Normalization of cerebral hemodynamics after hematopoietic stem cell transplant in children with sickle cell disease.

Children with sickle cell disease (SCD) demonstrate cerebral hemodynamic stress and are at high risk of strokes. We hypothesized that curative hematopoietic stem cell transplant (HSCT) normalizes cerebral hemodynamics in children with SCD compared with pre-transplant baseline. Whole-brain cerebral blood flow (CBF) and oxygen extraction fraction (OEF) were measured by magnetic resonance imaging 1 to 3 months before and 12 to 24 months after HSCT in 10 children with SCD.

Bulk volume susceptibility difference between deoxyhemoglobin and oxyhemoglobin for HbA and HbS: A comparative study.

Purpose: Sickle cell anemia is a blood disorder that alters the morphology and the oxygen affinity of the red blood cells. Cerebral oxygen extraction fraction measurements using quantitative BOLD contrast have been used for assessing inadequate oxygen delivery and the subsequent risk of ischemic stroke in sickle cell anemia. The BOLD signal in MRI studies relies on , the bulk volume susceptibility difference between fully oxygenated and fully deoxygenated blood.

Hydroxyurea reduces cerebral metabolic stress in patients with sickle cell anemia.

Chronic transfusion therapy (CTT) prevents stroke in selected patients with sickle cell anemia (SCA). We have shown that CTT mitigates signatures of cerebral metabolic stress, reflected by elevated oxygen extraction fraction (OEF), which likely drives stroke risk reduction. The region of highest OEF falls within the border zone, where cerebral blood flow (CBF) nadirs; OEF in this region was reduced after CTT.

Silent infarcts in sickle cell disease occur in the border zone region and are associated with low cerebral blood flow.

Silent cerebral infarcts (SCIs) are associated with cognitive impairment in sickle cell anemia (SCA). SCI risk factors include low hemoglobin and elevated systolic blood pressure; however, mechanisms underlying their development are unclear. Using the largest prospective study evaluating SCIs in pediatric SCA, we identified brain regions with increased SCI density.

Regional oxygen extraction predicts border zone vulnerability to stroke in sickle cell disease.

Objective: To determine mechanisms underlying regional vulnerability to infarction in sickle cell disease (SCD) by measuring voxel-wise cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen utilization (CMRO) in children with SCD.

Methods: Participants underwent brain MRIs to measure voxel-based CBF, OEF, and CMRO. An infarct heat map was created from an independent pediatric SCD cohort with silent infarcts and compared to prospectively obtained OEF maps.

Red cell exchange transfusions lower cerebral blood flow and oxygen extraction fraction in pediatric sickle cell anemia.

Blood transfusions are the mainstay of stroke prevention in pediatric sickle cell anemia (SCA), but the physiology conferring this benefit is unclear. Cerebral blood flow (CBF) and oxygen extraction fraction (OEF) are elevated in SCA, likely compensating for reduced arterial oxygen content (CaO). We hypothesized that exchange transfusions would decrease CBF and OEF by increasing CaO, thereby relieving cerebral oxygen metabolic stress.

Large-Vessel Vasculopathy in Children With Sickle Cell Disease: A Magnetic Resonance Imaging Study of Infarct Topography and Focal Atrophy.

Background: Large-vessel vasculopathy (LVV) increases stroke risk in pediatric sickle cell disease beyond the baseline elevated stroke risk in this vulnerable population. The mechanisms underlying this added risk and its unique impact on the developing brain are not established.

Methods: We analyzed magnetic resonance imaging and angiography scans of 66 children with sickle cell disease and infarcts by infarct density heatmaps and Jacobian determinants, a metric utilized to delineate focal volume change, to investigate if infarct location, volume, frequency, and cerebral atrophy differed among hemispheres with and without LVV.

Abnormal structural connectivity in the brain networks of children with hydrocephalus.

Increased intracranial pressure and ventriculomegaly in children with hydrocephalus are known to have adverse effects on white matter structure. This study seeks to investigate the impact of hydrocephalus on topological features of brain networks in children. The goal was to investigate structural network connectivity, at both global and regional levels, in the brains in children with hydrocephalus using graph theory analysis and diffusion tensor tractography.

Periventricular hyperintensity in children with hydrocephalus.

Background: Magnetic resonance images of children with hydrocephalus often include a rim of hyperintensity in the periventricular white matter (halo).

Objective: The purpose of this study was to decide between the hypothesis that the halo is caused by cerebrospinal fluid (CSF) flow during the cardiac cycle, and the alternate hypothesis that the halo is caused by anatomical changes (stretching and compression of white matter).

Materials And Methods: Participants were selected from a multicenter imaging study of pediatric hydrocephalus.

The accuracy of linear indices of ventricular volume in pediatric hydrocephalus: technical note.

Assessment of ventricular size is essential in clinical management of hydrocephalus and other neurological disorders. At present, ventricular size is assessed using indices derived from the dimensions of the ventricles rather than the actual volumes. In a population of 22 children with congenital hydrocephalus and 22 controls, the authors evaluated the relationship between ventricular volume and linear indices in common use, such as the frontooccipital horn ratio, Evans' index, and the bicaudate index.

