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E-raamat: Advanced MR Neuroimaging: From Theory to Clinical Practice

(University of Thessaly, Medical School, Medical Physics, Larissa, Greece)
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Over the last decade, some of the greatest achievements in the field of neuroimaging have been related to remarkable advances in magnetic resonance techniques, including diffusion, perfusion, magnetic resonance spectroscopy, and functional MRI. Such techniques have provided valuable insights into tissue microstructure, microvasculature, metabolism and brain connectivity.

Previously available mostly in research environments, these techniques are now becoming part of everyday clinical practice in a plethora of clinical MR systems. Nevertheless, despite growing interest and wider acceptance, there remains a lack of a comprehensive body of knowledge on the subject, exploring the intrinsic complexity and physical difficulty of the techniques.

This book focuses on the basic principles and theories of diffusion, perfusion, magnetic resonance spectroscopy, and functional MRI. It also explores their clinical applications and places emphasis on the associated artifacts and pitfalls with a comprehensive and didactic approach.

This book aims to bridge the gap between research applications and clinical practice. It will serve as an educational manual for neuroimaging researchers and radiologists, neurologists, neurosurgeons, and physicists with an interest in advanced MR techniques. It will also be a useful reference text for experienced clinical scientists who wish to optimize their multi-parametric imaging approach.

Arvustused

"I highly recommend Advanced MR Neuroimaging, From Theory to Clinical Practice by Dr Ioannis Tsougos. This book fills a gap in the market at the moment: providing an up-to-date one-stop-shop for the main MR methods most commonly used in clinical practice. It is rare to find a book that covers these techniques in a single text, including how best to use them and their pitfalls, before putting them in the context of a thorough clinical example.

The book can be read at different levels, each chapter providing both an overview of the techniques, in accessible language (with "Focus Point" boxes for quick reference), and also adding depth for those wanting more details. The "Artefacts and Pitfalls of " chapters are also a welcome addition enabling clinicians and scientists to understand the limitations of the techniques and how to best implement them. The last chapter puts everything in context by providing in-depth and comprehensive coverage of how multimodal neuroimaging could best be used in the assessment of cerebral tumours. I will certainly recommend this book to my colleagues and students as both a perfect introduction to the field, and, at the same time, as a clear and concise way to delve deeper into the MR methods that are now routinely used in the clinic." Dr Vincent Giampietro, Senior Lecturer and MSc Neuroimaging Programme Leader, Kings College London

"It was a pleasure to read the book Advanced MR Neuroimaging by Dr. Tsougos. Medical imaging, and Magnetic Resonance (MR) in particular, have revolutionized medical care over the past 4 decades in ways unimaginable prior to the introduction of MR. Advanced MR Neuroimaging represents a fundamental tool in understanding brain pathologies and function. It is no wonder then, that with the critical role MR plays and the rapid innovations in computer technology, that advances in the capabilities and complexity of MR imaging continues to evolve. An up to date complete and authoritative educational and reference volume covering the entire spectrum of advanced MR neuroimaging is a difficult task to accomplish, but the book edited by Dr Tsougos excels in meeting this need. This book is written by an international author recognized worldwide as a leaders in his field and his extensive experience and practical knowledge is logically presented, well organized and brilliantly visualized. This book consists of comprehensive chapters devoted to all the key areas of advanced MR imaging: Diffusion, Perfusion, Spectroscopy, functional-­MRI and multi parametric MR Imaging. Advanced MR Neuroimaging is a comprehensive text and all the chapters are comprehensive. The book is wonderfully well illustrated. I warmly recommend this text to researchers who are interested in a comprehensive introduction to advanced MR neuroimaging." Professor Luca Saba, Chair of Department of Radiology, Univeristy of Cagliari

"This book is a timely and useful resource for anyone who is interested in advanced magnetic resonance methods as applied to the brain. The approach adopted by the author is very informative and easy to navigate, with chapters devoted to four major techniques (Diffusion, Perfusion, MRS and fMRI), each one immediately followed by an "Artifacts and Pitfalls" chapter with hints and tips on practical implementation. The book is rounded off with a chapter on the assessment of cerebral tumours by multiparametric MR, which ties everything together. Tsougos book will be especially useful for graduate students entering the field, but is of equal relevance to established researchers seeking a "one-stop" overview of current methods." David J. Lurie, Professor in Biomedical Physics, University of Aberdeen

