Brain Maturation Patterns on Normalized FLAIR MR Imaging in Children and Adolescents

BACKGROUND AND PURPOSE

Signal analysis of FLAIR sequences is gaining momentum for studying neurodevelopment and brain maturation, but FLAIR intensity varies across scanners and needs to be normalized. This study aimed to establish normative values for standardized FLAIR intensity in the pediatric brain.

MATERIALS AND METHODS

A new automated algorithm for signal normalization was used to standardize FLAIR intensity across scanners and subjects. Mean intensity was extracted from GM, WM, deep GM, and cortical GM regions. Regression curves were fitted across the pediatric age range, and ANOVA was used to investigate intensity differences across age groups. Correlations between intensity and regional volume were also examined.

RESULTS

We analyzed 429 pediatric FLAIR sequences in children 2-19 years of age with a median age of 11.2 years, including 199 males and 230 females. WM intensity had a parabolic relationship with age, with significant differences between various age groups (P < .05). GM and cortical GM intensity increased over the pediatric age range, with significant differences between early childhood and adolescence (P < .05). There were no significant relationships between volume and intensity in early childhood, while there were significant positive and negative correlations (P < .05) in WM and GM, respectively, for increasing age groups. Only the oldest age group showed significant differences between males and females (P < .05).

CONCLUSIONS

This work presents a FLAIR intensity standardization algorithm to normalize intensity across large data sets, which allows FLAIR intensity to be used to compare regions and individuals as a surrogate measure of the developing pediatric brain.

Effects of gradient encoding and number of signal averages on fractional anisotropy and fiber density index in vivo at 1.5 tesla

BACKGROUND

Tensor estimation can be improved by increasing the number of gradient directions (NGD) or increasing the number of signal averages (NSA), but at a cost of increased scan time.

PURPOSE

To evaluate the effects of NGD and NSA on fractional anisotropy (FA) and fiber density index (FDI) in vivo.

MATERIAL AND METHODS

Ten healthy adults were scanned on a 1.5T system using nine different diffusion tensor sequences. Combinations of 7 NGD, 15 NGD, and 25 NGD with 1 NSA, 2 NSA, and 3 NSA were used, with scan times varying from 2 to 18 min. Regions of interest (ROIs) were placed in the internal capsules, middle cerebellar peduncles, and splenium of the corpus callosum, and FA and FDI were calculated. Analysis of variance was used to assess whether there was a difference in FA and FDI of different combinations of NGD and NSA.

RESULTS

There was no significant difference in FA of different combinations of NGD and NSA of the ROIs (P>0.005). There was a significant difference in FDI between 7 NGD/1 NSA and 25 NGD/3 NSA in all three ROIs (P<0.005). There were no significant differences in FDI between 15 NGD/3 NSA, 25 NGD/1 NSA, and 25 NGD/2 NSA and 25 NGD/3 NSA in all ROIs (P>0.005).

CONCLUSION

We have not found any significant difference in FA with varying NGD and NSA in vivo in areas with relatively high anisotropy. However, lower NGD resulted in reduced FDI in vivo. With larger NGD, NSA has less influence on FDI. The optimal sequence among the nine sequences tested with the shortest scan time was 25 NGD/1 NSA.

Fat-suppressed T2* sequences for routine 3.0-tesla lumbar spine magnetic resonance imaging: a preliminary report

BACKGROUND

Clear depiction of the ligamentum flavum on routine lumbar magnetic resonance imaging (MRI) is essential in accurately describing the extent of degenerative disease. In routine, noncontrast evaluations, focal fatty deposition or hemangiomas can be difficult to distinguish from malignant foci on fast spin-echo (FSE) T2-weighted images.

PURPOSE

To describe the use of T2* fast field echo (T2FFE) in combination with spectral presaturation inversion recovery (SPIR) fat suppression for noncontrast, routine lumbar spine outpatient MR imaging at 3.0 Tesla (3T).

MATERIAL AND METHODS

An axial gradient echo (GE) T2FFE sequence was combined with SPIR fat suppression (T2FFE-SPIR), via a 3T Philips Intera (Philips Medical Systems, Best, The Netherlands) scanner, and added to the routine, noncontrast lumbar MRI examinations, which included sagittal FSE T1-weighted (T1WI), T2-weighted (T2WI), short-tau inversion recovery (STIR), and axial FSE T2WI. The sequence was performed in over 500 patients over a 1-year period, without intravenous contrast, and with slice thickness and planes of section identical to the axial FSE T1WI and T2WI images. The sequence typically lasted about 4.5-6 min.

RESULTS

The use of T2FFE-SPIR enabled visualization of the ligamentum flavum in degenerative disease, and the exclusion of focal fatty lesions on FSE T2WI. Other benefits included: the identification of malignant foci, the uncommon detection of hemorrhage, and the elimination of spurious flow voids. Several brief examples are provided to demonstrate the utility of this technique.

CONCLUSION

The addition of T2FFE-SPIR to routine, noncontrast protocols in outpatients could provide further confidence in the visualization of the ligamentum flavum in degenerative disease, and can exclude malignancy in T2-bright areas of focal fatty marrow. Larger studies would be helpful to evaluate the accuracy of this technique versus FSE techniques in depicting degenerative, malignant, or inflammatory disorders.