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Utriainen D.,Magnetic Resonance Innovations, Inc. | Feng W.,Wayne State University | Elias S.,Magnetic Resonance Innovations, Inc. | Latif Z.,Wayne State University | And 3 more authors.
Techniques in Vascular and Interventional Radiology | Year: 2012

The goal of this work is to present a broad magnetic resonance imaging (MRI) protocol for use in the study of chronic cerebrospinal venous insufficiency (CCSVI). The CCSVI MRI protocol includes the following sequences: time-resolved contrast-enhanced 3D MR angiography, 2D time-of-flight MR venography, and 3D volumetric interpolated breath-hold examination to assess venous structural abnormalities; phase-contrast MR imaging at different levels in the neck and thoracic cavity to quantify flow through the veins, arteries, and cerebrospinal fluid; T2-weighted imaging, T2-weighted fluid-attenuated inversion recovery, and pre- and post-contrast T1-weighted imaging of the brain for examinations of parenchymal lesions; and finally, susceptibility-weighted imaging for quantification of iron deposition in the brain. Data from 111 clinically definite multiple sclerosis patients were assessed for potential structural and flow CCSVI risk criteria, including stenosis, atresia, aplasia, dominant to subdominant venous flow ratio (D:sD), and the sum of their flow rates. Of the 111 patients, 50 (45%) were determined to be nonstenotic (NST) with no stenosis or atresia in their internal jugular veins (IJV), and the rest 61 (55%) were stenotic (ST) having at least one internal jugular vein stenosis or atresia. No occurrence of aplasia was observed. A D:sD of greater than 3:1 was observed in 15 (24.6%) patients of the ST group and 2 (4.0%) patients of the NST group. A sum of dominant and subdominant venous flow rate of <8 mL/s was observed in 22 (36.1%) patients of the ST group and 6 (12.0%) patients of the NST group. MRI provides valuable information in the observation of potential CCSVI risk factors. Low total flow in the 2 dominant veins seemed to be the strongest indicator for risk of having stenoses in the multiple sclerosis population. The goal of this work is to present a broad magnetic resonance imaging (MRI) protocol for use in the study of chronic cerebrospinal venous insufficiency (CCSVI). The CCSVI MRI protocol includes the following sequences: time-resolved contrast-enhanced 3D MR angiography, 2D time-of-flight MR venography, and 3D volumetric interpolated breath-hold examination to assess venous structural abnormalities; phase-contrast MR imaging at different levels in the neck and thoracic cavity to quantify flow through the veins, arteries, and cerebrospinal fluid; T2-weighted imaging, T2-weighted fluid-attenuated inversion recovery, and pre- and post-contrast T1-weighted imaging of the brain for examinations of parenchymal lesions; and finally, susceptibility-weighted imaging for quantification of iron deposition in the brain. Data from 111 clinically definite multiple sclerosis patients were assessed for potential structural and flow CCSVI risk criteria, including stenosis, atresia, aplasia, dominant to subdominant venous flow ratio (D:sD), and the sum of their flow rates. Of the 111 patients, 50 (45%) were determined to be nonstenotic (NST) with no stenosis or atresia in their internal jugular veins (IJV), and the rest 61 (55%) were stenotic (ST) having at least one internal jugular vein stenosis or atresia. No occurrence of aplasia was observed. A D:sD of greater than 3:1 was observed in 15 (24.6%) patients of the ST group and 2 (4.0%) patients of the NST group. A sum of dominant and subdominant venous flow rate of <8 mL/s was observed in 22 (36.1%) patients of the ST group and 6 (12.0%) patients of the NST group. MRI provides valuable information in the observation of potential CCSVI risk factors. Low total flow in the 2 dominant veins seemed to be the strongest indicator for risk of having stenoses in the multiple sclerosis population. © 2012 Elsevier Inc.


