Robert I. Grossman, M.D.

Thalamus and cognitive impairment in Mild Traumatic Brain Injury: A Diffusional Kurtosis Imaging Study
Grossman EJ; Ge Y; Jensen JH; Babb JS; Miles L; Reaume J; Silver JM; Grossman RI; Inglese M
2011 Jun 3;:?-? #, Journal of neurotrauma
Conventional imaging is unable to detect damage that accounts for permanent cognitive impairment in patients with mild traumatic brain injury (MTBI). While diffusion tensor imaging (DTI) can help to detect diffuse axonal injury (DAI), it is a limited indicator of tissue complexity. It has also been suggested that the thalamus may play an important role in the development of clinical sequelae in MTBI. The purpose of this study was to determine if diffusional kurtosis imaging (DKI), a novel quantitative magnetic resonance imaging (MRI) technique, can provide early detection of damage in the thalamus and white matter (WM) of MTBI patients and if thalamic injury is associated with cognitive impairment. Twenty-two MTBI patients and 14 controls underwent MRI and neuropsychological testing. Mean kurtosis (MK), fractional anisotropy (FA), and mean diffusivity (MD) were measured in the thalamus and several WM regions classically identified with DAI. Compared to controls, patients examined within one year after injury exhibited variously altered DTI and DKI derived measures in the thalamus and the internal capsule while, in addition to these regions, patients examined more than one year after injury also showed similar differences in the splenium of the corpus callosum and the centrum semiovale. Cognitive impairment was correlated to MK in the thalamus and the internal capsule. These findings suggest that combined use of DTI and DKI provides a more sensitive tool for identifying brain injury. In addition, MK in the thalamus might be useful for early prediction of permanent brain damage and cognitive outcome
— id: 135641, year: 2011, vol: , page: ?, stat: Journal Article,

Brain iron quantification in mild traumatic brain injury: a magnetic field correlation study
Raz, E; Jensen, J H; Ge, Y; Babb, J S; Miles, L; Reaume, J; Grossman, R I; Inglese, M
2011 Nov;32(10):1851-1856, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Experimental studies have suggested a role for iron accumulation in the pathology of TBI. Magnetic field correlation MR imaging is sensitive to the presence of non-heme iron. The aims of this study are to 1) assess the presence, if any, and the extent of iron deposition in the deep gray matter and regional white matter of patients with mTBI by using MFC MR imaging; and 2) investigate the association of regional brain iron deposition with cognitive and behavioral performance of patients with mTBI. MATERIALS AND METHODS: We prospectively enrolled 28 patients with mTBI. Eighteen healthy subjects served as controls. The subjects were administered the Stroop color word test, the Verbal Fluency Task, and the Post-Concussion Symptoms Scale. The MR imaging protocol (on a 3T imager) consisted of conventional brain imaging and MFC sequences. After the calculation of parametric maps, MFC was measured by using a region of interest approach. MFC values across groups were compared by using analysis of covariance, and the relationship of MFC values and neuropsychological tests were evaluated by using Spearman correlations. RESULTS: Compared with controls, patients with mTBI demonstrated significant higher MFC values in the globus pallidus (P = .002) and in the thalamus (P = .036). In patients with mTBI, Stroop test scores were associated with the MFC value in frontal white matter (r = -0.38, P = .043). CONCLUSIONS: MFC values were significantly elevated in the thalamus and globus pallidus of patients with mTBI, suggesting increased accumulation of iron. This supports the hypothesis that deep gray matter is a site of injury in mTBI and suggests a possible role for iron accumulation in the pathophysiological events after mTBI
— id: 141487, year: 2011, vol: 32, page: 1851, stat: Journal Article,

Global N-acetylaspartate declines even in benign multiple sclerosis
Rigotti, D J; Gonen, O; Grossman, R I; Babb, J S; Falini, A; Benedetti, B; Filippi, M
2011 Jan;32(1):204-209, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Neuro-axonal damage is a well known sequelae of MS pathogeneses. Consequently, our aim was to test whether the approximately 20% of patients with MS exhibiting a clinically benign disease course also have minimal neural dysfunction as reflected by the global concentration of their MR imaging marker NAA. MATERIALS AND METHODS: Q(NAA) was obtained with nonlocalizing whole-head (1)H-MR spectroscopy in 43 patients with benign RRMS (30 women, 13 men; mean age, 44.7 +/- 7.3 years of age) with 21.0 +/- 4.4 years (range, 15-35 years) of disease duration from the first symptom and an EDSS score of 1.9 (range, 0-3). Q(NAA) was by divided by the brain volume (from MR imaging segmentation) to normalize it into WBNAA. All participants gave institutional review board-approved written informed consent, and the study was HIPAA compliant. RESULTS: The patients' lesion load was 12.2 +/- 7.7 cm(3). Their 8.3 +/- 1.8 mmol/L WBNAA was 35% lower than that in controls (P < .001). Individual average loss rates (absolute loss compared with controls divided by disease duration) clustered around 0.22 +/- 0.09 mmol/L/year (1.7%/year, assuming monotonic decline). This rate could be extrapolated from that already reported for patients with RRMS of much shorter disease duration. WBNAA did not correlate with lesion load or EDSS. CONCLUSIONS: Normal WBNAA is not characteristic of benign MS and is not an early predictor of its course. These patients, therefore, probably benefit from successful compensation and sparing of eloquent regions. Because they may ultimately have a rapid decline once their brain plasticity is exhausted, they may benefit from treatment options offered to more affected patients
— id: 120642, year: 2011, vol: 32, page: 204, stat: Journal Article,

