly, contact heat evoked potentials following stimulation of T10 showed significantly higher N2P2 amplitudes compared to C6 and C8. Adjacent dermatomes did not reveal a distinct somatotopical representation. Within the assessed cervical and trunk dermatomes, nociceptive cortical processing to heat differs significantly in magnitude even when controlling for pain perception. This study provides evidence that controlling for pain perception is not sufficient to compare directly the magnitude of cortical processing [blood oxygen level dependence (BOLD) response and amplitude of evoked potentials] between body sites., (Copyright © 2013 Wiley Periodicals, Inc.)

Analogies may arise from the conscious detection of similarities between a present and a past situation. In this functional magnetic resonance imaging study, we tested whether young volunteers would detect analogies unconsciously between a current supraliminal (visible) and a past subliminal (invisible) situation. The subliminal encoding of the past situation precludes awareness of analogy detection in the current situation. First, participants encoded subliminal pairs of unrelated words in either one or nine encoding trials. Later, they judged the semantic fit of supraliminally presented new words that either retained a previously encoded semantic relation ("analog") or not ("broken analog"). Words in analogs versus broken analogs were judged closer semantically, which indicates unconscious analogy detection. Hippocampal activity associated with subliminal encoding correlated with the behavioral measure of unconscious analogy detection. Analogs versus broken analogs were processed with reduced prefrontal but enhanced medial temporal activity. We conclude that analogous episodes can be detected even unconsciously drawing on the episodic memory network.

Objective: The purpose of this study was to develop and test a clinically relevant method to mechanically stimulate lumbar functional spinal units while recording brain activity by means of functional magnetic resonance imaging (MRI)., Methods: Subjects were investigated in the prone position with their face lying on a modified stabilization pillow. To minimize head motion, the pillow was fixed to the MRI headrest, and supporting straps were attached around the shoulders. An experienced manual therapist applied controlled, nonpainful pressure stimuli to 10 healthy subjects at 3 different lumbar vertebrae (L1, L3, and L5). Pressure applied to the thumb was used as a control. The stimulation consisted of posterior to anterior (PA) pressure movement. The therapist followed a randomized stimulation protocol projected onto a screen in the MRI room. Blood oxygenation level-dependent responses were analyzed in relation to the lumbar and the thumb stimulations. The study was conducted by the Chiropractic Department, Faculty of Medicine, University of Zürich, Switzerland., Results: No participant reported any discomfort due to the prone-lying position or use of the pillow. Importantly, PA-induced pressure produced only minimal head movements. Stimulation of the lumbar spinous processes revealed bilateral neural responses in medial parts of the postcentral gyrus (S1). Additional activity was observed in the secondary somatosensory cortex (S2), posterior parts of the insular cortex, different parts of the cingulate cortex, and the cerebellum. Thumb stimulations revealed activation only in lateral parts of the contralateral S1., Conclusion: The current study demonstrates the feasibility of the application of PA pressure on lumbar spinous processes in an MRI environment. This approach may serve as a promising tool for further investigations regarding neuroplastic changes in chronic low back pain subjects., (© 2014. Published by National University of Health Sciences All rights reserved.)

Patients with chronic daily headache and overuse of analgesics, triptans, or other acute headache compounds, are considered to suffer from medication-overuse headache (MOH). This implies that medication overuse is the cause of headache chronification. It remains a key question why only two-thirds of patients with chronic migraine-like headache and overuse of pain medication improve after detoxification, whereas the remainder continue to have chronic headache. In the present longitudinal MRI study, we used voxel-based morphometry to investigate gray matter changes related to medication withdrawal in a group of humans with MOH. As a main result, we found that only patients with significant clinical improvement showed a significant decrease of previously increased gray matter in the midbrain including periaqueductal gray matter and nucleus cuneiformis, whereas patients without improvement did not. Patients without treatment response had less gray matter in the orbitofrontal cortex. Another striking result is the correlation of treatment response with the amount of orbitofrontal gray matter. Thus, we demonstrate adaptive gray matter changes within the pain modulatory system in patients with MOH who responded to detoxification, probably reflecting neuronal plasticity. Decreased gray matter in the orbitofrontal cortex at baseline may be predictive of poor response to treatment.

Objective: The Theory of Structural Dissociation of the Personality (TSDP) proposes that dissociative identity disorder (DID) patients are fixed in traumatic memories as "Emotional Parts" (EP), but mentally avoid these as "Apparently Normal Parts" of the personality (ANP). We tested the hypotheses that ANP and EP have different biopsychosocial reactions to subliminally presented angry and neutral faces, and that actors instructed and motivated to simulate ANP and EP react differently., Methods: Women with DID and matched healthy female actors (CON) were as ANP and EP (DIDanp, DIDep, CONanp, CONep) consecutively exposed to masked neutral and angry faces. Their brain activation was monitored using functional magnetic resonance imaging. The black-and-white dotted masks preceding and following the faces each had a centered colored dot, but in a different color. Participants were instructed to immediately press a button after a perceived color change. State anxiety was assessed after each run using the STAI-S. Final statistical analyses were conducted on 11 DID patients and 15 controls for differences in neural activity, and 13 DID patients and 15 controls for differences in behavior and psychometric measures., Results: Differences between ANP and EP in DID patients and between DID and CON in the two dissociative parts of the personality were generally larger for neutral than for angry faces. The longest reaction times (RTs) existed for DIDep when exposed to neutral faces. Compared to DIDanp, DIDep was associated with more activation of the parahippocampal gyrus. Following neutral faces and compared to CONep, DIDep had more activation in the brainstem, face-sensitive regions, and motor-related areas. DIDanp showed a decreased activity all over the brain in the neutral and angry face condition. There were neither significant within differences nor significant between group differences in state anxiety. CON was not able to simulate genuine ANP and EP biopsychosocially., Conclusions: DID patients have dissociative part-dependent biopsychosocial reactions to masked neutral and angry faces. As EP, they are overactivated, and as ANP underactivated. The findings support TSDP. Major clinical implications are discussed.

