Restricted and anisotropic displacement of water in healthy cat brain and in stroke studied by NMR diffusion imaging

Towards a microMRI atlas of mouse development

This study investigates the potential of microscopic Magnetic Resonance Imaging to obtain information for 3D digital atlases of mouse development using fixed samples. Fixed samples allow direct comparison with already published atlases and provide a testing ground for future in vivo efforts. 3D MR images of mouse embryos (dpc 6.5-16) illustrate that the necessary contrast and level of detail is available with this technique. Diffusion weighted imaging, diffusion tensor imaging, and multi-valued data sets are presented as examples of uniquely MR methods of obtaining anatomical information. MRI is performed non-invasively on the intact sample, leaving open the possibility of other manipulations (e.g. classical histology, immunohistochemistry, in situ hybridization, and in vitro growth for unfixed samples) after conducting the MRI experiment.

Diffusion-weighted MR imaging: diagnostic accuracy in patients imaged within 6 hours of stroke symptom onset

PURPOSE

To evaluate the diagnostic accuracy of diffusion-weighted magnetic resonance (MR) imaging performed within 6 hours of the onset of stroke symptoms.

MATERIALS AND METHODS

The authors reviewed the patient records and images from all patients hospitalized in a 10-month period in whom diffusion-weighted imaging was performed within 6 hours of the onset of strokelike symptoms (n = 22). Analyses included comparison of the initial interpretation of the diffusion-weighted images with the final clinical diagnosis; blinded reviews of computed tomographic (CT) scans and conventional and diffusion-weighted images; and determination of lesion contrast-to-noise ratios (CNRs).

RESULTS

Diffusion-weighted images indicated stroke in 14 patients, all of whom had a final diagnosis of acute stroke. Diffusion-weighted images were negative in eight patients, all of whom had a final clinical diagnosis other than stroke (100% sensitivity, 100% specificity, chi 2 = 23.00, P < .0001). Blinded reviews yielded 100% sensitivity and 86% specificity for diffusion-weighted MR imaging (chi 2 = 15.43, P < .0005); 18% sensitivity and 100% specificity for conventional MR imaging (chi 2 = 2.85, P > .2); and 45% sensitivity and 100% specificity for CT (chi 2 = 4.40, P > .10). Lesion percentage CNRs were 77% for diffusion-weighted imaging, 5.5% for CT, 9.8% for T2-weighted MR imaging, and 3.1% for proton-density-weighted MR imaging (P < .002 for diffusion-weighted imaging vs others).

CONCLUSION

Diffusion-weighted MR imaging is highly accurate for diagnosing stroke within 6 hours of symptom onset and is superior to CT and conventional MR imaging.

A motion correction scheme by twin-echo navigation for diffusion-weighted magnetic resonance imaging with multiple RF echo acquisition

In this paper, a series of diffusion-weighted fast spin-echo (FSE) sequences with a new motion correction scheme are introduced. This correction scheme is based on the navigator echo technique. Unlike conventional spin-echo imaging, motion correction for FSE is complicated by the phase oscillation between odd-numbered and even-numbered echoes and the complex phase relationship between spin echo and stimulated echo components. In our approach, incoherent phase shifting due to motion is monitored by consecutive acquisition of two navigator echoes, which provide information on both inter-echo and intra-echo train phase shifts. Applications to both phantom and in vivo studies are presented.

Diffusional anisotropy of T2 components in bovine optic nerve

A diffusion-CPMG hybrid experiment was used to analyze the diffusion characteristics of different T2 relaxation components in bovine optic nerve. Data were collected using a pulsed field gradient (PFG) multi spin echo (MSE) CPMG sequence for parallel and perpendicular axon orientation and four diffusion times. The apparent diffusion coefficient (ADC) was evaluated for two observed T2 components as a function of axonal orientation and diffusion time delta. The short T2 component exhibited minor diffusional anisotropy and larger ADC, whereas the long T2 component showed significant anisotropy effects. This is consistent with the hypothesis that the short T2 component is associated with water within the myelin sheath, which is less restricted than axonal water that is limited by cell membrane permeability.

Cerebral infarction: time course of signal intensity changes on diffusion-weighted MR images

OBJECTIVE

The objective of this study was to determine the time course of signal intensity changes on diffusion-weighted MR images after cerebral infarction.

MATERIALS AND METHODS

Echoplanar diffusion-weighted MR images were obtained at 1.5 T in 212 patients referred for suspected cerebral infarction over a 6-month period. Of those patients, 85 met strict criteria for inclusion in this study: final clinical diagnosis of stroke, reliable timing of clinical ictus by history, and neurologic symptoms persisting longer than 48 hr after onset. Using adjacent or contralateral normal brain for comparison, diffusion-weighted images were visually analyzed retrospectively to evaluate for abnormalities in signal intensity. Because three patients were scanned on two occasions and five patients had two anatomically separable infarctions, 93 reliably dated brain lesions were analyzed.

RESULTS

Diffusion-weighted images showed abnormal findings in 13 (100%) of 13 lesions less than 1 day old, 46 (96%) of 48 lesions 1-4 days old, 16 (94%) of 17 lesions 5-9 days old, three (60%) of five lesions 10-14 days old, and zero (0%) of 10 lesions more than 14 days old.

CONCLUSION

Abnormal signal intensity was present on all diffusion-weighted MR studies obtained in patients within 24 hr of acute cerebral infarction and in up to 94% of patients scanned during the first 2 weeks after ictus. The percentage of abnormal diffusion studies declined with time, and no signal intensity abnormality was seen in stroke patients scanned more than 2 weeks after symptom onset.

