磁共振波谱分析在颅脑胶质瘤分级中的应用研究

目的 分析脑胶质瘤的氢质子磁共振波谱（proton magnetic resonance spectroscopy,1H-MRS）表现及其临床意义;探讨脑胶质瘤的1H-MRS特点与其病理级别相关性.方法 搜集经临床手术、病理证实的脑胶质瘤病例49例,按照WHO诊断标准分成两组：低级别脑胶质瘤组、高级别脑胶质瘤组.所有患者在术前行1H-MRs检查,均在MR非增强成像的基础上获得.使用Philips Achieva 1.5T超导磁共振扫描仪,单体素或多体素扫描,点分辨法,检测不同区域代谢物变化.结果 脑胶质瘤的1H-MRS表现：肌酸（Cr）轻度下降,N-乙酰天门冬氨酸（NAA）显著下降,胆碱（Cho）显著增高.低、高级别脑胶质瘤的肿瘤组织与对侧止常脑组织的NAA、Cho、NAA/Cr、NAA/Cho值存在显著性差异（P〈0.05）;低级别和高级别脑胶质瘤的肿瘤组织的NAA/Cr、NAA/Cho值存在显著性差异（P〈0.05）.脑胶质瘤的NAA/Cho、Cho/Cr、NAA/Cr值与病理级别相关,其中NAA/Cho和NAA/Cr值反映肿瘤级别较稳定;NAA/Cr、NAA/Cho值呈负相关关系,Cho/Cr值呈正相关关系.结论 ：1H-MRS结合MKI能提高脑胶质瘤术前诊断的准确性.1H-MRS能对胶质瘤进行分级,反映胶质瘤代谢特性以及肿瘤生长潜能.     

磁共振成像设备发展趋势

本文主要叙述了磁共振设备的原理、构造、产品发展趋势。并对提高磁共振图像分辨的新技术,如Tim全景矩阵成像、自由浪潮技术、高清晰MRI技术和双梯度技术作了综述。     

超顺磁氧化铁纳米探针用于磁共振分子成像的研究进展

分子影像学是近年来分子生物学和影像学相结合而形成的新型交叉学科,磁共振分子成像技术是分子影像学的重要手段之一,为临床医学诊断提供重要依据。但是由于不同组织之间的弛豫时间相互重叠等问题,导致较小的病变难以显示,磁共振造影剂能提高对软组织的分辨率,其中超顺磁性氧化铁纳米探针作为近年来发展起来的一种新型磁共振分子造影剂。由于具有敏感性、安全性、大的比表面积、高稳定性、靶向性等优点,近年来已成为国内外研究的热点之一。本文就超顺磁性氧化铁纳米探针的增强原理、制备工艺及靶向作用做一综述,以期为该技术的应用与研究提供借鉴和启示。     

弥散加权成像联合磁共振波谱分析在脑梗死中的应用研究

目的探讨脑梗死弥散加权成像（DWI）和磁共振波谱分析（MRS）的特点和影响因素,及二者对评估脑梗死的临床价值。方法采用Philips Achieva 1.5T双梯度超导磁共振扫描仪,对72例临床疑是脑梗死患者行常规T1WI、T2WI、FLAIR、DWI、MRS检查,在工作站上测定梗死核心区、内缘区、外缘区、周围区和镜像区的ADC值和代谢物Lac、NAA、Cr、Cho、NAA/Cr、Lac/Cr、Lac/NAA值。结果 DWI显示的梗死灶范围较常规MRI像更加准确、清晰;超急性期、急性期、亚急性期和慢性期梗死核心区的Lac/Cr值和Lac/NAA值高于对侧镜像区,ADC值和NAA/Cr值低于对侧镜像区,存在统计学差异（P〈0.05）;DWI的影响因素有b值、扩散系数、T2穿透效应和各向异性等,MRS的影响因素有磁场均匀性、压水压脂性能、体素、TE与TR、组织代谢物浓度和波谱采集链等。结论 DWI结合MRS能更加全面地评估缺血半暗带,更精确地对脑梗死进行分期和定位。     

Fetal Eye Movements on Magnetic Resonance Imaging

Objectives

Eye movements are the physical expression of upper fetal brainstem function. Our aim was to identify and differentiate specific types of fetal eye movement patterns using dynamic MRI sequences. Their occurrence as well as the presence of conjugated eyeball motion and consistently parallel eyeball position was systematically analyzed.

