Reducing patient radiation dose during CT-guided procedures: demonstration in spinal injections for pain
Shepherd, T M; Hess, C P; Chin, C T; Gould, R; Dillon, W P
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.
PMCID:7966006
PMID: 21920858
ISSN: 1936-959x
CID: 5839702
Reduced field-of-view diffusion-weighted imaging of the brain at 7 T
von Morze, Cornelius; Kelley, Douglas A C; Shepherd, Timothy M; Banerjee, Suchandrima; Xu, Duan; Hess, Christopher P
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).
PMCID:2988970
PMID: 20850242
ISSN: 0730-725x
CID: 174915
Aldehyde fixative solutions alter the water relaxation and diffusion properties of nervous tissue
Shepherd, Timothy M; Thelwall, Peter E; Stanisz, Greg J; Blackband, Stephen J
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
Postmortem interval alters the water relaxation and diffusion properties of rat nervous tissue--implications for MRI studies of human autopsy samples
Shepherd, Timothy M; Flint, Jeremy J; Thelwall, Peter E; Stanisz, Greg J; Mareci, Thomas H; Yachnis, Anthony T; Blackband, Stephen J
High-resolution imaging of human autopsy tissues may improve our understanding of in vivo MRI findings, but interpretation is complicated because samples are obtained by immersion fixation following a postmortem interval (PMI). This study tested the hypotheses that immersion fixation and PMI's from 0-24 h would alter the water relaxation and diffusion properties in rat cortical slice and spinal cord models of human nervous tissue. Diffusion data collected from rat cortical slices at multiple diffusion times (10-60 ms) and b-values (7-15,000 s/mm(2)) were analyzed using a two-compartment model with exchange. Rat spinal cords were characterized with standard diffusion tensor imaging (21 directions, b=1250 s/mm(2)). Switching from perfusion- to immersion-fixation at 0 h PMI altered most MRI properties of rat cortical slices and spinal cords, including a 22% decrease in fractional anisotropy (P<0.001). After 4 h PMI, cortical slice T(1) and T(2) increased 22% and 65% respectively (P<0.001), transmembrane water exchange decreased 23% (P<0.001) and intracellular proton fraction increased 25% (P=0.002). After 6 h PMI, spinal cord white matter fractional anisotropy had decreased 38% (P<0.001). MRI property changes were observed for PMIs up to 24 h. The MRI changes correlated with protease activity and histopathological signs of autolysis. Thus, immersion fixation and/or even short PMIs (4-6 h) altered the MRI properties of rat nervous tissue. This suggests comparisons between in vivo clinical MRI and MRI data from human autopsy tissues should be interpreted with caution.
PMCID:2836859
PMID: 18996206
ISSN: 1053-8119
CID: 174917
Imidazolyl benzimidazoles and imidazo[4,5-b]pyridines as potent p38alpha MAP kinase inhibitors with excellent in vivo antiinflammatory properties
Mader, Mary; de Dios, Alfonso; Shih, Chuan; Bonjouklian, Rosanne; Li, Tiechao; White, Wesley; Lopez de Uralde, Beatriz; Sanchez-Martinez, Concepcion; del Prado, Miriam; Jaramillo, Carlos; de Diego, Eugenio; Martin Cabrejas, Luisa M; Dominguez, Carmen; Montero, Carlos; Shepherd, Timothy; Dally, Robert; Toth, John E; Chatterjee, Arindam; Pleite, Sehila; Blanco-Urgoiti, Jaime; Perez, Leticia; Barberis, Mario; Lorite, Maria Jose; Jambrina, Enrique; Nevill, C Richard Jr; Lee, Paul A; Schultz, Richard C; Wolos, Jeffrey A; Li, Li C; Campbell, Robert M; Anderson, Bryan D
Herein we report investigations into the p38alpha MAP kinase activity of trisubstituted imidazoles that led to the identification of compounds possessing highly potent in vivo activity. The SAR of a novel series of imidazopyridines is demonstrated as well, resulting in compounds possessing cellular potency and enhanced in vivo activity in the rat collagen-induced arthritis model of chronic inflammation.