Thalamic resting-state functional networks: disruption in patients with mild traumatic brain injury
Tang, Lin; Ge, Yulin; Sodickson, Daniel K; Miles, Laura; Zhou, Yongxia; Reaume, Joseph; Grossman, Robert I
2011 Sep;260(3):831-840, Radiology
Purpose: To explore the neural correlates of the thalamus by using resting-state functional magnetic resonance (MR) imaging and to investigate whether thalamic resting-state networks (RSNs) are disrupted in patients with mild traumatic brain injury (MTBI). Materials and Methods: This HIPAA-compliant study was approved by the institutional review board, and written informed consent was obtained from 24 patients with MTBI and 17 healthy control subjects. The patients had varying degrees of symptoms, with a mean disease duration of 22 days. The resting-state functional MR imaging data were analyzed by using a standard seed-based whole-brain correlation method to characterize thalamic RSNs. Student t tests were used to perform comparisons. The association between thalamic RSNs and performance on neuropsychologic and neurobehavioral measures was also investigated in patients with MTBI by using Spearman rank correlation. Results: A normal pattern of thalamic RSNs was demonstrated in healthy subjects. This pattern was characterized as representing relatively symmetric and restrictive functional thalamocortical connectivity, suggesting an inhibitory property of the thalamic neurons during the resting state. This pattern was disrupted, with significantly increased thalamic RSNs (P </= .005) and decreased symmetry (P = .03) in patients with MTBI compared with healthy control subjects. Increased functional thalamocortical redistributive connectivity was correlated with diminished neurocognitive functions and clinical symptoms in patients with MTBI. Conclusion: These findings of abnormal thalamic RSNs lend further support to the presumed subtle thalamic injury in patients with MTBI. Resting-state functional MR imaging can be used as an additional imaging modality for detection of thalamocortical connectivity abnormalities and for better understanding of the complex persistent postconcussive syndrome. (c) RSNA, 2011
— id: 136638, year: 2011, vol: 260, page: 831, stat: Journal Article,

Similar global N-acetylaspartate concentration in clinically benign and non-benign multiple sclerosis patients with more than 15 years of disease duration
Achtnichts, L; Gonen, O; Rigotti, D; Babb, JS; Naegelin, Y; Bendtfeld, K; Hirsch, J; Amann, M; Grossman, RI; Kappos, L; Gass, A
2010 JUN ;257(5):S38-S38, Journal of neurology
— id: 111905, year: 2010, vol: 257, page: S38, stat: Journal Article,

Commentary: less is better: lessons from the new york university-mount sinai merger
Grossman, Robert I; Berne, Robert
2010 Dec;85(12):1817-1818, Academic medicine
Elsewhere in this issue, Kastor details the merger and demerger of New York University (NYU) and Mount Sinai hospitals and medical schools. Academic medical center mergers are difficult endeavors to execute under optimal circumstances. The failure of the NYU-Mount Sinai merger was inevitable on the basis of preexisting cultural distinctions, lack of substantial faculty and staff support, and the inability to generate significant early accomplishments that were meaningful to the respective constituencies. Economies of scale and improved academic performance are challenging for merged medical centers to achieve in the short term-caveat emptor. The authors of this commentary discuss, from the NYU perspective, key lessons learned and offer insights about how certain difficulties could have been addressed
— id: 114821, year: 2010, vol: 85, page: 1817, stat: Journal Article,

Sodium long-component T(2)(*) mapping in human brain at 7 Tesla
Fleysher, Lazar; Oesingmann, Niels; Stoeckel, Bernd; Grossman, Robert I; Inglese, Matilde
2009 Nov;62(5):1338-1341, Magnetic resonance in medicine
Sodium ((23)Na) MRI may provide unique information about the cellular and metabolic integrity of the brain. The quantification of tissue sodium concentration from (23)Na images with nonzero echo time (TE) requires knowledge of tissue-specific parameters that influence the single-quantum sodium signal such as transverse (T(2)) relaxation times. We report the sodium ((23)Na) long component of the effective transverse relaxation time T(2) (*) values obtained at 7 T in several brain regions from six healthy volunteers. A two-point protocol based on a gradient-echo sequence optimized for the least error per given imaging time was used (TE(1) = 12 ms; TE(2) = 37 ms; averaged N(1) = 5; N(2) = 15 times; pulse repetition time = 130 ms). The results reveal that long T(2)(*) component of tissue sodium (mean +/- standard deviation) varied between cerebrospinal fluid (54 +/- 4 ms) and gray (28 +/- 2 ms) and white (29 +/- 2 ms) matter structures. The results also show that the long T(2)(*) component increases as a function of the main static field B(0), indicating that correlation time of sodium ion motion is smaller than the time-scale defined by the Larmor frequency. These results are a prerequisite for the quantification of tissue sodium concentration from (23)Na MRI scans with nonzero echo time, will contribute to the design of future measurements (such as triple-quantum imaging), and themselves may be of clinical utility
— id: 105164, year: 2009, vol: 62, page: 1338, stat: Journal Article,

