Real-time multi-directional flow MRI using model-based reconstructions of undersampled radial FLASH - A feasibility study

The purpose of this work was to develop an acquisition and reconstruction technique for two- and three-directional (2d and 3d) phase-contrast flow MRI in real time. A previous real-time MRI technique for one-directional (1d) through-plane flow was extended to 2d and 3d flow MRI by introducing in-plane flow sensitivity. The method employs highly undersampled radial FLASH sequences with sequential acquisitions of two or three flow-encoding datasets and one flow-compensated dataset. Echo times are minimized by merging the waveforms of flow-encoding and radial imaging gradients. For each velocity direction individually, model-based reconstructions by regularized nonlinear inversion jointly estimate an anatomical image, a set of coil sensitivities and a phase-contrast velocity map directly. The reconstructions take advantage of a dynamic phase reference obtained by interpolating consecutive flow-compensated acquisitions. Validations include pulsatile flow phantoms as well as in vivo studies of the human aorta at 3 T. The proposed method offers cross-sectional 2d and 3d flow MRI of the human aortic arch at 53 and 67 ms resolution, respectively, without ECG synchronization and during free breathing. The in-plane resolution was 1.5 × 1.5 mm² and the slice thickness 6 mm. In conclusion, real-time multi-directional flow MRI offers new opportunities to study complex human blood flow without the risk of combining differential phase (i.e., velocity) information from multiple heartbeats as for ECG-gated data. The method would benefit from a further reduction of acquisition time and accelerated computing to allow for extended clinical trials.

Quantification of spinal cord compression using T1 mapping in patients with cervical spinal canal stenosis - Preliminary experience

Background

Degenerative changes of the cervical spinal column are the most common cause of spinal cord lesions in the elderly. Conventional clinical, electrophysiological and radiological diagnostics of spinal cord compression are often inconsistent.

Materials and methods

The feasibility and diagnostic potential of a novel T1 mapping method at 0.5 mm resolution and 4 s acquisition time was evaluated in 14 patients with degenerative cervical spinal canal stenosis (SCS) and 6 healthy controls. T1 mapping was performed in axial sections of the stenosis as well as above and below. All subjects received standard T2-weighted MRI of the cervical spine (including SCS-grading 0-III), electrophysiological and clinical examinations.

Results

Patients revealed significantly decreased T1 relaxation times of the compressed spinal cord within the SCS (912 ± 53 ms, mean ± standard deviation) in comparison to unaffected segments above (1027 ± 39 ms, p < .001) and below (1056 ± 93 ms, p < .001). There was no difference in mean T1 in unaffected segments in patients (p = .712) or between segments in controls (p = .443). Moreover, T1 values were significantly lower in grade II (881 ± 46 ms, p = .005) than in grade I SCS (954 ± 29 ms). Patients with central conduction deficit tended to have lower T1 values within the SCS than patients without (909 ± 50 ms vs 968 ± 7 ms, p = .069).

Conclusion

Rapid high-resolution T1 mapping is a robust MRI method for quantifying spinal cord compression in patients with cervical SCS. It promises additional diagnostic insights and warrants more extended patient studies.

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Rapid T1 mapping at 0.5 mm resolution was tested in cervical spinal canal stenosis (SCS).

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T1 relaxation times significantly decreased within the SCS.

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T1 relaxation times were significantly lower in grade II vs grade I SCS.

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Central conduction deficits were inversely correlated with T1 relaxation time.

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Rapid T1 mapping robustly and accurately quantifies spinal cord compression.

Carotid artery flow as determined by real-time phase-contrast flow MRI and neurovascular ultrasound: A comparative study of healthy subjects

BACKGROUND

The assessment of carotid artery flow by neurovascular ultrasound (nvUS) can be complemented by real-time phase-contrast (RT-PC) flow MRI which apart from quantitative flow parameters offers velocity distributions across the entire vessel lumen.

MATERIALS AND METHODS

The feasibility and diagnostic potential of RT-PC flow MRI was evaluated in 20 healthy volunteers in comparison to conventional nvUS. RT-PC flow MRI at 40 ms temporal resolution and 0.8 mm in-plane resolution resulted in velocity maps with low phase noise and high spatiotemporal accuracy by exploiting respective advances of a recent nonlinear inverse model-based reconstruction. Peak-systolic velocities (PSV), end-diastolic velocities (EDV), flow volumes and comprehensive velocity profiles were determined in the common, internal and external carotid artery on both sides.

RESULTS

Flow characteristics such as pulsatility and individual abnormalities shown on nvUS could be reproduced and visualized in detail by RT-PC flow MRI. PSV to EDV differences revealed good agreement between both techniques, mean PSV and EDV were significantly lower and flow volumes were higher for MRI.

CONCLUSION

Our findings suggest that RT-PC flow MRI adds to clinical diagnostics, e.g. by alterations of dynamic velocity distributions in patients with carotid stenosis. Lower PSV and EDV values than for nvUS mainly reflect the longer MRI acquisition time which attenuates short peak velocities, while higher flow volumes benefit from a proper assessment of the true vessel lumen.

An eigenvalue approach for the automatic scaling of unknowns in model-based reconstructions: Application to real-time phase-contrast flow MRI

The purpose of this work is to develop an automatic method for the scaling of unknowns in model-based nonlinear inverse reconstructions and to evaluate its application to real-time phase-contrast (RT-PC) flow magnetic resonance imaging (MRI). Model-based MRI reconstructions of parametric maps which describe a physical or physiological function require the solution of a nonlinear inverse problem, because the list of unknowns in the extended MRI signal equation comprises multiple functional parameters and all coil sensitivity profiles. Iterative solutions therefore rely on an appropriate scaling of unknowns to numerically balance partial derivatives and regularization terms. The scaling of unknowns emerges as a self-adjoint and positive-definite matrix which is expressible by its maximal eigenvalue and solved by power iterations. The proposed method is applied to RT-PC flow MRI based on highly undersampled acquisitions. Experimental validations include numerical phantoms providing ground truth and a wide range of human studies in the ascending aorta, carotid arteries, deep veins during muscular exercise and cerebrospinal fluid during deep respiration. For RT-PC flow MRI, model-based reconstructions with automatic scaling not only offer velocity maps with high spatiotemporal acuity and much reduced phase noise, but also ensure fast convergence as well as accurate and precise velocities for all conditions tested, i.e. for different velocity ranges, vessel sizes and the simultaneous presence of signals with velocity aliasing. In summary, the proposed automatic scaling of unknowns in model-based MRI reconstructions yields quantitatively reliable velocities for RT-PC flow MRI in various experimental scenarios.

