Faculty Bibliography

Visual working memory (VWM) plays an essential role in many perceptual and higher-order cognitive processes. Despite its reliance on a broad network of brain regions, VWM has a capacity limited to a few objects. This capacity varies substantially across individuals and relates closely to measures of overall cognitive function (Luck and Vogel, 2013). The mechanisms underlying these properties are not completely understood, although the amplitude of neural signal oscillations (Vogel and Machizawa, 2004) and brain activation in specific cortical regions (Todd and Marois, 2004) have been implicated. Variability in VWM performance may also reflect variability in white matter structural properties. However, data based primarily on diffusion tensor imaging approaches remain inconclusive. Here, we investigate the relationship between white matter and VWM capacity in human subjects using an advanced diffusion imaging technique, diffusion kurtosis imaging. Diffusion kurtosis imaging provides several novel quantitative white mater metrics, among them the axonal water fraction (faxon), an index of axonal density and caliber. Our results show that 59% of individual variability in VWM capacity may be explained by variations in faxon within a widely distributed network of white matter tracts. Increased faxon associates with increased VWM capacity. An additional 12% in VWM capacity variance may be explained by diffusion properties of the extra-axonal space. These data demonstrate, for the first time, the key role of white matter in limiting VWM capacity in the healthy adult brain and suggest that white matter may represent an important therapeutic target in disorders of impaired VWM and cognition.

AIM: To evaluate the performance of multidetector computed tomography (MDCT) in the measurement of endometrial thickness and assessment for endometrial disease. MATERIALS AND METHODS: Seventy-nine MDCT examinations, including sagittal reformats from isotropic data, were retrospectively evaluated for the presence of endometrial abnormality, endometrial thickness, and recommendation for transvaginal ultrasound (TVUS) after CT. The endometrial thickness was measured on sagittal images using two different methods, between the inner-to-inner hypoattenuating stripe, and when visible, between the outer-to-outer hyperattenuating stripe. TVUS performed within 48 h of CT in premenopausal and 1 month in postmenopausal patients served as reference standard. Interobserver agreement for endometrial thickness and abnormalities was assessed using concordance correlation (CC) and kappa statistics. RESULTS: Interobserver agreement for endometrial thickness on sagittal CT images was excellent (CC 0.98), and highly accurate using the inner-to-inner measurement. For determination of abnormal thickening, the positive predictive value and negative predictive value were 67-100% and 99.5-100%. For detection of any endometrial abnormality, the positive predictive value and negative predictive value were 79-90% and 84-95%, respectively. False-negative missed abnormalities included small volume hydrometra, a polyp, and endometrial distortion by a fibroid. CONCLUSION: At MDCT, sagittal reformatted images provide reliable endometrial measurement using the inner-to-inner hypoattenuating stripe and are accurately categorized as normal or abnormal thickness using the same numerical criteria as at sonography.

Concentration of the neuronal marker, N-acetylaspartate (NAA), a quantitative metric for the health and density of neurons, is currently obtained by integration of the manually defined peak in whole-head proton (1 H)-MRS. Our goal was to develop a full spectral modeling approach for the automatic estimation of the whole-brain NAA concentration (WBNAA) and to compare the performance of this approach with a manual frequency-range peak integration approach previously employed. MRI and whole-head 1 H-MRS from 18 healthy young adults were examined. Non-localized, whole-head 1 H-MRS obtained at 3 T yielded the NAA peak area through both manually defined frequency-range integration and the new, full spectral simulation. The NAA peak area was converted into an absolute amount with phantom replacement and normalized for brain volume (segmented from T1 -weighted MRI) to yield WBNAA. A paired-sample t test was used to compare the means of the WBNAA paradigms and a likelihood ratio test used to compare their coefficients of variation. While the between-subject WBNAA means were nearly identical (12.8 +/- 2.5 mm for integration, 12.8 +/- 1.4 mm for spectral modeling), the latter's standard deviation was significantly smaller (by ~50%, p = 0.026). The within-subject variability was 11.7% (+/-1.3 mm) for integration versus 7.0% (+/-0.8 mm) for spectral modeling, i.e., a 40% improvement. The (quantifiable) quality of the modeling approach was high, as reflected by Cramer-Rao lower bounds below 0.1% and vanishingly small (experimental - fitted) residuals. Modeling of the whole-head 1 H-MRS increases WBNAA quantification reliability by reducing its variability, its susceptibility to operator bias and baseline roll, and by providing quality-control feedback. Together, these enhance the usefulness of the technique for monitoring the diffuse progression and treatment response of neurological disorders