Assessment of thalamic perfusion in patients with mild traumatic brain injury by true FISP arterial spin labelling MR imaging at 3T
Ge, Yulin; Patel, Mayur B; Chen, Qun; Grossman, Elan J; Zhang, Ke; Miles, Laura; Babb, James S; Reaume, Joseph; Grossman, Robert I
2009 Jul;23(7):666-674, Brain injury
OBJECTIVE: To assess cerebral blood flow (CBF) changes in patients with mild traumatic brain injury (MTBI) using an arterial spin labelling (ASL) perfusion MRI and to investigate the severity of neuropsychological functional impairment with respect to haemodynamic changes. MATERIALS AND METHODS: Twenty-one patients with MTBI and 20 healthy controls were studied at 3T MR. The median time since the onset of brain injury in patients was 24.6 months. Both patients and controls underwent a traditional consensus battery of neurocognitive tests. ASL was performed using true fast imaging with steady state precession and a flow-sensitive alternating inversion recovery preparation. Regional CBF were measured in both deep and cortical gray matter as well as white matter at the level of basal ganglia. RESULTS: The mean regional CBF was significantly lower in patients with MTBI (45.9 +/- 9.8 ml/100 g min(-1)) as compared to normal controls (57.1 +/- 8.1 ml/100 g min(-1); p = 0.002) in both sides of thalamus. The decrease of thalamic CBF was significantly correlated with several neurocognitive measures including processing and response speed, memory/learning, verbal fluency and executive function in patients. CONCLUSIONS: Haemodynamic impairment can occur and persist in patients with MTBI, the extent of which is more severe in thalamic regions and correlate with neurocognitive dysfunction during the extended course of disease
— id: 100616, year: 2009, vol: 23, page: 666, stat: Journal Article,

Diminished visibility of cerebral venous vasculature in multiple sclerosis by susceptibility-weighted imaging at 3.0 Tesla
Ge, Yulin; Zohrabian, Vahe M; Osa, Etin-Osa; Xu, Jian; Jaggi, Hina; Herbert, Joseph; Haacke, E Mark; Grossman, Robert I
2009 May;29(5):1190-1194, Journal of magnetic resonance imaging
Multiple sclerosis (MS) is a disease of the central nervous system characterized by widespread demyelination, axonal loss and gliosis, and neurodegeneration; susceptibility-weighted imaging (SWI), through the use of phase information to enhance local susceptibility or T2* contrast, is a relatively new and simple MRI application that can directly image cerebral veins by exploiting venous blood oxygenation. Here, we use high-field SWI at 3.0 Tesla to image 15 patients with clinically definite relapsing-remitting MS and to assess cerebral venous oxygen level changes. We demonstrate significantly reduced visibility of periventricular white matter venous vasculature in patients as compared to control subjects, supporting the concept of a widespread hypometabolic MS disease process. SWI may afford a noninvasive and relatively simple method to assess venous oxygen saturation so as to closely monitor disease severity, progression, and response to therapy
— id: 98007, year: 2009, vol: 29, page: 1190, stat: Journal Article,

Characterizing iron deposition in multiple sclerosis lesions using susceptibility weighted imaging
Haacke, E Mark; Makki, Malek; Ge, Yulin; Maheshwari, Megha; Sehgal, Vivek; Hu, Jiani; Selvan, Madeswaran; Wu, Zhen; Latif, Zahid; Xuan, Yang; Khan, Omar; Garbern, James; Grossman, Robert I
2009 Mar;29(3):537-544, Journal of magnetic resonance imaging
PURPOSE: To investigate whether the variable forms of putative iron deposition seen with susceptibility weighted imaging (SWI) will lead to a set of multiple sclerosis (MS) lesion characteristics different than that seen in conventional MR imaging. MATERIALS AND METHODS: Twenty-seven clinically definite MS patients underwent brain scans using magnetic resonance imaging including: pre- and postcontrast T1-weighted imaging, T2-weighted imaging, FLAIR, and SWI at 1.5 T, 3 T, and 4 T. MS lesions were identified separately in each imaging sequence. Lesions identified in SWI were reevaluated for their iron content using the SWI filtered phase images. RESULTS: There were a variety of new lesion characteristics identified by SWI, and these were classified into six types. A total of 75 lesions were seen only with conventional imaging, 143 only with SWI, and 204 by both. From the iron quantification measurements, a moderate linear correlation between signal intensity and iron content (phase) was established. CONCLUSION: The amount of iron deposition in the brain may serve as a surrogate biomarker for different MS lesion characteristics. SWI showed many lesions missed by conventional methods and six different lesion characteristics. SWI was particularly effective at recognizing the presence of iron in MS lesions and in the basal ganglia and pulvinar thalamus
— id: 142010, year: 2009, vol: 29, page: 537, stat: Journal Article,