Model-based reconstruction for real-time phase-contrast flow MRI: Improved spatiotemporal accuracy

PURPOSE

To develop a model-based reconstruction technique for real-time phase-contrast flow MRI with improved spatiotemporal accuracy in comparison to methods using phase differences of two separately reconstructed images with differential flow encodings.

METHODS

The proposed method jointly computes a common image, a phase-contrast map, and a set of coil sensitivities from every pair of flow-compensated and flow-encoded datasets obtained by highly undersampled radial FLASH. Real-time acquisitions with five and seven radial spokes per image resulted in 25.6 and 35.7 ms measuring time per phase-contrast map, respectively. The signal model for phase-contrast flow MRI requires the solution of a nonlinear inverse problem, which is accomplished by an iteratively regularized Gauss-Newton method. Aspects of regularization and scaling are discussed. The model-based reconstruction was validated for a numerical and experimental flow phantom and applied to real-time phase-contrast MRI of the human aorta for 10 healthy subjects and 2 patients.

RESULTS

Under all conditions, and compared with a previously developed real-time flow MRI method, the proposed method yields quantitatively accurate phase-contrast maps (i.e., flow velocities) with improved spatial acuity, reduced phase noise and reduced streaking artifacts.

CONCLUSION

This novel model-based reconstruction technique may become a new tool for clinical flow MRI in real time. Magn Reson Med 77:1082-1093, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Peak flow velocities in the ascending aorta-real-time phase-contrast magnetic resonance imaging vs. cine magnetic resonance imaging and echocardiography

This prospective study of eight healthy volunteers evaluates peak flow velocities (PFV) in the ascending aorta using real-time phase-contrast magnetic resonance imaging (MRI) in comparison to cine phase-contrast MRI and echocardiography. Flow measurements by echocardiography and cine phase-contrast MRI with breath-holding were performed according to clinical standards. Real-time phase-contrast MRI at 40 ms temporal resolution and 1.3 mm in-plane resolution was based on highly undersampled radial fast low-angle shot (FLASH) sequences with image reconstruction by regularized nonlinear inversion (NLINV). Evaluations focused on the determination of PFV. Linear regressions and Bland-Altman plots were used for comparisons of methods. When averaged across subjects, real-time phase-contrast MRI resulted in PFV of 120±20 cm s(-1) (mean ± SD) in comparison to 122±16 cm s(-1) for cine MRI and 124±20 cm s(-1) for echocardiography. The maximum deviations between real-time phase-contrast MRI and echocardiography ranged from -20 to +14 cm s(-1) (cine MRI: -10 to +12 cm s(-1)). Thus, in general, real-time phase-contrast MRI of cardiac outflow revealed quantitative agreement with cine MRI and echocardiography. The advantages of real-time MRI are measurements during free breathing and access to individual cardiac cycles.

Advances in real-time phase-contrast flow MRI using asymmetric radial gradient echoes

PURPOSE

To provide multidimensional velocity compensation for real-time phase-contrast flow MRI.

METHODS

The proposed method introduces asymmetric gradient echoes for highly undersampled radial FLASH MRI with phase-sensitive image reconstruction by regularized nonlinear inversion (NLINV). Using an adapted gradient delay correction the resulting image quality was analyzed by simulations and experimentally validated at 3 Tesla. For real-time flow MRI the reduced gradient-echo timing allowed for the incorporation of velocity-compensating waveforms for all imaging gradients at even shorter repetition times.

RESULTS

The results reveal a usable degree of 20% asymmetry. Real-time flow MRI with full velocity compensation eliminated signal void in a flow phantom, confirmed flow parameters in healthy subjects and demonstrated signal recovery and phase conservation in a patient with aortic valve insufficiency and stenosis. Exemplary protocols at 1.4-1.5 mm resolution and 6 mm slice thickness achieved total acquisition times of 33.3-35.7 ms for two images (7 spokes each) with and without flow-encoding gradient.

CONCLUSION

Asymmetric gradient echoes were successfully implemented for highly undersampled radial trajectories. The resulting temporal gain offers full velocity compensation for real-time phase-contrast flow MRI which minimizes false-positive contributions from complex flow and further enhances the temporal resolution compared with acquisitions with symmetric echoes.

Single-shot Multi-slice T1 Mapping at High Spatial Resolution – Inversion-Recovery FLASH with Radial Undersampling and Iterative Reconstruction

Purpose:

To develop a method for T1 mapping at high spatial resolution and for multiple slices.

Methods:

The proposed method emerges as a single-shot inversion-recovery experiment which covers the entire spin-lattice relaxation process by serial acquisitions of highly undersampled radial FLASH images, either in single-slice or multi-slice mode. Serial image reconstructions are performed in time-reversed order and first involve regularized nonlinear inversion (NLINV) to estimate optimum coil sensitivity profiles. Subsequently, the coil profiles are fixed for the calculation of differently T1-weighted frames and the resulting linear inverse problem is solved by a conjugate gradient (CG) technique. T1 values are obtained by pixelwise fitting with a Deichmann correction modified for multi-slice applications.

Results:

T1 accuracy was validated for a reference phantom. For human brain, T1 maps were obtained at 0.5 mm resolution for single-slice acquisitions and at 0.75 mm resolution for up to 5 simultaneous slices (5 mm thickness). Corresponding T1 maps of the liver were acquired at 1 mm and 1.5 mm resolution, respectively. All T1 values were in agreement with literature data.

Conclusion:

Inversion-recovery sequences with highly undersampled radial FLASH images and NLINV/CG reconstruction allow for fast, robust and accurate T1 mapping at high spatial resolution and for multiple slices.

Real-time phase-contrast flow MRI of the ascending aorta and superior vena cava as a function of intrathoracic pressure (Valsalva manoeuvre)

OBJECTIVE

Real-time phase-contrast flow MRI at high spatiotemporal resolution was applied to simultaneously evaluate haemodynamic functions in the ascending aorta (AA) and superior vena cava (SVC) during elevated intrathoracic pressure (Valsalva manoeuvre).

