Magnetic resonance elastography (MRE) of the human brain: technique, findings and clinical applications

Magnetic Resonance Elastography of Anterior Mediastinal Tumors

BACKGROUND

Preoperative differentiation of the types of mediastinal tumors is essential. Magnetic resonance (MR) elastography potentially provides a noninvasive method to assess the classification of mediastinal tumor subtypes.

PURPOSE

To evaluate the use of MR elastography in anterior mediastinal masses and to characterize the mechanical properties of tumors of different subtypes.

STUDY TYPE

Prospective.

SUBJECTS

189 patients with anterior mediastinal tumors (AMTs) confirmed by histopathology (62 thymomas, 53 thymic carcinomas, 57 lymphomas, and 17 germ cell tumors).

FIELD STRENGTH/SEQUENCE

A gradient echo-based 2D MR elastography sequence and a diffusion-weighted imaging (DWI) sequence at 3.0 T.

ASSESSMENT

Stiffness and apparent diffusion coefficients (ADC) were measured in AMTs using MR elastography-derived elastograms and DWI-derived ADC maps, respectively. The aim of this study is to identify whether MR elastography can differentiate between the histological subtypes of ATMs.

STATISTICAL TESTS

One-way analysis of variance (ANOVA), two-way ANOVA, Pearson's linear correlation coefficient (r), receiver operating characteristic (ROC) curve analysis; P < 0.05 was considered significant.

RESULTS

Lymphomas had significantly lower stiffness than other AMTs (4.0 ± 0.63 kPa vs. 4.8 ± 1.39 kPa). The mean stiffness of thymic carcinomas was significantly higher than that of other AMTs (5.6 ± 1.41 kPa vs. 4.2 ± 0.94 kPa). Using a cutoff value of 5.0 kPa, ROC analysis showed that lymphomas could be differentiated from other AMTs with an accuracy of 59%, sensitivity of 97%, and specificity of 38%. Using a cutoff value of 5.1 kPa, thymic carcinomas could be differentiated from other AMTs with an accuracy of 84%, sensitivity of 67%, and specificity of 90%. However, there was an overlap in the stiffness values of individual thymomas (4.2 ± 0.71; 3.9-4.5), thymic carcinomas (5.6 ± 1.41; 5.0-6.1), lymphomas (4.0 ± 0.63; 3.8-4.2), and germ cell tumors (4.5 ± 1.79; 3.3-5.6).

DATA CONCLUSION

MR elastography-derived stiffness may be used to evaluate AMTs of various histologies.

LEVEL OF EVIDENCE: 4

TECHNICAL EFFICACY

Stage 2.

Mouse brain elastography changes with sleep/wake cycles, aging, and Alzheimer's disease

Understanding the physiological processes in aging and how neurodegenerative disorders affect cognitive function is a high priority for advancing human health. One specific area of recently enabled research is the in vivo biomechanical state of the brain. This study utilized reverberant optical coherence elastography, a high-resolution elasticity imaging method, to investigate stiffness changes during the sleep/wake cycle, aging, and Alzheimer's disease in murine models. Four-dimensional scans of 44 wildtype mice, 13 mice with deletion of aquaporin-4 water channel, and 12 mice with Alzheimer-related pathology (APP/PS1) demonstrated that (1) cortical tissue became softer (on the order of a 10% decrease in shear wave speed) when young wildtype mice transitioned from wake to anesthetized, yet this effect was lost in aging and with mice overexpressing amyloid-β or lacking the water channel AQP4. (2) Cortical stiffness increased with age in all mice lines, but wildtype mice exhibited the most prominent changes as a function of aging. The study provides novel insight into the brain's biomechanics, the constraints of fluid flow, and how the state of brain activity affects basic properties of cortical tissues.

Mechanical Properties of White Matter Tracts in Aging Assessed via Anisotropic MR Elastography

Magnetic resonance elastography (MRE) is a promising neuroimaging technique to probe tissue microstructure, which has revealed widespread softening with loss of structural integrity in the aging brain. Traditional MRE approaches assume mechanical isotropy. However, white matter is known to be anisotropic from aligned, myelinated axonal bundles, which can lead to uncertainty in mechanical property estimates in these areas when using isotropic MRE. Recent advances in anisotropic MRE now allow for estimation of shear and tensile anisotropy, along with substrate shear modulus, in white matter tracts. The objective of this study was to investigate age-related differences in anisotropic mechanical properties in human brain white matter tracts for the first time. Anisotropic mechanical properties in all tracts were found to be significantly lower in older adults compared to young adults, with average property differences ranging between 0.028-0.107 for shear anisotropy and between 0.139-0.347 for tensile anisotropy. Stiffness perpendicular to the axonal fiber direction was also significantly lower in older age, but only in certain tracts. When compared with fractional anisotropy measures from diffusion tensor imaging, we found that anisotropic MRE measures provided additional, complementary information in describing differences between the white matter integrity of young and older populations. Anisotropic MRE provides a new tool for studying white matter structural integrity in aging and neurodegeneration.

Evaluation of MR Elastography as a Noninvasive Diagnostic Test for Spontaneous Intracranial Hypotension

BACKGROUND AND PURPOSE

Spontaneous intracranial hypotension is a condition resulting from a leak of CSF from the spinal canal arising independent of a medical procedure. Spontaneous intracranial hypotension can present with normal brain MR imaging findings and nonspecific symptoms, leading to the underdiagnosis in some patients and unnecessary invasive myelography in others who are found not to have the condition. Given the likelihood that spontaneous intracranial hypotension alters intracranial biomechanics, the goal of this study was to evaluate MR elastography as a potential noninvasive test to diagnose the condition.

MATERIALS AND METHODS

We performed MR elastography in 15 patients with confirmed spontaneous intracranial hypotension from September 2022 to April 2023. Age, sex, symptom duration, and brain MR imaging Bern score were collected. MR elastography data were used to compute stiffness and damping ratio maps, and voxelwise modeling was performed to detect clusters of significant differences in mechanical properties between patients with spontaneous intracranial hypotension and healthy control participants. To evaluate diagnostic accuracy, we summarized each examination by 2 spatial pattern scores (one each for stiffness and damping ratio) and evaluated group-wise discrimination by receiver operating characteristic curve analysis.

RESULTS

Patients with spontaneous intracranial hypotension exhibited significant differences in both stiffness and damping ratio (false discovery rate-corrected, Q < 0.05). Pattern analysis discriminated patients with spontaneous intracranial hypotension from healthy controls with an area under the curve of 0.97 overall, and the area under the curve was 0.97 in those without MR imaging findings of spontaneous intracranial hypotension.

CONCLUSIONS

Results from this pilot study demonstrate MR elastography as a potential imaging biomarker and a noninvasive method for diagnosing spontaneous intracranial hypotension, including patients with normal brain MR imaging findings.

Feasibility study of the application of magnetic resonance elastography (MRE) to measure oral posture related changes in stiffness of zygomaticus major muscle

PURPOSE

Development of a technique for measuring the mechanical properties of zygomaticus major (ZM) may aid advances in clinical treatments for correcting abnormal oral posture. The objective of this work was to demonstrate the feasibility of measuring the stiffness of ZM using an MR elastography technique that incorporates a custom local driver and a phase-gradient (PG) inversion.

METHODS

2D MRE investigations were performed for 3 healthy subjects using a vibration frequency of 90 Hz to test the prediction that the stiffness of ZM would be greater in the mouth-open compared to the mouth-closed position. MRE wave images were acquired along the long axis of ZM and processed using a 2D spatial-temporal directional filter applied in the direction of wave propagation along the long axis of the muscle. Stiffness measurements were obtained by applying the PG technique to a 1D-profile drawn in the phase image of the first harmonic of the wave images and a one-tailed paired t-test was used to compare the ZM stiffness between the two mouth postures (p < 0.05).

RESULTS

The mean stiffness and standard deviation (SD) of ZM across the three participants in the mouth-closed and mouth-open postures was 6.75 kPa (SD 3.36 kPa) and 15.5 kPa (SD 5.15 kPa), respectively. Changes of ZM stiffness were significantly greater in the mouth-open than the mouth-closed posture (p = 0.038).

CONCLUSION

The feasibility of using the PG MRE technique to measure stiffness changes in a small muscle such as ZM for different mouth postures has been demonstrated. Further investigations are required in a larger cohort of participants to investigate the sensitivity and reproducibility of the technique for potential clinical application as well as in health and beauty related studies.

Wavelet MRE: Imaging propagating broadband acoustic waves with wavelet-based motion-encoding gradients

PURPOSE

To demonstrate a novel MR elastography (MRE) technique, termed here wavelet MRE. With this technique, broadband motion sensitivity is achievable. Moreover, the true tissue displacement can be reconstructed with a simple inverse transform.

METHODS

A wavelet MRE sequence was developed with motion-encoding gradients based on Haar wavelets. From the phase images' displacement was estimated using an inverse transform. Simulations were performed using a frequency sweep and a transient as ground-truth motions. A PVC phantom was scanned using wavelet MRE and standard MRE with both transient (one and 10 cycles of 90-Hz motion) and steady-state dual-frequency motion (30 and 60 Hz) for comparison. The technique was tested in a human brain, and motion trajectories were estimated for each voxel.

