Techniques and Semeiotics

Proven MS Treatment By Dr Gary Levin

Treatments for Multiple Sclerosis

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1 High-Field MRI and Safety: I. Installation

A. Maiorana, T. Scarabino, V. d'Alesio, M. Tosetti, M. Armillotta,

U. Salvolini 3

References 5

2 High-Field MRI and Safety: II. Utilization

A. Maiorana, T. Scarabino, V. d'Alesio, M. Tosetti, M. Armillotta,

U. Salvolini 6

2.1 Static Magnetic Field 6

2.1.1 Translation and Rotation Forces 6

2.2 Varying Electric and Magnetic Fields 8

2.2.1 Magnetic Field Gradients 8

2.2.2 Radiofrequency Electromagnetic Fields 8

2.3 Cryogenic Gases 8

2.3.1 Acoustic Noise 9

References 9

3 3.0 T MRI Diagnostic Features: Comparison with Lower Magnetic Fields

T. Scarabino, G. M. Giannatempo, T. Popolizio, A. Simeone,

A. Maggialetti, N. Maggialetti, U. Salvolini 10

3.1 Comparison of 3.0 T and 1.5 T MR Imaging 11

3.1.1 Advantages 11

3.1.2 Disadvantages 12

3.2 Diagnostic Features of 3.0 T MR Imaging 14

3.2.1 Changes in Tissue Contrast 14

3.2.2 Increased Magnetic Susceptibility 16

3.2.3 Increased Chemical Shift 19

3.3 Conclusions 19

References 20

4 Standard 3.0 T MR Imaging

T. Scarabino, F. Nemore, G. M. Giannatempo, A. Simeone, A. Maggialetti,

N. Maggialetti, U. Salvolini 21

4.1 Pulse Sequences 21

4.1.1 T1 Imaging 21

4.1.2 T2 Imaging 26

4.1.3 FLAIR Imaging 30

References 32

5 3.0 T MR Angiography

T. Scarabino, T. Popolizio, A. Stranieri, A. Maggialetti, A. Carrierq,

N. Maggialetti, U. Salvolini 34

5.1 MRA Techniques 35

5.3 Conclusions 45

References 49

6 3.0 T MR Spectroscopy

M. Tosetti, T. Schirmer, V. d'Alesio, A. Di Costanzo, T. Scarabino 51

6.1 Spectroscopy Basics 51

6.1.1 Proton MRS in Neuroradiology 52

6.1.2 MR Spectroscopy - Quality and Resolution 53

6.2 Spectroscopy Artefacts and Pitfalls 58

6.2.1 Magnetic Susceptibility and B0 and Bj Inhomogeneities 58

6.2.2 Chemical Shift Misregistration and J-Modulation Artefacts 58

6.2.3 Magnetic Field Stability and Radiofrequency Coil Efficiency 59

6.3 MR Spectroscopy Quantification and Analysis 60

6.4 Advanced Spectroscopy Sequences and Applications 60

6.4.1 Spectral Editing 60

6.4.2 Fast Acquisition Techniques 61

6.4.3 High Spatial Resolution Spectroscopy 62

6.5 Conclusions 63

References 63

7 3.0 T Diffusion Studies

T. Scarabino, F. Di Salle, F. Esposito, M. Tosetti, M. Armillotta,

R. Agati, U. Salvolini 66

7.1 Diffusion Studies 67

7.1.2 ADC Studies 70

7.1.3 Diffusion Tensor Imaging and Tractography 70

7.2 3.0 T Diffusion Studies 71

References 75

8 Nerve Pathways with MR Tractography

A. Cherubini, G. Luccichenti, F. Fasano, G. E. Hagberg, P. Peran,

F. Di Salle, F. Esposito, T. Scarabino, U. Sabatini 79

8.1 Basic Principles 79

8.2 Image Acquisition 80

8.3 Fibre Tracking Techniques 81

8.3.1 Seed Point 82

8.3.2 Stopping Criteria 82

8.3.3 Global Algorithms 82

8.4 Limitations of Tractography Techniques and Their Solutions 84

8.4.2 Partial Volume 84

8.4.3 Ultrastructure 84

8.4.4 Error Correction Methods 86

8.4.5 The Problem of Validation 86

8.5 Clinical Applications 86

8.6 Conclusions 87

References 88

9 3.0 T Perfusion Studies

G. M. Giannatempo, T. Scarabino, A. Simeone, T. Popolizio, A. Stranieri,

M. Armillotta, U. Salvolini 91

9.1 Exogenous Methods: Dynamic Susceptibility Contrast 91

9.1.1 Cerebral Blood Volume 94

9.1.2 Cerebral Blood Flow 95

9.1.3 Mean Transit Time 96

9.1.4 Time to Peak 96

9.2 High Field DSC 98

9.3 Endogenous Methods: Arterial Spin Labelling 100

9.4 High-Field ASL 101

9.5 New Frontiers 102

9.6 Conclusions 103

References 103

10 High-Field Strength Functional MRI

F. Di Sane, T. Scarabino, F. Esposito, A. Aragri, O. Santopaolo,

A. Elefante, M. Cirillo, S. Cirillo, R. Elefante 107

10.1 Effects of Field Strength on Spatial Resolution 108

10.2 High-Field and Temporal Resolution 110