METHODS

Real-time phase-contrast flow MRI at 3 T was based on highly undersampled radial gradient-echo acquisitions and phase-sensitive image reconstructions by regularized non-linear inversion. Dynamic alterations of flow parameters were obtained for 19 subjects at 40-ms temporal resolution, 1.33-mm in-plane resolution and 6-mm section thickness. Real-time measurements were performed during normal breathing (10 s), increased intrathoracic pressure (10 s) and recovery (20 s).

RESULTS

Real-time measurements were technically successful in all volunteers. During the Valsalva manoeuvre (late strain) and relative to values during normal breathing, the mean peak flow velocity and flow volume decreased significantly in both vessels (p < 0.001) followed by a return to normal parameters within the first 10 s of recovery in the AA. By contrast, flow in the SVC presented with a brief (1-2 heartbeats) but strong overshoot of both the peak velocity and blood volume immediately after pressure release followed by rapid normalization.

CONCLUSION

Real-time phase-contrast flow MRI may assess cardiac haemodynamics non-invasively, in multiple vessels, across the entire luminal area and at high temporal and spatial resolution.

ADVANCES IN KNOWLEDGE

Future clinical applications of this technique promise new insights into haemodynamic alterations associated with pre-clinical congestive heart failure or diastolic dysfunction, especially in cases where echocardiography is technically compromised.

Real-time phase-contrast flow MRI of haemodynamic changes in the ascending aorta and superior vena cava during Mueller manoeuvre

AIM

To evaluate the potential of real-time phase-contrast flow magnetic resonance imaging (MRI) at 40 ms resolution for the simultaneous determination of blood flow in the ascending aorta (AA) and superior vena cava (SVC) in response to reduced intrathoracic pressure (Mueller manoeuvre).

MATERIALS AND METHODS

Through-plane flow was assessed in 20 healthy young subjects using real-time phase-contrast MRI based on highly undersampled radial fast low-angle shot (FLASH) with image reconstruction by regularized non-linear inversion. Haemodynamic alterations (three repetitions per subject = 60 events) were evaluated during normal breathing (10 s), inhalation with nearly closed epiglottis (10 s), and recovery (20 s).

RESULTS

Relative to normal breathing and despite interindividual differences, reduced intrathoracic pressure by at least 30 mmHg significantly decreased the initial peak mean velocity (averaged across the lumen) in the AA by -24 ± 9% and increased the velocity in the SVC by +28 ± 25% (p < 0.0001, n = 23 successful events). Respective changes in flow volume per heartbeat were -25 ± 9% in the AA and +49 ± 44% in the SVC (p < 0.0001, n = 23). Flow parameters returned to baseline during sustained pressure reduction, while the heart rate was elevated by 10% (p < 0.0001) after the start (n = 24) and end (n = 17) of the manoeuvre.

CONCLUSIONS

Real-time flow MRI during low intrathoracic pressure non-invasively revealed quantitative haemodynamic adjustments in both the AA and SVC.

On the Temporal Fidelity of Nonlinear Inverse Reconstructions for Real- Time MRI – The Motion Challenge

Purpose:

To evaluate the temporal accuracy of a self-consistent nonlinear inverse reconstruction method (NLINV) for real-time MRI using highly undersampled radial gradient-echo sequences and to present an open source framework for the motion assessment of real-time MRI methods.

Methods:

Serial image reconstructions by NLINV combine a joint estimation of individual frames and corresponding coil sensitivities with temporal regularization to a preceding frame. The temporal fidelity of the method was determined with a phantom consisting of water-filled tubes rotating at defined angular velocity. The conditions tested correspond to real-time cardiac MRI using SSFP contrast at 1.5 T (40 ms resolution) and T1 contrast at 3.0 T (33 ms and 18 ms resolution). In addition, the performance of a post-processing temporal median filter was evaluated.

Results:

NLINV reconstructions without temporal filtering yield accurate estimations as long as the speed of a small moving object corresponds to a spatial displacement during the acquisition of a single frame which is smaller than the object itself. Faster movements may lead to geometric distortions. For small objects moving at high velocity, a median filter may severely compromise the spatiotemporal accuracy.

Conclusion:

NLINV reconstructions offer excellent temporal fidelity as long as the image acquisition time is short enough to adequately sample (“freeze”) the object movement. Temporal filtering should be applied with caution. The motion framework emerges as a valuable tool for the evaluation of real-time MRI methods.

The post-stimulation undershoot in BOLD fMRI of human brain is not caused by elevated cerebral blood volume

Functional magnetic resonance imaging (fMRI) based on blood oxygenation level dependent (BOLD) contrast is the most widely used technique for imaging human brain function. However, the dynamic interplay of altered cerebral blood flow (CBF), cerebral blood volume (CBV), and oxidative metabolism (CMRO2) is not yet fully understood. One of the characteristics of the BOLD response is the post-stimulation undershoot, that is increased deoxyhemoglobin, which has been suggested to originate from a delayed recovery of elevated CBV or CMRO2 to baseline. To investigate the CBV contribution to the post-stimulation BOLD undershoot, we performed bolus-tracking experiments using a paramagnetic contrast agent in eight healthy subjects at 3 T. In an initial BOLD experiment without contrast agent, we determined the individual hemodynamic responsiveness. In two separate experiments, we then evaluated the relative CBV (rCBV) during visual stimulation and the post-stimulation undershoot, respectively. The results confirm a pronounced rCBV increase during stimulation (31.4+/-8.6%), but reveal no change in rCBV relative to baseline in the post-stimulation phase (0.7+/-7.2%). This finding renders a CBV contribution to the BOLD MRI undershoot unlikely and--in conjunction with a rapid post-stimulation return of CBF to baseline--supports the idea of a prolonged elevation of oxidative metabolism.