RESULTS

In simulation, the displacement information estimated from wavelet MRE closely matched the true motion. In the phantom test, the MRE phase data generated from the displacement information derived from wavelet MRE agreed well with standard MRE data. Testing of wavelet MRE to assess transient motion waveforms in the brain was successful, and the tissue motion observed was consistent with a previous study.

CONCLUSION

The uniform and broadband frequency response of wavelet MRE makes it a promising method for imaging transient, multifrequency motion, or motion with unknown frequency content. One potential application is measuring the response of brain tissue undergoing low-amplitude, transient vibrations as a model for the study of traumatic brain injury.

Acute effects of high-intensity exercise on brain mechanical properties and cognitive function

Previous studies have shown that engagement in even a single session of exercise can improve cognitive performance in the short term. However, the underlying physiological mechanisms contributing to this effect are still being studied. Recently, with improvements to advanced quantitative neuroimaging techniques, brain tissue mechanical properties can be sensitively and noninvasively measured with magnetic resonance elastography (MRE) and regional brain mechanical properties have been shown to reflect individual cognitive performance. Here we assess brain mechanical properties before and immediately after engagement in a high-intensity interval training (HIIT) regimen, as well as one-hour post-exercise. We find that immediately after exercise, subjects in the HIIT group had an average global brain stiffness decrease of 4.2% (p < 0.001), and an average brain damping ratio increase of 3.1% (p = 0.002). In contrast, control participants who did not engage in exercise showed no significant change over time in either stiffness or damping ratio. Changes in brain mechanical properties with exercise appeared to be regionally dependent, with the hippocampus decreasing in stiffness by 10.4%. We also found that one-hour after exercise, brain mechanical properties returned to initial baseline values. The magnitude of changes to brain mechanical properties also correlated with improvements in reaction time on executive control tasks (Eriksen Flanker and Stroop) with exercise. Understanding the neural changes that arise in response to exercise may inform potential mechanisms behind improvements to cognitive performance with acute exercise.

Feasibility of assessing non-invasive intracranial compliance using FSI simulation-based and MR elastography-based brain stiffness

Intracranial compliance (ICC) refers to the change in intracranial volume per unit change in intracranial pressure (ICP). Magnetic resonance elastography (MRE) quantifies brain stiffness by measuring the shear modulus. Our objective is to investigate the relationship between ICC and brain stiffness through fluid-structure interaction (FSI) simulation, and to explore the feasibility of using MRE to assess ICC based on brain stiffness. This is invaluable due to the clinical importance of ICC, as well as the fast and non-invasive nature of the MRE procedure. We employed FSI simulation in hydrocephalus patients with aqueductal stenosis to non-invasively calculate ICP which is the basis of the calculation of ICC and FSI-based brain stiffness. The FSI simulated parameters used have been validated with experimental data. Our results showed that there is no relationship between FSI simulated-based brain stiffness and ICC in hydrocephalus patients. However, MRE-based brain stiffness may be sensitive to changes in intracranial fluid dynamic parameters such as cerebral perfusion pressure (CPP), cerebral blood flow (CBF), and ICP, as well as to mechano-vascular changes in the brain, which are determining parameters in ICC assessment. Although optimism has been found regarding the assessment of ICC using MRE-based brain stiffness, especially for acute-onset brain disorders, further studies are necessary to clarify their direct relationship.

Transcranial ultrasound estimation of viscoelasticity and fluidity in brain tumors aided by transcranial shear waves

Cerebral diseases, such as brain tumors, are intricately linked to the mechanical properties of brain tissues. Estimating the mechanical properties of brain tumors using transcranial ultrasound is a promising approach. However, the complexity of cranial features introduces challenges, such as ultrasound attenuation and interference from multidirectional transcranial shear waves induced by impact vibrations. To address these issues, this study proposes a transcranial ultrasound estimation method assisted by transcranial shear vibrations. Transcranial vibrations apply shear forces on the parietal bone, inducing unidirectional transcranial shear waves within brain tissue, as validated through simulations. Shear waves at different frequencies were captured via transcranial ultrasound, which were used to assess the viscoelasticity and fluidity of brain tumors. Transcranial experimental validations were conducted in 3D-printed models with tumor phantoms and ex vivo animal tumors. Vibration safety assessments were also performed. The results demonstrate that transcranial ultrasound can detect micron displacements induced by transcranial shear waves. In phantom and ex vivo animal experiments, speed distribution maps were employed to determine the size and location of one or two tumors enclosed in the skull model. The results revealed that the proposed approach could detect tumors with a minimum diameter of 0.8 cm and an inter-tumor distance of 0.8 cm. Notably, significant differences in viscoelasticity and fluidity between normal brain tissue and brain tumors were found (p<0.001). The maximum assessment errors for the elasticity, viscosity, and fluidity using transcranial ultrasound were 11.90%, 4.82%, and 0.73%, respectively, indicating that fluidity was more robust than viscoelasticity. The maximum accelerations of the skull were only 3.21 ms-2.

Repeatability of diffusion-based stiffness prediction - A healthy volunteer study

INTRODUCTION

The study investigated the repeatability of brain diffusion-based stiffness prediction (DWIstiff) in healthy volunteers.

METHODS

Thirty-one healthy volunteers were examined with DWIstiff using two different sets of b-values: b200-1500 s/mm2 (DWIstiff, 1500) and b200-1000 s/mm2 (DWIstiff, 1000). Each b-value set was scanned twice per imaging session without repositioning the participants. DWIstiff images were reconstructed from each set. Two observers delineated regions of interest (ROIs) on each DWIstiff image. The repeatability coefficient (RC), coefficient of variation (CV), inter- and intraobserver agreement were calculated.

RESULTS

After excluding three participants due to image artifacts, the study included twenty-eight volunteers (mean age (range)) 37 years (24-62), 10 males, 18 females). For DWIstiff, 1500, the lowest and the highest RCs were in the parietal lobe (0.52) and respectively the brain stem (1.17). The lowest RC for DWIstiff, 1000 was in the frontal lobe (0.42) and the highest in the brain stem (1.58). The CV for whole brain measurements was 3.83 % for DWIstiff, 1500 and 4.93 % for DWIstiff, 1000. The Bland‒Altman (BA) limits of agreement (LoA) for the intraobserver agreement of DWIstiff, 1500 were -0.90 to 1.06 and respectively -0.78 to 0.88 for DWIstiff, 1000. Regarding interobserver agreement, the LoA were -0.85 to 0.94 for DWIstiff, 1500 and -0.61 to 0.66 for DWIstiff, 1000.

CONCLUSION

DWIstiff is a precise technique with some observer dependence. Repeatability is higher for DWIstiff, 1000 s/mm2 than for DWIstiff 1500 s/mm2.

IMPLICATIONS FOR PRACTICE

Our findings suggest that DWIstiff can reliably detect stiffness changes larger than 4.93 % in healthy volunteers. Further studies should investigate whether the repeatability of DWIstiff may be affected by the presence of pathology such as a brain tumor.

Magnetic resonance elastography captures a transient benefit of exercise intervention on forebrain stiffness in a rat model of fetal alcohol spectrum disorders

BACKGROUND

Fetal alcohol spectrum disorders (FASD), a group of prevalent conditions resulting from prenatal alcohol exposure, affect the maturation of cerebral white matter as first identified with neuroimaging. However, traditional methods are unable to track subtle microstructural alterations to white matter. This preliminary study uses a highly sensitive and clinically translatable magnetic resonance elastography (MRE) protocol to assess brain tissue microstructure through its mechanical properties following an exercise intervention in a rat model of FASD.

METHODS

Female rat pups were either alcohol-exposed (AE) via intragastric intubation of alcohol in milk substitute (5.25 g/kg/day) or sham-intubated (SI) on postnatal days (PD) four through nine to model alcohol exposure during the brain growth spurt. On PD 30, half of AE and SI rats were randomly assigned to either a wheel-running or standard cage for 12 days. Magnetic resonance elastography was used to measure whole brain and callosal mechanical properties at the end of the intervention (around PD 42) and at 1 month post-intervention, and findings were validated with histological quantification of oligoglia.

RESULTS

Alcohol exposure reduced forebrain stiffness (p = 0.02) in standard-housed rats. The adolescent exercise intervention mitigated this effect, confirming that increased aerobic activity supports proper neurodevelopmental trajectories. Forebrain damping ratio was lowest in standard-housed AE rats (p < 0.01), but this effect was not mitigated by intervention exposure. At 1 month post-intervention, all rats exhibited comparable forebrain stiffness and damping ratio (p > 0.05). Callosal stiffness and damping ratio increased with age. With cessation of exercise, there was a negative rebound effect on the quantity of callosal oligodendrocytes, irrespective of treatment group, which diverged from our MRE results.