Noninvasive detection of cerebral hypoperfusion and reversible ischemia from reductions in the magnetic resonance imaging relaxation time, T2

The hypothesis was tested that hypoperfused brain regions, such as the ischemic penumbra, are detectable by reductions in absolute transverse relaxation time constant (T2) using magnetic resonance imaging (MRI). To accomplish this, temporal evolution of T2 was measured in several models of hypoperfusion and focal cerebral ischemia in the rat at 9.4 T. Occurrence of acute ischemia was determined through the absolute diffusion constant D(av) = 1/3 TraceD, while perfusion was assessed by dynamic contrast imaging. Three types of regions at risk of infarction could be distinguished: (1) areas with reduced T2 (4% to 15%, all figures relative to contralateral hemisphere) and normal D(av), corresponding to hypoperfusion without ischemia; (2) areas with both reduced T2 (4% to 12%) and D(av) (22% to 49%), corresponding to early hypoperfusion with ischemia; (3) areas with increased T2 (2% to 9%) and reduced D(av) (28% to 45%), corresponding to irreversible ischemia. In the first two groups, perfusion-deficient regions detected by bolus tracking were similar to those with initially reduced T2. In the third group, bolus tracking showed barely detectable arrival of the tracer in the region where D(av) was reduced. We conclude that T2 reduction in acute ischemia can unambiguously identify regions at risk and potentially discriminate between reversible and irreversible hypoperfusion and ischemia.

MR microscopy of transgenic mice that spontaneously acquire experimental allergic encephalomyelitis

Pathology of fixed spinal cords from transgenic mice with a myelin basic protein (MBP) specific T cell receptor was investigated. These mice spontaneously acquire the demyelinating disease experimental allergic encephalomyelitis (EAE). Several complementary imaging modalities, all on the same tissues, were used to visualize lesions; these included high-field (11.7-T) microscopic diffusion tensor imaging (DTI), T2*-weighted imaging, and optical microscopy on histological sections. Lesions were predominantly in white matter around meninges and vasculature and appeared hyperintense in anatomical images. DTIs showed reduced diffusion anisotropy in the same hyperintense regions, consistent with inflammation and edema. Histology in the same tissues exhibited the characteristic pathology of EAE. Two techniques for visualizing the effective diffusion tensor fields are presented, which display direction, organization, and integrity of neuronal fibers. It is shown that DTI offers intriguing possibilities for visualizing axonal organization and lesions within white matter.

Dependence of apparent diffusion coefficients on axonal spacing, membrane permeability, and diffusion time in spinal cord white matter

We used a numerical simulation of water self-diffusion among permeable cylinders to predict the dependence of MR-based apparent diffusion coefficients in white matter on axonal separation, barrier permeability, and diffusion time (T). The transverse apparent diffusion coefficient (tADC), calculated with simulated diffusion-sensitizing gradients perpendicular to the axon fibers, remains a function of T down to diffusion times as short as .1 microsec for a range of diffusion barrier permeability. As the diffusion time lengthens, the response of tADC depends on axon diameter, with decreases in tADC occurring earliest, and most dramatically, for the smallest fiber diameter simulated (2 microm). For a given axonal separation, asymptotic values of ADC are determined by permeability alone and are the same for 2-microm and 11-microm fibers of equal membrane permeability. The effect of increased relative intracellular volume is manifested primarily in a decrease in tADC at short T. Increases in interaxonal spacing increase the tADC at asymptotically long diffusion times and reduce the dependence on permeability. However, at the widest plausible axonal separations, permeability remains an important determinant of tADC. These simulations may enhance interpretation of measured tADC in the context of the underlying physiologic and structural changes at the cellular level that accompany white-matter disease.

Diffusion-, T2-, and perfusion-weighted nuclear magnetic resonance imaging of middle cerebral artery embolic stroke and recombinant tissue plasminogen activator intervention in the rat

Thrombolysis of embolic stroke in the rat was measured using diffusion (DWI)-, T2 (T2WI)-, and perfusion (PWI)-weighted magnetic resonance imaging (MRI). An embolus was placed at the origin of the middle cerebral artery (MCA) by injection of an autologous single blood clot via an intraluminal catheter placed in the intracranial segment of internal carotid artery. Rats were treated with a recombinant tissue plasminogen activator (rt-PA) 1 hour after embolization (n = 9) or were not treated (n = 15). Diffusion-weighted imaging, T2WI, and PWI were performed before, during, and after embolization from 1 hour to 7 days. After embolization in both rt-PA-treated and control animals, the apparent diffusion coefficient of water (ADCw) and cerebral blood flow (CBF) in the ischemic region significantly declined from the preischemic control values (P < 0.001). However, mean CBF and ADCw in the rt-PA-treated group was elevated early after administration of rt-PA compared with the untreated control group, and significant differences between the two groups were detected in CBF (24 hours after embolization, P < 0.05) and ADCw (3, 4, and 24 hours after embolization, P < 0.05). T2 values maximized at 24 (control group, P < 0.001) or 48 hours (treated group, P < 0.01) after embolization. The increase in T2 in the control group was significantly higher at 24 hours and 168 hours than in the rt-PA-treated group (P < 0.05). Significant correlations (r > or = 0.80, P < 0.05) were found between lesion volume measured 1 week after embolization and CBF and ADCw obtained 1 hour after injection of rt-PA. Within a coronal section of brain, MRI cluster analysis, which combines ADCw and T2 data maps, indicated a significant reduction (P < 0.05) in the lesion 24 hours after thrombolysis compared with nontreated animals. These data demonstrate that the values for CBF and ADCw obtained 1 hour after injection of rt-PA correlate with histologic outcome in the tissue, and that the beneficial effect of thrombolysis of an intracranial embolus by means of rt-PA is reflected in an increase of CBF and ADCw, a reduction in the increase of T2, and a reduction of the ischemic lesion size measured using MRI cluster analysis.