10.3 High-Field and BOLD Signal Behaviour 111

10.4 High-Field, Noise and Data Processing Issues 114

10.5 Conclusions 115

References 115

11 Recent Developments and Prospects in High-Field MR

11.1 Parallel Imaging 117

11.1.1 Parallel Imaging Applications 120

11.2 PROPELLER 124

11.3 New Prospects 127

11.3.1 Integration Between Different Functional Techniques 127

11.3.2 Molecular Imaging 129

References 131

12 3.0 T Brain MRI: A Pictorial Overview of the Most Interesting Sequences

II Applications

13 High-Field Neuroimaging in Traumatic Brain Injury

E. Giugni, G. Luccichenti, G. E. Hagberg, A. Cherubini, F. Fasano, U. Sabatini 169

13.1 Rationale for MR Imaging of Patients with TBI 169

13.1.1 Results Obtained with Low-and Medium-Field MR 170

13.2 High-Field MR in Patients with TBI 170

13.2.1 Advanced High-Field Techniques in TBI 171

References 174

14 3.0 T Imaging of Ischaemic Stroke

T. Popolizio, A. Simeone, G. M. Giannatempo, A. Stranieri, M. Armillotta, T. Scarabino 177

14.1 Neuropathological Features 177

14.2 Neuroradiological Protocol 178

14.3 Neuroradiological Diagnostic Imaging 178

14.3.1 Standard MRI 178

14.3.2 MR Diffusion 180

14.3.3 MR Perfusion 181

14.3.4 Combined Diffusion and Perfusion Studies 181

14.3.5 MR Spectroscopy 181

14.5 Conclusions 185

References 185

15 High-Field Strength MRI (3.0 T or More) in White Matter Diseases

15.1 The Quest for Improved Image Quality and Shorter Acquisition Times 186

15.2 3.0 T MRI Studies of Multiple Sclerosis 186

15.2.1 Role of MRI in Multiple Sclerosis 186

15.2.2 Conventional MRI Techniques: Better Lesion Identification and Quantification at Higher Fields 187

15.2.3 High-Field Magnetic Resonance Spectroscopy: Improved Measurements of Brain Metabolites 189

15.2.4 Diffusion Tensor Imaging and Fibre Tractography 190

15.2.5 Anatomical and Physiological Imaging of the Optic Chiasm 190

15.2.6 Pathological Iron Deposition 190

15.2.7 The Future of High-Field Functional MRI in MS 190

15.2.8 Very High-Field MRI in MS 190

15.3 Other White Matter Diseases 191

15.4 Conclusions 192

References 192

16 High-Field Neuroimaging in Parkinson's Disease

P. Péran, G. Lücciohenti, A. Cherubini, G. E. Hagberg, U. Sabatini 194

16.1 Rationale 194

16.1.1 Mesencephalic Level 195

16.1.2 Basal Ganglia Level 197

16.1.3 Cortical Level 198

16.2 Conclusions 198

References 199

17 High-Field 3 T Imaging of Alzheimer Disease

G. Luccichenti, P. Péran, A. Cherubini, E. Giugni, T. Scarabino,

17.1 Rationale in Imaging Neurodegenerative Diseases 201

17.2 Advanced Magnetic Resonance Techniques 203

17.3 Advantages of 3 T Scanning 204

References 205

18 3.0 T Imaging of Brain Tumours

A. Di Costanzo, F. Trojsi, T. Popolizio, G. M. Giannatempo, A. Simeone, S. Pollice, D. Catapano, M. Tosetti, N. Maggialetti, V. A. d'Angelo, A. Carriero, U. Salvolini, G. Tedeschi, T. Scarabino 208

18.1 Glial Neoplasms 208

18.2 Meningiomas 214

18.3 Primary Central Nervous System Lymphomas 216

18.4 Metastases 218

18.5 Conclusions 219

References 219

19 Use of fMRI Activation Paradigms: A Presurgical Tool for Mapping

Brain Function

D. Cevolani, R. Agati, M. Leonardi 221

19.1 The BOLD Phenomenon 221

19.3 The „Ideal" Paradigm 222

19.4 Stimulating Apparatus 222

19.5 Experimental Design 223

19.6 Data Processing 223

19.7 Software 224

19.8 Paradigms 225

19.8.1 Motor Paradigms 225

19.8.2 Sensory Paradigms 226

19.8.3 Visual Paradigms 227

19.8.4 Language and Lateralization Paradigms 227

19.9 Presurgical Applications of fMRI 231

19.9.1 fMRI and Brain Tumours 231

19.9.2 fMRI and Epilepsy 231

19.9.3 fMRI and AVM 231

19.9.4 fMRI and Other Pathologies 232

19.9.5 fMRI and Presurgical Risk 232

19.9.6 Our Experience 233

19.10 Conclusions 233

References 233

Subject Index 235

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