Thresholding in correlation analyses of magnetic resonance functional neuroimaging

The definition of objective and effective thresholds in MRI of human brain function is a crucial step in the analysis of paradigm-related activations. This paper introduces a user-independent and robust procedure that calculates statistical parametric maps based on correlation coefficients. Thresholds are introduced as p values and defined with respect to the physiologic noise distribution of the individual maps. Experimental examples from the human visual and motor system rely on dynamic acquisitions of gradient-echo echo-planar images (2.0 T, TR = 2,000 ms, 96 x 128 matrix) with blood oxygenation level-dependent contrast. The results demonstrate the disadvantages of thresholding with fixed correlation coefficients. In contrast, taking the individual noise into account allows for a derivation of p values and a reliable identification of highly significant activation centers. An adequate delineation of the spatial extent of activation may be achieved by adding directly neighboring pixels provided their correlation coefficients comply with a second lower p value threshold.

Functional MRI of the human amygdala?

In view of an increasing number of publications that deal with functional mapping of the human amygdala using blood oxygenation-level-dependent (BOLD) magnetic resonance imaging, we reevaluated the underlying image quality of T2*-weighted echoplanar imaging (EPI) and fast low angle shot (FLASH) sequences at 2.0-T with regard to susceptibility-induced signal losses and geometric distortions. Apart from the timing of the gradient echoes, the degree of susceptibility influences is controlled by the image voxel size. Whereas published amygdala studies report voxel sizes ranging from 22 to 125 microl, the present results suggest that reliable imaging of the amygdala with BOLD sensitivity requires voxel sizes of 4 to 8 microl or less. Preferentially, acquisitions should be performed with a coronal section orientation. Although high-resolution BOLD MRI is at the expense of temporal resolution and volume coverage, it seems to provide the only solution to this physical problem.

Functional MRI with reduced susceptibility artifact: high-resolution mapping of episodic memory encoding

Visual episodic memory encoding was investigated using echoplanar magnetic resonance imaging at 2.0 x 2.0 mm2 resolution and 1.0 mm section thickness, which allows for functional mapping of hippocampal, parahippocampal, and ventral occipital regions with reduced magnetic susceptibility artifact. The memory task was based on 54 image pairs each consisting of a complex visual scene and the face of one of six different photographers. A second group of subjects viewed the same set of images without memory instruction as well as a reversing checkerboard. Apart from visual activation in occipital cortical areas, episodic memory encoding revealed consistent activation in the parahippocampal gyrus but not in the hippocampus proper. This finding was most prominently evidenced in sagittal maps covering the right hippocampal formation. Mean activated volumes were 432 +/- 293 microl and 259 +/- 179 microl for intentional memory encoding and non-instructed viewing, respectively. In contrast, the checkerboard paradigm elicited pure visual activation without parahippocampal involvement.

Reducing inhomogeneity artifacts in functional MRI of human brain activation-thin sections vs gradient compensation

We evaluated two methods for correcting inhomogeneity-induced signal losses in magnetic resonance gradient-echo imaging that either use gradient compensation or simply acquire thin sections. The strategies were tested in the human brain in terms of achievable quality of T2*-weighted images at the level of the hippocampus and of functional activation maps of the visual cortex. Experiments were performed at 2.0 T and based on single-shot echo-planar imaging at 2. 0 x 2.0 mm(2) resolution, 4 mm section thickness, and 2.0 s temporal resolution. Gradient compensation involved a sequential 16-step variation of the refocusing lobe of the slice-selection gradient (TR/TE = 125/53 ms, flip angle 15 degrees ), whereas thin sections divided the 4-mm target plane into either four 1-mm or eight 0.5-mm interleaved multislice acquisitions (TR/TE = 2000/54 ms, flip angle 70 degrees ). Both approaches were capable of alleviating the inhomogeneity problem for structures in the base of the brain. When compared to standard 4-mm EPI, functional mapping in the visual cortex was partially compromised because of a lower signal-to-noise ratio of inhomogeneity-corrected images by either method. Relative to each other, consistently better results were obtained with the use of contiguous thin sections, in particular for a thickness of 1 mm. Multislice acquisitions of thin sections require minimal technical adjustments.

Effects of sedation, stimulation, and placebo on cerebral blood oxygenation: a magnetic resonance neuroimaging study of psychotropic drug action

The effects of pharmacologic depression and stimulation of cerebral activity were investigated in seven healthy young volunteers using blood oxygenation-sensitive MRI at 2.0 T. Dynamic gradient-echo imaging (7 min) was performed before, during and after the intravenous application of 10 mg diazepam and 15 mg metamphetamine as well as of the corresponding drug placebos (isotonic saline) in a brain section covering frontotemporal gray matter, subcortical gray matter structures, and cerebellum. The MRI responses were significantly different for the two drugs applied (p = 0.01). Relative to signal strength during injection, metamphetamine elicited a signal increase of 0.97 +/- 0.03% (mean +/- SD, p = 0.02) within the whole section 4-5 min after injection. Similarly, both placebo conditions led to a small signal increase, i.e. 0.50 +/- 0. 03% (n.s.) for the metamphetamine placebo and 0.40 +/- 0.07% (p = 0. 03) for the diazepam placebo. Diazepam abolished this signal increase. A topographic analysis revealed the metamphetamine-induced signal increase to be more pronounced in subcortical gray matter structures (p = 0.01) and cerebellum (p = 0.02) than in frontotemporal cortical gray matter (p = 0.04). This finding is in agreement with the hypothesis that pertinent responses not only reflect global cerebral hemodynamic adjustments, but also localized perfusion changes coupled to alterations in synaptic activity. The occurrence of a placebo response is best explained by expectancy and may provide a confounding factor in the design of functional activation experiments.

MRI of functional deactivation: temporal and spatial characteristics of oxygenation-sensitive responses in human visual cortex

Magnetic resonance imaging (MRI) of neuronal "activation" relies on the elevation of blood flow and oxygenation and a related increase of the blood oxygenation level-dependent (BOLD) MRI signal. Because most cognitive paradigms involve both switches from a low degree of activity to a high degree of activity and vice versa, we have undertaken a baseline study of the temporal and spatial characteristics of positive and negative BOLD MRI responses in human visual cortex. Experiments were performed at 2.0 T using a multislice gradient-echo EPI sequence (TR = 1 s, mean TE = 54 ms, flip angle 50 degrees) at 2x2-mm2 spatial resolution. Activation and "deactivation" processes were accomplished by reversing the order of stimulus presentations in paradigms using homogeneous gray light and an alternating checkerboard as distinct functional states. For sustained stimulation (> or = 60 s) the two conditions resulted in markedly different steady-state BOLD MRI signal strengths. The transient responses to brief stimulation (< or = 18 s) differed insofar as activation processes temporally separate positive BOLD and negative undershoot effects by about 10 s, whereas negative BOLD effects and undershoot contributions overlap for deactivation processes. Apart from differences in stimulus features (e.g., motion) the used activation and deactivation protocols revealed similar maps of neuronal activity changes.