Methods

Dynamic SSFP sequences were acquired in 72 singleton fetuses (17–40 GW, three age groups [17–23 GW, 24–32 GW, 33–40 GW]). Fetal eye movements were evaluated according to a modified classification originally published by Birnholz (1981): Type 0: no eye movements; Type I: single transient deviations; Type Ia: fast deviation, slower reposition; Type Ib: fast deviation, fast reposition; Type II: single prolonged eye movements; Type III: complex sequences; and Type IV: nystagmoid.

Results

In 95.8% of fetuses, the evaluation of eye movements was possible using MRI, with a mean acquisition time of 70 seconds. Due to head motion, 4.2% of the fetuses and 20.1% of all dynamic SSFP sequences were excluded.Eye movements were observed in 45 fetuses (65.2%). Significant differences between the age groups were found for Type I (p = 0.03), Type Ia (p = 0.031), and Type IV eye movements (p = 0.033). Consistently parallel bulbs were found in 27.3–45%.

Conclusions

In human fetuses, different eye movement patterns can be identified and described by MRI in utero. In addition to the originally classified eye movement patterns, a novel subtype has been observed, which apparently characterizes an important step in fetal brainstem development. We evaluated, for the first time, eyeball position in fetuses. Ultimately, the assessment of fetal eye movements by MRI yields the potential to identify early signs of brainstem dysfunction, as encountered in brain malformations such as Chiari II or molar tooth malformations.     

核磁功能成像在前列腺癌诊断中的应用

磁共振成像是诊断早期前列腺癌及评价分期最好的影像学技术之一,然而常规MRI-T2WI在诊断中存在较低的特异性缺陷.随着核磁技术的发展,对前列腺癌的诊断发展到从定性到定量、从形态到功能的变化,本文主要就近年来的磁共振功能成像技术在前列腺癌诊断中的研究进展作一论述.     

Quantitative Multi-Parametric Magnetic Resonance Imaging of Tumor Response to Photodynamic Therapy

ObjectiveThe aim of this study was to characterize response to photodynamic therapy (PDT) in a mouse cancer model using a multi-parametric quantitative MRI protocol and to identify MR parameters as potential biomarkers for early assessment of treatment outcome.MethodsCT26.WT colon carcinoma tumors were grown subcutaneously in the hind limb of BALB/c mice. Therapy consisted of intravenous injection of the photosensitizer Bremachlorin, followed by 10 min laser illumination (200 mW/cm²) of the tumor 6 h post injection. MRI at 7 T was performed at baseline, directly after PDT, as well as at 24 h, and 72 h. Tumor relaxation time constants (T₁ and T₂) and apparent diffusion coefficient (ADC) were quantified at each time point. Additionally, Gd-DOTA dynamic contrast-enhanced (DCE) MRI was performed to estimate transfer constants (K^trans) and volume fractions of the extravascular extracellular space (v_e) using standard Tofts-Kermode tracer kinetic modeling. At the end of the experiment, tumor viability was characterized by histology using NADH-diaphorase staining.ResultsThe therapy induced extensive cell death in the tumor and resulted in significant reduction in tumor growth, as compared to untreated controls. Tumor T₁ and T₂ relaxation times remained unchanged up to 24 h, but decreased at 72 h after treatment. Tumor ADC values significantly increased at 24 h and 72 h. DCE-MRI derived tracer kinetic parameters displayed an early response to the treatment. Directly after PDT complete vascular shutdown was observed in large parts of the tumors and reduced uptake (decreased K^trans) in remaining tumor tissue. At 24 h, contrast uptake in most tumors was essentially absent. Out of 5 animals that were monitored for 2 weeks after treatment, 3 had tumor recurrence, in locations that showed strong contrast uptake at 72 h.ConclusionDCE-MRI is an effective tool for visualization of vascular effects directly after PDT. Endogenous contrast parameters T₁, T₂, and ADC, measured at 24 to 72 h after PDT, are also potential biomarkers for evaluation of therapy outcome.     

Multi-Parametric Representation of Voxel-Based Quantitative Magnetic Resonance Imaging

The aim of the study was to explore the possibilities of multi-parametric representations of voxel-wise quantitative MRI data to objectively discriminate pathological cerebral tissue in patients with brain disorders. For this purpose, we recruited 19 patients with Multiple Sclerosis (MS) as benchmark samples and 19 age and gender matched healthy subjects as a reference group. The subjects were examined using quantitative Magnetic Resonance Imaging (MRI) measuring the tissue structure parameters: relaxation rates, R and R, and proton density. The resulting parameter images were normalized to a standard template. Tissue structure in MS patients was assessed by voxel-wise comparisons with the reference group and with correlation to a clinical measure, the Expanded Disability Status Scale (EDSS). The results were visualized by conventional geometric representations and also by multi-parametric representations. Data showed that MS patients had lower R and R, and higher proton density in periventricular white matter and in wide-spread areas encompassing central and sub-cortical white matter structures. MS-related tissue abnormality was highlighted in posterior white matter whereas EDSS correlation appeared especially in the frontal cortex. The multi-parameter representation highlighted disease-specific features. In conclusion, the proposed method has the potential to visualize both high-probability focal anomalies and diffuse tissue changes. Results from voxel-based statistical analysis, as exemplified in the present work, may guide radiologists where in the image to inspect for signs of disease. Future clinical studies must validate the usability of the method in clinical practice.     