White matter hemodynamic abnormalities precede sub-cortical gray matter changes in multiple sclerosis
Varga, Andrew W; Johnson, Glyn; Babb, James S; Herbert, Joseph; Grossman, Robert I; Inglese, Matilde
2009 Jul 15;282(1-2):28-33, Journal of the neurological sciences
BACKGROUND: Hypoperfusion has been reported in lesions, normal-appearing white (NAWM) and gray matter (NAGM) of patients with clinically definite multiple sclerosis (MS) by using perfusion MRI. However, it is still unknown how early such changes in perfusion occur. The aim of our study was to assess the presence of hemodynamic changes in the NAWM and subcortical NAGM of patients with clinically isolated syndrome (CIS) in comparison to healthy controls and to patients with early relapsing-remitting (RR) MS. METHODS: Absolute cerebral blood flow (CBF), blood volume (CBV) and mean transit time (MTT) were measured in the periventricular and frontal NAWM, thalamus and putamen nuclei of 12 patients with CIS, 12 with early RR-MS and 12 healthy controls using dynamic susceptibility contrast enhanced (DSC) T2-weighted MRI. RESULTS: Compared to controls, CBF was significantly decreased in the periventricular NAWM of CIS patients and in the periventricular NAWM and putamen of RR-MS patients. Compared to CIS, RR-MS patients showed a significant CBF decrease in the putamen. CONCLUSIONS: CBF was decreased in the NAWM of both CIS and RR-MS patients and in the subcortical NAGM of RR-MS patients suggesting a continuum of tissue perfusion decreases beginning in white matter and spreading to gray matter, as the disease progresses
— id: 95061, year: 2009, vol: 282, page: 28, stat: Journal Article,

Seven-Tesla magnetic resonance imaging: new vision of microvascular abnormalities in multiple sclerosis
Ge, Yulin; Zohrabian, Vahe M; Grossman, Robert I
2008 Jun;65(6):812-816, Archives of neurology
BACKGROUND: Although the role of vascular pathology in multiple sclerosis (MS) lesions was suggested long ago, the derivation of these lesions from the vasculature has been difficult to assess in vivo. Ultrahigh-field (eg, 7-T) magnetic resonance imaging (MRI) has become a tool for assessing vascular involvement in MS lesions owing to markedly increased image resolution and susceptibility contrast of venous blood. OBJECTIVE: To describe the perivenous association of MS lesions on high-resolution and high-contrast 7-T susceptibility-sensitive MRI. DESIGN: Case study. SETTING: University hospital. PATIENTS: Two women with clinically definite relapsing-remitting MS. RESULTS: We demonstrated markedly enhanced detection of unique microvascular involvement associated with most of the visualized MS lesions with abnormal signals on and around the venous wall on 7-T compared with 3-T MRI. CONCLUSIONS: These findings, which have never been shown on conventional fields of MRI, not only allow for direct evidence of vascular pathogenesis in MS in vivo but also have important implications for monitoring lesion activity and therapeutic response
— id: 79389, year: 2008, vol: 65, page: 812, stat: Journal Article,

Whole-brain N-acetylaspartate MR spectroscopic quantification: performance comparison of metabolite versus lipid nulling
Hovener, J-B; Rigotti, D J; Amann, M; Liu, S; Babb, J S; Bachert, P; Gass, A; Grossman, R I; Gonen, O
2008 Sep;29(8):1441-1445, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Despite the prominent peak of N-acetylaspartate (NAA) in proton MR spectroscopy ((1)H-MR spectroscopy) of the adult brain and its almost exclusive presence in neuronal cells, the total amount of NAA, regarded as their marker, is difficult to obtain due to signal contamination from the skull lipids. This article compares the performance of 2 methods that overcome this difficulty to yield the whole-brain NAA signal, important for the assessment of the total disease load in diffuse neurologic disorders. MATERIALS AND METHODS: The heads of 12 healthy volunteers, 3 women and 9 men, 31.0 +/- 7.1 years of age, were scanned at 3T by using 2 nonlocalizing (1)H-MR spectroscopy sequences: One nulls the NAA (TI = 940 ms) every second acquisition by inversion-recovery to cancel the signals of the lipids (T1 << TI) in an add-subtract scheme. The other nulls the signal of the lipids (TI = 155 ms) directly after each acquisition, requiring half as many averages for the same signal-to-noise ratio. Each sequence was repeated 3 times back-to-back on 3 occasions, and the comparison criteria were intrasubject precision (reproducibility) and total measurement duration. RESULTS: NAA nulling is nearly twice as precise in its intrinsic back-to-back (5.8% versus 8.6%) as well as longitudinal (10.6% versus 19.7%) coefficients of variation compared with lipid nulling, but at the cost of double the acquisition time. CONCLUSION: When speed is a more stringent requirement than precision, the new lipid-nulling sequence is a viable alternative. For precision in cross-sectional or longitudinal global NAA quantification, however, NAA nulling is still the approach of choice despite its x2 ( approximately 5 minutes) time penalty compared with the lipid-nulling approach
— id: 93322, year: 2008, vol: 29, page: 1441, stat: Journal Article,