Purpose: To measure B1 field distribution in different liver segments with and without dual transmission and to quantify the contrast-to-noise ratio (CNR) between normal liver tissue and segmental venous vessels on standard clinical 3.0-T liver magnetic resonance (MR) images., Materials and Methods: This prospective study was approved by the local ethics committee. All subjects gave written informed consent. Six patients with liver lesions and nine healthy volunteers were included. Average hepatic B1 field values in all Couinaud liver segments were assessed by using actual flip-angle imaging (first and second repetition times msec/echo time msec: 72, 192/2.2; transmission angle: 60°) for both single and dual transmission in a 3.0-T MR imaging unit that allowed both transmission modes. Additionally, two-dimensional T1-weighted gradient-echo (repetition time msec/echo time msec, 180/2.3; transmission angle, 55°) and T2-weighted single-shot fast spin-echo images (1501/80) were acquired. Average CNR between liver parenchyma and segmental veins were measured in each segment. Two-sided paired Student t tests were used for statistical evaluation. Two blinded radiologists independently identified lesions in images from acquisitions in both transmission modes., Results: Mean flip angles achieved with conventional single transmission were 44%-53% of the nominal value in segments II-IV and 67% and 63% of the nominal value in segments VI and VII, respectively, and were less than 77% in all segments. Mean actual flip angles measured for dual transmission were between 82% and 100% of the nominal value in all segments. T1-weighted single-transmission images exhibited areas of low B1 field strength with reduced image contrast. T2-weighted single-transmission images displayed significantly reduced signal intensity but nearly unchanged contrast weighting in these areas. On T1-weighted dual-transmission images, the two readers detected 22 and 14 additional lesions that they did not identify on the single-transmission images. On the dual-transmission T2-weighted images, they detected 11 and five additional lesions, respectively., Conclusion: Dual transmission can generate a B1 field with significantly improved homogeneity over all liver segments at a field strength of 3.0 T., (© RSNA, 2012)

People suppressing their emotions while facing an emotional event typically remember it less well. However, the neural mechanisms underlying the impairing effect of emotion suppression on successful memory encoding are not well understood. Because successful memory encoding relies on the hippocampus and the amygdala, we hypothesized that memory impairments due to emotion suppression are associated with down-regulated activity in these brain areas. 59 healthy females were instructed either to simply watch the pictures or to down-regulate their emotions by using a response-focused emotion suppression strategy. Brain activity was recorded using functional magnetic resonance imaging (fMRI), and free recall of pictures was tested afterwards. As expected, suppressing one's emotions resulted in impaired recall of the pictures. On the neural level, the memory impairments were associated with reduced activity in the right hippocampus during successful encoding. No significant effects were observed in the amygdala. In addition, functional connectivity between the hippocampus and the right dorsolateral prefrontal cortex was strongly reduced during emotion suppression, and these reductions predicted free-recall performance. Our results indicate that emotion suppression interferes with memory encoding on the hippocampal level, possibly by decoupling hippocampal and prefrontal encoding processes, suggesting that response-focused emotion suppression might be an adaptive strategy for impairing hippocampal memory formation in highly arousing situations., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: Medication-overuse headache (MOH) is associated with psychiatric comorbidities. Neurobiological similarities to substance dependence have been suggested. This study investigated grey matter changes, focussing on pain and reward systems., Methods: Using voxel-based morphometry, structural MRIs were compared between 29 patients with both, MOH and migraine, according to International Headache Society criteria, and healthy controls. The Migraine Disability Assessment (MIDAS) score was used. Anxiety and depression were screened for with the Hospital Anxiety and Depression Scale (HADS) and confirmed by a psychiatrist, using the Mini International Neuropsychiatric Interview., Results: Nineteen patients (66%) had a present or past psychiatric disorder, mainly affective (N = 11) and anxiety disorders (N = 8). In all patients a significant increase of grey matter volume (GMV) was found in the periaqueductal grey matter of the midbrain, which correlated positively with the MIDAS and the HADS-anxiety subscale. A GMV increase was found bilaterally in the thalamus, and the ventral striatum. A significant GMV decrease was detected in frontal regions including orbitofrontal cortex, anterior cingulate cortex, the left and right insula, and the precuneus., Conclusion: These findings are consistent with dysfunction of antinociceptive systems in MOH, which is influenced by anxiety. Dysfunction of the reward system may be a neurobiological basis for dependence in a subgroup of MOH patients.

The aim of this study was to quantitatively assess the field strength dependence of the transverse relaxation rate (R(2) *) change in cortical gray matter induced by hyperoxia and hyperoxic hypercapnia versus normoxia in an intra-individual comparison of young healthy volunteers. Medical air (21% O(2) ), pure oxygen and carbogen (95% O(2) , 5% CO(2) ) were alternatively administered in a block-design temporal pattern to induce normoxia, hyperoxia and hyperoxic hypercapnia, respectively. Local R(2) * values were determined from three-dimensional, multiple, radiofrequency-spoiled, fast field echo data acquired at 1.5, 3 and 7 T. Image quality was good at all field strengths. Under normoxia, the mean gray matter R(2) * values were 13.3 ± 2.7 s(-1) (1.5 T), 16.9 ± 0.9 s(-1) (3 T) and 29.0 ± 2.6 s(-1) (7 T). Both hyperoxic gases induced relaxation rate decreases ΔR(2) *, whose magnitudes increased quadratically with the field strength [carbogen: -0.69 ± 0.20 s(-1) (1.5 T), -1.49 ± 0.49 s(-1) (3 T), -5.64 ± 0.67 s(-1) (7 T); oxygen: -0.39 ± 0.20 s(-1) (1.5 T), -0.78 ± 0.48 s(-1) (3 T), -3.86 ± 1.00 s(-1) (7 T)]. Carbogen produced larger R(2) * changes than oxygen at all field strengths. The relative change ΔR(2) */R(2) * also increased with the field strength with a power between 1 and 2 for both carbogen and oxygen. The statistical significance of the R(2) * response improved with increasing B(0) and was higher for carbogen than for oxygen. For a sequence with pure T(2) * weighting of the signal response to respiratory challenge, the results suggested a maximum carbogen-induced signal difference of 19.3% of the baseline signal at 7 T and TE = 38 ms, but a maximum oxygen-induced signal difference of only 3.0% at 1.5 T and TE = 76 ms. For 3 T, maximum signal changes of 4.7% (oxygen) and 8.9% (carbogen) were computed. In conclusion, the R(2) * response to hyperoxic respiratory challenge was stronger for carbogen than for oxygen, and increased quadratically with the static magnetic field strength for both challenges, which highlights the importance of high field strengths for future studies aimed at probing oxygen physiology in clinical settings., (Copyright © 2012 John Wiley & Sons, Ltd.)