Does stimulus quality affect the physiologic MRI responses to brief visual activation?

We studied the effect of stimulus quality on the basic physiological response characteristics of oxygenation-sensitive MRI signals. Paradigms comprised a contrast-reversing checkerboard vs. darkness or vs. gray light as well as gray light vs. darkness in a 2 s/52 s protocol (nine subjects). MRI was performed at 2.0 T using single-shot gradient-echo EPI (TR/TE = 500/54 ms, flip angle 30 degrees). All paradigms elicited almost identical signal intensity time courses comprising a latency period (1-2s), an activation-induced signal increase (4-4.5% at about 6-7 s after stimulus onset) and a post-stimulus signal undershoot (-1%) that slowly recovered to baseline (about 50 s). Thus, in contrast to findings for sustained stimulation, brief presentations of distinct visual stimuli exhibit similar physiological response characteristics that support the use of a uniform response profile for the evaluation of event related paradigms.

Temporal and spatial MRI responses to subsecond visual activation

The temporal and spatial characteristics of oxygenation-sensitive MRI responses to very brief visual stimuli (five Hz reversing black and white checkerboard pattern versus darkness) were investigated (nine subjects) by means of serial single-shot gradient-echo echo-planar imaging (2.0 T, TR=400 ms, mean TE=54 ms, flip angle 30 degrees). The use of a 0.2-s stimulus and a 90-s control phase resulted in an initial latency phase (about 2 s, no signal change), a positive MRI response (2.5% signal increase peaking at 5 s after stimulus onset), and a post-stimulus undershoot (1% signal decrease peaking at 15 s after stimulus onset) lasting for about 50-60 s. The finding that a subsecond visual stimulus elicits both a strong positive MRI response and a long-lasting undershoot provides further evidence for the neuronal origin of slow signal fluctuations seen in the absence of functional challenge and their utility for mapping functional connectivity. The additional observation that a reduction of the inter-stimulus control phase from 90 s to 9.8 s does not seem to affect the spatial extent of cortical activation in pertinent maps is of major relevance for the design and analysis of "event-related" MRI studies.

Physiologic aspects of event related paradigms in magnetic resonance functional neuroimaging

In order to substantiate event related paradigms in magnetic resonance functional neuroimaging, we assessed the temporal and spatial characteristics of oxygenation-sensitive MRI responses to 1 s periods of visual activation in repetitive protocols. A main finding is a reduction of the functional contrast between conditions (reversing checkerboard vs. darkness) for decreasing interstimulus intervals yielding 4.5% signal change for 89 s, 4% for 9 s, 3% for 6 s, and 1% for 3 s, respectively. Although rapid repetitions of identical stimuli preclude the development of the full positive and negative MRI signal deflections, pertinent responses leave the spatial pattern of activated brain regions unaffected and result in identical maps. These findings suggest the use of interstimulus intervals of the order of the response time from stimulus onset to maximum signal strength (5-6 s in the visual system). The resulting distinction in time will allow for separate mapping of stimulus-related responses with spatially overlapping cortical representations.

Temporal characteristics of oxygenation-sensitive MRI responses to visual activation in humans

Series of single-shot blipped echo-planar images with spin-density weighting and T2* sensitivity (2.0 T, TR = 400 ms, TE = 54 ms, flip angle = 30 degrees) were used to study the temporal response profiles to repetitive visual activation (5 Hz, reversing black and white checkerboard versus darkness) for protocols comprising multiple cycles of a 1.6-s stimulus in conjunction with a 8.4-s or 90-s recovery phase and a 10-s stimulus with a 20-s or 90-s recovery phase. Analysis of the real-time data from all activated pixels resulted in a strong positive MRI response (mean values 3-6%) as well as a marked poststimulus undershoot (mean values 1-2%, duration 60-90 s) for all paradigms. Repetitive protocols with insufficient recovery periods of 8.4 s or 20 s gave rise to a wraparound effect when analyzing time-locked averages from multiple activation cycles. This problem may lead to an early signal decrease that originates from the ongoing undershoot of preceding activations folded back into the initial latency phase of a subsequent activation. When ensuring complete decoupling of responses to successive stimuli by using a 90-s recovery period, the wraparound effect vanished and an initial dip was observed in one of seven subjects for a 10-s/90-s protocol.

A comparative FLASH and EPI study of repetitive and sustained visual activation

Functional responses to either brief repetitive or sustained activation of the human visual cortex (movie presentation) were monitored using both fast low angle shot and echo planar imaging sequences. To allow for proper comparisons, native image contrasts were equally sensitized to changes in cerebral blood oxygenation with other experimental conditions matched as much as possible. Putative influences of receiver bandwidth and absolute voxel size were specifically addressed. In all cases resulting correlation maps and regional signal intensity time courses showed excellent spatial and temporal congruence, respectively. In particular, for a 6 min protocol of sustained activation, both FLASH and EPI yielded an initial signal increase (oxygenation overshoot), a subsequent signal decrease during ongoing stimulation, and a marked signal drop (oxygenation undershoot) after the end of stimulation. These findings exclude technical differences between FLASH and EPI as the source of previous contradictory observations more likely to be explained by differences in stimulus design.