脑功能磁共振成像的研究现状

脑功能磁共振成像是近年来磁共振成像技术的一项新发展,为从单一形态学研究到形态与功能相结合的系统研究开辟了一条崭新的道路。本文主要介绍了人脑的功能活动磁共振成像的概念、原理、试验设计、临床的研究现状。     

High Dynamic Range Processing for Magnetic Resonance Imaging

Purpose

To minimize feature loss in T₁- and T₂-weighted MRI by merging multiple MR images acquired at different T_R and T_E to generate an image with increased dynamic range.

Materials and Methods

High Dynamic Range (HDR) processing techniques from the field of photography were applied to a series of acquired MR images. Specifically, a method to parameterize the algorithm for MRI data was developed and tested. T₁- and T₂-weighted images of a number of contrast agent phantoms and a live mouse were acquired with varying T_R and T_E parameters. The images were computationally merged to produce HDR-MR images. All acquisitions were performed on a 7.05 T Bruker PharmaScan with a multi-echo spin echo pulse sequence.

Results

HDR-MRI delineated bright and dark features that were either saturated or indistinguishable from background in standard T₁- and T₂-weighted MRI. The increased dynamic range preserved intensity gradation over a larger range of T₁ and T₂ in phantoms and revealed more anatomical features in vivo.

Conclusions

We have developed and tested a method to apply HDR processing to MR images. The increased dynamic range of HDR-MR images as compared to standard T₁- and T₂-weighted images minimizes feature loss caused by magnetization recovery or low SNR.     

SD大鼠磁共振成像技术

目的：在常规磁共振成像仪（magnetic resonance imaging,MRI）上进行小型动物实验,探讨SD大鼠MRI最佳成像参数,为小型动物影像学实验研究提供参考.方法：采用西门子1.5T超导MR成像仪（Siemens Sonata, Erlangen, Germany）,膝关节专用线圈.选取雄性SD大鼠41只,体重250～400g,分5组依次进行T1加权（T1WI）、T2加权（T2WI）及质子密度加权成像,并比较5组参数成像的图像质量,确立Siemens Sonata 1.5T超导MR成像仪应用于大鼠的最佳成像参数.结果：T1WI采用SE序列、T2WI及质子密度加权采用TSE序列;T1WI、T2WI及质子密度加权的最佳成像参数分别为TR 350 ms/TE 12 ms、TR 2500 ms/TE 75 ms和TR 3000 ms/TE 15 ms.在MRI成像相关参数中,重复时间（TR）、回波时间（TE）主要影响对比度,决定权重;扫描野（FOV）、矩阵（Matrix）主要影响空间分辨率;层厚、激励次数（Nex）、带宽（Bandwidth）主要影响信噪比.结论：在常规MRI上进行小型动物实验切实可行,通过综合调节相应参数,不仅可以发现肝脏病变,证实了肝癌模型的成功建立,而且可以获得较理想的图像质量.     

Radiology: Magnetic Resonance Imaging of Musculoskeletal Tumors

The Scientific Board of the California Medical Association presents the following inventory of items of progress in radiology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in radiology that have recently achieved a substantial degree of authoritative acceptance. Whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Radiology of the California Medical Association, and the summaries were prepared under its direction.     

Bayesian Spatiotemporal Inference in Functional Magnetic Resonance Imaging

Mapping of the human brain by means of functional magnetic resonance imaging (fMRI) is an emerging field in cognitive and clinical neuroscience. Current techniques to detect activated areas of the brain mostly proceed in two steps. First, conventional methods of correlation, regression, and time series analysis are used to assess activation by a separate, pixelwise comparison of the fMRI signal time courses to the reference function of a presented stimulus. Spatial aspects caused by correlations between neighboring pixels are considered in a separate second step, if at all. The aim of this article is to present hierarchical Bayesian approaches that allow one to simultaneously incorporate temporal and spatial dependencies between pixels directly in the model formulation. For reasons of computational feasibility, models have to be comparatively parsimonious, without oversimplifying. We introduce parametric and semiparametric spatial and spatiotemporal models that proved appropriate and illustrate their performance applied to visual fMRI data.     