Whether an agent receives positive task feedback or a monetary reward, neural activity in their striatum increases. In the latter case striatal activity reflects extrinsic reward processing, while in the former, striatal activity reflects the intrinsically rewarding effects of performing well. There can be a "hidden cost of reward", which is a detrimental effect of extrinsic on intrinsic reward value. This raises the question how these two types of reward interact. To address this, we applied a monetary incentive delay task: in all trials participants received feedback depending on their performance. In half of the trials they could additionally receive monetary reward if they performed well. This resulted in high performance trials, which were monetarily rewarded and high performance trials that were not. This made it possible to dissociate the neural correlates of performance feedback from the neural correlates of monetary reward that comes with high performance. Performance feedback alone elicits activation increases in the ventral striatum. This activation increases due to additional monetary reward. Neural response in the dorsal striatum on the other hand is only significantly increased by feedback when a monetary incentive is present. The quality of performance does not significantly influence dorsal striatum activity. In conclusion, our results indicate that the dorsal striatum is primarily sensitive to optional or actually received external rewards, whereas the ventral striatum may be coding intrinsic reward due to positive performance feedback. Thus the ventral striatum is suggested to be involved in the processing of intrinsically motivated behavior., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Relational inference denotes the capacity to encode, flexibly retrieve, and integrate multiple memories to combine past experiences to update knowledge and improve decision-making in new situations. Although relational inference is thought to depend on the hippocampus and consciousness, we now show in young, healthy men that it may occur outside consciousness but still recruits the hippocampus. In temporally distinct and unique subliminal episodes, we presented word pairs that either overlapped ("winter-red", "red-computer") or not. Effects of unconscious relational inference emerged in reaction times recorded during unconscious encoding and in the outcome of decisions made 1 min later at test, when participants judged the semantic relatedness of two supraliminal words. These words were either episodically related through a common word ("winter-computer" related through "red") or unrelated. Hippocampal activity increased during the unconscious encoding of overlapping versus nonoverlapping word pairs and during the unconscious retrieval of episodically related versus unrelated words. Furthermore, hippocampal activity during unconscious encoding predicted the outcome of decisions made at test. Hence, unconscious inference may influence decision-making in new situations.

Aim: Dentine hypersensitivity (DH) is characterized by a short, sharp pain arising from exposed dentin. Most published literature reports on peripheral neural aspects of this pain condition. The current investigation focused on differential cerebral activity elicited by stimulation of sensitive and insensitive teeth by means of natural air stimuli., Materials and Methods: Five graded stimulus strengths were randomly applied by means of a multi-injector air jet delivery system, each followed by an individual rating of perceived stimulus intensity. Brain activity was analysed by functional magnetic resonance imaging (fMRI)., Results: Stimulation of sensitive teeth induced significant activation in the thalamus, somatosensory cortices (SI & SII), anterior, middle and posterior insular cortices, anterior mid cingulate cortex, perigenual anterior cingulate cortex and frontal regions (BA10 and BA46). Differential responses to DH and painless perceptions were observed in the anterior insula and anterior midcingulate cortex., Conclusion: For the first time, this fMRI study demonstrates the feasibility of investigating cerebral processes related to DH evoked by natural (air) stimuli. Our neuroimaging data additionally provide evidence that differential activity in the anterior Insula (aIC) and anterior midcingulate cortex (aMCC) may represent clinically relevant pain experienced by DH patients., (© 2012 John Wiley & Sons A/S.)

Sparse and clustered-sparse temporal sampling fMRI protocols have been devised to reduce the influence of auditory scanner noise in the context of auditory fMRI studies. Here, we report an improvement of the previously established clustered-sparse acquisition scheme. The standard procedure currently used by many researchers in the field is a scanning protocol that includes relatively long silent pauses between image acquisitions (and therefore, a relatively long repetition time or cluster-onset asynchrony); it is during these pauses that stimuli are presented. This approach makes it unlikely that stimulus-induced BOLD response is obscured by scanner-noise-induced BOLD response. It also allows the BOLD response to drop near baseline; thus, avoiding saturation of BOLD signal and theoretically increasing effect size. A possible drawback of this approach is the limited number of stimulus presentations and image acquisitions that are possible in a given period of time, which could result in an inaccurate estimation of effect size (higher standard error). Since this line of reasoning has not yet been empirically tested, we decided to vary the cluster-onset asynchrony (7.5, 10, 12.5, and 15 s) in the context of a clustered-sparse protocol. In this study sixteen healthy participants listened to spoken sentences. We performed whole-brain fMRI group statistics and region of interest analysis with anatomically defined regions of interest (auditory core and association areas). We discovered that the protocol, which included a short cluster-onset asynchrony (7.5 s), yielded more advantageous results than the other protocols, which involved longer cluster-onset asynchrony. The short cluster-onset asynchrony protocol exhibited a larger number of activated voxels and larger mean effect sizes with lower standard errors. Our findings suggest that, contrary to prior experience, a short cluster-onset asynchrony is advantageous because more stimuli can be delivered within any given period of time. Alternatively, a given number of stimuli can be presented in less time, and this broadens the spectrum of possible fMRI applications.

Purpose: To assess by cardiovascular magnetic resonance (CMR) and CMR tagging if the Amplatzer Septal Occluder affects right ventricular (RV) and left ventricular (LV) motion pattern., Materials and Methods: Sixteen consecutive patients with significant atrial septal defect (ASD) and nine consecutive patients with persistent foramen ovale (PFO) as controls were studied before and a median of 14 days after defect closure by an Amplatzer occluder. By CMR end-diastolic (EDV) and end-systolic (ESV) RV and LV volumes were determined. Aortic and pulmonary artery flow was measured for assessment of left-to-right shunt (Qp/Qs). By CMR tagging circumferential strain and radial shortening, maximal rotation and torsion were measured,, Results: In ASD patients RV-EDV and RV-ESV decreased (P < 0.05). LV-EDV and LV-ESV increased after ASD closure (P < 0.005). Qp/Qs dropped from 1.8 to 1.0 (P < 0.001). PFO patients showed no ventricular volume change after PFO closure. In ASD patients circumferential strain and radial shortening and maximal rotation of the RV decreased by ASD closure (P < 0.01). In LV only maximal rotation at the base and apex decreased significantly (P < 0.05). Torsion remained constant. In PFO patients no tagging parameter changed after defect closure., Conclusion: The Amplatzer occluder itself does not change the ventricular contraction pattern. All volume and myocardial deformation changes were caused by ventricular loading shifts., (Copyright © 2012 Wiley Periodicals, Inc.)