Series Preface xi
Preface xiii
About the Author xv
1 Diffusion MR Imaging
1.1 Introduction
1(2)
1.1.1 Diffusion
1(1)
1.1.2 Diffusion in Magnetic Resonance Imaging
2(1)
1.2 Diffusion Imaging: Basic Principles
3(11)
1.2.1 Diffusion-Weighted Imaging
3(2)
1.2.2 The b-Value
5(3)
1.2.3 Apparent Diffusion Coefficient
8(2)
1.2.4 Isotropic or Anisotropic Diffusion?
10(2)
1.2.5 Echo Planar Imaging
12(1)
1.2.6 Main Limitations of DWI
13(1)
1.3 Diffusion Tensor Imaging
14(8)
1.3.1 "Rotationally Invariant" Parameters (Mean Diffusivity and Fractional Anisotropy)
17(2)
1.3.2 Fiber Tractography
19(3)
1.4 Conclusions and Future Perspectives
22(7)
References
23(6)
2 Artifacts and Pitfalls in Diffusion MRI
2.1 Introduction
29(1)
2.2 Artifacts and Pitfalls Categorization
30(1)
2.3 Artifacts from the Gradient System
30(3)
2.3.1 Eddy Current Artifacts
30(2)
2.3.2 Eddy Currents---Mitigating Strategies
32(1)
2.4 Motion Artifacts
33(5)
2.4.1 Motion Artifacts---Mitigating Strategies
35(1)
2.4.2 EPI Specific Artifacts
35(1)
2.4.3 Distortions Originating from BO Inhomogeneities
36(1)
2.4.4 Misregistration Artifacts from Eddy Currents and Subject Motion
36(1)
2.4.5 Mitigating Strategies---EPI Specific
37(1)
2.5 Artifacts Due to Properties of the Subject Being Imaged and "Physiological" Noise
38(2)
2.5.1 Susceptibility-Induced Distortions
38(1)
2.5.2 Physiological Noise
38(1)
2.5.3 Susceptibility Effects and Physiological Noise---Mitigating Strategies
39(1)
2.6 Processing and Interpretation Pitfalls
40(8)
2.6.1 Preprocessing of Data
40(2)
2.6.2 Quantitation of Parameters
42(3)
2.6.3 Dependence of Estimated Mean Diffusivity on b-Factor
45(1)
2.6.4 Effect on ROI Positioning and Bias on Parametric Maps
45(2)
2.6.5 CSF Contamination in Tract Specific Measurements
47(1)
2.6.6 Intrasubject and Intersubject Comparisons
47(1)
2.7 Mitigating Strategies---Available Methods and Software for Diffusion Data Correction
48(2)
2.7.1 RESTORE Algorithm
48(1)
2.7.2 ExploreDTI
49(1)
2.7.3 FSL-FDT
49(1)
2.7.4 FreeSurfer---TRACULA
49(1)
2.7.5 TORTOISE
50(1)
2.8 Conclusion
50(5)
References
50(5)
3 Perfusion MR Imaging
3.1 Introduction
55(1)
3.2 DSCMRI
56(5)
3.2.1 DSC Imaging Explained
58(1)
3.2.2 DSC Perfusion Parameters: CBV, CBF, MTT
58(1)
3.2.2.1 CBV
58(2)
3.2.2.2 CBF
60(1)
3.2.2.3 MTT
61(1)
3.3 DCE-MRI
61(5)
3.3.1 DCE Imaging Explained
62(4)
3.4 ASL
66(3)
3.4.1 ASL Imaging Explained
66(1)
3.4.2 Different ASL Techniques
66(1)
3.4.2.1 CASL and pCASL
67(1)
3.4.2.2 PASL
68(1)
3.4.2.3 VSASL
68(1)
3.4.3 ASL beyond CBF Estimation
69(1)
3.5 Conclusions and Future Perspectives
69(6)
References
70(5)
4 Artifacts and Pitfalls of Perfusion MRI
4.1 Introduction
75(1)
4.2 Dynamic Susceptibility Contrast (DSC) Imaging Limitations
76(3)
4.2.1 Subject Motion
76(1)
4.2.2 Relationship between MR Signal and Contrast Concentration
76(1)