CONCLUSIONS

This is the first application of MRE to measure the brain's mechanical properties in a rodent model of FASD. MRE successfully captured alcohol-related changes in forebrain stiffness and damping ratio. Additionally, MRE identified an exercise-related increase to forebrain stiffness in AE rats.

Magnetic Resonance Elastography in the Study of Neurodegenerative Diseases

Neurodegenerative diseases such as Alzheimer's disease (AD) and Parkinson's disease (PD) present a major health burden to society. Changes in brain structure and cognition are generally only observed at the late stage of the disease. Although advanced magnetic resonance imaging (MRI) techniques such as diffusion imaging may allow identification of biomarkers at earlier stages of neurodegeneration, early diagnosis is still challenging. Magnetic resonance elastography (MRE) is a noninvasive MRI technique for studying the mechanical properties of tissues by measuring the wave propagation induced in the tissues using a purpose-built actuator. Here, we present a systematic review of preclinical and clinical studies in which MRE has been applied to study neurodegenerative diseases. Actuator systems for data acquisition, inversion algorithms for data analysis, and sample demographics are described and tissue stiffness measures obtained for the whole brain and internal structures are summarized. A total of six animal studies and eight human studies have been published. The animal studies refer to 123 experimental animals (68 AD and 55 PD) and 121 wild-type animals, while the human studies refer to 142 patients with neurodegenerative disease (including 56 AD and 17 PD) and 166 controls. The animal studies are consistent in the reporting of decreased stiffness of the hippocampal region in AD mice. However, in terms of disease progression, although consistent decreases in either storage modulus or shear modulus magnitude are reported for whole brain, there is variation in the results reported for the hippocampal region. The clinical studies are consistent in reports of a significant decrease in either whole brain storage modulus or shear modulus magnitude, in both AD and PD and with different brain structures affected in different neurodegenerative diseases. MRE studies of neurodegenerative diseases are still in their infancy, and in future it will be interesting to investigate potential relationships between brain mechanical properties and clinical measures, which may help elucidate the mechanisms underlying onset and progression of neurodegenerative diseases. EVIDENCE LEVEL: 1. TECHNICAL EFFICACY: Stage 2.

Estimating the viscoelastic properties of the human brain at 7 T MRI using intrinsic MRE and nonlinear inversion

Intrinsic actuation magnetic resonance elastography (MRE) is a phase-contrast MRI technique that allows for in vivo quantification of mechanical properties of the brain by exploiting brain motion that arise naturally due to the cardiac pulse. The mechanical properties of the brain reflect its tissue microstructure, making it a potentially valuable parameter in studying brain disease. The main purpose of this study was to assess the feasibility of reconstructing the viscoelastic properties of the brain using high-quality 7 T MRI displacement measurements, obtained using displacement encoding with stimulated echoes (DENSE) and intrinsic actuation. The repeatability and sensitivity of the method for detecting normal regional variation in brain tissue properties was assessed as secondary goal. The displacement measurements used in this analysis were previously acquired for a separate study, where eight healthy subjects (27 ± 7 years) were imaged with repeated scans (spatial resolution approx. 2 mm isotropic, temporal resolution 75 ms, motion sensitivity 0.35 mm/2π for displacements in anterior-posterior and left-right directions, and 0.7 mm/2π for feet-head displacements). The viscoelastic properties of the brain were estimated using a subzone based non-linear inversion scheme. The results show comparable consistency to that of extrinsic MRE between the viscoelastic property maps obtained from repeated displacement measurements. The shear stiffness maps showed fairly consistent spatial patterns. The whole-brain repeatability coefficient (RC) for shear stiffness was (mean ± standard deviation) 8 ± 8% relative to the mean whole-brain stiffness, and the damping ratio RC was 28 ± 17% relative to the whole-brain damping ratio. The shear stiffness maps showed similar statistically significant regional trends as demonstrated in a publicly available atlas of viscoelastic properties obtained with extrinsic actuation MRE at 50 Hz. The damping ratio maps showed less consistency, likely due to data-model mismatch of describing the brain as a viscoelastic material under low frequencies. While artifacts induced by fluid flow within the brain remain a limitation of the technique in its current state, intrinsic actuation based MRE allow for consistent and repeatable estimation of the mechanical properties of the brain. The method provides enough sensitivity to investigate regional variation in such properties in the normal brain, which is likely sufficient to also investigate pathological changes.

Clinical application of magnetic resonance elastography in pediatric neurological disorders

Magnetic resonance elastography is a relatively new, rapidly evolving quantitative magnetic resonance imaging technique which can be used for mapping the viscoelastic mechanical properties of soft tissues. MR elastography measurements are akin to manual palpation but with the advantages of both being quantitative and being useful for regions which are not available for palpation, such as the human brain. MR elastography is noninvasive, well tolerated, and complements standard radiological and histopathological studies by providing in vivo measurements that reflect tissue microstructural integrity. While brain MR elastography studies in adults are becoming frequent, published studies on the utility of MR elastography in children are sparse. In this review, we have summarized the major scientific principles and recent clinical applications of brain MR elastography in diagnostic neuroscience and discuss avenues for impact in assessing the pediatric brain.

Vascular determinants of hippocampal viscoelastic properties in healthy adults across the lifespan

Arterial stiffness and cerebrovascular pulsatility are non-traditional risk factors of Alzheimer's disease. However, there is a gap in understanding the earliest mechanisms that link these vascular determinants to brain aging. Changes to mechanical tissue properties of the hippocampus (HC), a brain structure essential for memory encoding, may reflect the impact of vascular dysfunction on brain aging. We tested the hypothesis that arterial stiffness and cerebrovascular pulsatility are related to HC tissue properties in healthy adults across the lifespan. Twenty-five adults underwent measurements of brachial blood pressure (BP), large elastic artery stiffness, middle cerebral artery pulsatility index (MCAv PI), and magnetic resonance elastography (MRE), a sensitive measure of HC viscoelasticity. Individuals with higher carotid pulse pressure (PP) exhibited lower HC stiffness (β = -0.39, r = -0.41, p = 0.05), independent of age and sex. Collectively, carotid PP and MCAv PI significantly explained a large portion of the total variance in HC stiffness (adjusted R2 = 0.41, p = 0.005) in the absence of associations with HC volumes. These cross-sectional findings suggest that the earliest reductions in HC tissue properties are associated with alterations in vascular function.

Individual Muscle Force Estimation in the Human Forearm Using Multi-Muscle MR Elastography (MM-MRE)

OBJECTIVE

To establish the sensitivity of magnetic resonance elastography (MRE) to active muscle contraction in multiple muscles of the forearm.

METHODS

We combined MRE of forearm muscles with an MRI-compatible device, the MREbot, to simultaneously measure the mechanical properties of tissues in the forearm and the torque applied by the wrist joint during isometric tasks. We measured shear wave speed of thirteen forearm muscles via MRE in a series of contractile states and wrist postures and fit these outputs to a force estimation algorithm based on a musculoskeletal model.

RESULTS

Shear wave speed changed significantly upon several factors, including whether the muscle was recruited as an agonist or antagonist (p = 0.0019), torque amplitude (p = <0.0001), and wrist posture (p = 0.0002). Shear wave speed increased significantly during both agonist (p = <0.0001) and antagonist (p = 0.0448) contraction. Additionally, there was a greater increase in shear wave speed at greater levels of loading. The variations due to these factors indicate the sensitivity to functional loading of muscle. Under the assumption of a quadratic relationship between shear wave speed and muscle force, MRE measurements accounted for an average of 70% of the variance in the measured joint torque.

CONCLUSION

This study shows the ability of MM-MRE to capture variations in individual muscle shear wave speed due to muscle activation and presents a method to estimate individual muscle force through MM-MRE derived measurements of shear wave speed.

SIGNIFICANCE

MM-MRE could be used to establish normal and abnormal muscle co-contraction patterns in muscles of the forearm controlling hand and wrist function.

An atlas of the heterogeneous viscoelastic brain with local power-law attenuation synthesised using Prony-series

This review addresses the acute need to acknowledge the mechanical heterogeneity of brain matter and to accurately calibrate its local viscoelastic material properties accordingly. Specifically, it is important to compile the existing and disparate literature on attenuation power-laws and dispersion to make progress in wave physics of brain matter, a field of research that has the potential to explain the mechanisms at play in diffuse axonal injury and mild traumatic brain injury in general. Currently, viscous effects in the brain are modelled using Prony-series, i.e., a sum of decaying exponentials at different relaxation times. Here we collect and synthesise the Prony-series coefficients appearing in the literature for twelve regions: brainstem, basal ganglia, cerebellum, corona radiata, corpus callosum, cortex, dentate gyrus, hippocampus, thalamus, grey matter, white matter, homogeneous brain, and for eight different mammals: pig, rat, human, mouse, cow, sheep, monkey and dog. Using this data, we compute the fractional-exponent attenuation power-laws for different tissues of the brain, the corresponding dispersion laws resulting from causality, and the averaged Prony-series coefficients. STATEMENT OF SIGNIFICANCE: Traumatic brain injuries are considered a silent epidemic and finite element methods (FEMs) are used in modelling brain deformation, requiring access to viscoelastic properties of brain. To the best of our knowledge, this work presents 1) the first multi-frequency viscoelastic atlas of the heterogeneous brain, 2) the first review focusing on viscoelastic modelling in both FEMs and experimental works, 3) the first attempt to conglomerate the disparate existing literature on the viscoelastic modelling of the brain and 4) the largest collection of viscoelastic parameters for the brain (212 different Prony-series spanning 12 different tissues and 8 different animal surrogates). Furthermore, this work presents the first brain atlas of attenuation power-laws essential for modelling shear waves in brain.