Perfusion magnetic resonance imaging correlates of neuropsychological impairment in multiple sclerosis
Inglese, Matilde; Adhya, Sumita; Johnson, Glyn; Babb, James S; Miles, Laura; Jaggi, Hina; Herbert, Joseph; Grossman, Robert I
2008 Jan;28(1):164-171, Journal of cerebral blood flow & metabolism
Although cognitive impairment is common in multiple sclerosis (MS), its pathophysiology is still poorly understood. Abnormalities of cerebral blood flow (CBF) have long been acknowledged in MS and advances in perfusion magnetic resonance imaging (MRI) allow for their assessment in vivo. We investigated the relationship between regional perfusion changes and neuropsychological (NP) dysfunctions in patients with relapsing-remitting and primary-progressive MS. Absolute CBF, cerebral blood volume (CBV) and mean transit time were measured in 32 MS patients and 11 healthy controls using dynamic susceptibility contrast-enhanced T2(*)-weighted MRI. A comprehensive NP test battery was administered to all patients. A mixed model analysis of covariance was performed for group comparisons in terms of perfusion measures in normal-appearing white matter (NAWM) and deep gray matter (GM). Pearson's correlations were used to describe the association of perfusion metrics with NP Z-scores. CBF and CBV values were significantly decreased in both NAWM and deep GM in MS patients compared with controls (P=0.01). In all patients, deep GM CBF was significantly associated with Rey Complex Figure Test (RCFT)-Copy (r=0.5; P=0.001) and deep GM CBV and NAWM CBV were significantly associated with Color-Word Interference Inhibition Switching test (D-KEFSIS) (r=0.4; P=0.008 and r=0.4; P=0.02). However, the only associations that remained significant after Bonferroni correction were between deep GM CBF and RCFT-Copy (P=0.006), and deep GM CBV and D-KEFSIS (P=0.04). Our results suggest a role for tissue perfusion impairment in NP dysfunction in MS. Large-scale studies are needed to characterize better this association.Journal of Cerebral Blood Flow & Metabolism advance online publication, 2 May 2007; doi:10.1038/sj.jcbfm.9600504
— id: 74676, year: 2008, vol: 28, page: 164, stat: Journal Article,

Global average gray and white matter N-acetylaspartate concentration in the human brain
Inglese, Matilde; Rusinek, Henry; George, Ilena C; Babb, James S; Grossman, Robert I; Gonen, Oded
2008 Jun;41(2):270-276, Neuroimage
Since the amino acid derivative N-acetylaspartate (NAA) is almost exclusive to neuronal cells in the adult mammalian brain and its concentration has shown local (or global) abnormalities in most focal (or diffuse) neurological diseases, it is considered a specific neuronal marker. Yet despite its biological and clinical prominence, the relative NAA concentration in the gray and white matter (GM, WM) remains controversial, with each reported to be higher than, equal to, or less than the other. To help resolve the controversy and importantly, access the NAA in both compartments in their entirety, we introduce a new approach to distinguish and quantify the whole-brain average GM and WM NAA concentration by integrating MR-image segmentation, localized and non-localized quantitative (1)H-MRS. We demonstrate and validate the method in ten healthy volunteers (5 women) 27+/-6 years old (mean+/-standard-deviation) at 1.5T. The results show that the healthy adult human brain comprises significantly less WM, 39+/-3%, than GM 60+/-4% by volume (p<0.01). Furthermore, the average NAA concentration in the WM, 9.5+/-1.0 mM, is significantly lower than in GM, 14.3+/-1.1 mM (p<0.01)
— id: 79422, year: 2008, vol: 41, page: 270, stat: Journal Article,

Fully automatic segmentation of the brain from T1-weighted MRI using Bridge Burner algorithm
Mikheev, Artem; Nevsky, Gregory; Govindan, Siddharth; Grossman, Robert; Rusinek, Henry
2008 Jun;27(6):1235-1241, Journal of magnetic resonance imaging
PURPOSE: To validate Bridge Burner, a new brain segmentation algorithm based on thresholding, connectivity, surface detection, and a new operator of constrained growing. MATERIALS AND METHODS: T1-weighted MR images were selected at random from three previous neuroimaging studies to represent a spectrum of system manufacturers, pulse sequences, subject ages, genders, and neurological conditions. The ground truth consisted of brain masks generated manually by a consensus of expert observers. All cases were segmented using a common set of parameters. RESULTS: Bridge Burner segmentation errors were 3.4% +/- 1.3% (volume mismatch) and 0.34 +/- 0.17 mm (surface mismatch). The disagreement among experts was 3.8% +/- 2.0% (volume mismatch) and 0.48 +/- 0.49 mm (surface mismatch). The error obtained using the brain extraction tool (BET), a widely used brain segmentation program, was 8.3% +/- 9.1%. Bridge Burner brain masks are visually similar to the masks generated by human experts. Areas affected by signal intensity nonuniformity artifacts were occasionally undersegmented, and meninges and large sinuses were often falsely classified as the brain tissue. Segmentation of one MRI dataset takes seven seconds. CONCLUSION: The new fully automatic algorithm appears to provide accurate brain segmentation from high-resolution T1-weighted MR images
— id: 86546, year: 2008, vol: 27, page: 1235, stat: Journal Article,

Short-term DTI predictors of cognitive dysfunction in mild traumatic brain injury
Miles, Laura; Grossman, Robert I; Johnson, Glyn; Babb, James S; Diller, Leonard; Inglese, Matilde
2008 Feb;22(2):115-122, Brain injury
PRIMARY OBJECTIVE: To explore whether baseline diffusion tensor imaging (DTI) metrics are predictive of cognitive functioning 6 months post-injury in patients with mild traumatic brain injury (MTBI). RESEARCH DESIGN: Seventeen patients with MTBI and 29 sex- and age-matched healthy controls were studied. METHODS AND PROCEDURES: Participants underwent an MRI protocol including DTI, at an average of 4.0 (range: 1-10) days post-injury. Mean diffusivity (MD) and fractional anisotropy (FA) were measured in the following white matter (WM) regions: centra semiovale, the genu and the splenium of the corpus callosum and the posterior limb of the internal capsule. Participants underwent neuropsychological (NP) testing at baseline and at 6-month follow-up. Least squares regression analysis was used to evaluate the association of MD and FA with each NP test score at baseline and follow-up. MAIN OUTCOMES AND RESULTS: Compared to controls, average MD was significantly higher (p = 0.02) and average FA significantly lower (p = 0.0001) in MTBI patients. At the follow-up, there was a trend toward a significant association between baseline MD and response speed (r = -0.53, p = 0.087) and a positive correlation between baseline FA and Prioritization form B (r = 0.72, p = 0.003). CONCLUSIONS: DTI may provide short-term non-invasive predictive markers of cognitive functioning in patients with MTBI
— id: 91954, year: 2008, vol: 22, page: 115, stat: Journal Article,