Temporal and regional changes during focal ischemia in rat brain studied by proton spectroscopic imaging and quantitative diffusion NMR imaging

The early development of focal ischemia after permanent occlusion of the right middle cerebral artery (MCA) was studied in six rats using interleaved measurements by diffusion-weighted NMR imaging (DWI) of water and two variants of proton spectroscopic imaging (SI), multiecho SI (TE: 136, 272, 408 ms) and short TE SI (TE: 20 ms). Measurements on a 4.7-T NMR imaging system were performed between the control phase and approximately 6 h postocclusion. In the center of the ischemic lesion of all rats, the apparent diffusion coefficient (ADC) decreased rapidly to 84.4 +/- 4.2% (mean +/- SD) of the control values approximately 2 min postocclusion. Approximately 6 h postocclusion, the ADC was reduced to 67.1 +/- 5.9%. In contrast, large differences between the animals were observed for the temporal increase of lactate (Lac) in the ipsilateral hemisphere. The maximum Lac signal was reached in four rats after 0.5-1.5 h, and in two rats was not reached even after 6 h postocclusion. Six h postocclusion, SI spectra measured at a TE of 136 ms revealed a decrease in the CH3 signal of N-acetylaspartate (NAA) to 67 +/- 13% of the control values. Differences were observed between the spatial regions of decreased NAA and increased Lac. In the lesions, a T2 relaxation time of Lac of 292 +/- 40 ms, considering a J-coupling constant of 6.9 Hz, was measured. Furthermore, a prolongation of the T2 of the CH3 signal of creatine/phosphocreatine (Cr/PCr) was observed in the lesion, from 163 +/- 22 ms during control to 211 +/- 41 ms approximately 6 h postocclusion. The experiments proved that DWI and proton SI are valuable tools to provide complementary information on processes associated with brain infarcts.

Diffusion, perfusion, and T2 magnetic resonance imaging of anti-intercellular adhesion molecule 1 antibody treatment of transient middle cerebral artery occlusion in rat

The effect of anti-intercellular adhesion molecule-1 (anti-ICAM-1) antibody treatment of transient (2 h) middle cerebral artery (MCA) occlusion in the rat was measured using diffusion (DWI)-, T2 (T2I)- and perfusion (PWI)-weighted magnetic resonance imaging. Rats were treated upon reperfusion with an anti-ICAM-1 monoclonal antibody (n=11) or a control antibody (n=7). DWI, T2I and PWI were performed before, during, and after induction of focal cerebral ischemia from 1 h to 7 days. In both groups, the apparent diffusion coefficient of water (ADCw) and cerebral blood flow (CBF) values in the ischemic region significantly declined from the preischemic ADCw values (p<0. 05). The post ischemic increase in T2 of the control group was significantly higher at 48 h than in the anti-ICAM-1 treated group (p<0.05). CBF was not significantly different between the two groups. The temporal profiles of MRI cluster analysis, which combines ADCw and T2 maps into a single image, was significantly different between groups. These data suggest that the neuroprotective effect of anti-ICAM-1 antibody treatment is reflected in reductions of T2 and lesion growth during reperfusion and may not be associated with increased cerebral perfusion.

Diffusion imaging of human breast

It is shown that diffusion-weighted imaging is possible in the human breast. Diffusion constants were measured in the breast parenchyma of four volunteers with no known breast lesions. The apparent diffusion constant of water measured in regions of interest chosen in normal human breast fibroglandular tissue was 1.64 +/- 0.19 x 10(-5) cm2/S and that measured in the area of fatty breast tissue was 0.32 +/- 0.18 x 10(-5) cm2/S. The resulting images indicate that fibroglandular tissue and fat can be clearly distinguished in diffusion-weighted as well as in absolute diffusion images of the breast. Potential future applications of this technology for the study of breast pathologies are suggested.

The influence of preischemic hyperglycemia on acute changes in the apparent diffusion coefficient of brain water following global ischemia in rats

We report the effect of increased plasma glucose levels on changes in the apparent diffusion coefficient of brain water (ADCw) during the first few minutes of global ischemia in rats. Brain ADCw values were acquired every 15 s using a diffusion-weighted line-scan MR pulse sequence. Preischemic hyperglycemia was achieved by infusion of 50% dextrose (i.v.) prior to KCl-induced cardiac arrest global ischemia. Analysis based on single voxels (3.4 microl) in brain demonstrated significant differences in the time course of ADCw decline between normoglycemic (n = 8) and hyperglycemic (n = 6) groups. Mean data from the hyperglycemic group indicated a biphasic decline of ADCw that was characterized by an initial rapid drop followed by a plateau of approximately 1 min before gradually declining and leveling off to its minimum value. In the normoglycemic group, ADCw declined to the same value as in the hyperglycemic group, but without a notable plateau. In the cerebral cortex, the times to maximal and half maximal ADCw drop following global ischemia in the hyperglycemic group were 3.96 and 2.26 min respectively. Corresponding time intervals for the normoglycemic group were 1.86 and 1.14 min, respectively. The time course for changes in ADCw demonstrated here is significantly different than that for anoxic depolarization reported under similar experimental conditions and suggests that events other than the complete loss of membrane ionic homeostasis and subsequent cell swelling may be involved in the initial decline of ADCw in global cerebral ischemia.

Numerical model for calculation of apparent diffusion coefficients (ADC) in permeable cylinders--comparison with measured ADC in spinal cord white matter

We have implemented a numerical method for calculation of the apparent diffusion coefficient (ADC) in spinal cord injury, which takes into account the distribution of axon diameters and permeability found in spinal cord white matter, as well as relative axonal volume. We propose a procedure for determining the status of axonal integrity from measured ADC values. These methods have been applied to a well characterized rat spinal cord injury model, affording a prediction of the increase in axonal permeability which is presumed to be closely related to functional deficit. ADC values are compared to those calculated from analytical formulas in the literature, and possible factors underlying the ADC behavior are explored. Calculated results indicate both axonal swelling and cell membrane permeability to be important factors contributing to ADC in traumatic spinal cord injury.

An analytical model of restricted diffusion in bovine optic nerve

An analytical model of restricted diffusion in bovine optic nerve is presented. The nerve tissue model is composed of two different objects: prolate ellipsoids (axons) and spheres (glial cells) surrounded by partially permeable membranes. The free diffusion coefficients of intracellular and extracellular water may differ. Analytical formulas for signal loss due to diffusion in the pulsed gradient spin echo (PGSE) experiment for this tissue model are derived. The model is fitted to experimental data for bovine optic nerve. The obtained model parameters are shown to be reasonable. The model describes all of the characteristics of the PGSE data: anisotropy, upward curvature of decay curves, and diffusion time dependence. The validity and sensitivity of the model are also discussed.