Monitoring lasting changes to brain tissue integrity through mechanical properties following adolescent exercise intervention in a rat model of Fetal Alcohol Spectrum Disorders

Background

Fetal Alcohol Spectrum Disorders (FASD) encompass a group of highly prevalent conditions resulting from prenatal alcohol exposure. Alcohol exposure during the third trimester of pregnancy overlapping with the brain growth spurt is detrimental to white matter growth and myelination, particularly in the corpus callosum, ultimately affecting tissue integrity in adolescence. Traditional neuroimaging techniques have been essential for assessing neurodevelopment in affected youth; however, these methods are limited in their capacity to track subtle microstructural alterations to white matter, thus restricting their effectiveness in monitoring therapeutic intervention. In this preliminary study we use a highly sensitive and clinically translatable Magnetic Resonance Elastography (MRE) protocol for assessing brain tissue microstructure through its mechanical properties following an exercise intervention in a rat model of FASD.

Methods

Rat pups were divided into two groups: alcohol-exposed (AE) pups which received alcohol in milk substitute (5.25 g/kg/day) via intragastric intubation on postnatal days (PD) four through nine during the rat brain growth spurt (Dobbing and Sands, 1979), or sham-intubated (SI) controls. In adolescence, on PD 30, half AE and SI rats were randomly assigned to either a modified home cage with free access to a running wheel or to a new home cage for 12 days (Gursky and Klintsova, 2017). Previous studies conducted in the lab have shown that 12 days of voluntary exercise intervention in adolescence immediately ameliorated callosal myelination in AE rats (Milbocker et al., 2022, 2023). MRE was used to measure longitudinal changes to mechanical properties of the whole brain and the corpus callosum at intervention termination and one-month post-intervention. Histological quantification of precursor and myelinating oligoglia in corpus callosum was performed one-month post-intervention.

Results

Prior to intervention, AE rats had lower forebrain stiffness in adolescence compared to SI controls ( p = 0.02). Exercise intervention immediately mitigated this effect in AE rats, resulting in higher forebrain stiffness post-intervention in adolescence. Similarly, we discovered that forebrain damping ratio was lowest in AE rats in adolescence ( p < 0.01), irrespective of intervention exposure. One-month post-intervention in adulthood, AE and SI rats exhibited comparable forebrain stiffness and damping ratio (p > 0.05). Taken together, these MRE data suggest that adolescent exercise intervention supports neurodevelopmental "catch-up" in AE rats. Analysis of the stiffness and damping ratio of the body of corpus callosum revealed that these measures increased with age. Finally, histological quantification of myelinating oligodendrocytes one-month post-intervention revealed a negative rebound effect of exercise cessation on the total estimate of these cells in the body of corpus callosum, irrespective of treatment group which was not convergent with noninvasive MRE measures.

Conclusions

This is the first application of MRE to measure changes in brain mechanical properties in a rodent model of FASD. MRE successfully captured alcohol-related changes to forebrain stiffness and damping ratio in adolescence. These preliminary findings expand upon results from previous studies which used traditional diffusion neuroimaging to identify structural changes to the adolescent brain in rodent models of FASD (Milbocker et al., 2022; Newville et al., 2017). Additionally, in vivo MRE identified an exercise-related alteration to forebrain stiffness that occurred in adolescence, immediately post-intervention.

Stiffness pulsation of the human brain detected by non-invasive time-harmonic elastography

Introduction: Cerebral pulsation is a vital aspect of cerebral hemodynamics. Changes in arterial pressure in response to cardiac pulsation cause cerebral pulsation, which is related to cerebrovascular compliance and cerebral blood perfusion. Cerebrovascular compliance and blood perfusion influence the mechanical properties of the brain, causing pulsation-induced changes in cerebral stiffness. However, there is currently no imaging technique available that can directly quantify the pulsation of brain stiffness in real time. Methods: Therefore, we developed non-invasive ultrasound time-harmonic elastography (THE) technique for the real-time detection of brain stiffness pulsation. We used state-of-the-art plane-wave imaging for interleaved acquisitions of shear waves at a frequency of 60 Hz to measure stiffness and color flow imaging to measure cerebral blood flow within the middle cerebral artery. In the second experiment, we used cost-effective lineby-line B-mode imaging to measure the same mechanical parameters without flow imaging to facilitate future translation to the clinic. Results: In 10 healthy volunteers, stiffness increased during the passage of the arterial pulse wave from 4.8% ± 1.8% in the temporal parenchyma to 11% ± 5% in the basal cisterns and 13% ± 9% in the brain stem. Brain stiffness peaked in synchrony with cerebral blood flow at approximately 180 ± 30 ms after the cardiac R-wave. Line-by-line THE provided the same stiffness values with similar time resolution as high-end plane-wave THE, demonstrating the robustness of brain stiffness pulsation as an imaging marker. Discussion: Overall, this study sets the background and provides reference values for time-resolved THE in the human brain as a cost-efficient and easy-touse mechanical biomarker associated with cerebrovascular compliance.

Viscoelastic Property of the Brain Assessed With Magnetic Resonance Elastography and Its Association With Glymphatic System in Neurologically Normal Individuals

OBJECTIVE

To investigate the feasibility of assessing the viscoelastic properties of the brain using magnetic resonance elastography (MRE) and a novel MRE transducer to determine the relationship between the viscoelastic properties and glymphatic function in neurologically normal individuals.

MATERIALS AND METHODS

This prospective study included 47 neurologically normal individuals aged 23-74 years (male-to-female ratio, 21:26). The MRE was acquired using a gravitational transducer based on a rotational eccentric mass as the driving system. The magnitude of the complex shear modulus |G*| and the phase angle ϕ were measured in the centrum semiovale area. To evaluate glymphatic function, the Diffusion Tensor Image Analysis Along the Perivascular Space (DTI-ALPS) method was utilized and the ALPS index was calculated. Univariable and multivariable (variables with P < 0.2 from the univariable analysis) linear regression analyses were performed for |G*| and ϕ and included sex, age, normalized white matter hyperintensity (WMH) volume, brain parenchymal volume, and ALPS index as covariates.

RESULTS

In the univariable analysis for |G*|, age (P = 0.005), brain parenchymal volume (P = 0.152), normalized WMH volume (P = 0.011), and ALPS index (P = 0.005) were identified as candidates with P < 0.2. In the multivariable analysis, only the ALPS index was independently associated with |G*|, showing a positive relationship (β = 0.300, P = 0.029). For ϕ, normalized WMH volume (P = 0.128) and ALPS index (P = 0.015) were identified as candidates for multivariable analysis, and only the ALPS index was independently associated with ϕ (β = 0.057, P = 0.039).

CONCLUSION

Brain MRE using a gravitational transducer is feasible in neurologically normal individuals over a wide age range. The significant correlation between the viscoelastic properties of the brain and glymphatic function suggests that a more organized or preserved microenvironment of the brain parenchyma is associated with a more unimpeded glymphatic fluid flow.

Advanced MR Techniques for Preoperative Glioma Characterization: Part 2

Preoperative clinical MRI protocols for gliomas, brain tumors with dismal outcomes due to their infiltrative properties, still rely on conventional structural MRI, which does not deliver information on tumor genotype and is limited in the delineation of diffuse gliomas. The GliMR COST action wants to raise awareness about the state of the art of advanced MRI techniques in gliomas and their possible clinical translation. This review describes current methods, limits, and applications of advanced MRI for the preoperative assessment of glioma, summarizing the level of clinical validation of different techniques. In this second part, we review magnetic resonance spectroscopy (MRS), chemical exchange saturation transfer (CEST), susceptibility-weighted imaging (SWI), MRI-PET, MR elastography (MRE), and MR-based radiomics applications. The first part of this review addresses dynamic susceptibility contrast (DSC) and dynamic contrast-enhanced (DCE) MRI, arterial spin labeling (ASL), diffusion-weighted MRI, vessel imaging, and magnetic resonance fingerprinting (MRF). EVIDENCE LEVEL: 3. TECHNICAL EFFICACY: Stage 2.