Reproducibility of the whole-brain N-acetylaspartate level across institutions, MR scanners, and field strengths
Benedetti, B; Rigotti, D J; Liu, S; Filippi, M; Grossman, R I; Gonen, O
2007 Jan;28(1):72-75, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Radiologic markers in multicenter trials are often confounded by different instrumentation used. Our goal was to estimate the variance of the global concentration of the neuronal cell marker N-acetylaspartate (NAA) among research centers using MR imaging scanners of different models, from different manufacturers, and of different magnetic field strength. MATERIALS AND METHODS: Absolute millimolar amounts of whole-brain NAA (WBNAA) were quantified with nonlocalizing proton MR spectroscopy in the brains of 101 healthy subjects (53 women, 48 men) aged 16-59 years (mean, 34.2 years). Twenty-three were scanned at 1 institute in a 1.5T Siemens Vision; 31 from another institute were studied with a 1.5T Siemens SP63; 36 were scanned at a third institute (24 with a 1.5T Vision, 12 with a 3T Siemens Trio); and 11 were obtained at a fourth institute using a 4T GE Signa 5.x. The NAA amounts were quantified with phantom-replacement and divided by the brain volume, segmented from MR imaging, to yield the concentration, a metric independent of brain size suitable for cross-sectional comparison. RESULTS: The average WBNAA concentration among institutions was 12.2 +/- 1.2 mmol/L. The subjects' WBNAA distributions did not differ significantly (p > .237) among the 4 centers, regardless of scanner manufacturer, model, or field strength and irrespective of whether adjustments were made for age or sex. CONCLUSION: Absolute quantification against a standard makes the WBNAA concentration insensitive to the MR hardware used to acquire it. This important attribute renders it a robust surrogate marker for multicenter neurologic trials
— id: 70831, year: 2007, vol: 28, page: 72, stat: Journal Article,

Proton MR spectroscopy and MRI-volumetry in mild traumatic brain injury
Cohen, B A; Inglese, M; Rusinek, H; Babb, J S; Grossman, R I; Gonen, O
2007 May;28(5):907-913, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: More than 85% of brain traumas are classified as 'mild'; MR imaging findings are minimal if any and do not correspond to clinical symptoms. Our goal, therefore, was to quantify the global decline of the neuronal marker N-acetylaspartate (NAA), as well as gray (GM) and white matter (WM) atrophy after mild traumatic brain injury (mTBI). MATERIALS AND METHODS: Twenty patients (11 male, 9 female; age range, 19-57 years; median, 35 years) with mTBI (Glasgow Coma Scale score 13-15 with loss of consciousness for at least 30 seconds) and 19 age- and sex-matched control subjects were studied. Seven patients were studied within 9 days of TBI; the other 13 ranged from 1.2 months to 31.5 years (average and median of 4.6 and 1.7 years, respectively) after injury. Whole-brain NAA (WBNAA) concentration was obtained in all subjects with nonlocalizing proton MR spectroscopy. Brain volume and GM and WM fractions were segmented from T1-weighted MR imaging and normalized to the total intracranial volume, suitable for intersubject comparisons. The data were analyzed with least squares regression. RESULTS: Patients with mTBI exhibited, on average, a 12% WBNAA deficit that increased with age, compared with the control subjects (p<.05). Adjusted for age effects, patients also suffered both global atrophy (-1.09%/year; P=.029) and GM atrophy (-0.89%/year; P=.042). Patients with and without visible MR imaging pathology, typically punctate foci of suspected shearing injury, were indistinguishable in both atrophy and WBNAA. CONCLUSION: WBNAA detected neuronal/axonal injury beyond the minimal focal MR-visible lesions in mTBI. Combined with GM atrophy, the findings may provide further, noninvasive insight into the nature and progression of mTBI
— id: 73233, year: 2007, vol: 28, page: 907, stat: Journal Article,

Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials
Fawcett, J W; Curt, A; Steeves, J D; Coleman, W P; Tuszynski, M H; Lammertse, D; Bartlett, P F; Blight, A R; Dietz, V; Ditunno, J; Dobkin, B H; Havton, L A; Ellaway, P H; Fehlings, M G; Privat, A; Grossman, R; Guest, J D; Kleitman, N; Nakamura, M; Gaviria, M; Short, D
2007 Mar;45(3):190-205, Spinal cord
The International Campaign for Cures of Spinal Cord Injury Paralysis (ICCP) supported an international panel tasked with reviewing the methodology for clinical trials in spinal cord injury (SCI), and making recommendations on the conduct of future trials. This is the first of four papers. Here, we examine the spontaneous rate of recovery after SCI and resulting consequences for achieving statistically significant results in clinical trials. We have reanalysed data from the Sygen trial to provide some of this information. Almost all people living with SCI show some recovery of motor function below the initial spinal injury level. While the spontaneous recovery of motor function in patients with motor-complete SCI is fairly limited and predictable, recovery in incomplete SCI patients (American spinal injury Association impairment scale (AIS) C and AIS D) is both more substantial and highly variable. With motor complete lesions (AIS A/AIS B) the majority of functional return is within the zone of partial preservation, and may be sufficient to reclassify the injury level to a lower spinal level. The vast majority of recovery occurs in the first 3 months, but a small amount can persist for up to 18 months or longer. Some sensory recovery occurs after SCI, on roughly the same time course as motor recovery. Based on previous data of the magnitude of spontaneous recovery after SCI, as measured by changes in ASIA motor scores, power calculations suggest that the number of subjects required to achieve a significant result from a trial declines considerably as the start of the study is delayed after SCI. Trials of treatments that are most efficacious when given soon after injury will therefore, require larger patient numbers than trials of treatments that are effective at later time points. As AIS B patients show greater spontaneous recovery than AIS A patients, the number of AIS A patients requiring to be enrolled into a trial is lower. This factor will have to be balanced against the possibility that some treatments will be more effective in incomplete patients. Trials involving motor incomplete SCI patients, or trials where an accurate assessment of AIS grade cannot be made before the start of the trial, will require large subject numbers and/or better objective assessment methods
— id: 119261, year: 2007, vol: 45, page: 190, stat: Journal Article,

Quantitative assessment of iron accumulation in the deep gray matter of multiple sclerosis by magnetic field correlation imaging
Ge, Y; Jensen, J H; Lu, H; Helpern, J A; Miles, L; Inglese, M; Babb, J S; Herbert, J; Grossman, R I
2007 Oct;28(9):1639-1644, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Deposition of iron has been recognized recently as an important factor of pathophysiologic change including neurodegenerative processes in multiple sclerosis (MS). We propose that there is an excess accumulation of iron in the deep gray matter in patients with MS that can be measured with a newly developed quantitative MR technique--magnetic field correlation (MFC) imaging. MATERIALS AND METHODS: With a 3T MR system, we studied 17 patients with relapsing-remitting MS and 14 age-matched healthy control subjects. We acquired MFC imaging using an asymmetric single-shot echo-planar imaging sequence. Regions of interest were selected in both deep gray matter and white matter regions, and the mean MFC values were compared between patients and controls. We also correlated the MFC data with lesion load and neuropsychologic tests in the patients. RESULTS: MFC measured in the deep gray matter in patients with MS was significantly higher than that in the healthy controls (P < or = .03), with an average increase of 24% in the globus pallidus, 39.5% in the putamen, and 30.6% in the thalamus. The increased iron deposition measured with MFC in the deep gray matter in the patients correlated positively with the total number of MS lesions (thalamus: r = 0.61, P = .01; globus pallidus: r = 0.52, P = .02). A moderate but significant correlation between the MFC value in the deep gray matter and the neuropsychologic tests was also found. CONCLUSION: Quantitative measurements of iron content with MFC demonstrate increased accumulation of iron in the deep gray matter in patients with MS, which may be associated with the disrupted iron outflow pathway by lesions. Such abnormal accumulation of iron may contribute to neuropsychologic impairment and have implications for neurodegenerative processes in MS
— id: 75382, year: 2007, vol: 28, page: 1639, stat: Journal Article,

Chemical-shift artifact reduction in hadamard-encoded MR spectroscopic imaging at high (3T and 7T) magnetic fields
Goelman, Gadi; Liu, Songtao; Fleysher, Roman; Fleysher, Lazar; Grossman, Robert I; Gonen, Oded
2007 Jul;58(1):167-173, Magnetic resonance in medicine
Proton MR spectroscopic imaging (MRSI) at higher magnetic fields (B(0)) suffers metabolite localization errors from different chemical-shift displacements (CSDs) if spatially-selective excitation is used. This phenomenon is exacerbated by the decreasing radiofrequency (RF) field strength, B(1), at higher B(0)s, precluding its suppression with stronger gradients. To address this, two new methods are proposed: 1) segmenting the volume-of-interest (VOI) into several slabs, allowing proportionally stronger slice-select gradients; and 2) sequentially cascading rather than superposing the components of the Hadamard selective pulses used for reasons of better point-spread function (PSF) to localize the few slices within each slab. This can reduce the peak B(1) to that of a single slice. Combining these approaches permits us to increase the selective gradient four- to eightfold per given B(1), to 12 or 18mT/m for 4- or 2-cm VOIs. This 'brute force' approach reduces the CSD to under 0.05 cm/ppm at 7T, or less than half that at 3T
— id: 73906, year: 2007, vol: 58, page: 167, stat: Journal Article,