The temporal evolution of MRI tissue signatures after transient middle cerebral artery occlusion in rat

We have developed a multiparameter magnetic resonance imaging (MRI) cluster analysis model of acute ischemic stroke using T2 relaxation times and the diffusion coefficient of water (ADCw). To test the ability of this model to predict cerebral infarction, male Wistar rats (n = 7) were subjected to 2 h of transient middle cerebral artery (MCA) occlusion, and diffusion and T2 weighted MRI were performed on these rats before, during and up to 7 days after MCA occlusion. MRI tissue signatures, specified by values of ADCw and T2 were assigned to tissue histopathology. Significant correlations were obtained between MRI signatures at different time points and histopathologic measurements of lesion area obtained at 1 week. In addition, we compared the temporal evolution of MRI tissue signatures to a separate population of animals at which histological data were obtained at select times of reperfusion. A significant shift (p < or = 0.05) within signatures reflecting tissue histopathology was demonstrated as the ischemic lesion evolved over time. Our data suggest, that the MRI signatures are associated with the degree of ischemic cell damage. Thus, the tissue signature model may provide a noninvasive means to monitor the evolution of ischemic cell damage and to predict final outcome of ischemic cell damage.

Unraveling diffusion constants in biological tissue by combining Carr-Purcell-Meiboom-Gill imaging and pulsed field gradient NMR

A diffusion-weighted multi-spin-echo pulse sequence is presented, which allows for simultaneous measurement of T2, the fractional amplitude, and the diffusion constant of different fractions. Monte Carlo simulations demonstrate an improvement of this sequence with respect to the accuracy of diffusion constant and fractional amplitude for slow exchange. Examples are shown for a simple phantom containing two fractions. In addition, experiments on cat brain in healthy condition and following occlusion of the middle cerebral artery show that the fractional amplitude and the diffusion constant of cerebral spinal fluid and normal brain tissue can be analyzed within each pixel with acceptable accuracy.

Diffusion of metabolites in normal and ischemic rat brain measured by localized 1H MRS

The apparent diffusion coefficient (ADC) of choline-containing compounds (Cho), creatine and phosphocreatine (Cre), N-acetyl-aspartate (NAA), lactate, and water was measured in normal rat brain, and in the ischemic and contralateral region of rat brain approximately 3 and 24 h after induction of focal cerebral ischemia. After 3 h of ischemia, the ADC of Cre and NAA in the ischemic region had significantly decreased by 29% and 19%, respectively (P < 0.05). Lactate ADC was also obtained in the ischemic region. After 24 h of focal ischemia, no ADC values could be measured for NAA, Cre and Cho in the ischemic region because their concentrations had become too low. The ADCs of lactate and water in the ischemic volume were virtually identical at 3 and 24 h after occlusion. The experiments suggest that the ADC decrease of water after induction of ischemia is partly caused by changes in the diffusion characteristics of the intracellular compartment.

Correlation of the average water diffusion constant with cerebral blood flow and ischemic damage after transient middle cerebral artery occlusion in cats

Magnetic resonance water diffusion imaging can detect early ischemic changes in stroke. Using a middle cerebral artery occlusion model, we examined which range of values of the orientation-independent diffusion quantity Dav = 1/3Trace(D) = 1/3(Dxx + Dyy + Dzz) is an early noninvasive indicator of reduced cerebral perfusion and focal brain injury. Cats underwent either a 30-min occlusion followed by 3.5 h reperfusion (n = 7) or a 60-min occlusion followed by 4-h reperfusion (n = 6). Repeated measurements of CBF were made with radiolabeled microspheres, and acute focal injury was measured with triphenyltetrazolium chloride (TTC) staining. During occlusion, the decrease in Dav correlated with CBF for caudate [30-min occlusion (n = 13): p < 0.0001: 60-min occlusion (n = 6): p < 0.02] and for cortex [30-min occlusion (n = 12): p < 0.0001: 60-min occlusion (n = 5): p < 0.04]. Variable caudate and hemispheric injury levels were found among cats in both groups. The area of tissue injury demarcated by TTC began to correlate with the area of reduced Dav by 30 min of occlusion (p < 0.02), and this correlation improved (p < 0.0001) at 1, 1.5, and 2.0 h after the onset of occlusion. The time necessary to reach a one-to-one correspondence between the percent of hemisphere injured and the percent of hemispheric area with Dav < 0.65 x 10(-9) m2/s was 2 h after occlusion. Thus, the absolute value of Dav is a good indicator of the risk of tissue injury, whereas the combination of Dav and the length of time of Dav reduction is an excellent predictor of acute focal tissue injury demarcated by TTC staining.

Delayed progression of cytotoxic oedema in focal cerebral ischemia after treatment with a torasemide derivative: a diffusion-weighted magnetic resonance imaging study

Diffusion-weighted magnetic resonance imaging (MRI) was used to assess the effect of an astrocytic Na+2Cl-K+ cotransporter inhibitor, a novel torasemide derivative, on the time course and spatial evolution of a focal cerebral ischemia in the rat. The drug (1 mg/ kg, i.p.) was injected 30 min before middle cerebral artery occlusion and diffusion-weighted images were acquired at various times thereafter. The results showed that the drug reduced the size of the hyperintensity during the first hours, but did not affect the time constant of growth or the final size. The temporary reduction of the cytotoxic oedema induced by the torasemide derivative, demonstrates an antioedematous activity.

Acute focal cerebral ischemia in rats studied by diffusion-weighted magnetic resonance imaging--an experimental study

BACKGROUND

Temporary occlusion of the cerebral artery is occasionally repeated during neurosurgical operations, but the safety of such a procedure remains to be studied further.

METHOD

We studied early changes and reversibility of focal cerebral ischemia and the cumulative effects of repeated ischemic insults in rats using magnetic resonance imaging (MRI).