This paper investigates the main characteristics of the magneto-hemodynamic (MHD) response for application as a biomarker of vascular blood flow. The induced surface potential changes of a volunteer exposed to a 3 T static B0 field of a magnetic resonance imaging (MRI) magnet were measured over time at multiple locations by an electrocardiogram device and compared to simulation results. The flow simulations were based on boundary conditions derived from MRI flow measurements restricted to the aorta and vena cava. A dedicated and validated low-frequency electromagnetic solver was applied to determine the induced temporal surface potential change from the obtained 4D flow distribution using a detailed whole-body model of the volunteer. The simulated MHD signal agreed with major characteristics of the measured signal (temporal location of main peak, magnitude, variation across chest and along torso) except in the vicinity of the heart. The MHD signal is mostly influenced by the aorta; however, more vessels and better boundary conditions are needed to analyze the finer details of the response. The results show that the MHD signal is strongly position dependent with highly variable but reproducibly measurable distinguished characteristics. Additional investigations are necessary before determining whether the MHD effect is a reliable reference for location-specific information on blood flow.

Retinal detachment results in visual loss and requires surgical treatment. The risk of retinal detachment depends, among other factors, on the vitreous rheology, which varies with age. To date, the viscoelasticity of the vitreous body has only been measured in cadaver eyes. However, the ex vivo and in vivo viscoelasticity may differ as a result of the effect of intravitreal membranes. Therefore, an MRI method and appropriate postprocessing tools were developed to determine the vitreous deformation and viscoelastic properties in the eyes of living humans. Nineteen subjects (eight women and 11 men; mean age, 33 years; age range, 14-62 years) gazed at a horizontal sinusoidal moving target during the segmented acquisition of complementary spatial modulation of magnetization images. The center of the lens and the scleral insertion of the optic nerve defined the imaging plane. The vitreous deformation was tracked with a dedicated algorithm and fitted with the commonly used viscoelastic model to determine the model parameters: the modified Womersley number a and the phase angle b. The vitreous deformation was successfully quantified in all 17 volunteers having a monophasic vitreous. The mean and standard deviation of the model parameters were determined to be 5.5 ± 1.3 for a and -2.3 ± 0.2 for b. The correlation coefficient (-0.76) between a and b was significant. At the eye movement frequency used, the mean storage and loss moduli of the vitreous were around 3 ± 1 hPa. For two subjects, the vitreous deformation was clearly polyphasic: some compartments of the vitreous were gel-like and others were liquefied. The borders of these compartments corresponded to reported intravitreal membrane patterns. Thus, the deformation of the vitreous can now be determined in situ, leaving the structure of the intravitreal membranes intact. Their effect on vitreous dynamics challenges actual vitreous viscoelastic models. The determination of the vitreous deformation will aid in the quantification of local vitreous stresses and their correlation with retinal detachment., (Copyright © 2011 John Wiley & Sons, Ltd.)

In this study, we investigated central/supraspinal processes mediating cessation of a muscle fatiguing exercise. Fifteen male subjects performed 39 intermittent, isometric handgrip contractions (13 s on, 5-6 s off) with the dominant right hand while brain activation was assessed by means of functional magnetic resonance imaging (fMRI). An adaptive, partly stochastic protocol was designed such that in approximately 50% of the contraction trials the required force could not be held until the end of the trial (task failure trial). Trials performed in compliance with the force requirements (succeeded trial) were compared with task failure trials concerning neural activity during a small time window before task failure occurred. The data revealed significantly increased activation contralaterally in both the mid/anterior insular cortex and the thalamus during the investigated time window in the case of subsequent task failure. In accordance with other studies investigating sensations that alert the organism to urgent homeostatic imbalance such as air hunger, hunger for food, and pain, we assume that an increased thalamo-insular activation in the context of a fatigue-induced handgrip exercise could reflect increased homeostatic disturbance in the exercising muscle and may be of essential importance by mediating task failure to maintain the integrity of the organism., (Copyright © 2010 Wiley Periodicals, Inc.)

Background: Recent studies suggest that magnetic resonance (MR) imaging of the brain and spine may safely be performed in patients with pacemakers (PMs) and implantable cardioverter/defibrillators (ICDs), when taking adequate precautions. The aim of this study was to investigate safety, feasibility, and diagnostic value (DV) of MR imaging in cardiac applications (cardiac MR [CMR]) in patients with PMs and ICDs for the first time., Methods: Thirty-two PM/ICD patients with a clinical need for CMR were examined. The specific absorption rate was limited to 1.5 W/kg. Devices were reprogrammed pre-CMR to minimize interference with the electromagnetic fields. Devices were interrogated pre-CMR and post-CMR and after 3 months. Troponin I levels were measured pre-CMR and post-CMR; image quality (IQ) and DV of CMR were assessed., Results: All devices could be reprogrammed normally post-CMR. No significant changes of pacing capture threshold, lead impedance, and troponin I were observed. Image quality in patients with right-sided devices (RSD) was better compared with that in patients with left-sided devices (LSD) (P < .05), and less myocardial segments were affected by device-related artefacts (P < .05). Diagnostic value was rated as sufficiently high, allowing for diagnosis, or better in 12 (100%) of 12 patients with RSD, and only in 7 (35%) of 20 patients with LSD., Conclusions: Cardiac MR may be performed safely when limiting specific absorption rate, appropriately monitoring patients, and following device reprogramming. Cardiac MR delivers good IQ and DV in patients with RSD. Cardiac MR in patients with RSD may therefore be performed with an acceptable risk/benefit ratio, whereas the risk/benefit ratio is rather unfavorable in patients with LSD., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Spontaneous internal carotid artery (ICA) dissection (sICAD) results from an intimal tear located around the distal carotid sinus. The mechanisms causing the tear are unknown. This case-control study tested the hypotheses that head movements increase the wall stress in the cervical ICA and that the stress increase is greater in patients with sICAD than in controls. Five patients with unilateral, recanalized, left sICAD and five matched controls were investigated before and after maximal head rotation to the left and neck hyperextension after 45° head rotation to the left. The anatomy of the extracranial carotid arteries was assessed by magnetic resonance imaging and used to create finite element models of the right ICA. Wall stress increased after head movements. Increases above the 80th and 90th percentile were located at the intimal side of the artery wall from 7.4 mm below to 10 mm above the cranial edge of the carotid sinus, i.e., at the same location as histologically confirmed tears in patients with sICAD. Wall stress increase did not differ between patients and controls. The present findings suggest that wall stress increases at the intimal side of the artery wall surrounding the distal edge of the carotid bulb after head movements may be important for the development of carotid dissection. The lack of wall stress difference between the two groups indicates that the carotid arteries of patients with carotid dissection have either distinct functional or anatomical properties or endured unusually heavy wall stresses to initiate dissection.

