Purpose
To develop a framework for 3D sodium (23Na) MR fingerprinting (MRF), based on irreducible spherical tensor operators with tailored flip angle (FA) pattern and time‐efficient data acquisition ...for simultaneous quantification of T1, T2l∗, T2s∗, and T2∗ in addition to ΔB0.
Methods
23Na‐MRF was implemented in a 3D sequence and irreducible spherical tensor operators were exploited in the simulations. Furthermore, the Cramér Rao lower bound was used to optimize the flip angle pattern. A combination of single and double echo readouts was implemented to increase the readout efficiency. A study was conducted to compare results in a multicompartment phantom acquired with MRF and reference methods. Finally, the relaxation times in the human brain were measured in four healthy volunteers.
Results
Phantom experiments revealed a mean difference of 1.0% between relaxation times acquired with MRF and results determined with the reference methods. Simultaneous quantification of the longitudinal and transverse relaxation times in the human brain was possible within 32 min using 3D 23Na‐MRF with a nominal resolution of (5 mm)3. In vivo measurements in four volunteers yielded average relaxation times of: T1,brain = (35.0 ± 3.2) ms, T2l,brain∗ = (29.3 ± 3.8) ms and T2s,brain∗ = (5.5 ± 1.3) ms in brain tissue, whereas T1,CSF = (61.9 ± 2.8) ms and T2,CSF∗ = (46.3 ± 4.5) ms was found in cerebrospinal fluid.
Conclusion
The feasibility of in vivo 3D relaxometric sodium mapping within roughly ½ h is demonstrated using MRF in the human brain, moving sodium relaxometric mapping toward clinically relevant measurement times.
Determination of the etiology of primary aldosteronism remains a diagnostic challenge. The most common types of primary aldosteronism are bilateral adrenal hyperplasia (BAH), aldosterone-producing ...adenomas (APA), and primary adrenal hyperplasia. Computed tomography (CT) and adrenal vein sampling (AVS) are the primary modalities used to differentiate these subtypes. The purpose of this study was to compare AVS and CT imaging of the adrenal glands in patients with hyperaldosteronism in whom CT imaging was normal or in whom focal unilateral or bilateral adrenal abnormalities were detected. The diagnosis of primary aldosteronism was made in 62 patients based on an elevated plasma aldosterone to PRA ratio and an elevated urinary aldosterone excretion rate. Thirty-eight patients had CT imaging and successful bilateral adrenal vein sampling and were included in the final analysis. AVS was considered the gold standard in determining the specific subtype of primary aldosteronism. There were 15 patients with APA, 21 patients with BAH, and 2 patients with primary adrenal hyperplasia. Plasma aldosterone was significantly higher in patients with APA (46.3 +/- 8.5 ng/dL; 1284 +/- 235 pmol/L) than in those with BAH (29.3 +/- 2.4 ng/dL; 813 +/- 11 pmol/L; P < 0.05). Plasma potassium was significantly lower in patients with APA (3.1 +/- 0.1 mmol/L) than in patients with BAH (3.5 +/- 0.1 mmol/L; P < 0.02). There was considerable overlap in the other biochemical indices (e.g. PRA and urinary aldosterone) in patients with the different subtypes. In patients with APA proven by AVS, eight had concordant findings with CT imaging, four had discordant findings, and three had normal CT imaging. In patients with BAH proven by AVS, four had concordant findings with CT imaging, eight had discordant findings, and nine had normal CT imaging. Compared with AVS, CT imaging was either inaccurate or provided no additional information in 68% of the patients with primary aldosteronism. We conclude that adrenal CT imaging is not a reliable method to differentiate primary aldosteronism. Adrenal vein sampling is essential to establish the correct diagnosis of primary aldosteronism.
OBJECTIVE Ki-67 immunohistochemistry is widely used as a prognostic marker in meningiomas, but visual estimations tend to be imprecise. Whether the average Ki-67 over an entire slide, a particular ...block, or areas of high staining (hotspots) is prognostic for recurrence-free survival (RFS) and overall survival (OS) is unknown. This study aimed to generate evidence-based recommendations for the optimal use of Ki-67 immunohistochemistry in the workup of meningiomas. METHODS All tissue blocks from a retrospective cohort of 221 patients with primary meningioma (141 WHO grade 1, 64 WHO grade 2, 16 WHO grade 3) were immunostained for Ki-67 and scanned using automated digital analysis software. QuPath was used to quantify the average Ki-67 proliferation index per slide as well as the Ki-67 hotspot in a 2.2-mm 2 area within each slide. The best block was defined subjectively by a neuropathologist as the most representative tissue block from each case. The pathology report Ki-67 was determined by visual estimation. Age, sex, WHO grade, extent of resection, tumor location, and quantitative Ki-67 labeling were tested to determine risk factors for RFS and OS. RESULTS Multivariable analyses demonstrated that WHO grade 2 (HR 2.42, p = 0.018), subtotal resection (HR 8.16, p < 0.0001), near-total resection (HR 2.24, p = 0.041), QuPath Ki-67 averaged across all blocks (HR per % increase = 1.72, p = 0.030), and pathology report Ki-67 (HR per % increase = 1.05, p = 0.0026) were associated with shorter RFS. The average Ki-67 in the best block, maximum across all slides, and maximum hotspot in the best block were not associated with RFS. Only male sex was independently associated with shorter OS (HR 8.52, p = 0.0003). The pathology report Ki-67 was, on average, 6.5 times higher than the QuPath average. CONCLUSIONS These data on Ki-67 in meningiomas indicate the following: 1) visual estimation substantially overestimates Ki-67, 2) digital quantification of average Ki-67 across all tissue blocks provides more prognostic information than small hotspot regions or an entire single block, and 3) Ki-67 is not informative for OS. The results suggest that best practices for incorporating Ki-67 into meningioma prognostication include digital quantification of average Ki-67 over multiple blocks.