PMID: 18039577
ISSN: 0960-894x
CID: 174919
Tensor splines for interpolation and approximation of DT-MRI with applications to segmentation of isolated rat hippocampi
Barmpoutis, Angelos; Vemuri, Baba C; Shepherd, Timothy M; Forder, John R
In this paper, we present novel algorithms for statistically robust interpolation and approximation of diffusion tensors-which are symmetric positive definite (SPD) matrices-and use them in developing a significant extension to an existing probabilistic algorithm for scalar field segmentation, in order to segment diffusion tensor magnetic resonance imaging (DT-MRI) datasets. Using the Riemannian metric on the space of SPD matrices, we present a novel and robust higher order (cubic) continuous tensor product of B-splines algorithm to approximate the SPD diffusion tensor fields. The resulting approximations are appropriately dubbed tensor splines. Next, we segment the diffusion tensor field by jointly estimating the label (assigned to each voxel) field, which is modeled by a Gauss Markov measure field (GMMF) and the parameters of each smooth tensor spline model representing the labeled regions. Results of interpolation, approximation, and segmentation are presented for synthetic data and real diffusion tensor fields from an isolated rat hippocampus, along with validation. We also present comparisons of our algorithms with existing methods and show significantly improved results in the presence of noise as well as outliers.
PMCID:2759271
PMID: 18041268
ISSN: 0278-0062
CID: 174918
Diffusion tensor microscopy indicates the cytoarchitectural basis for diffusion anisotropy in the human hippocampus
Shepherd, T M; Ozarslan, E; Yachnis, A T; King, M A; Blackband, S J
BACKGROUND AND PURPOSE/OBJECTIVE:Observing changes to water diffusivity and fractional anisotropy (FA) for particular hippocampal regions may improve the sensitivity and specificity of diffusion tensor MR imaging for hippocampal pathologies like Alzheimer disease and mesial temporal sclerosis. As a first step toward this goal, this study characterized the cytoarchitectural features underlying diffusion anisotropy in human hippocampus autopsy specimens at 60-microm in-plane resolution. MATERIALS AND METHODS/METHODS:Eight-millimeter coronal segments of the hippocampal body were dissected from 5 autopsy specimens (mean = 55.6 +/- 6.2 years of age) with short postmortem intervals to fixation (21.2 +/- 5.7 hours) and no histologic evidence of neuropathology. Diffusion tensor microscopy data were collected from hippocampal specimens by using a 14.1T magnet with a protocol that included 21 unique diffusion gradient orientations (diffusion time = 17 ms, b = 1250 s/mm(2)). The resulting images were used to determine the mean diffusivity, FA, and principal fiber orientation for manually segmented hippocampal regions that included the stratum oriens, stratum radiatum, stratum pyramidale (CA1 and CA3), stratum lacunosum-molecular, hilus, molecular layer, granule cell layer, fimbria, and subiculum. RESULTS:Diffusion-weighted images had high signal-to-noise ratios (31.1 +/- 13.0) and delineated hippocampal anatomy well. Water diffusivity ranged from 1.21 +/- 0.22 x 10(-4) mm(2)/s in the fimbria to 3.48 +/- 0.72 x 10(-4) mm(2)/s in granule cells (analysis of variance, P<.001). Color fiber-orientation maps indicated the underlying microstructures responsible for diffusion anisotropy in the hippocampal lamina. CONCLUSION/CONCLUSIONS:Diffusion tensor microscopy provided novel microstructural information about the different lamina of the human hippocampus. These ex vivo data obtained at high-magnetic-field strengths can be used to study injury-specific diffusion changes to susceptible hippocampal regions and may lead to more specific MR imaging surrogate markers for Alzheimer disease or epilepsy.