Recently, pulsed magnetic field therapy (PMFT) systems have become available for private use. Although they may be applied without medical supervision, only a little is known about their field quantities. In this study, the spatial distribution and the temporal characteristics of the magnetic flux densities of three PMFT systems, available in Europe, were analysed. In close proximity to the surface, the maxima of the peak magnetic flux densities were 461 µT, 170 µT and 133 µT, respectively. At a distance of 30 cm above the whole body mat, the peak magnetic flux density was 77 µT. The excitation patterns consisted of repeating bursts with carrier frequencies between 210 and 1667 Hz. In conclusion, magnetic flux densities were far above International Commission on Non-Ionizing Radiation Protection reference levels. Since these systems are supposed to be medical devices as well as wellness devices, risk analysis of PMFT systems and the effectiveness of these devices need to be investigated in future studies.

The current fMRI study investigated cortical processing of electrically induced painful tooth stimulation of both maxillary canines and central incisors in 21 healthy, right-handed volunteers. A constant current, 150% above tooth specific pain perception thresholds was applied and corresponding online ratings of perceived pain intensity were recorded with a computerized visual analog scale during fMRI measurements. Lateralization of cortical activations was investigated by a region of interest analysis. A wide cortical network distributed over several areas, typically described as the pain or nociceptive matrix, was activated on a conservative significance level. Distinct lateralization patterns of analyzed structures allow functional classification of the dental pain processing system. Namely, certain parts are activated independent of the stimulation site, and hence are interpreted to reflect cognitive emotional aspects. Other parts represent somatotopic processing and therefore reflect discriminative perceptive analysis. Of particular interest is the observed amygdala activity depending on the stimulated tooth that might indicate a role in somatotopic encoding.

Background: Magnetic resonance imaging (MRI) of pacemaker patients is contraindicated due to documented potential risks to the patient from hazardous interactions between the MRI and pacemaker system., Objective: The purpose of this prospective, randomized, controlled, worldwide clinical trial was to evaluate the safety and effectiveness of a pacemaker system designed for safe use in MRI for any bradycardia indicated patient., Methods: Patients (n = 464) were randomized to undergo an MRI scan between 9 and 12 weeks postimplant (MRI group, n = 258) or not to undergo MRI (control group, n = 206) after successful implantation of the specially designed dual-chamber pacemaker and leads. Patients were monitored for arrhythmias, symptoms, and pacemaker system function during 14 nonclinically indicated relevant brain and lumbar MRI sequences. Sequences were performed at 1.5 T and included scans with high radiofrequency power deposition and/or high gradient dB/dt exposure. Clinical evaluation of the pacemaker system function occurred immediately before and after MRI, 1 week and 1 month post-MRI, and at corresponding times for the control group. Primary endpoints for safety analyzed the MRI procedure complication-free rate and for effectiveness compared capture and sensing performance between MRI and control groups., Results: No MRI-related complications occurred during or after MRI, including sustained ventricular arrhythmias, pacemaker inhibition or output failures, electrical resets, or other pacemaker malfunctions. Pacing capture threshold and sensed electrogram amplitude changes were minimal and similar between study groups., Conclusion: This trial documented the ability of this pacemaker system to be exposed in a controlled fashion to MRI in a 1.5 T scanner without adverse impact on patient outcomes or pacemaker system function., (Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: Radio Frequency Identification (RFID) devices are becoming more and more essential for patient safety in hospitals. The purpose of this study was to determine patient safety, data reliability and signal loss wearing on skin RFID devices during magnetic resonance imaging (MRI) and computed tomography (CT) scanning., Methods: Sixty RFID tags of the type I-Code SLI, 13.56 MHz, ISO 18000-3.1 were tested: Thirty type 1, an RFID tag with a 76 x 45 mm aluminum-etched antenna and 30 type 2, a tag with a 31 x 14 mm copper-etched antenna. The signal loss, material movement and heat tests were performed in a 1.5 T and a 3 T MR system. For data integrity, the tags were tested additionally during CT scanning. Standardized function tests were performed with all transponders before and after all imaging studies., Results: There was no memory loss or data alteration in the RFID tags after MRI and CT scanning. Concerning heating (a maximum of 3.6 degrees C) and device movement (below 1 N/kg) no relevant influence was found. Concerning signal loss (artifacts 2 - 4 mm), interpretability of MR images was impaired when superficial structures such as skin, subcutaneous tissues or tendons were assessed., Conclusions: Patients wearing RFID wristbands are safe in 1.5 T and 3 T MR scanners using normal operation mode for RF-field. The findings are specific to the RFID tags that underwent testing.

Purpose: To study extraocular muscle (EOM) function, the local physiologic contraction and elongation (deformation) along human horizontal EOMs were quantified by using motion-encoded magnetic resonance imaging (MRI)., Methods: Eleven subjects (healthy right eye) gazed at a target that moved horizontally in a sinusoidal fashion (period, 2 seconds; amplitude, +/-20 degrees), during MRI with an optimized protocol. In addition, EOM longitudinal deformation in two patients with Duane's syndrome type I was analyzed. The horizontal EOMs and the optic nerve were tracked through 15 time frames, and their local deformation was calculated. Eight segments were separated along the EOMs and left-to-right and right-to-left eye movements were compared., Results: In healthy subjects, the maximum EOM deformation was situated at approximately two thirds of the muscle lengths from the scleral insertions. The EOM deformations were similar for the entire movement range as well as in both movement directions. In the two patients with Duane's syndrome type I, the abnormal innervation of lateral rectus muscle affected specific EOM segments only. The posterior muscle segments contracted and the anterior muscle segments relaxed during adduction., Conclusions: Motion-encoded MRI is a useful technique for advancing the understanding of the physiology and pathophysiology of EOMs in humans during eye movement.