Transversely-isotropic brain in vivo MR elastography with anisotropic damping

Measuring tissue parameters from increasingly sophisticated mechanical property models may uncover new contrast mechanisms with clinical utility. Building on previous work on in vivo brain MR elastography (MRE) with a transversely-isotropic with isotropic damping (TI-ID) model, we explore a new transversely-isotropic with anisotropic damping (TI-AD) model that involves six independent parameters describing direction-dependent behavior for both stiffness and damping. The direction of mechanical anisotropy is determined by diffusion tensor imaging and we fit three complex-valued moduli distributions across the full brain volume to minimize differences between measured and modeled displacements. We demonstrate spatially accurate property reconstruction in an idealized shell phantom simulation, as well as an ensemble of 20 realistic, randomly-generated simulated brains. We characterize the simulated precisions of all six parameters across major white matter tracts to be high, suggesting that they can be measured independently with acceptable accuracy from MRE data. Finally, we present in vivo anisotropic damping MRE reconstruction data. We perform t-tests on eight repeated MRE brain exams on a single-subject, and find that the three damping parameters are statistically distinct for most tracts, lobes and the whole brain. We also show that population variations in a 17-subject cohort exceed single-subject measurement repeatability for most tracts, lobes and whole brain, for all six parameters. These results suggest that the TI-AD model offers new information that may support differential diagnosis of brain diseases.

Fluid compartments influence elastography of the aging mouse brain

Objective. Elastography of the brain has the potential to reveal subtle but clinically important changes in the structure and composition as a function of age, disease, and injury.Approach. In order to quantify the specific effects of aging on mouse brain elastography, and to determine the key factors influencing observed changes, we applied optical coherence tomography reverberant shear wave elastography at 2000 Hz to a group of wild-type healthy mice ranging from young to old age.Main results. We found a strong trend towards increasing stiffness with age, with an approximately 30% increase in shear wave speed from 2 months to 30 months within this sampled group. Furthermore, this appears to be strongly correlated with decreasing measures of whole brain fluid content, so older brains have less water and are stiffer. Rheological models are applied, and the strong effect is captured by specific assignment of changes to the glymphatic compartment of the brain fluid structures along with a correlated change in the parenchymal stiffness.Significance. Short-term and longer-term changes in elastography measures may provide a sensitive biomarker of progressive and fine-scale changes in the glymphatic fluid channels and parenchymal components of the brain.

Reverberant magnetic resonance elastographic imaging using a single mechanical driver

Reverberant elastography provides fast and robust estimates of shear modulus; however, its reliance on multiple mechanical drivers hampers clinical utility. In this work, we hypothesize that for constrained organs such as the brain, reverberant elastography can produce accurate magnetic resonance elastograms with a single mechanical driver. To corroborate this hypothesis, we performed studies on healthy volunteers (n= 3); and a constrained calibrated brain phantom containing spherical inclusions with diameters ranging from 4-18 mm. In both studies (i.e. phantom and clinical), imaging was performed at frequencies of 50 and 70 Hz. We used the accuracy and contrast-to-noise ratio performance metrics to evaluate reverberant elastograms relative to those computed using the established subzone inversion method. Errors incurred in reverberant elastograms varied from 1.3% to 16.6% when imaging at 50 Hz and 3.1% and 16.8% when imaging at 70 Hz. In contrast, errors incurred in subzone elastograms ranged from 1.9% to 13% at 50 Hz and 3.6% to 14.9% at 70 Hz. The contrast-to-noise ratio of reverberant elastograms ranged from 63.1 to 73 dB compared to 65 to 66.2 dB for subzone elastograms. The average global brain shear modulus estimated from reverberant and subzone elastograms was 2.36 ± 0.07 kPa and 2.38 ± 0.11 kPa, respectively, when imaging at 50 Hz and 2.70 ± 0.20 kPa and 2.89 ± 0.60 kPa respectively, when imaging at 70 Hz. The results of this investigation demonstrate that reverberant elastography can produce accurate, high-quality elastograms of the brain with a single mechanical driver.

In vivoestimation of anisotropic mechanical properties of the gastrocnemius during functional loading with MR elastography

Objective.In vivoimaging assessments of skeletal muscle structure and function allow for longitudinal quantification of tissue health. Magnetic resonance elastography (MRE) non-invasively quantifies tissue mechanical properties, allowing for evaluation of skeletal muscle biomechanics in response to loading, creating a better understanding of muscle functional health.Approach. In this study, we analyze the anisotropic mechanical response of calf muscles using MRE with a transversely isotropic, nonlinear inversion algorithm (TI-NLI) to investigate the role of muscle fiber stiffening under load. We estimate anisotropic material parameters including fiber shear stiffness (μ1), substrate shear stiffness (μ2), shear anisotropy (ϕ), and tensile anisotropy (ζ) of the gastrocnemius muscle in response to both passive and active tension.Main results. In passive tension, we found a significant increase inμ1,ϕ,andζwith increasing muscle length. While in active tension, we observed increasingμ2and decreasingϕandζduring active dorsiflexion and plantarflexion-indicating less anisotropy-with greater effects when the muscles act as agonist.Significance. The study demonstrates the ability of this anisotropic MRE method to capture the multifaceted mechanical response of skeletal muscle to tissue loading from muscle lengthening and contraction.

Characterization of material properties and deformation in the ANGUS phantom during mild head impacts using MRI

Traumatic brain injury (TBI) is a major health concern affecting both military and civilian populations. Despite notable advances in TBI research in recent years, there remains a significant gap in linking the impulsive loadings from a blast or a blunt impact to the clinical injury patterns observed in TBI. Synthetic head models or phantoms can be used to establish this link as they can be constructed with geometry, anatomy, and material properties that match the human brain, and can be used as an alternative to animal models. This study presents one such phantom called the Anthropomorphic Neurologic Gyrencephalic Unified Standard (ANGUS) phantom, which is an idealized gyrencephalic brain phantom composed of polyacrylamide gel. Here we mechanically characterized the ANGUS phantom using tagged magnetic resonance imaging (MRI) and magnetic resonance elastography (MRE), and then compared the outcomes to data obtained in healthy volunteers. The direct comparison between the phantom's response and the data from a cohort of in vivo human subjects demonstrate that the ANGUS phantom may be an appropriate model for bulk tissue response and gyral dynamics of the human brain under small amplitude linear impulses. However, the phantom's response differs from that of the in vivo human brain under rotational impacts, suggesting avenues for future improvements to the phantom.

Mechanical behavior of the hippocampus and corpus callosum: An attempt to reconcile ex vivo with in vivo and micro with macro properties

Mechanical properties of brain tissue are very complex and vary with the species, region, method, and dynamic range, and between in vivo and ex vivo measurements. To reconcile this variability, we investigated in vivo and ex vivo stiffness properties of two distinct regions in the human and mouse brain - the hippocampus (HP) and the corpus callosum (CC) - using different methods. Under quasi-static conditions, we examined ex vivo murine HP and CC by atomic force microscopy (AFM). Between 16 and 40Hz, we investigated the in vivo brains of healthy volunteers by magnetic resonance elastography (MRE) in a 3-T clinical scanner. At high-frequency stimulation between 1000 and 1400Hz, we investigated the murine HP and CC ex vivo and in vivo with MRE in a 7-T preclinical system. HP and CC showed pronounced stiffness dispersion, as reflected by a factor of 32-36 increase in shear modulus from AFM to low-frequency human MRE and a 25-fold higher shear wave velocity in murine MRE than in human MRE. At low frequencies, HP was softer than CC, in both ex vivo mouse specimens (p < 0.05) and in vivo human brains (p < 0.01) while, at high frequencies, CC was softer than HP under in vivo (p < 0.01) and ex vivo (p < 0.05) conditions. The standard linear solid model comprising three elements reproduced the observed HP and CC stiffness dispersions, while other two- and three-element models failed. Our results indicate a remarkable consistency of brain stiffness across species, ex vivo and in vivo states, and different measurement techniques when marked viscoelastic dispersion properties combining equilibrium and non-equilibrium mechanical elements are considered.

Mimicking the neural stem cell niche: An engineer’s view of cell: material interactions

Neural stem cells have attracted attention in recent years to treat neurodegeneration. There are two neurogenic regions in the brain where neural stem cells reside, one of which is called the subventricular zone (SVZ). The SVZ niche is a complicated microenvironment providing cues to regulate self-renewal and differentiation while maintaining the neural stem cell’s pool. Many scientists have spent years understanding the cellular and structural characteristics of the SVZ niche, both in homeostasis and pathological conditions. On the other hand, engineers focus primarily on designing platforms using the knowledge they acquire to understand the effect of individual factors on neural stem cell fate decisions. This review provides a general overview of what we know about the components of the SVZ niche, including the residing cells, extracellular matrix (ECM), growth factors, their interactions, and SVZ niche changes during aging and neurodegenerative diseases. Furthermore, an overview will be given on the biomaterials used to mimic neurogenic niche microenvironments and the design considerations applied to add bioactivity while meeting the structural requirements. Finally, it will discuss the potential gaps in mimicking the microenvironment.

Compression Elastography and Shear Wave Ultrasound Elastography for Measurement of Brain Elasticity in Full-Term and Premature Neonates: A Prospective Study

OBJECTIVES

To investigate the brain tissue elasticity in normal term and premature neonates using compression elastography and shear wave elastography.

METHODS

This prospective observational study enrolled term and premature neonates admitted to the Third Affiliated Hospital of Guangzhou Medical University between July 2019 and December 2020.