Feng W.,Wayne State University | Utriainen D.,Wayne State University | Trifan G.,Magnetic Resonance Innovations, Inc. | Sethi S.,Magnetic Resonance Imaging Institute for Biomedical Research | And 3 more authors.
Reviews on Recent Clinical Trials | Year: 2012

Purpose: To study the blood flow through the internal jugular veins (IJVS) of the MS population. Materials and Methods: Two hundred MS patients and 14 normal volunteers were evaluated with magnetic resonance imaging (MRI) at 3T. Contrast-enhanced time-resolved 3D MR angiography and 2D time-of-flight imaging were performed to assess abnormalities in the extracranial vascular anatomy. Based on this assessment, the MS population was divided into subgroups of non-stenotic (NST), cervical 1 stenotic only (C1ST) and cervical 6 stenotic (C6ST) subjects. In this study, 2D phase contrast MR imaging was used to quantify blood flow through major veins and arteries in the neck and flow differences among the groups were analyzed. Results: Of the 200 MS patients, 87 (43.5%) belonged to the NST group, 50 (25%) belonged to the C1ST group and 63 (31.5%) belonged to the C6ST group. The total IJV flow normalized to the total arterial flow of the NST group was 75.12 ± 12.22%. This was significantly higher than that of the C1ST group, 63.93 ± 16.08% (p<0.0001), which in turn was significantly higher than that of the C6ST group, 52.13 ± 20.71% (p = 0.001). Seventy-nine percent of the stenotic groups had a normalized subdominant IJV flow of less than 20%, a combined IJV flow of less than 50% and/or a sub-dominant IJV flow vs. dominant IJV flow ratio of less than 1/3. Only 2% of the NST group had a combined IJV flow of less than 50%, compared to 35% of the stenotic groups. Conclusion: Blood flow through the IJVs was reduced in the MS population with stenoses compared to those without. © 2012 Bentham Science Publishers.


Trifan G.,Magnetic Resonance Innovations, Inc. | Sethi S.,Magnetic Resonance Innovations, Inc. | Elias S.,Magnetic Resonance Innovations, Inc. | Hewett J.,Synergy Health | And 5 more authors.
Neurological Research | Year: 2012

Venous vascular contributing factors to multiple sclerosis (MS) have been known for some time. Only recently has the scope of their potential role become more apparent with the theory of chronic cerebrospinal venous insufficiency (CCSVI). As research expands to further explore the role of vascular pathology in the MS population, it is expedient to review the evidence from an imaging perspective. In this paper, we review the current state-of-the-art methods using magnetic resonance imaging (MRI) as applied to imaging MS patients and CCSVI. This includes evaluating imaging signatures of vascular structure and flow as well as brain iron content. Upon review of the literature, we find that extracranial venous anomalies including stenosis, venous malformations, and collateralization of flow in the major veins of the neck have been observed to be prevalent in the MS population. Abnormal flow has been reported in MS patients both in major vessels using phase-contrast flow quantification and in the brain using perfusion-weighted imaging. We discuss the role of quantitative flow imaging and its potential in assessing possible biomarkers for abnormal flow. Finally, it has been suggested that the presence of high iron content may indirectly indicate progression of existing vascular pathology. To that end, we review the use of susceptibility- weighted imaging in monitoring iron in the thalamus, basal ganglia, and MS lesions. © W. S. Maney & Son Ltd 2012.


Haacke E.M.,Wayne State University | Haacke E.M.,Magnetic Resonance Innovations, Inc. | Haacke E.M.,Magnetic Resonance Imaging Institute for Biomedical Research | Haacke E.M.,McMaster University | And 8 more authors.
Journal of Vascular and Interventional Radiology | Year: 2012

Purpose: To evaluate extracranial venous structural and flow characteristics in patients with multiple sclerosis (MS). Materials and Methods: Two hundred subjects with MS from two sites (n = 100 each) were evaluated with magnetic resonance (MR) imaging at 3 T. Contrast-enhanced time-resolved MR angiography and time-of-flight MR venography were used to assess vascular anatomy. Two-dimensional phase-contrast MR imaging was used to quantify blood flow. The MS population was divided into two groups: those with evident internal jugular vein (IJV) stenoses (stenotic group) and those without (nonstenotic group). Results: Of the 200 patients, 136 (68%) showed IJV structural abnormalities, including unilateral or bilateral stenoses at different levels in the neck (n = 101; 50.5%) and atresia (n = 35; 17.5%). The total IJV flow normalized to the total arterial flow of the stenotic group (56% ± 22) was significantly lower than that of the nonstenotic group (77% ± 14; P < .001). The arterial/venous flow mismatch in the stenotic group (12% ± 15) was significantly greater than that in the nonstenotic group (6% ± 12; P < .001). The ratio of subdominant venous flow rate (Fsd) to dominant venous flow rate (Fd) for the stenotic group (0.38 ± 0.27) was significantly lower than for the nonstenotic group (0.59 ± 0.23; P < .001). The majority of the stenotic group (67%) also had an Fsd of less than 3 mL/s, a Fd/Fsd ratio greater than 3:1, and/or a total IJV flow rate of less than 8 mL/s. Conclusions: MR imaging provides a noninvasive means to separate stenotic from nonstenotic MS cases. The former group was more prevalent in the present MS population and carried significantly less flow in the IJVs than the latter. © 2012 SIR.