Objectives: This study tested the feasibility of applying k-t BLAST to blood oxygen level dependent functional MRI of the brain at 3 Tesla (T) and at 7 T. Shorter echo train lengths, achieved through the application of k-t BLAST, are expected to counteract increased sensitivity to inhomogeneities in B0 at higher magnetic field strengths, especially in echo planar images, and reduce the relatively long acquisition times and high RF power deposition in spin-echo based methods., Materials and Methods: k-t BLAST was combined with displaced UFLARE at 3 T and 7 T. Temporal and spatial fidelity of k-t BLAST were investigated using a test object, in which localized variations in signal intensity mimic activation-induced signal changes. fMRI was performed using typical box-car design finger tapping. In a separate analysis full k-space data were decimated to simulate k-t BLAST acquisitions and compare results with the fully sampled data, thereby avoiding physiological and noise differences between acquisitions., Results: Activation can be detected at under-sampling factors as high as 16, whereas appropriately reconstructed data, under-sampled at factors below 8 entail insignificant loss of sensitivity and considerable reductions in acquisition times and RF power deposition., Conclusions: k-t BLAST is compatible with fMRI acquisitions and opens up possibilities including distortion-free T2*-weighted blood oxygen level dependent fMRI with displaced UFLARE at high magnetic field strengths.

Background: Magnetic Resonance Imaging (MRI) of patients with implanted cardiac devices is currently considered hazardous due to potential for electromagnetic interference to the patient and pacemaker system. With approximately 60 million MRI scans performed worldwide per year, an estimated majority of pacemaker patients may develop an indication for an MRI during the lifetime of their pacemakers, suggesting that safe use of pacemakers in the MRI environment would be clinically valuable. A new pacing system (Medtronic EnRhythm MRI(TM) SureScan(TM) and CapSureFix MRI(TM) leads) has been designed and pre-clinically tested for safe use in the MRI environment. The EnRhythm MRI study is designed to confirm the safety and efficacy of this new pacing system., Methods: The EnRhythm MRI study is a prospective, randomized controlled, unblinded clinical trial to confirm the safety and efficacy of MRI at 1.5 Tesla in patients implanted with a specifically designed pacemaker and lead system. The patients have standard indications for dual chamber pacemaker implantation. Successfully implanted patients are randomized in a 2:1 ratio to undergo MRI (MRI group) or to have no MRI scan (control group) at 9-12 weeks after pacemaker system implantation. Magnetic resonance (MR) scanning includes 14 head and lumbar scan sequences representing clinically relevant scans while maximizing the gradient slew rate up to 200 T/m/s, and/or the transmitted radiofrequency (RF) power up to SAR (specific absorption rate) levels of 2 W/kg body weight (upper limit of normal operating mode). Full interrogation of all device information and sensing and capture function are measured at device implantation, every follow-up and before and immediately after MRI in the MRI group and at the same time points in the control group. Complete pacemaker and lead evaluations are also done at one week and one month after the scan for the MRI and control group patients.The primary endpoint is safe and successful completion of the MRI scan as measured by freedom from both MRI-procedure related complications and clinically significant changes in the sensing and capture function of the leads., Results: Results will be communicated after approximately 156 and 470 patients have completed 4 months of follow-up., Trial Registration: ClinicalTrials.gov identifier: NCT00433654.

The mechanical property of articular cartilage determines to a great extent the functionality of diarthrodial joints. Consequently, the early detection of mechanical and, thus, functional changes of cartilage is crucial for preventive measures to maintain the mobility and the quality of life of individuals. An alternative to conventional mechanical testing is the inverse finite element approach, enabling non-destructive testing of the tissue. We evaluated a method for the assessment of the equilibrium material properties of the patellar cartilage based on magnetic resonance imaging during patellofemoral compression. We performed ex vivo testing of two equine patellas with healthy cartilage, one with superficial defects, and one with synthetically degenerated cartilage to simulate a pre-osteoarthritic stage. Static compression with 400 N for 2 h resulted in morphological changes comparable to physiological in vivo deformations in humans. We observed a decrease of the equilibrium Young's modulus of the degenerated cartilage by -59%, which was in the range of the results from indentation (-74%) and confined compression tests (-58%). With the reported accuracy of magnetic resonance imaging and its reproducibility, the results indicate the potential to measure differences in Young's modulus with regard to cartilage degeneration and consequently to distinguish between healthy and pre-osteoarthritic cartilage.

Purpose: To evaluate the safety and feasibility of 3-T magnetic resonance (MR) imaging of the brain in patients with implanted cardiac pacemakers (PMs) by using a transmit-receive head coil., Materials and Methods: The study protocol was approved by the institutional review board. Signed informed consent was obtained from all subjects. In vitro testing at 3 T was performed with 32 PMs and 45 PM leads that were evaluated for force and torque (by using a floating platform) and radiofrequency (RF)-related heating by using a transmit-receive head coil (maximum specific absorption rate, 3.2 W/kg). Patient examinations at 3 T were performed in 44 patients with a cardiac PM and a strong clinical need; patients underwent a total of 51 MR examinations of the brain by using a transmit-receive head coil to minimize RF exposure of the PM system. An electrocardiograph and pulse oximetry were used for continuous monitoring during MR imaging. The technical and functional PM status was assessed prior to and immediately after MR imaging and at 3 months thereafter. Serum troponin I level was measured before and 12 hours after imaging to detect myocardial thermal injury. PM reprogramming was performed prior to MR imaging depending on the patient's intrinsic heart rate (< 60 beats per minute, asynchronous pacing; > or = 60 beats per minute, sense-only mode)., Results: For in vitro testing, the maximum translational force was 2150 mN (mean, 374.38 mN +/- 392.75 [standard deviation]), and maximum torque was 17.8 x 10(-3) N x m (mean, [2.29 +/- 4.08] x 10(-3) N x m). The maximum temperature increase was 2.98 degrees C (mean, 0.16 degrees C +/- 0.45). For patient examinations, all MR examinations (51 of 51) were completed safely. There were no significant (P < .05) changes in lead impedance, pacing capture threshold level, or serum troponin I level., Conclusion: MR imaging of the brain at 3 T in patients with a cardiac PM can be performed safely when dedicated safety precautions (including the use of a transmit-receive head coil) are taken., (RSNA, 2008)

Background: Atherosclerotic lesions of the upper extremity arise three to five times more often at the origin of the left subclavian artery than on the right side. The aim of this study was to investigate, whether the hemodynamic forces (peak wall shear rate) in the large supra-aortic branches measured by MRI differ in healthy subjects., Patients and Methods: Peak wall shear rate (WSR) and blood flow was assessed in the left carotid, left subclavian and innominate artery in ten healthy volunteers (5 females, mean age of 35.2 +/- 9 years) using high resolution (pixel size 0.6 mm 2) magnetic resonance imaging (MRI) flow velocity measurements., Results: There is no difference between the maximum WSR of the three large supra-aortic vessels. Only within the proximal (327 +/- 132s-1) and distal wall (458 +/- 154s-1) of the innominate artery a significant difference (p = 0.011) of the WSR was found., Conclusion: The results from this study indicate that WSR is not different in the supra-aortic vessels. Therefore the atherosclerotic pattern in the subclavian and innominate arteries may not be explained by differences in these hemodynamic forces.