RESULTS

A total of 106 neonates, including 65 premature neonates and 41 term neonates, were enrolled. The elastic modulus of the frontal white matter in males was significantly lower than in females (11.67 ± 0.98 versus 12.25 ± 1.31, P = .030), but the shear wave velocity of the thalamus in males was significantly lower than in females (1.18 ± 0.13 versus 1.82 ± 0.10, P < .001). There was no significant correlation between real-time body weight and brain tissue elasticity including elastic modulus and shear wave velocity. But, the shear wave velocity of parietal white matter (r = 0.319, P = .014) and thalamus (r = -0.268, P = .040) and the elastic modulus of parietal white matter (r = 0.356, P = .006) were correlated with corrected gestational age.

CONCLUSIONS

Clinicians may consider using elastography to determine brain tissue elasticity in term and preterm neonates.

Hippocampal subfield viscoelasticity in amnestic mild cognitive impairment evaluated with MR elastography

Hippocampal subfields (HCsf) are brain regions important for memory function that are vulnerable to decline with amnestic mild cognitive impairment (aMCI), which is often a preclinical stage of Alzheimer's disease. Studies in aMCI patients often assess HCsf tissue integrity using measures of volume, which has little specificity to microstructure and pathology. We use magnetic resonance elastography (MRE) to examine the viscoelastic mechanical properties of HCsf tissue, which is related to structural integrity, and sensitively detect differences in older adults with aMCI compared to an age-matched control group. Group comparisons revealed HCsf viscoelasticity is differentially affected in aMCI, with CA1-CA2 and DG-CA3 exhibiting lower stiffness and CA1-CA2 exhibiting higher damping ratio, both indicating poorer tissue integrity in aMCI. Including HCsf stiffness in a logistic regression improves classification of aMCI beyond measures of volume alone. Additionally, lower DG-CA3 stiffness predicted aMCI status regardless of DG-CA3 volume. These findings showcase the benefit of using MRE in detecting subtle pathological tissue changes in individuals with aMCI via the HCsf particularly affected in the disease.

Cerebral tomoelastography based on multifrequency MR elastography in two and three dimensions

Purpose: Magnetic resonance elastography (MRE) generates quantitative maps of the mechanical properties of biological soft tissues. However, published values obtained by brain MRE vary largely and lack detail resolution, due to either true biological effects or technical challenges. We here introduce cerebral tomoelastography in two and three dimensions for improved data consistency and detail resolution while considering aging, brain parenchymal fraction (BPF), systolic blood pressure, and body mass index (BMI). Methods: Multifrequency MRE with 2D- and 3D-tomoelastography postprocessing was applied to the brains of 31 volunteers (age range: 22-61 years) for analyzing the coefficient of variation (CV) and effects of biological factors. Eleven volunteers were rescanned after 1 day and 1 year to determine intraclass correlation coefficient (ICC) and identify possible long-term changes. Results: White matter shear wave speed (SWS) was slightly higher in 2D-MRE (1.28 ± 0.02 m/s) than 3D-MRE (1.22 ± 0.05 m/s, p < 0.0001), with less variation after 1 day in 2D (0.33 ± 0.32%) than in 3D (0.96 ± 0.66%, p = 0.004), which was also reflected in a slightly lower CV and higher ICC in 2D (1.84%, 0.97 [0.88-0.99]) than in 3D (3.89%, 0.95 [0.76-0.99]). Remarkably, 3D-MRE was sensitive to a decrease in white matter SWS within only 1 year, whereas no change in white matter volume was observed during this follow-up period. Across volunteers, stiffness correlated with age and BPF, but not with blood pressure and BMI. Conclusion: Cerebral tomoelastography provides high-resolution viscoelasticity maps with excellent consistency. Brain MRE in 2D shows less variation across volunteers in shorter scan times than 3D-MRE, while 3D-MRE appears to be more sensitive to subtle biological effects such as aging.

Ensemble Kalman inversion for magnetic resonance elastography

Magnetic resonance elastography (MRE) is an MRI-based diagnostic method for measuring mechanical properties of biological tissues. MRE measurements are processed by an inversion algorithm to produce a map of the biomechanical properties. In this paper a new and powerful method (ensemble Kalman inversion with level sets (EKI)) of MRE inversion is proposed and tested. The method has critical advantages: material property variation at disease boundaries can be accurately identified, and uncertainty of the reconstructed material properties can be evaluated by consequence of the probabilistic nature of the method. EKI is tested in 2D and 3D experiments with synthetic MRE data of the human kidney. It is demonstrated that the proposed inversion method is accurate and fast.

Theory of sleep/wake cycles affecting brain elastography

As elastography of the brain finds increasing clinical applications, fundamental questions remain about baseline viscoelastic properties of the brainin vivo. Furthermore, the underlying mechanisms of how and why elastographic measures can change over time are still not well understood. To study these issues, reverberant shear wave elastography using an optical coherence tomography scanner is implemented on a mouse model, both under awake conditions and in a sleep state where there are known changes in the glymphatic fluid flow system in the brain. We find that shear wave speed, a measure of stiffness, changes by approximately 12% between the two states, sleep versus awake, in the entire cortical brain imaging volume. Our microchannel flow model of biphasic (fluid plus solid) tissue provides a plausible rheological model based on the fractal branching vascular and perivascular system, plus a second parallel system representing the finer scale glymphatic fluid microchannels. By adjusting the glymphatic system fluid volume proportional to the known sleep/wake changes, we are able to approximately predict the measured shear wave speeds and their change with the state of the glymphatic system. The advantages of this model are that its main parameters are derived from anatomical measures and are linked to other major derivations of branching fluid structures including Murray's Law. The implications for clinical studies are that elastography of the brain is strongly influenced by the regulation or dysregulation of the vascular, perivascular, and glymphatic systems.

Structure-Function Dissociations of Human Hippocampal Subfield Stiffness and Memory Performance

Aging and neurodegenerative diseases lead to decline in thinking and memory ability. The subfields of the hippocampus (HCsf) play important roles in memory formation and recall. Imaging techniques sensitive to the underlying HCsf tissue microstructure can reveal unique structure-function associations and their vulnerability in aging and disease. The goal of this study was to use magnetic resonance elastography (MRE), a noninvasive MR imaging-based technique that can quantitatively image the viscoelastic mechanical properties of tissue to determine the associations of HCsf stiffness with different cognitive domains across the lifespan. Eighty-eight adult participants completed the study (age 23-81 years, male/female 36/51), in which we aimed to determine which HCsf regions most strongly correlated with different memory performance outcomes and if viscoelasticity of specific HCsf regions mediated the relationship between age and performance. Our results revealed that both interference cost on a verbal memory task and relational memory task performance were significantly related to cornu ammonis 1-2 (CA1-CA2) stiffness (p = 0.018 and p = 0.011, respectively), with CA1-CA2 stiffness significantly mediating the relationship between age and interference cost performance (p = 0.031). There were also significant associations between delayed free verbal recall performance and stiffness of both the dentate gyrus-cornu ammonis 3 (DG-CA3; p = 0.016) and subiculum (SUB; p = 0.032) regions. This further exemplifies the functional specialization of HCsf in declarative memory and the potential use of MRE measures as clinical biomarkers in assessing brain health in aging and disease.SIGNIFICANCE STATEMENT Hippocampal subfields are cytoarchitecturally unique structures involved in distinct aspects of memory processing. Magnetic resonance elastography is a technique that can noninvasively image tissue viscoelastic mechanical properties, potentially serving as sensitive biomarkers of aging and neurodegeneration related to functional outcomes. High-resolution in vivo imaging has invigorated interest in determining subfield functional specialization and their differential vulnerability in aging and disease. Applying MRE to probe subfield-specific cognitive correlates will indicate that measures of subfield stiffness can determine the integrity of structures supporting specific domains of memory performance. These findings will further validate our high-resolution MRE method and support the potential use of subfield stiffness measures as clinical biomarkers in classifying aging and disease states.

Hydrogels for Brain Repair: Application to Parkinson's Disease

INTRODUCTION

Parkinson's disease is the second most common neurodegenerative disease. Currently, there are no curative therapies, with only symptomatic treatment available. One of the principal reasons for the lack of treatments is the problem of delivering drugs to the brain, mainly due to the blood-brain barrier. Hydrogels are presented as ideal platforms for delivering treatments to the brain ranging from small molecules to cell replacement therapies.

AREAS COVERED

The potential application of hydrogel-based therapies for Parkinson's disease is addressed. The desirable composition and mechanical properties of these therapies for brain application are discussed, alongside the preclinical research available with hydrogels in Parkinson's disease. Lastly, translational and manufacturing challenges are presented.

EXPERT OPINION

Parkinson's disease urgently needs novel therapies to delay its progression and for advanced stages, at which conventional therapies fail to control motor symptoms. Neurotrophic factor-loaded hydrogels with stem cells offer one of the most promising therapies. This approach may increase the striatal dopamine content while protecting and promoting the differentiation of stem cells although the generation of synapses between engrafted and host cells remains an issue to overcome. Other challenges to consider are related to the route of administration of hydrogels and their large-scale production, required to accelerate their translation toward the clinic.