产前胎儿磁共振成像的临床应用及研究进展

出生缺陷已经成为影响我国人口素质的重要卫生问题,产前诊断是减少患儿出生缺陷的有效预防手段和措施。作为产前超声诊断重要补充的手段,胎儿MRI检查具有多方位、多参数、高质量、大视野成像的特点。尤其在中枢神经系统方面具有US无法比拟的优势,随着宫内治疗技术的开展和提高,其潜在的价值和应用前景越来越明显。近年来,随着各种快速MR成像方法的应用,胎儿MRI研究有了很大进步,不仅能有效地评估胎儿的正常解剖、发育变异及病理改变,而且功能MRI也正积极尝试用于胎儿正常发育及疾病的研究中。正硝地解释胎儿MRI的影像学表现仍是今后一段时间内胎儿MRI研究的方向。客观地认识MRI在产前检查中的优势与劣势、合理地应用不同的成像序列,有利于更准确地检出病变。     

Diaphragm Postural Function Analysis Using Magnetic Resonance Imaging

We present a postural analysis of diaphragm function using magnetic resonance imaging (MRI). The main aim of the study was to identify changes in diaphragm motion and shape when postural demands on the body were increased (loading applied to a distal part of the extended lower extremities against the flexion of the hips was used). Sixteen healthy subjects were compared with 17 subjects suffering from chronic low back pain and in whom structural spine disorders had been identified. Two sets of features were calculated from MRI recordings: dynamic parameters reflecting diaphragm action, and static parameters reflecting diaphragm anatomic characteristics. A statistical analysis showed that the diaphragm respiratory and postural changes were significantly slower, bigger in size and better balanced in the control group. When a load was applied to the lower limbs, the pathological subjects were mostly not able to maintain the respiratory diaphragm function, which was lowered significantly. Subjects from the control group showed more stable parameters of both respiratory and postural function. Our findings consistently affirmed worse muscle cooperation in the low back pain population subgroup. A clear relation with spinal findings and with low back pain remains undecided, but various findings in the literature were confirmed. The most important finding is the need to further address various mechanisms used by patients to compensate deep muscle insufficiency.     

Diffusion Tensor Magnetic Resonance Imaging of the Pancreas

Purpose

To develop a diffusion-tensor-imaging (DTI) protocol that is sensitive to the complex diffusion and perfusion properties of the healthy and malignant pancreas tissues.

Materials and Methods

Twenty-eight healthy volunteers and nine patients with pancreatic-ductal-adenocacinoma (PDAC), were scanned at 3T with T2-weighted and DTI sequences. Healthy volunteers were also scanned with multi-b diffusion-weighted-imaging (DWI), whereas a standard clinical protocol complemented the PDAC patients’ scans. Image processing at pixel resolution yielded parametric maps of three directional diffusion coefficients λ1, λ2, λ3, apparent diffusion coefficient (ADC), and fractional anisotropy (FA), as well as a λ1-vector map, and a main diffusion-direction map.

Results

DTI measurements of healthy pancreatic tissue at b-values 0,500 s/mm²yielded: λ1 = (2.65±0.35)×10⁻³, λ2 = (1.87±0.22)×10⁻³, λ3 = (1.20±0.18)×10⁻³, ADC = (1.91±0.22)×10⁻³ (all in mm²/s units) and FA = 0.38±0.06. Using b-values of 100,500 s/mm² led to a significant reduction in λ1, λ2, λ3 and ADC (p<.0001) and a significant increase (p<0.0001) in FA. The reduction in the diffusion coefficients suggested a contribution of a fast intra-voxel-incoherent-motion (IVIM) component at b≤100 s/mm², which was confirmed by the multi-b DWI results. In PDACs, λ1, λ2, λ3 and ADC in both 0,500 s/mm² and 100,500 s/mm² b-values sets, as well as the reduction in these diffusion coefficients between the two sets, were significantly lower in comparison to the distal normal pancreatic tissue, suggesting higher cellularity and diminution of the fast-IVIM component in the cancer tissue.

Conclusion

DTI using two reference b-values 0 and 100 s/mm² enabled characterization of the water diffusion and anisotropy of the healthy pancreas, taking into account a contribution of IVIM. The reduction in the diffusion coefficients of PDAC, as compared to normal pancreatic tissue, and the smaller change in these coefficients in PDAC when the reference b-value was modified from 0 to 100 s/mm², helped identifying the presence of malignancy.     