The prion protein Met129Val polymorphism has recently been related to human long-term memory with carriers of either the 129MM or the 129MV genotype recalling 17% more words than 129(VV) carriers at 24h following learning. Here, we sampled genotype differences in retrieval-related brain activity at 30min and 24h following learning. Furthermore, genotype groups were compared regarding grey matter concentrations and cognitive profiles. We used event-related functional magnetic resonance imaging (fMRI) during a word recognition task on 12 Met/Met carriers, 12 Val/Met carriers, and 12 Val/Val carriers. These groups were matched for retrieval performance, gender, age, education, and other memory-related genetic polymorphisms. Although retrieval performance was matched, Val carriers exhibited enhanced retrieval-related brain activity at 30min and 24h following learning. At both time lags, correlations between retrieval-related brain activity and retrieval success were negative for Val homozygotes (the more activity, the worse retrieval success), while correlations showed no significance or were positive for Met homozygotes and heterozygotes. These results suggest a less economic use of retrieval-related neural resources in Val relative to Met carriers. Furthermore, Val carriers exhibited higher neocortical grey matter concentrations compared to Met carriers. When controlling for grey matter concentration, genotype effects in retrieval-related brain activity remained significant. Val and Met carriers yielded comparable brain activations for correct rejections of non-studied words and for working memory, which speaks to the specificity of the genotype effect. Findings suggest that the prion protein Met129Val polymorphism affects neural plasticity following learning at a time-scale of minutes to hours.

Background: The dependence of the movements of the calcaneus, cuboid, navicular, and talus on each other have been described as the tarsal gearbox. To provide a basis of its modeling, data on transmissions between tarsal joint rotations within this gearbox are required. The feasibility of tibiocalcaneal rotations to predict tarsal joint rotations is of interest because a meaningful relation would allow the use of common motion analysis with skin markers to investigate rearfoot kinematics., Methods: We performed linear regression analyses between tarsal joint and tibiocalcaneal rotations on the basis of magnetic resonance imaging of tibia and tarsal bone positions during quasi-static foot pronation and supination., Results: In the frontal plane and transverse planes, linear models were found to predict tarsal joint rotations quite well (r(2) = 0.83-0.97 for the frontal plane and r(2) = 0.73-0.95 for the transverse plane). For each degree of talocalcaneal rotation, there was 1.8 degrees of talonavicular rotation in the frontal plane and 1.6 degrees in the transverse plane; each degree of talocalcaneal rotation resulted in 0.6 degrees of calcanealcuboid rotation in the frontal plane and 0.7 degrees in the transverse plane; each degree of calcaneocuboid rotation resulted in 3 degrees of talonavicular rotation in the frontal plane and 2.8 degrees in the transverse; each degree of tibiocalcaneal rotation resulted in 0.9 degrees of talocalcaneal rotation in the frontal plane and 0.9 degrees in the transverse plane; and each degree of tibiocalcaneal rotation resulted in 1.6 degrees of talonavicular rotation in the frontal plane and 1.3 degrees in the transverse plane., Conclusion: The present study provides a basis on which the tarsal gearbox in the frontal and the transverse planes under quasi-static conditions can be modeled. Furthermore, it is concluded that tibiocalcaneal rotations are practical for predicting tarsal joint rotations during quasi-static motions.

Conventional magnetic resonance imaging (MRI) is useful for assessing morphological changes but not for assessing deformations inside homogeneous structures (M. D. Abràmoff, A. P. Van Gils, G. H. Jansen, & M. P. Mourits, 2000). Since no intrinsic contrast can be imaged for distinguishing heterogeneous patterns of muscle contraction, morphological changes along the length of the extraocular muscles (EOMs) are not macroscopically detectable. However, an imaging method that is able to directly encode motion could give evidence about the dynamics of the inhomogeneous deformation of the EOMs. Thus, we developed a method for acquiring motion-encoded MRI images of the EOMs during eye movements. Seven healthy subjects gazed at a horizontal sinusoidally oscillating target. A small surface coil was placed in front of the right orbit. The contracting and relaxing horizontal rectus muscles and the noncontracting optic nerve were reliably tracked. The differential contractility of the EOMs could be distinguished from the third time frame on (=140 ms from the beginning of the right to left eye movement lasting 1 s). The muscle belly of the contracting medial rectus muscle could be distinguished from the posterior and the anterior segment from the sixth time frame on (=350 ms). In conclusion, motion-encoded MRI resolved the heterogeneous contraction of moving EOM segments in healthy subjects without using physical markers.

Our aim was to determine the diagnostic value of myocardial tagging sequences with regard to the evaluable share of the cardiac cycle. Thirty-three patients were examined at 1.5 T using tagging sequences with gradient-echo (GRE) readout, 18 patients at 1.5 T with steady-state free precession (SSFP), and 11 patients at 3 T using GRE. Two observers graded image quality and determined the share of the cardiac cycle for which postprocessing could be performed (1, optimal; 2, little interaction; 3, whole cycle assessable; 4, diastole non-assessable; 5, systole incomplete; 6, non-diagnostic). With GRE at 1.5 T, median image quality was 4.0 (95% CI 4.0-5.0), while it was significantly better with 2.0 (2.0-3.0) using the SSFP technique and similar at 3 T with 2.9 (1.7-3.5). With GRE at 1.5 T, systole could be assessed in 69% of patients, and an evaluation of the whole cardiac cycle was not possible. With the SSFP sequence at 1.5 T and GRE at 3 T, an evaluation of the whole cardiac cycle was possible in 71% and 70% of the patients, respectively, and systole was assessable in all patients. Tagging sequences with SSFP readout at 1.5 T make a semi-automatic evaluation of the whole cardiac cycle feasible in a large share of patients.