INTRODUCTION: To compare qualitative and quantitative imaging features from conventional and diffusion-weighted (DW) magnetic resonance imaging (MRI) in detection of metastatic pelvic lymph nodes in bladder cancer patients undergoing cystectomy. MATERIALS AND METHODS: Thirty-six patients who had undergone cystectomy for bladder cancer with preoperative MRI with DWI sequence prior to surgery were included. Imaging features on conventional and DW-MRI were compared with histopathology at cystectomy. RESULTS: Nodal features associated with metastatic lymphadenopathy were short axis (AUC = 0.85, p < 0.001; when SA > 5 mm: sensitivity = 88%, specificity = 75%), long axis (AUC = 0.80, p < 0.001; when LA > 6 mm: sensitivity = 88%, specificity = 71%), apparent diffusion coefficient (ADC) on DWI, normalized to muscle (AUC = 0.66, p = 0.113; when nADC < 1.35: sensitivity = 75%, specificity = 68%), and absence of fatty hilum on conventional imaging (AUC = 0.73, p = 0.012; when fatty hilum absent, sensitivity = 75%, specificity = 71%). ADC without normalization was not associated with metastasis (p = 0.303). CONCLUSIONS: Imaging findings from conventional MRI and DWI achieved reasonable accuracy for detecting metastatic lymph nodes in bladder cancer, although sensitivity was higher than specificity. A short axis greater than 5 mm on conventional MRI had the highest accuracy of any individual finding. When using DWI, normalization of ADC values to muscle ADC may improve diagnostic performance.

PURPOSE: To compare and assess subregional, compartmental, and whole T1rho values of menisci in patients with doubtful-minimal (Kellgren-Lawrence [KL] grade 1-2) as compared to moderate-severe (KL3-4) osteoarthritis (OA) and healthy controls at 3 Tesla (T). MATERIALS AND METHODS: Forty-six subjects were included in the study and subdivided into three subgroups: 16 healthy controls (4 females, 12 males; mean age = 34.4 +/- 10.2 years; age range, 24-63 years), 20 patients with doubtful-minimal (KL1-2) OA (9 females, 11 males; mean age = 61.9 +/- 10.8 years; age range, 40-80 years), and 10 patients with moderate-severe (KL3-4) OA (4 females, 6 males; mean age = 71.1 +/- 9.6 years; age range, 58-89 years). All subjects were evaluated on a 3T MR scanner using a spin-lock-based three-dimensional GRE sequence for T1rho mapping. Clinical proton density (PD)-weighted fast spin echoes (FSE) images in the sagittal (without fat saturation), axial, and coronal (fat-saturated) planes were acquired for cartilage Whole-Organ MR Imaging Score (WORMS) grading. Analysis of covariance was performed to determine whether there were any statistically significant differences between subregional, compartmental, and whole T1rho values of meniscus among healthy controls, OA patients with KL1-2 and with KL3-4. RESULTS: Lateral anterior (median +/- interquartile range: 26 +/- 3 ms) and medial posterior (29 +/- 6 ms) meniscus subregions in healthy controls had significantly lower T1rho values (P < 0.05) than the corresponding meniscus subregions in both KL1-2 (29 +/- 7 ms and 35 +/- 8 ms, respectively) and KL3-4 (30 +/- 12 ms and 40 +/- 13 ms, respectively) OA subjects. Significantly lower meniscus T1rho values (P < 0.05) were also identified in the medial compartment in healthy controls (28 +/- 5 ms) relative to both KL1-2 OA subjects and KL3-4 OA subjects (32 +/- 7 ms and 37 +/- 7 ms, respectively). The entire meniscus T1rho values in healthy controls (28 +/- 4 ms) were significantly lower than those of both KL1-2 and KL3-4 OA subjects (33 +/- 6 ms and 34 +/- 6 ms, respectively). CONCLUSION: Significant elevations of T1rho values in specific regions of menisci in both KL1-2 and KL3-4 OA patients indicate that T1rho mapping may be sensitive to meniscus degeneration. The preliminary results suggest that damage in the medial posterior subregion and medial compartment of menisci may possibly be associated with osteoarthritis. J. Magn. Reson. Imaging 2013. (c) 2013 Wiley Periodicals, Inc.