Dynamic NMR studies of perfusion and oxidative metabolism during focal brain activation

Together, the present results on oxygenation, flow, and metabolism indicate that the prevalence of nonoxidative glycolysis and associated lactate production during the initial phase of activation is replaced by the upregulation of oxidative glucose consumption (see sketches in Fig. 5). Following rapid circulatory changes the gap between oxygen availability and oxygen consumption gradually closes until a recoupling of perfusion and oxidative metabolism is achieved a few minutes after switching the state of neural activity. While brain glucose and lactate concentrations reflect an initial prevalence of anaerobic glycolysis, the changes in blood oxygenation suggest that the rapid adjustment of blood flow (enhanced oxygen delivery) is followed by a slower upregulation of oxidative metabolism (enhanced oxygen consumption). The physiological uncoupling of perfusion and oxidative metabolism emerges as a transient phenomenon in response to both onset and end of stimulation. Recoupling at enhanced cerebral metabolic rates of oxygen (CMRO2) and glucose occurs a few minutes after switching the state of neural activity. Since glycolysis takes place primarily in astrocytes, the stimulus-related increase and decrease of lactate seen here may reflect a transfer of astrocytic lactate to neurons where it is converted into pyruvate and channelled into oxidative phosphorylation. This model of metabolic responses to functional activation is supported by a recently detected pathway for glutamate-stimulated glycolysis in astrocytes that provides a simple mechanism linking astrocytic glucose utilization to neuronal activity (Pellerin and Magistretti, 1994). In summary, evidence has accumulated that the physiological uncoupling of perfusion and oxidative metabolism associated with the onset of functional activation is a transient phenomenon leading to an only temporal mismatch of oxygen delivery and consumption. Recoupling at enhanced though balanced levels of glucose and oxygen consumption is most remarkably documented by the pronounced "negative" uncoupling at the end of stimulation.

Equivalent responses to lexical and nonlexical visual stimuli in occipital cortex: a functional magnetic resonance imaging study

Stimulus-related changes in cerebral blood oxygenation were measured using high-resolution functional magnetic resonance imaging sequentially covering visual occipital areas in contiguous sections. During dynamic imaging, healthy subjects silently viewed pseudowords, single false fonts, or length-matched strings of the same false fonts. The paradigm consisted of a sixfold alternation of an activation and a control task. With pseudowords as activation vs single false fonts as control, responses were seen mainly in medial occipital cortex. These responses disappeared when pseudowords were alternated with false font strings as the control and reappeared when false font strings instead of pseudowords served as activation and were alternated with single false fonts. The string-length contrast alone, therefore, is sufficient to account for the activation pattern observed in medial visual cortex when word-like stimuli are contrasted with single characters.

Simultaneous recording of cerebral blood oxygenation changes during human brain activation by magnetic resonance imaging and near-infrared spectroscopy

Changes in cerebral blood oxygenation due to functional activation of the primary sensorimotor cortex during a unilateral finger opposition task were simultaneously mapped by deoxyhemoglobin-sensitive magnetic resonance imaging (MRI) and monitored by near-infrared spectroscopy (NIRS). Activation foci along the contralateral central sulcus displayed task-associated increases in MRI signal intensity, indicating a concomitant decrease of the focal concentration of deoxyhemoglobin. This interpretation was confirmed by simultaneous reductions in deoxyhemoglobin measured optically. Since observation of the latter effect required exact spatial matching of the MRI-detected activation foci and position of the fiber optic bundles ("optodes") used for transmitting and receiving light, it may be concluded that optical recordings of changes in deoxyhemoglobin during functional challenge probe only a restricted brain tissue region. While deoxyhemoglobin responses seen by NIRS were smaller for ipsi- than for contralateral finger movements, task-related increases in oxyhemoglobin were rather similar between both conditions and, thus, seem to be less specific. Furthermore, no consistent changes were obtained for total hemoglobin during task performance, possibly due to the short timing of the repetitive protocol. In general, results underline, in humans, the hitherto assumed signal physiology for functional brain mapping by oxygenation-sensitive MRI and allow assessment of both constraints and practicability of functional studies by NIRS.

Dynamic uncoupling and recoupling of perfusion and oxidative metabolism during focal brain activation in man

Changes in glucose consumption, lactate production, and blood oxygenation were measured during prolonged neuronal activation (4-6 min) in human primary visual cortex using dynamic magnetic resonance spectroscopy and imaging. A decrease of steady-state glucose by 40% because of enhanced use by 21% was accompanied by a transient accumulation of lactate with a peak value of 170% 2.5 min after stimulation onset. Rapid blood hyperoxygenation indicating "uncoupling" of blood flow and oxidative metabolism was followed by a return to basal levels over 3 min. Thus, initial nonoxidative glucose consumption during functional activation is gradually complemented by a slower adjustment of oxidative phosphorylation that "recouples" perfusion and oxygen consumption at a new equilibrium.

Hemimegalencephaly: localized proton magnetic resonance spectroscopy in vivo

Two children with hemimegalencephaly were examined by magnetic resonance imaging (MRI) and localized proton MR spectroscopy (MRS). In both cases, structural changes in the enlarged hemisphere included pachy- or polymicrogyria and gliosis of white matter. Associated metabolic disturbances included a dramatic reduction of glutamate and N-acetylaspartate (NAA) in white matter. Less severe or no alterations were noted in cortical gray matter, basal ganglia, and cerebellum. The older child (13 years) showed increased myoinositol in both gray and white matter as well as markedly increased choline-containing compounds in gray matter. Both children also had mildly decreased NAA levels in the white matter of the contralateral hemisphere. The spectroscopic findings indicate loss of vital neuroaxonal tissue and glial cell proliferation. Metabolic disturbances were more pronounced in the older child. The normal-appearing hemisphere was mildly affected in both cases.

Functional MRI of human brain activation combining high spatial and temporal resolution by a CINE FLASH technique

Functional mapping of human brain activation has been accomplished at high spatial and temporal resolution (voxel size 4.9 microliter, temporal increment 100 ms). The approach was based on oxygenation-sensitive long-echo time FLASH MRI sequences synchronized to multiply repeated cycles of visual stimulation in a CINE acquisition mode. This high temporal resolution revealed that stimulus-related signal intensity changes in human visual cortex display an initial latency followed by increases extending over several seconds. Furthermore, the temporal characteristics of the complete CINE MRI signal time course depended on the absolute and relative durations of activation and control periods and, for example, caused an apparent absence of a poststimulation "under-shoot" phenomenon. Complementing hyperoxygenation due to rapid hemodynamic adjustments, these results suggest signal intensity modulation by enhanced oxygen consumption and concomitant deoxygenation during prolonged and/or repetitive stimulation.