Purpose: To assess the state and dynamics of the intracranial system in idiopathic normal-pressure hydrocephalus (I-NPH), we determined intracranial compliance using magnetic resonance imaging (MRI)., Materials and Methods: The intracranial compliance index (ICCI), which was defined as the ratio of the peak-to-peak intracranial volume change (ICVC(p-p)) to the peak-to-peak cerebrospinal fluid (CSF) pressure gradient (PG(p-p)) during the cardiac cycle, was obtained from the net transcranial blood and CSF flow measured with phase-contrast (PC) cine MRI. ICCI was determined in patients with I-NPH (N = 7), brain atrophy, or asymptomatic ventricular dilation (VD) (N = 6), and in healthy volunteers (control group; N = 11). The changes in ICCI indices were also analyzed after a CSF tap test (N = 2)., Results: The ICCI in the I-NPH group was significantly lower than in the control and VD groups, whereas no difference was found between the control and VD groups. The ICVC(p-p) was also lower than in the control and VD groups. However, no significant difference was found in the PG(p-p) between groups. The ICCI increased after the tap test., Conclusion: Intracranial compliance analysis with MRI makes it possible to noninvasively obtain more detailed information of intracranial biomechanics in the I-NPH and to assist in the diagnosis of I-NPH., ((c) 2007 Wiley-Liss, Inc.)

Large orthopedic external fixation clamps and related components were evaluated for force, torque, and heating response when subjected to the strong electromagnetic fields of magnetic-resonance (MR) imaging devices. Forces induced by a 3-Tesla (T) MR scanner were compiled for newly designed nonmagnetic clamps and older clamps that contained ferromagnetic components. Heating trials were performed in a 1.5 and in a 3 T MR scanner with two assembled external fixation frames. Forces of the newly designed clamps were more than a factor 2 lower as the gravitational force on the device whereas, magnetic forces on the older devices showed over 10 times the force induced by earth acceleration of gravity. No torque effects could be found for the newly designed clamps. Temperature measurements at the tips of Schanz screws in the 1.5 T MR scanner showed a rise of 0.7 degrees C for a pelvic frame and of 2.1 degrees C for a diamond knee bridge frame when normalized to a specific absorption rate (SAR) of 2 W/kg. The normalized temperature increases in the 3 T MR scanner were 0.9 degrees C for the pelvic frame and 1.1 degrees C for the knee bridge frame. Large external fixation frames assembled with the newly designed clamps (390 Series Clamps), carbon fiber reinforced rods, and implant quality 316L stainless steel Schanz screws met prevailing force and torque limits when tested in a 3-T field, and demonstrated temperature increase that met IEC-60601 guidelines for extremities. The influence of frame-induced eddy currents on the risk of peripheral nerve stimulation was not investigated., (Copyright 2006 Wiley Periodicals, Inc.)

The goal of this study was to propose a general numerical analysis methodology to evaluate the magnetic resonance imaging (MRI)-safety of active implants. Numerical models based on the finite element (FE) technique were used to estimate if the normal operation of an active device was altered during MRI imaging. An active implanted pump was chosen to illustrate the method. A set of controlled experiments were proposed and performed to validate the numerical model. The calculated induced voltages in the important electronic components of the device showed dependence with the MRI field strength. For the MRI radiofrequency fields, significant induced voltages of up to 20 V were calculated for a 0.3T field-strength MRI. For the 1.5 and 3.0OT MRIs, the calculated voltages were insignificant. On the other hand, induced voltages up to 11 V were calculated in the critical electronic components for the 3.0T MRI due to the gradient fields. Values obtained in this work reflect to the worst case situation which is virtually impossible to achieve in normal scanning situations. Since the calculated voltages may be removed by appropriate protection circuits, no critical problems affecting the normal operation of the pump were identified. This study showed that the proposed methodology helps the identification of the possible incompatibilities between active implants and MR imaging, and can be used to aid the design of critical electronic systems to ensure MRI-safety.

Background: Magnetic fields may interfere with the function of cardiac pacemakers and implantable cardioverter-defibrillators (ICDs). Neodymium-iron-boron (NdFeB) magnets, which are small in size but produce strong magnetic fields, have become widely available in recent years. Therefore, NdFeB magnets may be associated with an emerging risk of device interference., Objective: We conducted a clinical study to evaluate the potential of small NdFeB magnets to interfere with cardiac pacemakers and ICDs., Methods: The effect of four NdFeB magnets (two spherical magnets 8 and 10 mm in diameter, a necklace made of 45 spherical magnets, and a magnetic name tag) was tested in forty-one ambulatory patients with a pacemaker and 29 patients with an ICD. The maximum distance at which the magnetic switch of a device was influenced was observed., Results: Magnetic interference was observed in all patients. The maximum distance resulting in device interference was 3 cm. No significant differences were found with respect to device manufacturer and device types., Conclusion: Small NdFeB magnets may cause interference with cardiac pacemakers and ICDs. Patients should be cautioned about the interference risk associated with NdFeB magnets during daily life.

Purpose: To measure peripheral artery function using a real-time phase-contrast (PC)-MRI sequence with tailored image-processing algorithms for flow computation., Materials and Methods: An approach to real-time flow measurements was developed based on two-dimensional spatially selective excitation pulses and consecutive tailored processing of the data to derive blood flow and vessel area variations. The data acquisition strategy allows for flow measurements at high spatial and temporal resolutions of 1 mm(2) and 50 msec, respectively. In postprocessing the vessel area is automatically extracted using correlation measures in conjunction with morphological image operators. By means of in vitro and in vivo validations, it is shown that the current methods provide accurate and reproducible measurements of flow and vessel area variations., Results: In vitro the comparison between the lumen area measured with the presented method and the values obtained by caliper gauge measurement showed a difference of 3.4% +/- 3.4% (mean +/- 2 SD). Similarly, the comparison between the stroke volumes determined with the presented method and by stopwatch and bucket measurements yielded a difference of 6.1% +/- 2.1%. In vivo the results from the real-time measurements for lumen area and stroke volume were compared with those from a gated PC-MRI technique with differences of 4.8% +/- 14% and 3.0% +/- 24.7%, respectively., Conclusion: The presented method constitutes a reliable tool set for quantifying the variations of blood flow and lumen area in the superficial femoral artery during reactive hyperemia and for studying their correlation with cardiovascular risk factors., ((c) 2006 Wiley-Liss, Inc.)