Purpose To determine the feasibility of using finite element analysis applied to 3-T magnetic resonance (MR) images of proximal femur microarchitecture for detection of lower bone strength in subjects with fragility fractures compared with control subjects without fractures. Materials and Methods This prospective study was institutional review board approved and HIPAA compliant. Written informed consent was obtained. Postmenopausal women with (n = 22) and without (n = 22) fragility fractures were matched for age and body mass index. All subjects underwent standard dual-energy x-ray absorptiometry. Images of proximal femur microarchitecture were obtained by using a high-spatial-resolution three-dimensional fast low-angle shot sequence at 3 T. Finite element analysis was applied to compute elastic modulus as a measure of strength in the femoral head and neck, Ward triangle, greater trochanter, and intertrochanteric region. The Mann-Whitney test was used to compare bone mineral density T scores and elastic moduli between the groups. The relationship (R2) between elastic moduli and bone mineral density T scores was assessed. Results Patients with fractures showed lower elastic modulus than did control subjects in all proximal femur regions (femoral head, 8.51-8.73 GPa vs 9.32-9.67 GPa; P = .04; femoral neck, 3.11-3.72 GPa vs 4.39-4.82 GPa; P = .04; Ward triangle, 1.85-2.21 GPa vs 3.98-4.13 GPa; P = .04; intertrochanteric region, 1.62-2.18 GPa vs 3.86-4.47 GPa; P = .006-.007; greater trochanter, 0.65-1.21 GPa vs 1.96-2.62 GPa; P = .01-.02), but no differences in bone mineral density T scores. There were weak relationships between elastic moduli and bone mineral density T scores in patients with fractures (R2 = 0.25-0.31, P = .02-.04), but not in control subjects. Conclusion Finite element analysis applied to high-spatial-resolution 3-T MR images of proximal femur microarchitecture can allow detection of lower elastic modulus, a marker of bone strength, in subjects with fragility fractures compared with control subjects. MR assessment of proximal femur strength may provide information about bone quality that is not provided by dual-energy x-ray absorptiometry. (c) RSNA, 2014.

RATIONALE AND OBJECTIVES: The objectives of this study were to investigate the changes in compartment-specific subchondral bone marrow lipids of femoral-tibial bone in acute anterior cruciate ligament (ACL)-injured patients compared to that of healthy volunteers and patients with osteoarthritis (OA) (Kellgren-Lawrence [KL] grade 2-3). MATERIALS AND METHODS: A total of 55 subjects were recruited in the study and subdivided into three subgroups: 17 healthy controls (4 females, 13 males; mean age = 41 +/- 16, age range 24-78 years), 17 patients with acute ACL injury (3 females, 14 males; mean age = 30 +/- 11, age range 18-61 years), and 21 patients with KL2-3 OA (12 females, 9 males; mean age = 65 +/- 12, age range 44-89 years). Routine clinical proton density-weighted fast spin echo images in sagittal (without fat saturation), axial, and coronal (fat saturation) planes were acquired on a 3 T clinical scanner for cartilage morphology using Whole-Organ Magnetic Resonance Imaging Score grading. A voxel of 10 x 10 x 10 mm3 was positioned in the medial and lateral compartments of the tibia and femur for proton magnetic resonance spectroscopy measurements using the single voxel stimulated echo acquisition mode pulse sequence. All proton magnetic resonance data were processed with Java-based magnetic resonance user interface. Wilcoxon rank sum test and mixed model two-way analysis of variance were performed to determine significant differences between different compartments and examine the effect of ACL injury, OA grade and compartment, and their interactions. RESULTS: The index of unsaturation in lateral tibial compartment in ACL-injured patients was significantly higher (P < .05) than all compartments except lateral femoral in patients with KL2-3 OA. Significantly lower values (P < .05) were also identified in saturated lipids at 2.03 ppm in all compartments in ACL-injured patients than those of all compartments in patients with KL2-3 OA. CONCLUSIONS: The preliminary results suggest that the indices of unsaturation in the lateral tibial compartment and the peaks of saturated lipids at 1.3 and 2.03 ppm in medial tibial compartment may be clinically useful to characterize subchondral bone marrow among healthy controls, acute ACL-injured patients, and patients with OA.