Liu M.,Wayne State University | Xu H.,Union Hospital | Wang Y.,Union Hospital | Zhong Y.,Magnetic Resonance Innovations, Inc. | And 6 more authors.
Journal of Vascular Surgery | Year: 2015

Background Idiopathic Parkinson's disease (IPD) remains one of those neurodegenerative diseases for which the cause remains unknown. Many clinically diagnosed cases of IPD are associated with cerebrovascular disease and white matter hyperintensities (WMHs). The purpose of this study was to investigate the presence of transverse sinus and extracranial venous abnormalities in IPD patients and their relationship with brain WMHs. Methods Twenty-three IPD patients and 23 age-matched normal controls were recruited in this study. They had conventional neurologic magnetic resonance structural and angiographic scans and, for blood flow, quantification of the extracranial vessels. Venous structures were evaluated with two-dimensional time of flight; flow was evaluated with two-dimensional phase contrast; and WMH volume was quantified with T2-weighted fluid-attenuated inversion recovery. The IPD and normal subjects were classified by both the magnetic resonance time-of-flight and phase contrast images into four categories: (1) complete or local missing transverse sinus and internal jugular veins on the time-of-flight images; (2) low flow in the transverse sinus and stenotic internal jugular veins; (3) reduced flow in the internal jugular veins; and (4) normal flow and no stenosis. Results Broken into the four categories with categories 1 to 3 combined, a significant difference in the distribution of the IPD patients and normal controls (χ2 = 7.7; P <.01) was observed. Venous abnormalities (categories 1, 2, and 3) were seen in 57% of IPD subjects and in only 30% of controls. In IPD subjects, category type correlated with both flow abnormalities and WMHs. Conclusions From this preliminary study, we conclude that a major fraction of IPD patients appear to have abnormal venous anatomy and flow on the left side of the brain and neck and that the flow abnormalities appear to correlate with WMH volume. Studies with a larger sample size are still needed to confirm these findings. © 2015 Society for Vascular Surgery.


Grant
Agency: Department of Health and Human Services | Branch: | Program: STTR | Phase: Phase I | Award Amount: 80.08K | Year: 2012

DESCRIPTION (provided by applicant): There has been a huge increase in demand for comprehensive quantitative analysis of neurovascular imaging data produced in the clinical setting for diseases such as multiple sclerosis, traumatic brain injury, stroke anddementia. Our objective in this project is to design and develop advanced image processing software that can rapidly and accurately analyze such data. To achieve this objective, we propose a range of novel algorithms to process data from the following MRimaging sequences widely used in the aforementioned applications: time resolved 3D contrast enhanced MR angiography (CE-MRA) for the assessment of vascular anatomy, time resolved 2D phase contrast flow imaging (PC-MRI) for the evaluation of vascular hemodynamics, susceptibility weighted imaging (SWI) for quantifying iron deposition in the brain, and fluid attenuated inversion recovery (FLAIR) imaging for the detection of white matter hyperintensities (WMH) and lesions. A variety of tools will be designed and implemented to tackle these problems including: tissue similarity mapping and active shape models to segment the vasculature in both CE-MRA and PC-MRI images; automatic tissue segmentation in the basal ganglia and thalamus for a two-region of interest analysis for iron quantification with SWI; and finally adaptive approaches incorporating fuzzy C-means, shape factor analysis, compactness and fractional anisotropy to quantify lesions and WMHs. To exploit the advantages provided by different imaging sequences, co-registration algorithms will be used to improve segmentation of vessels between CE-MRA and PC-MRI, and between 3D T1 weighted imaging and SWI. Upon finishing this project, we expect a multi-fold increase in processing efficiency and a significant increase in accuracy will be achieved. The resulting software will not only help the growth of our company, but also improve the diagnosis and treatment of neurovascular diseases. PUBLIC HEALTH RELEVANCE: The huge increase in demand for a more comprehensive and accurate analysis of the vast amount of clinical MR imaging data for neurovascular diseases such as multiple sclerosis, traumatic brain injury, stroke and dementia is the driving force for th development of more advanced image processing software in our company. In this project, we propose an integrated approach to develop a set of processing software for imaging sequences that target the assessment of both anatomy and function of the neurovasculature system. The results will lead to a better access to quantitative data about the brain's vasculature, flow, hemodynamics and iron content present in neurovascular diseases. The completion of this project will not only help the growth of our company by increasing processing throughput and accuracy, but also improve the diagnosis and treatment of patients with neurovascular disease.