Unraveling the Mechanobiology Underlying Traumatic Brain Injury with Advanced Technologies and Biomaterials

Traumatic brain injury (TBI) is a worldwide health and socioeconomic problem, associated with prolonged and complex neurological aftermaths, including a variety of functional deficits and neurodegenerative disorders. Research on the long-term effects has highlighted that TBI shall be regarded as a chronic health condition. The initiation and exacerbation of TBI involve a series of mechanical stimulations and perturbations, accompanied by mechanotransduction events within the brain tissues. Mechanobiology thus offers a unique perspective and likely promising approach to unravel the underlying molecular and biochemical mechanisms leading to neural cells dysfunction after TBI, which may contribute to the discovery of novel targets for future clinical treatment. This article investigates TBI and the subsequent brain dysfunction from a lens of neuromechanobiology. Following an introduction, the mechanobiological insights are examined into the molecular pathology of TBI, and then an overview is given of the latest research technologies to explore neuromechanobiology, with particular focus on microfluidics and biomaterials. Challenges and prospects in the current field are also discussed. Through this article, it is hoped that extensive technical innovation in biomedical devices and materials can be encouraged to advance the field of neuromechanobiology, paving potential ways for the research and rehabilitation of neurotrauma and neurological diseases.

Development and validation of subject-specific 3D human head models based on a nonlinear visco-hyperelastic constitutive framework

Computational head models are promising tools for understanding and predicting traumatic brain injuries. Most available head models are developed using inputs (i.e. head geometry, material properties and boundary conditions) from experiments on cadavers or animals and employ hereditary integral-based constitutive models that assume linear viscoelasticity in part of the rate-sensitive material response. This leads to high uncertainty and poor accuracy in capturing the nonlinear brain tissue response. To resolve these issues, a framework for the development of subject-specific three-dimensional head models is proposed, in which all inputs are derived in vivo from the same living human subject: head geometry via magnetic resonance imaging (MRI), brain tissue properties via magnetic resonance elastography (MRE), and full-field strain-response of the brain under rapid head rotation via tagged MRI. A nonlinear, viscous dissipation-based visco-hyperelastic constitutive model is employed to capture brain tissue response. Head models are validated using quantitative metrics that compare spatial strain distribution, temporal strain evolution, and the magnitude of strain maxima, with the corresponding experimental observations from tagged MRI. Results show that our head models accurately capture the strain-response of the brain. Further, employment of the nonlinear visco-hyperelastic constitutive framework provides improvements in the prediction of peak strains and temporal strain evolution over hereditary integral-based models.

Mapping brain mechanical property maturation from childhood to adulthood

Magnetic resonance elastography (MRE) is a phase contrast MRI technique which uses external palpation to create maps of brain mechanical properties noninvasively and in vivo. These mechanical properties are sensitive to tissue microstructure and reflect tissue integrity. MRE has been used extensively to study aging and neurodegeneration, and to assess individual cognitive differences in adults, but little is known about mechanical properties of the pediatric brain. Here we use high-resolution MRE imaging in participants of ages ranging from childhood to adulthood to understand brain mechanical properties across brain maturation. We find that brain mechanical properties differ considerably between childhood and adulthood, and that neuroanatomical subregions have differing maturational trajectories. Overall, we observe lower brain stiffness and greater brain damping ratio with increasing age from 5 to 35 years. Gray and white matter change differently during maturation, with larger changes occurring in gray matter for both stiffness and damping ratio. We also found that subregions of cortical and subcortical gray matter change differently, with the caudate and thalamus changing the most with age in both stiffness and damping ratio, while cortical subregions have different relationships with age, even between neighboring regions. Understanding how brain mechanical properties mature using high-resolution MRE will allow for a deeper understanding of the neural substrates supporting brain function at this age and can inform future studies of atypical maturation.

Data-driven Uncertainty Quantification in Computational Human Head Models

Computational models of the human head are promising tools for estimating the impact-induced response of the brain, and thus play an important role in the prediction of traumatic brain injury. The basic constituents of these models (i.e., model geometry, material properties, and boundary conditions) are often associated with significant uncertainty and variability. As a result, uncertainty quantification (UQ), which involves quantification of the effect of this uncertainty and variability on the simulated response, becomes critical to ensure reliability of model predictions. Modern biofidelic head model simulations are associated with very high computational cost and high-dimensional inputs and outputs, which limits the applicability of traditional UQ methods on these systems. In this study, a two-stage, data-driven manifold learning-based framework is proposed for UQ of computational head models. This framework is demonstrated on a 2D subject-specific head model, where the goal is to quantify uncertainty in the simulated strain fields (i.e., output), given variability in the material properties of different brain substructures (i.e., input). In the first stage, a data-driven method based on multi-dimensional Gaussian kernel-density estimation and diffusion maps is used to generate realizations of the input random vector directly from the available data. Computational simulations of a small number of realizations provide input-output pairs for training data-driven surrogate models in the second stage. The surrogate models employ nonlinear dimensionality reduction using Grassmannian diffusion maps, Gaussian process regression to create a low-cost mapping between the input random vector and the reduced solution space, and geometric harmonics models for mapping between the reduced space and the Grassmann manifold. It is demonstrated that the surrogate models provide highly accurate approximations of the computational model while significantly reducing the computational cost. Monte Carlo simulations of the surrogate models are used for uncertainty propagation. UQ of the strain fields highlights significant spatial variation in model uncertainty, and reveals key differences in uncertainty among commonly used strain-based brain injury predictor variables.

Mechanical Properties of the Extracellular Environment of Human Brain Cells Drive the Effectiveness of Drugs in Fighting Central Nervous System Cancers

The evaluation of nanomechanical properties of tissues in health and disease is of increasing interest to scientists. It has been confirmed that these properties, determined in part by the composition of the extracellular matrix, significantly affect tissue physiology and the biological behavior of cells, mainly in terms of their adhesion, mobility, or ability to mutate. Importantly, pathophysiological changes that determine disease development within the tissue usually result in significant changes in tissue mechanics that might potentially affect the drug efficacy, which is important from the perspective of development of new therapeutics, since most of the currently used in vitro experimental models for drug testing do not account for these properties. Here, we provide a summary of the current understanding of how the mechanical properties of brain tissue change in pathological conditions, and how the activity of the therapeutic agents is linked to this mechanical state.

Comparison of inversion methods in MR elastography: An open-access pipeline for processing multifrequency shear-wave data and demonstration in a phantom, human kidneys, and brain

PURPOSE

Magnetic resonance elastography (MRE) maps the viscoelastic properties of soft tissues for diagnostic purposes. However, different MRE inversion methods yield different results, which hinder comparison of values, standardization, and establishment of quantitative MRE markers. Here, we introduce an expandable, open-access, webserver-based platform that offers multiple inversion techniques for multifrequency, 3D MRE data.

METHODS

The platform comprises a data repository and standard MRE inversion methods including local frequency estimation (LFE), direct-inversion based multifrequency dual elasto-visco (MDEV) inversion, and wavenumber-based (k-) MDEV. The use of the platform is demonstrated in phantom data and in vivo multifrequency MRE data of the kidneys and brains of healthy volunteers.

RESULTS

Detailed maps of stiffness were generated by all inversion methods showing similar detail of anatomy. Specifically, the inner renal cortex had higher shear wave speed (SWS) than renal medulla and outer cortex without lateral differences. k-MDEV yielded higher SWS values than MDEV or LFE (full kidney/brain k-MDEV: 2.71 ± 0.19/1.45 ± 0.14 m/s, MDEV: 2.14 ± 0.16/0.99 ± 0.11 m/s, LFE: 2.12 ± 0.15/0.89 ± 0.06 m/s).

CONCLUSION

The freely accessible platform supports the comparison of MRE results obtained with different inversion methods, filter thresholds, or excitation frequencies, promoting reproducibility in MRE across community-developed methods.

Magnetic resonance elastography of the ageing brain in normal and demented populations: A systematic review

The aim of this systematic review was to evaluate the ability of magnetic resonance elastography (MRE) to identify significant changes in brain mechanical properties during normal and pathological aging. PubMed, Web of Science and Scopus were searched for human studies using MRE to assess brain mechanical properties in cognitively healthy individuals, individuals at risk of dementia or patients diagnosed with dementia. Study characteristics, sample demographics, clinical characterization and main MRE outcomes were summarized in a table. A total of 19 studies (nine aging, 10 dementia), comprising 700 participants, were included. The main findings were decreased cerebral stiffness along aging, with rates of annual change ranging from −0.008 to −0.025 kPa per year. Also, there were regional differences in the age effect on brain stiffness. Concerning demented patients, differential patterns of stiffness were found for distinct dementia subtypes. Alzheimer's disease and frontotemporal dementia exhibited decreased brain stiffness in comparison to cognitively healthy controls and significant declines were found in regions known to be affected by the disease. In normal pressure hydrocephalus, the results were not consistent across studies, and in dementia with Lewy bodies no significant differences in brain stiffness were found. In conclusion, aging is characterized by the softening of brain tissue and this event is even more pronounced in pathological aging, such as dementia. MRE technique could be applied as a sensible diagnostic tool to identify deviations from normal aging and develop new brain biomarkers of cognitive decline/dementia that would help promote healthier cognitive aging.