[Strategies for data analysis of brain activation studies with functional MR tomography]

The sensitivity of gradient-echo magnetic resonance imaging (MRI) to changes in cerebral blood oxygenation has been introduced for mapping functional brain activation. To benefit from the high spatial and temporal resolution of the respective dynamic MRI data sets, their analysis requires algorithms that are capable of both precisely delineating task-related activation patterns and demonstrating functional connectivity of interacting areas. Here, we present various strategies for data evaluation by means of correlational analyses that surpass the quality of subtraction-based activation maps by improving both sensitivity and robustness. On a pixel-by-pixel basis the approach correlates signal time courses with a reference function, reflecting the temporal sequence of activated and control states. Extended versions employ the calculation of auto- or cross-correlation functions that increase sensitivity, but require periodic stimulations. Following individual correction for non-specific but correlated signal fluctuations, mapping of task-related coherent activation can be improved using neighborhood principles. Such refined strategies are expected to enhance the usefulness of oxygenation-sensitive MRI for studying the functional anatomy of the human brain under both physiological and pathological conditions.

Magnetic resonance imaging of regional cerebral blood oxygenation changes under acetazolamide in carotid occlusive disease

BACKGROUND

Gradient-echo magnetic resonance imaging can demonstrate changes in cerebral blood oxygenation with high spatiotemporal resolution. We have previously shown that this technique allows monitoring of autoregulatory responses under vasodilatory stress in the healthy human brain. Here the approach has been extended to assess impairment of the autoregulatory reserve capacity in patients with carotid occlusive disease.

SUMMARY OF REPORT

We studied four patients with unilateral occlusion of the internal carotid artery on a 2.0-T clinical high-field magnetic resonance system. Oxygenation-sensitive imaging was based on long-echo-time, gradient-echo sequences (repetition time, 62.5 milliseconds; echo time, 30 milliseconds) with low flip angles (10 degrees) to emphasize changes in blood oxygenation rather than flow velocity. Dynamic recording monitored signal intensities before and after injecting 1 g of acetazolamide. In sections covering the hand area of the primary sensorimotor cortex, acetazolamide-induced magnetic resonance signal increases were attenuated in the vascular territories of occluded arteries. Lateralization of responses in the left and right hemispheric parts of the section corresponded to decreased hemodynamic reserve capacity as measured globally by transcranial Doppler ultrasonography.

CONCLUSIONS

The present findings indicate that magnetic resonance imaging can demonstrate exhaustion of the autoregulatory reserve capacity when monitoring cerebral blood oxygenation changes during vasodilatory stress. We suggest that this method can help to evaluate regional cerebral hemodynamics in patients with carotid occlusive disease.

Functional cooperativity of human cortical motor areas during self-paced simple finger movements. A high-resolution MRI study

Magnetic resonance imaging of changes in cerebral blood oxygenation (CBO) delineated areas of neural activation during self-paced unilateral middle finger tapping in five normal volunteers. Four contiguous imaging sections parallel to the bicommissural plane covered the hand area of the primary sensori-motor cortex bilaterally. All measurements were performed at 2.0 T using rapid gradient-echo sequences (TR/TE = 63/30 ms) with high spatial resolution (0.8 x 1.6 x 4 mm) and both strong (40 degrees flip angle) and weak (10 degrees) radiofrequency excitation pulses. This allows differentiation of flow and CBO contributions to the observed signal alterations. Functional cooperativity was analysed by a pixel-by-pixel correlation of signal intensity time courses with the stimulus protocol. Areas of activation included the contralateral primary motor cortex, the homologue part of the primary sensory cortex, the supplementary motor area (SMA) and the lateral premotor areas in all volunteers. Task-related activation of ipsilateral primary motor cortex above a threshold correlation coefficient of 0.5 was seen in two out of five volunteers (at 40 degrees) and one out of five (at 10 degrees) when performing the right-hand task. The present MRI findings readily demonstrate in single subjects that the SMA is involved in self-paced finger tapping. Only sparse activation in the ipsilateral primary motor cortex is consistent with the motor paradigm used.

Correlational imaging of thalamocortical coupling in the primary visual pathway of the human brain

While the anatomy of the human brain is well defined, the functional connectivity of its structures is far less understood. Modern neuroimaging techniques offer the unique opportunity of visualizing physiologic activation in central nervous structures and of identifying the elements underlying distributed networks for information processing. Following improved spatial resolution of deoxyhemoglobin-sensitive magnetic resonance imaging, we were able to detect simultaneous signal changes in the lateral geniculate nucleus and primary visual cortex during periodic photic stimulation. Visualization of coupled activation by cross-correlation analysis resulted in the first demonstration of thalamocortical interaction in the primary visual pathway of the intact human brain.

The effect of acetazolamide on regional cerebral blood oxygenation at rest and under stimulation as assessed by MRI

The sensitivity of gradient echo magnetic resonance imaging (MRI) to changes in cerebral blood oxygenation (CBO) has been introduced for mapping functional brain activation. Here, we report that this approach allows monitoring autoregulation in the human brain under vasodilatory stress. Following the administration of acetazolamide, signal intensities of deoxyhemoglobin-sensitive images increased in cortical and subcortical gray matter and to a lesser extent in white matter. This result reflects a venous hyperoxygenation stemming from an increase in cerebral perfusion with oxygen consumption remaining constant. In addition, pharmacologic induction of vasodilation attenuated activity-related MRI signal changes in the visual cortex under photic stimulation. Although intersubject variability was high, this finding indicates individually persisting autoregulatory responsiveness to functional challenge despite an "exhausted" reserve capacity. It is suggested that recording CBO by MRI will foster our understanding of modulation of vasomotor tone and cerebral perfusion. Furthermore, this technique may prove valuable for assessing the cerebrovascular reserve capacity in patients with carotid artery occlusive disease.

Brain or vein--oxygenation or flow? On signal physiology in functional MRI of human brain activation

Stimulus-related signal changes in functional MRI of human brain activation not only reflect associated adjustments of cerebral blood flow and oxygen consumption, but strongly depend on the MRI technique chosen and the actual experimental setting. A list of relevant parameters includes static field homogeneity of the magnet, MR pulse sequence and signal type, TE, TR, flip angle, gradient strengths, gradient waveforms, receiver bandwidth and voxel size. In principle, a local signal increase during functional activation may reflect a regional change in cerebral blood flow or deoxyhemoglobin concentration or both. This ambiguity was demonstrated using long TE FLASH MRI at high spatial resolution. Subsequently, experimental strategies were evaluated that either discriminate MRI effects in large vessels from those in the cortical microvasculature or separate changes in blood flow velocity from those in blood oxygenation. Examples comprise studies of the human visual and motor cortex.