Visualizing the prostate gland by MR imaging in young and old mice.

Purpose: Prostate imaging requires optimization in young and old mouse models. We tested which MR sequences and field strengths best depict the prostate gland in young and old mice; and, whether prostate MR signal, size, and architecture change with age.

Technique: Magnetic resonance imaging (MRI) of the prostate of young (2 months) and old (18 months) male nude mice (n = 6) was performed at 4.

Alterations in cerebral oxygen metabolism after traumatic brain injury in children.

Traumatic brain injury (TBI) is the most common cause of acquired disability in children. Metabolic defects, and in particular mitochondrial dysfunction, are important contributors to brain injury after TBI. Studies of metabolic dysfunction are limited, but magnetic resonance methods suitable for use in children are overcoming this limitation.

Depression of whole-brain oxygen extraction fraction is associated with poor outcome in pediatric traumatic brain injury.

Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability in children. Metabolic failure is an integral component of the pathological aftermath of TBI. The oxygen extraction fraction (OEF) is a valuable parameter for characterization and description of metabolic abnormalities; however, OEF measurement has required either invasive procedures or the use of ionizing radiation, which significantly limits its use in pediatric research.

Suppression of vascular enhancement artifacts through the use of a multiband, selectively spoiled radiofrequency excitation pulse.

Purpose: To test the ability of a multi-band RF pulse to reduce flow enhancement artifacts for steady state imaging without compromising temporal resolution or spatial coverage.

Materials And Methods: Selectively spoiled composite RF pulses that provide simultaneous excitation and flow preparation were designed and tested by means of simulation, phantom, and in vivo measurements under varying conditions of flow.

Results: Suppression of flow enhancement was found to depend on flow velocity and spatial extent of spoiled regions.

Fast, reproducible measurement of the vascular input function in mice using constrained reconstruction and cardiac sampling.

Dynamic contrast-enhanced MRI is often used to assess the response to therapy in small animal models of cancer. Rigorous quantification of dynamic contrast-enhanced MRI data using common pharmacokinetic models requires dynamic determination of the concentration of contrast in tumor tissue and in blood. Measurement of the blood concentration, or vascular input function (VIF), requires high temporal resolution and is prone to distortion as a result of flow and partial volume artifacts when measured in local blood vessels.

Two-point Dixon technique provides robust fat suppression for multi-mouse imaging.

Purpose: To determine whether Dixon-based fat separation techniques can provide more robust removal of lipid signals from multiple-mouse magnetic resonance imaging (MRI)-acquired images than conventional frequency selective chemical saturation techniques.

Materials And Methods: A two-point Dixon technique was implemented using a RARE-based pulse sequence and techniques for multivolume fat suppression were evaluated using a 4-element array of volume resonators at 4.7 T.

Feasibility of multiple-mouse dynamic contrast-enhanced MRI.

Dynamic contrast-enhanced (DCE-) MRI is often used to evaluate the response to experimental antiangiogenic therapies in small animal models of cancer. Unfortunately, DCE-MRI studies often require a substantial investment of both time and money to achieve the desired level of statistical significance. Multiple-mouse MRI has previously been used to improve imaging efficiency, but its feasibility for DCE-MRI has not been investigated.

A fast spin echo two-point Dixon technique and its combination with sensitivity encoding for efficient T2-weighted imaging.

A fast spin echo two-point Dixon (fast 2PD) technique was developed for efficient T2-weighted imaging with uniform water and fat separation. The technique acquires two interleaved fast spin echo images with water and fat in-phase and 180 degrees out-of-phase, respectively, and generates automatically separate water and fat images for each slice. The image reconstruction algorithm uses an improved and robust region-growing scheme for phase correction and achieves consistency in water and fat identification between different slices by exploiting the intrinsic correlation between the complex images from two neighboring slices.

Semiautomated four-dimensional computed tomography segmentation using deformable models.

The purpose of this work is to demonstrate a proof of feasibility of the application of a commercial prototype deformable model algorithm to the problem of delineation of anatomic structures on four-dimensional (4D) computed tomography (CT) image data sets. We acquired a 4D CT image data set of a patient's thorax that consisted of three-dimensional (3D) image data sets from eight phases in the respiratory cycle. The contours of the right and left lungs, cord, heart, and esophagus were manually delineated on the end inspiration data set.

Semiautomated four-dimensional computed tomography segmentation using deformable models.

The purpose of this work is to demonstrate a proof of feasibility of the application of a commercial prototype deformable model algorithm to the problem of delineation of anatomic structures on four-dimensional (4D) computed tomography (CT) image data sets. We acquired a 4D CT image data set of a patient's thorax that consisted of three-dimensional (3D) image data sets from eight phases in the respiratory cycle. The contours of the right and left lungs, cord, heart, and esophagus were manually delineated on the end inspiration data set.