Evaluation of cerebral cortex viscoelastic property estimation with nonlinear inversion magnetic resonance elastography

Objective. Magnetic resonance elastography (MRE) of the brain has shown promise as a sensitive neuroimaging biomarker for neurodegenerative disorders; however, the accuracy of performing MRE of the cerebral cortex warrants investigation due to the unique challenges of studying thinner and more complex geometries.Approach. A series of realistic, whole-brain simulation experiments are performed to examine the accuracy of MRE to measure the viscoelasticity (shear stiffness,μ, and damping ratio, ξ) of cortical structures predominantly effected in aging and neurodegeneration. Variations to MRE spatial resolution and the regularization of a nonlinear inversion (NLI) approach are examined.Main results. Higher-resolution MRE displacement data (1.25 mm isotropic resolution) and NLI with a low soft prior regularization weighting provided minimal measurement error compared to other studied protocols. With the optimized protocol, an average error inμand ξ was 3% and 11%, respectively, when compared with the known ground truth. Mid-line structures, as opposed to those on the cortical surface, generally display greater error. Varying model boundary conditions and reducing the thickness of the cortex by up to 0.67 mm (which is a realistic portrayal of neurodegenerative pathology) results in no loss in reconstruction accuracy.Significance. These experiments establish quantitative guidelines for the accuracy expected ofin vivoMRE of the cortex, with the proposed method providing valid MRE measures for future investigations into cortical viscoelasticity and relationships with health, cognition, and behavior.

Advanced Neuroimaging Role in Traumatic Brain Injury: A Narrative Review

Traumatic brain injury (TBI) is a common source of morbidity and mortality among civilians and military personnel. Initial routine neuroimaging plays an essential role in rapidly assessing intracranial injury that may require intervention. However, in the context of TBI, limitations of routine neuroimaging include poor visualization of more subtle changes of brain parenchymal after injury, poor prognostic ability and inability to analyze cerebral perfusion, metabolite and mechanical properties. With the development of modern neuroimaging techniques, advanced neuroimaging techniques have greatly boosted the studies in the diagnosis, prognostication, and eventually impacting treatment of TBI. Advances in neuroimaging techniques have shown potential, including (1) Ultrasound (US) based techniques (contrast-enhanced US, intravascular US, and US elastography), (2) Magnetic resonance imaging (MRI) based techniques (diffusion tensor imaging, magnetic resonance spectroscopy, perfusion weighted imaging, magnetic resonance elastography and functional MRI), and (3) molecular imaging based techniques (positron emission tomography and single photon emission computed tomography). Therefore, in this review, we aim to summarize the role of these advanced neuroimaging techniques in the evaluation and management of TBI. This review is the first to combine the role of the US, MRI and molecular imaging based techniques in TBI. Advanced neuroimaging techniques have great potential; still, there is much to improve. With more clinical validation and larger studies, these techniques will be likely applied for routine clinical use from the initial research.

Quantifying stability of parameter estimates forin vivonearly incompressible transversely-isotropic brain MR elastography

Easily computable quality metrics for measured medical data at point-of-care are important for imaging technologies involving offline reconstruction. Accordingly, we developed a new data quality metric forin vivotransversely-isotropic (TI) magnetic resonance elastography (MRE) based on a generalization of the widely accepted octahedral shear-strain calculation. The metric uses MRE displacement data and an estimate of the TI property field to yield a 'stability map' which predicts regions of low versus high accuracy in the resulting material property reconstructions. We can also calculate an average TI parameter stability (TIPS) score over all voxels in a region of interest for a given measurement to indicate how reliable the recovered mechanical property estimate for the region is expected to be. The calculation is rapid and places little demand on computing resources compared to the computationally intensive material property reconstruction from non-linear inversion (TI-NLI) of displacement fields, making it ideal for point-of-care evaluation of data quality. We test the predictions of the stability map for both simulated phantoms andin vivohuman brain data. We used a range of different displacement datasets from vibrations applied in the anterior-posterior (AP), left-right (LR) and combined AP + LR directions. The TIPS and variability maps (noise sensitivity or variation from the mean of repeated MRE scans) were consistently anti-correlated. Notably, Spearman correlation coefficients ∣R∣>0.6 were found between variability and TIPS score for individual white matter tracts within vivodata. These observations demonstrate the reliability and promise of this data quality metric to screen data rapidly in realistic clinical MRE applications.

Magnetic resonance elastography in normal pressure hydrocephalus-a scoping review

BACKGROUND

Magnetic resonance elastography (MRE) of the brain allows quantitative measurement of tissue mechanics. Multiple studies are exploring possible applications in normal pressure hydrocephalus (NPH) in clinical and paraclinical contexts. This is of great interest in neurological surgery due to challenges related to diagnosis and prediction of treatment effects. In this scoping review, we present a topical overview and discuss the current literature, with particular attention to clinical implications and current challenges.

METHODS

The protocol was based on the PRISMA extension for scoping reviews. After a systematic database search (PubMed, Embase, and Web of Science), the articles were screened for relevance. Thirty articles were subject to detailed screening, and key technical and clinical data items were extracted. The inclusion criteria included the use of MRE on human subjects with NPH.

RESULTS

Seven articles were included in the final study. These studies had various objectives including the role of MRE in the assessment of regional elastic changes in NPH, shunt effect, and evaluation of NPH symptoms. MRE revealed patterns of mechanical changes in NPH that differed from other dementias. Regional MRE changes were associated with specific NPH signs and symptoms. Neurosurgical shunting caused partial normalization in tissue scaffold parameters. The studies were highly heterogeneous in technical aspects and design.

CONCLUSION

MRE studies in NPH are still limited by few participants, variable cohorts, inconsistent methodologies, and technical challenges, but the approach shows great potential for future clinical application.

Correlated noise in brain magnetic resonance elastography

PURPOSE

Magnetic resonance elastography (MRE) uses phase-contrast MRI to generate mechanical property maps of the in vivo brain through imaging of tissue deformation from induced mechanical vibration. The mechanical property estimation process in MRE can be susceptible to noise from physiological and mechanical sources encoded in the phase, which is expected to be highly correlated. This correlated noise has yet to be characterized in brain MRE, and its effects on mechanical property estimates computed using inversion algorithms are undetermined.

METHODS

To characterize the effects of signal noise in MRE, we conducted 3 experiments quantifying (1) physiomechanical sources of signal noise, (2) physiological noise because of cardiac-induced movement, and (3) impact of correlated noise on mechanical property estimates. We use a correlation length metric to estimate the extent that correlated signal persists in MRE images and demonstrate the effect of correlated noise on property estimates through simulations.

RESULTS

We found that both physiological noise and vibration noise were greater than image noise and were spatially correlated across all subjects. Added physiological and vibration noise to simulated data resulted in property maps with higher error than equivalent levels of Gaussian noise.

CONCLUSION

Our work provides the foundation to understand contributors to brain MRE data quality and provides recommendations for future work to correct for signal noise in MRE.

Inducing Biomechanical Heterogeneity in Brain Tumor Modeling by MR Elastography: Effects on Tumor Growth, Vascular Density and Delivery of Therapeutics

Simple Summary

Biomechanical forces aggravate brain tumor progression. In this study, magnetic resonance elastography (MRE) is employed to extract tissue biomechanical properties from five glioblastoma patients and a healthy subject, and data are incorporated in a mathematical model that simulates tumor growth. Mathematical modeling enables further understanding of glioblastoma development and allows patient-specific predictions for tumor vascularity and delivery of drugs. Incorporating MRE data results in a more realistic intratumoral distribution of mechanical stress and anisotropic tumor growth and a better description of subsequent events that are closely related to the development of stresses, including heterogeneity of the tumor vasculature and intrapatient variations in tumor perfusion and delivery of drugs.

Abstract

The purpose of this study is to develop a methodology that incorporates a more accurate assessment of tissue mechanical properties compared to current mathematical modeling by use of biomechanical data from magnetic resonance elastography. The elastography data were derived from five glioblastoma patients and a healthy subject and used in a model that simulates tumor growth, vascular changes due to mechanical stresses and delivery of therapeutic agents. The model investigates the effect of tumor-specific biomechanical properties on tumor anisotropic growth, vascular density heterogeneity and chemotherapy delivery. The results showed that including elastography data provides a more realistic distribution of the mechanical stresses in the tumor and induces anisotropic tumor growth. Solid stress distribution differs among patients, which, in turn, induces a distinct functional vascular density distribution—owing to the compression of tumor vessels—and intratumoral drug distribution for each patient. In conclusion, incorporating elastography data results in a more accurate calculation of intratumoral mechanical stresses and enables a better mathematical description of subsequent events, such as the heterogeneous development of the tumor vasculature and intrapatient variations in tumor perfusion and delivery of drugs.