RESULTS

Diffusion-weighted magnetic resonance images (DWI) and determination of signal intensity ratio (SIR) proved to be a valuable measure of studying early changes and reversibility of transient focal cerebral ischemia and cumulative adverse effects of repeated ischemic insults. DWIs showed marked intensity changes shortly after focal cerebral ischemia, while T2-weighted images failed to show hyperintensities until 2.5 hours after the onset of permanent ischemia. The critical period of ischemia in this model was 60 minutes. However, 20 minutes ischemia, when repeated twice with 60 minutes reperfusion in between, showed irreversible damage.

CONCLUSION

Repeated insults of focal regional cerebral ischemia may cause irreversible tissue damage even if each ischemic period is less than the critical one.

Diffusion MRI: precision, accuracy and flow effects

After a decade of evolution and application of diffusion imaging, a large body of literature has been accumulated. It is in this context that the accuracy and precision of diffusion-weighted and quantitative diffusion MRI are reviewed. The emphasis of the review is on practical methods for clinical human imaging, particularly in the brain. The requirements for accuracy and precision are reviewed for various clinical and basic science applications. The methods of measuring and calculating diffusion effects with MRI are reviewed. The pulse gradient spin echo (PGSE) methods are emphasized as these methods are used most commonly in the clinical setting. Processing of PGSE data is reviewed. Various PGSE encoding schemes are also reviewed in terms of the accuracy and precision of isotropic and anisotropic diffusion measurements. The broad range of factors impacting the accuracy of the PGSE methods and other encoding schemes is then considered. Firstly, system inaccuracies such as background imaging gradients, gradient linearity, refocusing RF pulses, eddy currents, image misregistration, noise and dynamic range are considered. A second class of inaccuracies is contributed by the bulk effects of the imaged object, and include sample background gradients, subject motion of cerebrospinal fluid and organs, and aperiodic organ motion. A final category of potential inaccuracies is classified as being contributed by microscopic, biophysical tissue properties and include partial volume effects, anisotropy, restriction, diffusion distance, compartmentation, exchange, multiexponential diffusion decay, T2 weighting and microvascular perfusion. Finally, the application of diffusion methods to studies of blood flow in the microvasculature (i.e. the arterioles, capillaries and venules) are reviewed in detail, particularly in terms of feasibility and the stringent accuracy and precision requirements. Recent provocative studies examining the use of PGSE approaches to suppress microvascular signals in brain functional MRI (fMRI) are also reviewed.

Molecular diffusion, tissue microdynamics and microstructure

Diffusion NMR is the only method available today that noninvasively provides information on molecular displacements over distances comparable to cell dimensions. This information can be used to infer tissue microstructure and microdynamics. However, data may be fairly difficult to interpret in biological tissues which differ markedly from the theoretical "infinite isotrope medium", as many factors may affect the NMR signal. The object of this paper is to analyze the expected effects of temperature, restriction, hindrance, membrane permeability, anisotropy and tissue inhomogeneity on the diffusion measurements. Powerful methods, such as q-space imaging, diffusion tensor imaging and diffusion spectroscopy of metabolites further enhance the specificity of the information obtained from diffusion NMR experiments.

Interpretation of DW-NMR data: dependence on experimental conditions

This review examines the effect of experimental conditions on the data obtainable from diffusion weighted NMR experiments. The origin and forms of the Stejskal-Tanner experiment are presented, and the relative merits of bipolar to monopolar diffusion weighting gradient pulses are discussed, as are those of spin-echo and stimulated-echo weighting schemes. The short pulse Stejskal-Tanner experiment as required for q-space imaging is described. Criteria for successful diffusion weighted imaging are given, and current strategies for diffusion weighted imaging are evaluated against these. The range of biological objects accessible to diffusion weighted NMR is summarized, together with the associated experimental limitations. In the final section the dependence of diffusion weighted NMR data on diffusion time and b-value range is examined, and the relationship between apparent restricted diffusion and the size of the extracellular space is demonstrated.

A model to predict the histopathology of human stroke using diffusion and T2-weighted magnetic resonance imaging

BACKGROUND AND PURPOSE

We sought to identify MRI measures that have high probability in a short acquisition time to predict, at early time points after onset of ischemia, the eventual development of cerebral infarction in clinical patients who suffer occlusion of a cerebral artery.

METHODS

We developed an MR tissue signature model based on experimentally derived relationships of the apparent diffusion coefficient of water (ADCw) and T2 to ischemic brain tissue histopathology. In eight stroke patients we measured ADCw and T2 intensity using diffusion-weighted echo-planar imaging (DW-EPI). Tissue signature regions were defined, and theme maps of the ischemic focus at subacute time points after stroke onset were generated.

RESULTS

Five MR signatures were identified in human stroke foci: two that may predict either cell recovery or progression to necrosis, one that may mark the transition to cell necrosis, and two that may be markers of established cell necrosis.

CONCLUSIONS

An MR tissue signature model of ischemic histopathology using ADCw and T2 can now be tested for its potential to predict reversible and identify irreversible cellular damage in human ischemic brain regions.

Correlation of rapid changes in the average water diffusion constant and the concentrations of lactate and ATP breakdown products during global ischemia in cat brain

Rapid changes in the average water diffusion constant, Dav = 1/3[Dxx+Dyy+Dzz], and in the concentrations of lactate and purine nucleotides and nucleosides were measured upon global ischemia (cardiac arrest) in cat brain, at a combined time resolution of 36 s (n = 7). At this time resolution, the normalized time curves of 1 - Dav and the increase in ATP breakdown product did not coincide, with the changes in Dav being most rapid. The normalized curves of 1 - Dav and the lactate increase coincided for the first 2-2.5 min after which the change in Dav was more rapid. After this time point, an excellent correlation was found between the drop in Dav and the decrease in energy utilization rate, which was calculated from the measured time curves of lactate formation and ATP breakdown, and from the time curve for phosphocreatine use reported in the literature. These results are in agreement with the expected biphasic changes in ion and water homeostasis during ischemia and with the model of diffusional changes being a consequence of a water shift from interstitial to intracellular space.