PMCID:8134334
PMID: 17494678
ISSN: 0195-6108
CID: 5839692
Symmetric positive 4th order tensors & their estimation from diffusion weighted MRI
Barmpoutis, Angelos; Jian, Bing; Vemuri, Baba C; Shepherd, Timothy M
In Diffusion Weighted Magnetic Resonance Image (DW-MRI) processing a 2nd order tensor has been commonly used to approximate the diffusivity function at each lattice point of the DW-MRI data. It is now well known that this 2nd-order approximation fails to approximate complex local tissue structures, such as fibers crossings. In this paper we employ a 4th order symmetric positive semi-definite (PSD) tensor approximation to represent the diffusivity function and present a novel technique to estimate these tensors from the DW-MRI data guaranteeing the PSD property. There have been several published articles in literature on higher order tensor approximations of the diffusivity function but none of them guarantee the positive semi-definite constraint, which is a fundamental constraint since negative values of the diffusivity coefficients are not meaningful. In our methods, we parameterize the 4th order tensors as a sum of squares of quadratic forms by using the so called Gram matrix method from linear algebra and its relation to the Hilbert's theorem on ternary quartics. This parametric representation is then used in a nonlinear-least squares formulation to estimate the PSD tensors of order 4 from the data. We define a metric for the higher-order tensors and employ it for regularization across the lattice. Finally, performance of this model is depicted on synthetic data as well as real DW-MRI from an isolated rat hippocampus.
PMCID:2759272
PMID: 17633709
ISSN: 1011-2499
CID: 174921
Observation of anomalous diffusion in excised tissue by characterizing the diffusion-time dependence of the MR signal
Ozarslan, Evren; Basser, Peter J; Shepherd, Timothy M; Thelwall, Peter E; Vemuri, Baba C; Blackband, Stephen J
This report introduces a novel method to characterize the diffusion-time dependence of the diffusion-weighted magnetic resonance (MR) signal in biological tissues. The approach utilizes the theory of diffusion in disordered media where two parameters, the random walk dimension and the spectral dimension, describe the evolution of the average propagators obtained from q-space MR experiments. These parameters were estimated, using several schemes, on diffusion MR spectroscopy data obtained from human red blood cell ghosts and nervous tissue autopsy samples. The experiments demonstrated that water diffusion in human tissue is anomalous, where the mean-square displacements vary slower than linearly with diffusion time. These observations are consistent with a fractal microstructure for human tissues. Differences observed between healthy human nervous tissue and glioblastoma samples suggest that the proposed methodology may provide a novel, clinically useful form of diffusion MR contrast.
PMID: 16962801
ISSN: 1090-7807
CID: 174924
Structural insights from high-resolution diffusion tensor imaging and tractography of the isolated rat hippocampus
Shepherd, Timothy M; Ozarslan, Evren; King, Michael A; Mareci, Thomas H; Blackband, Stephen J
The hippocampus is a critical structure for learning and memory formation injured by diverse neuropathologies such as epilepsy or Alzheimer's disease. Recently, clinical investigations have attempted to use diffusion tensor MRI as a more specific surrogate marker for hippocampal damage. To first better understand the tissue architecture of healthy hippocampal regions, this study characterized 10 rat hippocampi with diffusion tensor imaging (DTI) at 50-microm in-plane image resolution using a 14.1-T magnet. Chemical fixation of the dissected and straightened rat hippocampus provided a simple, effective way to reduce partial volume effects when segmenting hippocampal regions and improved mean signal-to-noise per unit time (e.g. 50.6+/-4.4 at b=1250 s/mm2 in 27 min). Contrary to previous reports that water diffusion is homogeneous throughout the nervous system, statistically different mean diffusivities were observed (e.g. 0.238+/-0.054 and 0.318+/-0.084 microm2/ms for the molecular and granule cell layers respectively) (ANOVA, P<0.05). Different hippocampal subregions had lower fractional anisotropy than uniformly fibrous structures like corpus callosum because of their complex architecture. DTI-derived color fiber orientation maps and tractography demonstrated most components of the trisynaptic intrahippocampal pathway (e.g. orientations in stratum lacunosum-moleculare were dominated by perforant and Schaffer fibers) and also permitted some assessment of connectivity in the rat hippocampus.
PMID: 16806988
ISSN: 1053-8119
CID: 174926