4.2.3 Bolus Delay and Dispersion
77(1)
4.2.4 BBB Disruption and Leakage Correction
77(1)
4.2.5 Absolute versus Relative Quantification
78(1)
4.3 Dynamic Contrast Enhancement (DCE) Imaging Limitations
79(2)
4.3.1 Suitability of Tumor Lesions
79(1)
4.3.2 Subject Motion
79(1)
4.3.3 Estimation of Arterial Input Function (AIF)
79(1)
4.3.4 Temporal and Spatial Resolutions
80(1)
4.3.5 Variability of Results According to the Models Used
80(1)
4.3.6 Quality Assurance
80(1)
4.4 Arterial Spin Labeling (ASL) Imaging Limitations
81(4)
4.4.1 Subject Motion
81(1)
4.4.2 Physiological Signal Variations
82(1)
4.4.3 Magnetic Susceptibility Artifacts
83(1)
4.4.4 Coil Sensitivity Variations
84(1)
4.4.5 Labeling Efficiency
84(1)
4.4.6 Transit Time Effects
84(1)
4.4.7 Errors from Quantification Models
85(1)
4.5 Conclusions and Future Perspectives
85(6)
References
86(5)
5 Magnetic Resonance Spectroscopy
5.1 Introduction
91(2)
5.2 MRS Basic Principles Explained
93(11)
5.2.1 Technical Issues
95(1)
5.2.2 Data Acquisition
95(3)
5.2.3 Field Strength (B0)
98(2)
5.2.4 Voxel Size Dependency
100(1)
5.2.5 Shimming
101(1)
5.2.6 Water and Lipid Suppression Techniques
102(2)
5.3 MRS Metabolites and Their Biological and Clinical Significance
104(6)
5.3.1 Myo-Inositol
104(2)
5.3.2 Choline-Containing Compounds
106(1)
5.3.3 Creatine and Phosphocreatine
107(1)
5.3.4 Glutamate and Glutamine
107(1)
5.3.5 N-Acetyl Aspartate
107(1)
5.3.6 Lactate and Lipids
108(1)
5.3.7 Less Commonly Detected Metabolites
108(2)
5.4 MRS Quantification and Data Analysis
110(3)
5.4.1 Quantification
110(1)
5.4.2 Post Processing Techniques
111(2)
5.5 Quality Assurance in MRS
113(1)
5.6 Conclusion
113(10)
References
114(9)
6 Artifacts and Pitfalls of MRS
6.1 Introduction
123(1)
6.2 Artifacts and Pitfalls
124(14)
6.2.1 Effects of Patient Movement
124(1)
6.2.2 Field Homogeneity and Linewidth
124(1)
6.2.3 Frequency Shifts and Temperature Variations
125(1)
6.2.4 Voxel Positioning
126(2)
6.2.5 Use of Contrast and Positioning in MRS
128(1)
6.2.6 Chemical Shift Displacement
129(1)
6.2.7 Spectral Contamination or Voxel Bleeding
130(1)
6.2.8 To Quantify or Not to Quantify?
131(1)
6.2.8.1 Relative Quantification
131(1)
6.2.8.2 Absolute Quantification
132(2)
6.2.9 Available Software Packages for Quantification and Analysis of MRS Data
134(1)
6.2.9.1 LCModel
134(1)
6.2.9.2 jMRUI
135(1)
6.2.9.3 TARQUIN
135(1)
6.2.9.4 SI VIC
136(1)
6.2.9.5 AQSES
137(1)
6.3 Conclusion
138(3)
References
138(3)
7 Functional Magnetic Resonance Imaging (fMRI)
7.1 Introduction
141(7)
7.1.1 What Is Functional Magnetic Resonance Imaging (fMRI) of the Brain?
141(1)
7.1.2 Blood Oxygenation Level Dependent (BOLD) fMRI
142(2)
7.1.3 fMRI Paradigm Design and Implementation
144(1)
7.1.3.1 Blocked versus Event-Related Paradigms
145(1)
7.1.3.2 Mixed Paradigm Designs
146(2)