OBJECTIVE: To determine the utility of short-interval follow-up after benign concordant MRI-guided breast biopsy. MATERIALS AND METHODS: Institutional review board approved, retrospective review of consecutive biopsies performed over 3 years (2007-10) yielded 170 women with 188 lesions that were considered benign concordant. Indication for original study, biopsy results, follow-up recommendations, compliance and outcomes of subsequent MRI and mammography examinations were reviewed. RESULTS: The most common indication for breast MRI was high-risk screening 119/170 (70 %). Overall, 59 % of lesions (113/188) had follow-up MRI. Of those lesions (n = 113), 43 % (49/113) presented within 7 months, 26 % (29/113) presented within 8-13 months, 11.5 % (13/113) presented within 14-22 months, and 19 % (22/113) presented after 23 months. At initial follow-up, 37 % of lesions were stable and 61 % were decreased in size. Three lesions were recommended for excision based on follow-up imaging with one malignancy diagnosed 2 years following biopsy. One additional patient had MRI-detected bilateral cancers remote from the biopsy site 3 years after biopsy. CONCLUSION: Overall cancer yield of lesions with follow-up MRI was 0.9 % (1/113); no cancers were detected at 6 months. Our data suggests that 6-month follow-up may not be required and that annual screening MRI would be acceptable to maintain a reasonable cancer detection rate. KEY POINTS: * Follow-up recommendations after benign concordant MRI-guided breast biopsy remain controversial. * Cancer detection rate was 0.9 % overall with no cancers detected at 6 months. * Short-interval follow-up after benign concordant MRI-guided breast biopsy may not be necessary.

PURPOSE: To assess liver stiffness using magnetization-tagged magnetic resonance imaging (MRI) to measure the cardiac-induced motion in the liver of cirrhosis patients with known Child-Pugh scores. MATERIALS AND METHODS: Tagged MRI was performed using a 3T MR scanner on 52 cirrhosis patients classified into two groups: liver cirrhosis with Child-Pugh A (LCA; n = 39) and liver cirrhosis with Child-Pugh B or C (LCBC; n = 13). We also included 19 healthy controls. Tagged images were acquired encompassing both the liver and the heart. The corresponding displacement and strains were calculated using a Gabor filter bank. The maximum displacement (MaxDisp) was found over the cardiac cycle, as well as the local maximum P1 (MaxP1) and minimum P2 strains (MinP2). Group comparisons were made without and with adjustment for age and gender. RESULTS: In control, LCA, and LCBC groups, the MaxDisp was 3.98 +/- 0.88 mm, 2.52 +/- 0.73 mm, and 1.86 +/- 0.77 mm; the MaxP1 was 0.10 +/- 0.02, 0.04 +/- 0.01, and 0.02 +/- 0.01; and the MinP2 was -0.08 +/- 0.01, -0.05 +/- 0.02, and -0.03 +/- 0.01, respectively. Statistically significant differences were found between groups (P < 0.05 for all). CONCLUSION: This method measures cardiac-induced liver motion and deformation to assess liver stiffness. Significant differences were found in our stiffness measures between control, LCA, and LCBC groups, with more severe disease being associated with greater stiffness. J. Magn. Reson. Imaging 2014;39:1301-1307. (c) 2013 Wiley Periodicals, Inc.