Faculty Bibliography

Background: Simultaneous PET/MR is a new technology that may be used in the evaluation of dementia patients. There are few data in the literature regarding quantitative differences between PET data obtained at PET/CT vs PET/ MR and how this may impact image interpretation. This study compared the PET interpretation of PET/CT vs PET/ MR by two independent experienced nuclear medicine physicians. Methods: Forty-five minutes following injection of 10 mCi of FDG, 19 patients with clinically-suspected dementia underwent a 15-min clinical brain PET/CT. Simultaneous PET/MR scanning was subsequently performed (60 min listmode) at approximately 90 min post-injection. Two experienced nuclear medicine physicians blindly interpreted the PET portion of all PET/CT scans, attributing a specific diagnosis (normal, AD, FTD, LBD, other dementia, mixed phenotype or unspecified disease) and severity scale (mild, moderate or severe abnormality). The readers then blindly interpreted the PET data obtained from PET/MR. Concordance between PET/CT (reference standard) and PET/ MR with respect to diagnosis and disease severity was assessed for each reader. Results: Reader A classified 12 PET/CT scans as AD, 5 as unspecified dementia, 1 as LBD and 1 as normal with a mean severity score of 2.0. Reader B classified 10 PET/CT scans as AD, 3 as unspecified, 1 as LBD and 5 as normal with mean severity score of 2.1. PET/MR interpretations with comparison to PET/CT yielded an 84% (16/19) intrareader concordance of diagnosis, with 95% (18/19) of severity scores varying by one point or less. Reader B exhibited 84% intra-reader concordance of dementia pattern diagnosis, with 89% (17/19) of all scores varying by one point or less. Conclusions: Our preliminary analysis in clinically-suspected dementia patients showed a relatively high concordance of intra-reader assignment of diagnosis and severity of findings between PET/CT and PET/MR when evaluated by two blinded experienced nuclear medicine physicians. These results suggest PET/MR!

Diffusion-weighted magnetic resonance (MR) signals reflect information about underlying tissue microstructure and cytoarchitecture. We propose a quantitative, efficient, and robust mathematical and physical framework for representing diffusion-weighted MR imaging (MRI) data obtained in "q-space," and the corresponding "mean apparent propagator (MAP)" describing molecular displacements in "r-space." We also define and map novel quantitative descriptors of diffusion that can be computed robustly using this MAP-MRI framework. We describe efficient analytical representation of the three-dimensional q-space MR signal in a series expansion of basis functions that accurately describes diffusion in many complex geometries. The lowest order term in this expansion contains a diffusion tensor that characterizes the Gaussian displacement distribution, equivalent to diffusion tensor MRI (DTI). Inclusion of higher order terms enables the reconstruction of the true average propagator whose projection onto the unit "displacement" sphere provides an orientational distribution function (ODF) that contains only the orientational dependence of the diffusion process. The representation characterizes novel features of diffusion anisotropy and the non-Gaussian character of the three-dimensional diffusion process. Other important measures this representation provides include the return-to-the-origin probability (RTOP), and its variants for diffusion in one- and two-dimensions-the return-to-the-plane probability (RTPP), and the return-to-the-axis probability (RTAP), respectively. These zero net displacement probabilities measure the mean compartment (pore) volume and cross-sectional area in distributions of isolated pores irrespective of the pore shape. MAP-MRI represents a new comprehensive framework to model the three-dimensional q-space signal and transform it into diffusion propagators. Experiments on an excised marmoset brain specimen demonstrate that MAP-MRI provides several novel, quantifiable parameters that capture previously obscured intrinsic features of nervous tissue microstructure. This should prove helpful for investigating the functional organization of normal and pathologic nervous tissue.

Lower back pain is a common problem frequently encountered without specific biomarkers that correlate well with an individual patient's pain generators. MRI quantification of diffusion and T2 relaxation properties may provide novel insight into the mechanical and inflammatory changes that occur in the lumbosacral nerve roots in patients with lower back pain. Accurate imaging of the spinal nerve roots is difficult because of their small caliber and oblique course in all three planes. Two-dimensional in-plane imaging of the lumbosacral nerve roots requires oblique coronal imaging with large field of view (FOV) in both dimensions, resulting in severe geometric distortions using single-shot echo planar imaging (EPI) techniques. The present work describes initial success using a reduced-FOV single-shot spin-echo EPI acquisition to obtain in-plane diffusion tensor imaging (DTI) and T2 mapping of the bilateral lumbar nerve roots at the L4 level of healthy subjects, minimizing partial volume effects, breathing artifacts and geometric distortions. A significant variation in DTI and T2 mapping metrics is also reported along the course of the normal nerve root. The fractional anisotropy is statistically significantly lower in the dorsal root ganglia (0.287 +/- 0.068) than in more distal regions in the spinal nerve (0.402 +/- 0.040) (p < 10(-5) ). The T2 relaxation value is statistically significantly higher in the dorsal root ganglia (78.0 +/- 11.9 ms) than in more distal regions in the spinal nerve (59.5 +/- 7.4 ms) (p < 10(-5) ). The quantification of nerve root DTI and T2 properties using the proposed methodology may identify the specific site of any degenerative and inflammatory changes along the nerve roots of patients with lower back pain.