Correction of motional artifacts in diffusion-weighted images using a reference phase map

A method of correcting motional artifacts in diffusion-weighted images is described. Motion causes changes in the phase of the k-space NMR signal and thereby introduces positional shifts (or ghosts) in the spatial domain. By correcting the phase of the NMR signal before Fourier transformation, the image sharpness is greatly enhanced. The new method measures the phases of the NMR signal once and stores this phase information in a phase map. Subsequent images with motional artifacts are corrected during postprocessing using this reference phase map.

Perfusion and diffusion-weighted MR imaging for in vivo evaluation of treatment with U74389G in a rat stroke model

BACKGROUND AND PURPOSE

The present study was performed to examine the potential of diffusion-weighted (DW) imaging and dynamic first-passage bolus tracking of susceptibility contrast agents (perfusion imaging) for early in vivo evaluation of the effects of treatment with the free radical scavenger U74389G in a rat model of temporary focal ischemia.

METHODS

After 45 minutes of middle cerebral artery occlusion, the treatment group (n = 9) received an infusion of U74389G, and the control group (n = 9) received the identical volume of the vehicle. Reperfusion was instituted in both groups after 120 minutes of middle cerebral artery occlusion. The DW images were collected during middle cerebral artery occlusion and reperfusion and were compared with histologically assessed areas of tissue injury after 2 hours of reperfusion. The dynamic perfusion series were processed on a pixel-to-pixel basis to produce parametric maps reflecting the maximum reduction in the signal obtained during the first passage of the contrast agent and the time delay between the arrival of the bolus and the point of maximum contrast-agent effect.

RESULTS

The area of ischemic injury, as assessed from the DW imaging at 60 minutes of reperfusion, was significantly smaller in the treatment group: 9 +/- 8% of ipsilateral hemisphere compared with 19 +/- 8% in the control group. The histological examination after 2 hours of reperfusion demonstrated an area of ischemic injury of 10 +/- 8% for the treatment group compared to 25 +/- 10% in the control group. In the treatment group, the perfusion imaging showed a reduction in time delay to maximum effect of the contrast agent in the ischemic hemisphere compared with the control group.

CONCLUSIONS

The DW imaging during early reperfusion showed a protective effect of postocclusion treatment with the free radical scavenger U74389G. The improvement of time delay to maximum effect of the contrast agent observed in the perfusion imaging of the treatment group may reflect an improvement in the collateral flow to the ischemic tissue.

Theoretical model for water diffusion in tissues

Water diffusion in a tissue model is studied both analytically and numerically. Tissue is regarded as a periodic array of boxes surrounded by partially permeable membranes (cells), embedded in an extracellular medium. intracellular and extracellular diffusion coefficients may differ. Expressions for the apparent diffusion coefficients (ADC) in isotropic and nonisotropic tissues are derived and compared with Monte Carlo simulations. Calculated ADCs disagree with values obtained from the widely used "fast exchange" formula. Effects of differences between intracellular and extracellular T2 relaxation times on measured values of ADC and T2 are discussed. The general analysis is specifically applied to the changes occurring in ADC following ischemic insults to brain tissue. It is found that although membranes affect ADC significantly, the observed changes in diffusion cannot be due to reduced membrane permeabilities. They may result from the combined effect of changes in cellular volume fraction, extracellular and intracellular diffusion.

Diffusion-weighted imaging in epilepsy

Diffusion-weighted imaging (DWI) is a relatively new magnetic resonance imaging (MRI) technique that can be used to probe the microenvironment of water. Contrast in DWI depends on properties different from traditional T1 and T2 contrast, and is derived form the translational motion of water molecules. Since it is reasonable to think that a change in the microenvironment of water might be reflected in a change in water diffusion characteristics, the quantitative assessment of the (apparent) diffusion coefficient ADCw may represent a unique means of assessing tissue status. DWI has already shown great utility in the study of cerebral ischemia in animal models and has proved useful in the early identification of cerebral ischemia in patients. More recent reports have indicated a potential for DWI in studying epilepsy. Here, we briefly review some of what is known about the measurement of ADCw in ischemia and compare these results with what has recently been reported for epilepsy. In this manner we hope to better understand the underlying mechanisms behind changes in water diffusion associated with specific pathologies.

Diffusion weighting by the trace of the diffusion tensor within a single scan

The anisotropy of the water diffusion tensor inside brain causes contrast in diffusion images, which depends on the relative orientation of the diffusion gradients and the subject. Because the trace of a tensor is invariant upon rotation, measurement of this trace can reduce the orientation effect. A family of imaging pulse sequences is presented in which the signal intensity is weighted by the trace of the diffusion tensor in a single scan. The methods are demonstrated for chicken gizzard in several orientations with respect to the gradient frame of reference, and for ischemic injury in cat brain after middle cerebral artery occlusion. The sensitivity of the techniques to the presence of background gradients is measured and discussed in detail. As a result, pulse sequences are suggested that provide reliable diffusion constants in both homogeneous and inhomogeneous magnetic fields. The efficiency of the techniques for clinical application is also evaluated.

Anisotropy of NMR properties of tissues

Orientational anisotropy of T2 and T1 relaxation times, diffusion, and magnetization transfer has been investigated for six different tissues: tendon, cartilage, kidney, muscle, white matter, and optic nerve. Relaxation anisotropy was observed for tendon and cartilage, and diffusional anisotropy was measured in kidney, muscle, white matter, and optic nerve. All other NMR measurements of these tissues showed no orientational dependence. This pattern of NMR anisotropies can be interpreted from the underlying geometrical structures of the tissues.

Health and infarcted brain tissues studied at short diffusion times: the origins of apparent restriction and the reduction in apparent diffusion coefficient

The significance of NMR water diffusion measurements performed at short diffusion times (< 10 ms) for brain tissue is examined. An apparent restriction to diffusion for both healthy and cytotoxically edematous tissue is shown: cytotoxic edema lengthens the diffusion time at which this phenomenon is visible. The dramatic reduction in apparent diffusion coefficient (ADC) observed in the core of cytotoxic edema is explained in terms of the enclosure of extracellular water in non-contiguous pockets in conjunction with the shift of water from the extra-to the intracellular space. The model presented provides an explanation for the ADC reduction without recourse to changes in the cell membrane permeability to water, or unrealistic values for the extra- and intracellular diffusion coefficients.