Magnetic Resonance Imaging of Cerebral Aspergillosis: Imaging and Pathological Correlations

Cerebral aspergillosis is associated with a significant morbidity and mortality rate. The imaging data present different patterns and no full consensus exists on typical imaging characteristics of the cerebral lesions. We reviewed MRI findings in 21 patients with cerebral aspergillosis and correlated them to the immune status of the patients and to neuropathological findings when tissue was available. The lesions were characterized by their number, topography, and MRI signal. Dissemination to the brain resulted from direct spread from paranasal sinuses in 8 patients, 6 of them being immunocompetent. Hematogenous dissemination was observed in 13 patients, all were immunosuppressed. In this later group we identified a total of 329 parenchymal abscesses involving the whole brain with a predilection for the corticomedullary junction. More than half the patients had a corpus callosum lesion. Hemorrhagic lesions accounted for 13% and contrast enhancement was observed in 61% of the lesions. Patients with hematogenous dissemination were younger (p = 0.003), had more intracranial lesions (p = 0.0004) and had a higher 12-week mortality rate (p = 0.046) than patients with direct spread from paranasal sinuses. Analysis of 12 aneurysms allowed us to highlight two distinct situations. In case of direct spread from the paranasal sinuses, aneurysms are saccular and located on the proximal artery portions, while the hematogenous dissemination in immunocompromised patients is more frequently associated with distal and fusiform aneurysms. MRI is the exam of choice for cerebral aspergillosis. Number and type of lesions are different according to the mode of dissemination of the infection.     

Brain Characterization Using Normalized Quantitative Magnetic Resonance Imaging

Objectives

To present a method for generating reference maps of typical brain characteristics of groups of subjects using a novel combination of rapid quantitative Magnetic Resonance Imaging (qMRI) and brain normalization. The reference maps can be used to detect significant tissue differences in patients, both locally and globally.

Materials and Methods

A rapid qMRI method was used to obtain the longitudinal relaxation rate (R₁), the transverse relaxation rate (R₂) and the proton density (PD). These three tissue properties were measured in the brains of 32 healthy subjects and in one patient diagnosed with Multiple Sclerosis (MS). The maps were normalized to a standard brain template using a linear affine registration. The differences of the mean value ofR₁, R₂ and PD of 31 healthy subjects in comparison to the oldest healthy subject and in comparison to an MS patient were calculated. Larger anatomical structures were characterized using a standard atlas. The vector sum of the normalized differences was used to show significant tissue differences.

Results

The coefficient of variation of the reference maps was high at the edges of the brain and the ventricles, moderate in the cortical grey matter and low in white matter and the deep grey matter structures. The elderly subject mainly showed significantly lower R₁ and R₂ and higher PD values along all sulci. The MS patient showed significantly lower R₁ and R₂ and higher PD values at the edges of the ventricular system as well as throughout the periventricular white matter, at the internal and external capsules and at each of the MS lesions.

Conclusion

Brain normalization of rapid qMRI is a promising new method to generate reference maps of typical brain characteristics and to automatically detect deviating tissue properties in the brain.     

The Effect of Obesity and Weight Loss on Aortic Pulse Wave Velocity as Assessed by Magnetic Resonance Imaging

Obesity is an escalating global health problem associated with both an increased risk of death and an increased risk of cardiovascular events. Our goal was to use magnetic resonance imaging (MRI) to determine the effect of obesity and weight loss, in the absence of the traditional cardiovascular risk factors, on aortic pulse wave velocity (PWV) a reliable, reproducible, and accurate clinical measure of aortic stiffness linked to increased mortality. Fifty obese (BMI 38.3 ± 6.8 kg/m²) and eighteen normal‐weight controls (BMI 22.0 ± 1.7 kg/m²) with no identifiable cardiovascular risk factors underwent vascular MRI to assess PWV between the ascending aorta at the level of the pulmonary artery and the abdominal aorta (AA). Twenty‐eight subjects underwent repeat imaging after a 1‐year period of weight loss. Both groups were well matched for age, systolic blood pressure, fasting glucose, and total cholesterol. Obesity was associated with a 14% increase in PWV (P = 0.021), and with elevated C‐reactive protein (CRP) (P < 0.01) and leptin levels (P < 0.001) factors known to cause increase arterial stiffness. Weight loss (average 50% excess weight) was associated with a 14% improvement in PWV (P = 0.03), and with reductions in serum leptin levels (P < 0.01). Obesity, in the absence of the traditional cardiovascular risk factors, is associated with increased aortic PWV, a noninvasive clinical measure of aortic stiffness independently predictive of cardiovascular mortality. Significant weight loss results in improvements in aortic PWV. This may provide a potential link between both obesity and increased mortality, and the reduction in mortality that occurs with weight loss.