Dynamic high-resolution MR imaging of brain deoxygenation during transient anoxia in the anesthetized rat

Transient alterations in brain oxygenation during 60-s periods of anoxia were visualized at high spatial resolution (voxel size < or = 0.15 microliter) with the use of serial long echo time FLASH (fast low-angle shot) magnetic resonance images (measuring time > or = 6 s) of halothane-anesthetized rats in vivo. Difference images from normoxia and anoxia exploit the signal decrease associated with increased levels of paramagnetic deoxyhemoglobin in the arterial and venous blood pool. Insights into the spatial heterogeneity of oxygen deprivation are complemented by physiologic information from the time course of pertinent signal changes in different regions of the brain.

Absolute concentrations of metabolites in the adult human brain in vivo: quantification of localized proton MR spectra

In vivo concentrations of cerebral metabolites were obtained by means of 52 single-voxel, localized proton magnetic resonance (MR) spectroscopic examinations of different regions of the brain performed in 26 healthy adults aged 21-32 years. The study was performed at 2.0 T with use of a circularly polarized head coil to ensure homogeneous radio-frequency excitation and signal reception. Proton MR spectra were obtained in the stimulated-echo acquisition mode under fully relaxed conditions (repetition time > or = 6,000 msec) and at short echo times (20 msec) to minimize corrections due to T1 and T2 attenuation and depict the spectra of metabolites with strongly coupled resonances. Absolute concentrations were obtained by means of calibration of resonance signal areas with those of pertinent metabolite solutions from separate studies and correction for coil loading and partial volume effects (eg, with perfused capillary networks and cerebrospinal fluid). The results provide a quantitative basis for studies of both normal human neurochemistry in vivo and metabolic alterations in diseases of the brain.

Functional MRI of human brain activation at high spatial resolution

Functional activation maps of the human visual cortex were obtained at a spatial resolution almost two orders of magnitude better than achievable by positron emission tomography and within measuring times of a few seconds. Transient alterations in the concentration of paramagnetic deoxyhemoglobin were conveniently detected at 2.0-T with use of RF-spoiled FLASH MRI sequences employing gradient echo times of 6 to 60 ms and voxel sizes of 2.5 to 39 microliters.

Identification of Scyllo-inositol in proton NMR spectra of human brain in vivo

Scyllo-inositol has been identified in proton NMR spectra of mammalian brain in vitro and in vivo. In contrast to myo-inositol this isomer comprises six equivalent CH protons that yield a singlet resonance at a chemical shift of 3.35 ppm. 1-D and 2-D J-resolved proton NMR studies (7.0 T) of perchloric acid extracts of brain tissues revealed different amounts of scyllo-inositol in man, sheep, cow and rat. Absolute quantification of localized short-echo time proton NMR spectra (2.0 T) of human brain in vivo resulted in scyllo-inositol concentrations of 0.35 +/- 0.06 mM for white matter (n = 25), 0.43 +/- 0.11 mM for grey matter (n = 23) and 0.57 +/- 0.14 mM for cerebellum (n = 10). Evidence for a tight metabolic link to myo-inositol was supported by a simultaneous variation of myo- and scyllo-inositol in patients with various brain diseases.

Molecular self-diffusion of intracellular metabolites in rat brain in vivo investigated by localized proton NMR diffusion spectroscopy

Molecular self-diffusion coefficients of water (0.75 +/- 0.05), N-acetylaspartate (0.27 +/- 0.04), creatines (0.27 +/- 0.04), and cholines (0.28 +/- 0.08) x 10(-5) cm2 s-1 were obtained from localized proton NMR spectra of rat brain in vivo using diffusion-weighted stimulated-echo (STEAM) sequences with a diffusion time of (delta--delta/3) = 17 ms.

Dynamic MR imaging of human brain oxygenation during rest and photic stimulation

Dynamic FLASH (fast low-angle shot) magnetic resonance (MR) imaging was used to monitor changes in brain oxygenation in the human visual cortex during photic stimulation. The approach exploits the sensitivity of the gradient-echo signal to susceptibility changes induced by varying concentrations of paramagnetic deoxyhemoglobin in the cerebral blood pool. After the onset of binocular photic stimulation (10 Hz, red light, checker-board), there was a distinct increase in the MR signal in the calcarine cortex within 6-9 seconds, indicating a decrease in the total deoxyhemoglobin concentration. After the stimulation was switched off, the MR signal returned to a basal value within a similar period of time. Assuming enhanced blood flow and only a minor increase in oxygen consumption (production of deoxyhemoglobin) during physiologic activation, the results reflect an enhanced supply of diamagnetic oxyhemoglobin and an increase in the partial oxygen pressure in the capillary and venous blood pools. In addition, a decrease in the basal MR signal in the calcarine cortex was observed during the first 60-90 seconds of persistent activation, which may be understood as an autoregulatory adaptation to increased overall brain activity associated with information processing due to continuous perception of visual stimuli.

Multiple sclerosis in children: cerebral metabolic alterations monitored by localized proton magnetic resonance spectroscopy in vivo

In vivo proton magnetic resonance spectroscopy of 8 children (7-16 years) with established multiple sclerosis revealed distinct alterations in regional cerebral metabolism associated with different aspects of the disease: (1) Localized proton spectra (2 to 4-ml volumes of interest) from multiple sclerosis plaques were generally characterized by a decrease in N-acetylaspartate and creatine, and an increase in cholines and myo-inositol relative to age-matched control subjects, (2) neither chronic nor enhancing plaques (by gadolinium-diethylenetriamine pentaacetic acid) during an acute exacerbation showed elevated levels of lactate or lipids, (3) spectra from adjacent white matter that did not appear suspicious in magnetic resonance images were similar to those of normal control subjects, and (4) cortical gray matter related to neighboring multiple sclerosis lesions showed a notable reduction of N-acetylaspartate. The present results show that functional impairment in multiple sclerosis is linked to gross metabolic disturbances of neuronal cell chemistry. We suggest that focal demyelination is accompanied by increased membrane precursors of proliferative turnover and is associated with secondary neuronal shrinkage or loss, perhaps extending into related cortical gray matter.