Features of the diffusion-time dependence of the diffusion-weighted magnetic resonance imaging (MRI) signal provide a new contrast that could be altered by numerous biological processes and pathologies in tissue at microscopic length scales. An anomalous diffusion model, based on the theory of Brownian motion in fractal and disordered media, is used to characterize the temporal scaling (TS) characteristics of diffusion-related quantities, such as moments of the displacement and zero-displacement probabilities, in excised rat hippocampus specimens. To reduce the effect of noise in magnitude-valued MRI data, a novel numerical procedure was employed to yield accurate estimation of these quantities even when the signal falls below the noise floor. The power-law dependencies characterize the TS behavior in all regions of the rat hippocampus, providing unique information about its microscopic architecture. The relationship between the TS characteristics and diffusion anisotropy is investigated by examining the anisotropy of TS, and conversely, the TS of anisotropy. The findings suggest the robustness of the technique as well as the reproducibility of estimates. TS characteristics of the diffusion-weighted signals could be used as a new and useful marker of tissue microstructure.

This case demonstrates extraosseous 99m-technetium methylene diphosphonate (Tc-99m MDP) accumulation from a gastrointestinal stromal tumor. A 75-year-old woman underwent a temporal bone CT for conductive hearing loss that showed sclerosis in the right occipital condyle. Follow-up Tc-99m MDP bone scan for osseous metastases instead showed a mass-like extraosseous accumulation of Tc-99m MDP in the anterior left upper quadrant. Differential diagnoses included gastric cancer, lymphoma, metastatic melanoma, systemic hypercalcemia, or heterotopic mesenteric ossification. Contrast CT showed a well-circumscribed mass arising from the stomach, and subsequent pathology confirmed gastrointestinal stromal tumor. These tumors rarely can contain osteoclast-like giant cells and should be considered for extraosseous Tc-99m MDP accumulation.

BACKGROUND AND PURPOSE/OBJECTIVE:CT guidance may improve precision for diagnostic and therapeutic spinal injections, but it can increase patient radiation dose. This study examined the impact of reducing tube current on patient radiation exposure and the technical success for these procedures, by using axial acquisitions for short scan lengths and eliminating nonessential imaging. MATERIALS AND METHODS/METHODS:Our institutional review board approved retrospective analysis of records from 100 consecutive outpatients undergoing spinal injections for pain before and after the CT protocol modification to reduce radiation dose. Data collected included patient age and sex, response to injection, number of sites and spinal levels treated, injection type, performing physician, CT acquisition method, number of imaging series, tube current, scan length, and DLP. RESULTS:Image contrast was reduced with the low-dose protocol, but this did not affect technical success or immediate pain relief. Mean DLP for all procedures decreased from 1458 ± 1022 to 199 ± 101 mGy · cm (P < .001). The range of radiologist-dependent DLP per procedure also was reduced significantly with the modified protocol. Selective nerve root blocks, lumbar injections, multiple injection sites, and the lack of prior imaging were each associated with a slightly higher DLP (<50 mGy · cm). CONCLUSIONS:Radiation to patients undergoing CT-guided spinal injections can be decreased significantly without affecting outcome by reducing tube current, using axial acquisitions for short scan lengths, and eliminating nonessential imaging guidance. These measures also decrease variability in radiation doses between different practitioners and should be useful for other CT-guided procedures in radiology.

Ventral and rostral regions of the brain are of emerging importance for the MRI characterization of early dementia, traumatic brain injury and epilepsy. Unfortunately, standard single-shot echo planar diffusion-weighted imaging of these regions at high fields is contaminated by severe imaging artifacts in the vicinity of air-tissue interfaces. To mitigate these artifacts and improve visualization of the temporal and frontal lobes at 7 T, we applied a reduced field-of-view strategy, enabled by outer volume suppression (OVS) with novel quadratic phase radiofrequency (RF) pulses, combined with partial Fourier and parallel imaging methods. The new acquisition greatly reduced the level of artifacts in six human subjects (including four patients with early symptoms of dementia).

Chemically-fixed nervous tissues are well-suited for high-resolution, time-intensive MRI acquisitions without motion artifacts, such as those required for brain atlas projects, but the aldehyde fixatives used may significantly alter tissue MRI properties. To test this hypothesis, this study characterized the impact of common aldehyde fixatives on the MRI properties of a rat brain slice model. Rat cortical slices immersion-fixed in 4% formaldehyde demonstrated 21% and 81% reductions in tissue T(1) and T(2), respectively (P < 0.001). The T(2) reduction was reversed by washing slices with phosphate-buffered saline (PBS) for 12 h to remove free formaldehyde solution. Diffusion MRI of cortical slices analyzed with a two-compartment analytical model of water diffusion demonstrated 88% and 30% increases in extracellular apparent diffusion coefficient (ADC(EX)) and apparent restriction size, respectively, when slices were chemically-fixed with 4% formaldehyde (P

PMCID:3188415

PMID: 19353660

ISSN: 0740-3194

CID: 174916