The advancement of clinical applications of ultrahigh field (UHF) MRI depends heavily on advances in technology, including the development of new radiofrequency (RF) coil designs. Currently, the ...number of commercially available 7 T head RF coils is rather limited, implying a need to develop novel RF head coil designs that offer superior transmit and receive performance. RF coils to be used for clinical applications must be robust and reliable. In particular, for transmit arrays, if a transmit channel fails the local specific absorption rate may increase, significantly increasing local tissue heating. Recently, dipole antennas have been proposed and used to design UHF head transmit and receive arrays. The dipole provides a unique simplicity while offering comparable transmit efficiency and signal‐to‐noise ratio with the conventional loop design. Recently, we developed a novel array design in our laboratory using a folded‐end dipole antenna. In this work, we developed, constructed and evaluated an eight‐element transceiver bent folded‐end dipole array for human head imaging at 7 T. Driven in the quadrature circularly polarized mode, the array demonstrated more than 20% higher transmit efficiency and significantly better whole‐brain coverage than that provided by a widely used commercial array. In addition, we evaluated passive dipole antennas for decoupling the proposed array. We demonstrated that in contrast to the common unfolded dipole array, the passive dipoles moved away from the sample not only minimize coupling between the adjacent folded‐end active dipoles but also produce practically no destructive interference with the quadrature mode of the array.
An eight‐element transceiver bent folded‐end dipole array for human head imaging at 7 T was developed. Driven in the quadrature mode, the array demonstrated more than 20% higher transmit efficiency and significantly better whole‐brain coverage than that provided by a widely used commercial array. We demonstrated that in contrast to the common dipole array, the passive decoupling dipoles not only minimize coupling between the adjacent active dipoles but also produce minimal destructive interference with the quadrature mode of the array.
Bilateral, high-frequency stimulation (HFS) of the subthalamic nucleus (STN) is the surgical therapy of choice for movement disability in advanced Parkinson's disease (PD), but this procedure evokes ...debilitating psychiatric effects, including depressed mood, of unknown neural origin. Here, we report the unexpected finding that HFS of the STN inhibits midbrain 5-hydroxytryptamine (5-HT) neurons to evoke depression-related behavioral changes. We found that bilateral HFS of the STN consistently inhibited (40-50%) the firing rate of 5-HT neurons in the dorsal raphe nucleus of the rat, but not neighboring non-5-HT neurons. This effect was apparent at clinically relevant stimulation parameters (>=100 Hz, >=30 μA), was not elicited by HFS of either neighboring or remote structures to the STN, and was still present in rat models of PD. We also found that bilateral HFS of the STN evoked clear-cut, depressive-like behavior in a widely used experimental paradigm of depression (forced swim test), and this effect was also observed in a PD model. Importantly, the depressive-like behavior elicited by HFS of the STN was reversed by a selective 5-HT-enhancing antidepressant, thereby linking the behavioral change to decreased 5-HT neuronal activity. Overall, these findings link reduced 5-HT function to the psychiatric effects of HFS of the STN observed in PD patients and provide a rational basis for their clinical management. More generally, the powerful interaction between the STN and 5-HT system uncovered here offers insights into the high level of comorbidity of basal ganglia disease and mood disorder.
Purpose
To investigate the correlation between electrical conductivity and sodium concentration, both measured in vivo, in the human brain.
Methods
Conductivity measurements were performed on samples ...with different sodium (Na+) and agarose concentrations using a dielectric probe, and the correlation between conductivity and Na+ content was evaluated. Subsequently, brain conductivity and total Na+ content maps were measured in 8 healthy subjects using phase‐based MREPT and sodium MRI, respectively. After co‐registration and spatial normalization to the 1 mm 152 MNI brain atlas, the relationship between conductivity and tissue sodium concentration (TSC) was examined within different brain regions.
Results
The conductivities of agarose gels increased linearly with NaCl concentration, while remaining almost independent of agarose content. When measured in healthy subjects, conductivities showed positive correlation with total tissue sodium concentration (R = 0.39, P < 0.005). The same trend was found in gray matter (R = 0.36, P < 0.005) and in white matter (R = 0.28, P < 0.05).
Conclusion
Tissue conductivity shows a positive correlation with total sodium concentration. Conductivity might serve as a novel technique to visualize the total tissue electrolyte concentration, although refinements in the consideration of e.g., tissue water content, would be necessary to improve the quantitative value.
Abstract
Intensifying global change is propelling many ecosystems toward irreversible transformations. Natural resource managers face the complex task of conserving these important resources under ...unprecedented conditions and expanding uncertainty. As once familiar ecological conditions disappear, traditional management approaches that assume the future will reflect the past are becoming increasingly untenable. In the present article, we place adaptive management within the resist–accept–direct (RAD) framework to assist informed risk taking for transforming ecosystems. This approach empowers managers to use familiar techniques associated with adaptive management in the unfamiliar territory of ecosystem transformation. By providing a common lexicon, it gives decision makers agency to revisit objectives, consider new system trajectories, and discuss RAD strategies in relation to current system state and direction of change. Operationalizing RAD adaptive management requires periodic review and update of management actions and objectives; monitoring, experimentation, and pilot studies; and bet hedging to better identify and tolerate associated risks.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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