Detection of apparent restricted diffusion in healthy rat brain at short diffusion times

The application of bipolar diffusion sensitizing gradient pulses to significantly reduce the diffusion time is described. This approach is combined with the rapid U-FLARE imaging sequence. Three diffusion-sensitized types of experiments are compared and their suitability for detecting restricted diffusion is discussed. Experiments using a modification of the diffusion weighting by varying the diffusion time between 1.6 and 6.0 ms obtained nonmonoexponential signal attenuation curves from both healthy brains and postmortem. This behavior is indicative of restricted diffusion, but as it is detectable only at short diffusion times, in contrast to a restriction due to impermeable barriers, we have termed this "apparent restriction."

MRI characterization of diffusion coefficients in a rat spinal cord injury model

Apparent diffusion coefficients (ADC) were measured in a rat spinal cord weight-drop injury model. After sacrifice, the spinal cords were fixed in situ and excised for MR imaging and ADC measurement. Diffusion is anisotropic in normal gray and white matter. There were significant decreases in ADCs measured along the longitudinal axis of the injured cord and increases in ADCs measured transverse to the cord. Injured segments demonstrated reductions in diffusion anisotropy in the white matter. Diffusion was completely isotropic at the epicenter of the weight-drop injury. Significant decreases in longitudinal ADC and increases in transverse ADC were observed in portions of the cord which appeared normal on conventional spin-echo and calculated T2 images. Thus ADC measurement may complement routine imaging for evaluation of spinal cord injury.

Rapid monitoring of changes in water diffusion coefficients during reversible ischemia in cat and rat brain

Changes in the diffusion constant of water during reversible brain ischemia and cardiac arrest were monitored with a 10-s time resolution. Results (five cats, three rats) indicate that these changes are reversible and that the bulk of the changes are not caused by temperature or motion related to brain pulsations and blood flow. The rapid time course of the changes corresponds to the known time course for changes in energy state, signal transduction, and ionic homeostasis.

Water diffusion and acute stroke

The occlusion of the middle cerebral artery was used as an experimental acute stroke model in 30 cats. The diffusion of water was followed by diffusion-sensitized MRI between 1 and 15 h after induction of stroke. It is demonstrated that images representing the trace of the diffusion tensor provide a much more accurate delineation of affected area than images representing the diffusion in one direction only. The reason is that the strong contrast caused by the anisotropy and orientation of myelin fibers is completely removed in the trace of the diffusion tensor. The trace images show a small contrast between white and gray matter. The diffusion coefficient of white matter is decreased in acute stroke to approximately the same extent as gray matter. It is further shown that the average lifetime of water in extra and intracellular space is shorter than 20 ms both for healthy and ischemic tissue indicating that myelin fibers are permeable to water. The anisotropy contrast did not change before or after induction of stroke, nor after sacrifice. Together, these observations are consistent with the view that the changes in water diffusion during acute stroke are directly related to cytotoxic oedema, i.e., to the change in relative volume of intra- and extracellular spaces. Changes in membrane permeability do not appear to contribute significantly to the changes in diffusion.

A method for myelin fiber orientation mapping using diffusion-weighted MR images

In the past, the anisotropic diffusion of water molecules in white matter in the brain has been correlated to the basic symmetry of the myelin fibers: water diffuses more readily along the fiber direction than perpendicular to it. As a consequence, diffusion sensitized magnetic resonance imaging can be expected to be useful for studying the fiber orientation. In this work, we present a method for exploiting this type of information to map the fiber orientations in the image plane. It makes use of three diffusion-weighted images with sensitizing gradients along x, y and u, an axis at 45 degrees with respect to x and y. The orientation information contained in these images is summarized in a single image representing the angle between the fiber direction and a fixed axis, making use of a cyclic color scale. The method is evaluated using computer simulations for a variety of diffusion weighting strengths and signal-to-noise ratios, tested on a phantom and illustrated on an in vivo example. An extension to the determination of the fiber orientation in three dimensions is also described.

In vivo differentiation of edematous changes after stroke in spontaneously hypertensive rats using diffusion weighted MRI

Apparent diffusion coefficients (ADCs) of tissue water were determined in chronic brain lesions of a rat stroke model, the stroke-prone spontaneously hypertensive rat, and compared with histology. ADCs increased in the order normal < edema < gliosis < cyst. The differences between individual groups were statistically significant. The increase in ADC is thought to mainly reflect a relative increase in the extracellular space in brain tissue. ADC may be a new parameter for tissue characterization.

Incidence of apparent restricted diffusion in three different models of cerebral infarction

High speed magnetic resonance imaging (MRI) and short diffusion times are used to investigate the appearance of restricted diffusion in three different models of cerebral infarction. The models are: the middle cerebral artery occlusion (MCAO) model in the rat, the carotid occlusion model in the gerbil, and the Rose Bengal microvascular occlusion model in the rat. All three were investigated for 16 b-values equally spaced between 10 and 1510 s/mm2 using two distinct experiments. In the ct (constant time) experiment, the diffusion time was held constant at 11.7 ms while the b-value was varied with the gradient strength. In the cg (constant gradient) experiment, the gradient strength was held constant and the b-value increased by varying the diffusion time from 4.4 to 11.7 ms. A monoexponential decay of the signal intensity with b-value in the ct experiment accompanied by nonmonoexponential (NME) decay in the cg experiment is indicative of restricted diffusion. As this phenomenon is detectable only at short diffusion times, it cannot be due to restriction by impermeable membranes, and we have thus termed this apparent restriction. For the MCAO model and the carotid occlusion model, apparent restriction was found both inside the infarct territory and in some regions outside it. No definite evidence for restriction was found for the Rose Bengal model, which was, however, only studied from 24 h post-insult.