7.2 fMRI Acquisitions---MR Scanning Sequences
148(3)
7.2.1 Spatial Resolution
148(1)
7.2.2 Temporal Resolution
148(1)
7.2.3 Pulse Sequences Used in fMRI
149(2)
7.3 Analysis and Processing of fMRI Experiments
151(3)
7.3.1 fMRI Datasets
151(1)
7.3.2 Data Preprocessing
152(1)
7.3.2.1 Slice-Scan Timing Correction
152(1)
7.3.2.2 Head Motion Correction
152(1)
7.3.2.3 Distortion Correction
153(1)
7.3.2.4 Spatial and Temporal Smoothing
153(1)
7.3.3 Statistical Analysis
153(1)
7.4 Pre-Surgical Planning with fMRI
154(1)
7.5 Resting State fMRI
154(2)
7.5.1 Resting State fMRI Procedure
155(1)
7.6 Conclusion and the Future of fMRI
156(5)
References
157(4)
8 Artifacts and Pitfalls of fMRI
8.1 Introduction to Quantitative fMRI Limitations
161(1)
8.2 Image Acquisition Limitations
162(5)
8.2.1 Spatial and Temporal Resolution
162(2)
8.2.2 Spatial and Temporal fMRI Resolution---Mitigating Strategies
164(2)
8.2.3 EPI-Related Image Distortions
166(1)
8.3 Physiological Noise and Motion Limitations
167(4)
8.3.1 Physiological Noise---Mitigating Strategies
169(1)
8.3.1.1 Cardiac Gating
169(1)
8.3.1.2 Acquisition-Based Image Corrections
170(1)
8.3.1.3 Calibration
170(1)
8.4 Interpretation Limitations
171(2)
8.5 Quality Assurance in fMRI
173(1)
8.6 Conclusion
174(5)
References
174(5)
9 The Role of Multiparametric MR Imaging---Advanced MR Techniques in the Assessment of Cerebral Tumors
9.1 Introduction
179(2)
9.2 Gliomas
181(8)
9.2.1 DWI Contribution in Gliomas
183(3)
9.2.2 DTI Contribution in Gliomas
186(1)
9.2.3 Perfusion Contribution in Gliomas
187(1)
9.2.4 MRS Contribution in Gliomas
188(1)
9.3 Cerebral Metastases
189(5)
9.3.1 DWI/DTI Contribution in Metastases
191(2)
9.3.2 Perfusion Contribution in Metastases
193(1)
9.3.3 MRS Contribution in Metastases
193(1)
9.4 Meningiomas
194(4)
9.4.1 DWI/DTI Contribution in Meningiomas
194(2)
9.4.2 Perfusion Contribution in Meningiomas
196(1)
9.4.3 MRS Contribution in Meningiomas
197(1)
9.5 Primary Cerebral Lymphoma
198(2)
9.5.1 DWI/DTI Contribution in PCLs
198(1)
9.5.2 Perfusion Contribution in PCLs
198(1)
9.5.3 MRS Contribution in PCLs
199(1)
9.6 Intracranial Abscesses
200(2)
9.6.1 DWI DTI Contribution in Abscesses
200(1)
9.6.2 Perfusion Contribution in Abscesses
201(1)
9.6.3 MRS Contribution in Abscesses
202(1)
9.7 Summary and Conclusion
202(13)
References
203(12)
Index 215
Dr. Ioannis Tsougos holds a BSc in Physics and an MSc and a PhD in Medical Physics. Currently, he is an Assistant Professor of Medical Radiation Physics at the Medical School of the University of Thessaly, Larissa, Greece and a Visiting Researcher in the Neuroimaging Division at the Institute of Psychiatry, Psychology, & Neuroscience, Kings College London, UK. He has authored more than 70 research papers and 10 international book chapters. He is a member of the EFOMP, ESR, and ESMRMB.