Grant
Agency: Department of Health and Human Services | Branch: | Program: STTR | Phase: Phase II | Award Amount: 999.99K | Year: 2013

DESCRIPTION (provided by applicant): There has been a huge increase in demand for comprehensive quantitative analysis of neurovascular imaging data produced in the clinical setting for diseases such as multiple sclerosis, traumatic brain injury, stroke anddementia. Our objective in this project is to design and develop advanced image processing software that can rapidly and accurately analyze such data. To achieve this objective, we propose a range of novel algorithms to process data from the following MRimaging sequences widely used in the aforementioned applications: time resolved 3D contrast enhanced MR angiography (CE-MRA) for the assessment of vascular anatomy, time resolved 2D phase contrast flow imaging (PC-MRI) for the evaluation of vascular hemodynamics, susceptibility weighted imaging (SWI) for quantifying iron deposition in the brain, and fluid attenuated inversion recovery (FLAIR) imaging for the detection of white matter hyperintensities (WMH) and lesions. A variety of tools will be designed and implemented to tackle these problems including: tissue similarity mapping and active shape models to segment the vasculature in both CE-MRA and PC-MRI images; automatic tissue segmentation in the basal ganglia and thalamus for a two-region of interest analysis for iron quantification with SWI; and finally adaptive approaches incorporating fuzzy C-means, shape factor analysis, compactness and fractional anisotropy to quantify lesions and WMHs. To exploit the advantages provided by different imaging sequences, co-registration algorithms will be used to improve segmentation of vessels between CE-MRA and PC-MRI, and between 3D T1 weighted imaging and SWI. Upon finishing this project, we expect a multi-fold increase in processing efficiency and a significant increase in accuracy will be achieved. The resulting software will not only help the growth of our company, but also improve the diagnosis and treatment of neurovascular diseases. PUBLIC HEALTH RELEVANCE The huge increase in demand for a more comprehensive and accurate analysis of the vast amount of clinical MR imaging data for neurovascular diseases such as multiple sclerosis, traumatic brain injury, stroke and dementia is the driving force for th development of more advanced image processing software in our company. In this project, we propose an integrated approach to develop a set of processing software for imaging sequences that target the assessment of both anatomy and function of the neurovasculature system. The results will lead to a better access to quantitative data about the brain's vasculature, flow, hemodynamics and iron content present in neurovascular diseases. The completion of this project will not only help the growth of our company by increasing processing throughput and accuracy, but also improve the diagnosis and treatment of patients with neurovascular disease.


PubMed | Magnetic Resonance Innovations, Inc. and University of Trento
Type: Journal Article | Journal: Phlebology | Year: 2016

The presence of abnormal anatomy and flow in neck veins has been recently linked to neurological diseases. The precise impact of extra-cranial abnormalities such as stenoses remains unexplored.Pressure and velocity fields in the full cardiovascular system are computed by means of a global mathematical model that accounts for the relationship between pulsating cerebral blood flow and intracranial pressure.Our model predicts that extra-cranial strictures cause increased pressure in the cerebral venous system. Specifically, there is a predicted pressure increase of about 10% in patients with a 90% stenoses. Pressure increases are related to significant flow redistribution with flow reduction of up to 70% in stenosed vessels and consequent flow increase in collateral pathways.Extra-cranial venous strictures can lead to pressure increases in intra-cranial veins of up to 1.3mmHg, despite the shielding role of the Starling resistor. The long-term clinical implications of the predicted pressure changes are unclear.


A method of generating a susceptibility map of an object utilizes a regularizing inverse function, oversampling k-space, removing external phase noise and rapid phase change effects, accounting for the known geometry of the object, and using modified SWI phase data to generate reasonable susceptibility maps and digital images therefrom, such as SWI images. The inventors refers to the inventive methods set forth herein as Susceptibility Weighted Imaging and Mapping (SWIM).


A method of generating a susceptibility map of an object utilizes a regularizing inverse function, oversampling k-space, removing external phase noise and rapid phase change effects, accounting for the known geometry of the object, and using modified SWI phase data to generate reasonable susceptibility maps and digital images therefrom, such as SWI images. The inventors refers to the inventive methods set forth herein as Susceptibility Weighted Imaging and Mapping (SWIM).

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