Differentiation of chronic lesions after stroke in stroke-prone spontaneously hypertensive rats using diffusion weighted MRI

Apparent diffusion coefficients (ADCs) of tissue water were determined in chronic brain lesions of a rat stroke model, stroke-prone spontaneously hypertensive rats and compared with histology. ADCs increased in the order control < edema < gliosis < cyst. The differences between individual groups were statistically significant. The increase in ADC is thought to mainly reflect a relative increase in the extracellular space in brain tissue. ADC values may be a clinically useful parameter for tissue characterization.

Diffusion-weighted MR microscopy with fast spin-echo

A diffusion-weighted fast spin-echo (FSE) imaging sequence for high-field MR microscopy was developed and experimentally validated in a phantom and in a live rat. Pulsed diffusion gradients were executed before and after the initial 180 degrees pulse in the FSE pulse train. This produced diffusion-related reductions in image signal intensity corresponding to gradient ("b") factors between 1.80 and 1352 s/mm2. The degree of diffusion weighting was demonstrated to be independent of echo train length for experiments using trains up to 16 echoes long. Quantitative measurements on a phantom and on a live rat produced diffusion coefficients consistent with literature values. Importantly, the eight- to 16-fold increase in imaging efficiency with FSE was not accompanied by a significant loss of spatial resolution or contrast. This permits acquisition of in vivo three-dimensional data in time periods that are appropriate for evolving biological processes. The combination of accurate diffusion weighting and high spatial resolution provided by FSE makes the technique particularly useful for MR microscopy.

Diffusion imaging of experimental allergic encephalomyelitis

Diffusion-weighted magnetic resonance imaging (MRI) was compared with T2-weighted MRI in longitudinal studies of experimental allergic encephalomyelitis (EAE), an animal model of multiple sclerosis, in five monkeys (Macaca fascicularis). In a region of the brain that had highly directional myelinated fibers (internal capsule) sequential changes were identified on diffusion-weighted images on and before the day these changes were detected on conventional T2-weighted images. Changes were also identified on diffusion-weighted images in brain areas that did not develop T2-weighted abnormalities. This result suggests that diffusion-weighted image intensities are sensitive to pathologic conditions of the brain that can not be seen on T2-weighted images.

Quantitation of non-Einstein diffusion behavior of water in biological tissues by proton MR diffusion imaging: synthetic image calculations

The non-Einstein diffusion behavior of water in a model biological tissue system, intact duck embryos, has been investigated by the use of an in vivo proton pulsed-gradient spin-echo (PGSE) MR imaging technique. Multiple-frame MR images of the intact duck embryos and control solution (0.5 mM CuSO4 doped water) were acquired systematically at different diffusion times and strengths of the diffusion-sensitizing magnetic field gradients of the PGSE sequence. These raw images were then used to generate various dynamic (self-diffusion coefficient) and structural (fractal, residual attenuation, and compartment fraction) diffusion parameter maps of water in the imaging objects on the basis of different Einstein and higher order (non-Brownian, Residual, and 2-compartment) diffusion models. The self-diffusion coefficients of the body tissues of the embryos obtained from all diffusion models were significantly lower than those of the surrounding embryonic fluid. The structural diffusion parameter maps obtained from the higher order diffusion models revealed that water molecules exhibited either non-Brownian, restricted, or compartmentalized diffusion behavior in the embryonic tissues, but Einstein or Brownian diffusion behavior in the embryonic fluid and control solution. The diffusion parameter maps, both dynamic and structural, were found to provide much better contrasts than the conventional relaxation time (T1, T2, and biexponential T2) maps in separating the tissues from the surrounding embryonic fluid in the duck embryos. The mathematical models and procedures for generating the dynamic and structural diffusion parameter maps are also presented in this paper.

Histopathological correlations of nuclear magnetic resonance imaging parameters in experimental cerebral ischemia

Changes in the nuclear magnetic resonance (NMR) parameters of spin-lattice relaxation (T1), spin-spin relaxation (T2), proton density (rho), and water diffusion (DNMR) were measured over time together with the histopathological status in three regions of rat brain cortex after permanent middle cerebral artery occlusion (MCA-O). Histological response ranged from severe irreversible damage (necrosis and cavitation) to relatively mild and apparently reversible damage. DNMR was the only NMR parameter which demonstrated a statistically significant change in all three regions of brain studied. Additionally, rho was significantly increased only in the region of brain studied which eventually progressed to necrosis and cavitation. Finally, data are presented which indicate that changes in T2, DNMR, and rho can occur independently of one another.

Evaluation of experimental early acute cerebral ischemia before the development of edema: use of dynamic, contrast-enhanced and diffusion-weighted MR scanning

The ability of dynamic, contrast-enhanced, magnetic susceptibility-weighted scanning to delineate early experimental acute cerebral infarction was compared with that of heavily T2-weighted and diffusion-weighted spin echo scanning. Spontaneously hypertensive rats, which had undergone right middle cerebral artery occlusion, were studied from 15 min to 3 h post ligation on a 1.5-T clinical whole-body imager. In contrast to the diffusion- and T2-weighted spin echo scans, the dynamic, contrast-enhanced technique clearly and consistently delineated the nonperfused regions as early as 15 min post ligation.

Experimental focal cerebral ischaemia assessed with IVIM*-MRI in the acute phase at 0.5 tesla

Intravoxel incoherent motion (IVIM*)-MRI has been performed on a clinical system at 0.5 tesla with a b gradient factor of 100 s/mm2, in a feline focal model of cerebral ischaemia. Images were obtained in 26 cats from less than 1 hour and up to 7-12 hours after stroke. The apparent diffusion coefficient (ADC) was decreased at the site of injury when compared to the contralateral normal side, by 30% in the first, 33% in 1-2 h and 27% in 2-4 h; it increased at 7-12 h, when vasogenic oedema occurred. IVIM*-MRI demonstrated early changes, due to cytotoxic oedema, during the acute phase of cerebral ischaemia to which conventional T2-weighted spin-echo imaging was not sensitive.