Reproducibility of three whole-brain N-acetylaspartate decline cohorts in relapsing-remitting multiple sclerosis
Gonen, O; Oberndorfer, T A; Inglese, M; Babb, J S; Herbert, J; Grossman, R I
2007 Feb;28(2):267-271, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: The cross-sectional rate of whole-brain N-acetylaspartate (NAA, a neuronal cell marker) loss in clinically similar relapsing-remitting multiple sclerosis (RRMS) patients has recently been shown to fall into 3 distinct decline rate strata. Our goal was to test the reproducibility of this observation in a new cohort of RRMS patients. MATERIALS AND METHODS: Sixteen serial patients (12 women, 4 men, median age 38 [27-55] years) with clinically definite RRMS for an average of 5 (0.3-18) years' disease duration and a mean Expanded Disability Status Score of 2.0 (0-6) were studied, once each. Their whole-brain NAA (WBNAA) amounts, obtained with proton MR spectroscopy, were divided by brain volumes (segmented from MR imaging) to yield concentrations suitable for cross-sectional comparisons. RESULTS: Three distinct strata of cross-sectional NAA decline rates were found: -0.031, -0.32, and -1.71 mmol/L/y when disease duration was estimated from confirmed diagnosis, or -0.057, -0.20, and -1.38 mmol/L/y when measured from the first clinical symptom. These rates and their corresponding fractions of the study population were indistinguishable from those reported previously in a different group of 49 clinically similar (mean Expanded Disability Status Score also 2.0) RRMS patients. CONCLUSION: Reproducing the previous cohort's cross-sectional WBNAA decline characteristics in this new group of clinically similar RRMS patients indicates that 3 WBNAA loss strata may be a general attribute of MS. Consequently, WBNAA could serve as a surrogate marker for the global load of neuronal and axonal dysfunction and damage in this disease
— id: 70829, year: 2007, vol: 28, page: 267, stat: Journal Article,

Deep gray matter perfusion in multiple sclerosis: dynamic susceptibility contrast perfusion magnetic resonance imaging at 3 T
Inglese, Matilde; Park, Sun-Jung; Johnson, Glyn; Babb, James S; Miles, Laura; Jaggi, Hina; Herbert, Joseph; Grossman, Robert I
2007 Feb;64(2):196-202, Archives of neurology
OBJECTIVES: To assess the presence of perfusion abnormalities in the deep gray matter of patients with relapsing-remitting and primary progressive multiple sclerosis (MS) in comparison with healthy controls and to investigate the impact of perfusion impairment on clinical disability and fatigue. DESIGN: Survey. SETTING: Research-oriented hospital. Patients Twenty-two patients with MS and 11 age- and sex-matched healthy volunteers. Intervention Absolute cerebral blood flow, cerebral blood volume, and mean transit time were measured in the thalamus, putamen, and caudate nuclei. MAIN OUTCOME MEASURES: Decrease of cerebral blood flow in the deep gray matter of patients with MS and correlation between perfusion impairment and the severity of fatigue. RESULTS: The cerebral blood flow value averaged over the thalamus, putamen, and caudate nuclei was significantly lower in patients with primary progressive MS (P<.001) and in patients with relapsing-remitting MS (P = .01) compared with controls, and there was a trend for patients with primary progressive MS to have lower average cerebral blood flow than patients with relapsing-remitting MS (P = .06). With respect to cerebral blood volume, there was a significant difference between patients with primary progressive MS and controls (P<.001) and between the 2 groups of patients (P = .03) but not between patients with relapsing-remitting MS and controls (P>.30). The fatigue score was significantly correlated with cerebral blood flow (r = 0.4; P<.001) and cerebral blood volume (r = 0.5; P = .004). CONCLUSION: The decrease of tissue perfusion in the deep gray matter of patients with MS is associated with the severity of fatigue
— id: 70830, year: 2007, vol: 64, page: 196, stat: Journal Article,

Characterizing 'mild' in traumatic brain injury with proton MR spectroscopy in the thalamus: Initial findings
Kirov, Ivan; Fleysher, Lazar; Babb, James S; Silver, Jonathan M; Grossman, Robert I; Gonen, Oded
2007 Oct;21(11):1147-1154, Brain injury
OBJECTIVE: Although most mild traumatic brain injury (mTBI) patients suffer any of several post-concussion symptoms suggestive of thalamic involvement, they rarely present with any MRI-visible pathology. The aim here, therefore, is to characterize their thalamic metabolite levels with proton MR spectroscopy (1H-MRS) compared with healthy controls. METHODS: T1-weighted MRI and multi-voxel 1H-MRS were acquired at 3 Tesla from 20 mTBI (Glasgow Coma Scale score of 15-13) patients, 19-59 years old, 0-7 years post-injury; and from 17 age and gender matched healthy controls. Mixed model regression was used to compare patients and controls with respect to the mean absolute N-acetylaspartate (NAA), choline (Cho) and creatine (Cr) levels within each thalamus. RESULTS: The mTBI-induced thalamic metabolite concentration changes were under +/- 13.0% for NAA, +/- 13.5% for Cr and +/- 18.8% for Cho relative to their corresponding concentrations in the controls: NAA: 10.08 +/- 0.30 (mean +/- standard error), Cr: 5.62 +/- 0.18 and Cho: 2.08 +/- 0.09 mM. These limits represent the minimal detectable differences between the two cohorts. CONCLUSION: The change in metabolic levels in the thalamus of patients who sustained clinically defined mTBI could be an instrumental characteristic of 'mildness'. 1H-MRS could, therefore, serve as an objective laboratory indicator for differentiating 'mild' from more severe categories of head-trauma, regardless of the presence or lack of current clinical symptoms
— id: 93791, year: 2007, vol: 21, page: 1147, stat: Journal Article,

Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: clinical trial design
Lammertse, D; Tuszynski, M H; Steeves, J D; Curt, A; Fawcett, J W; Rask, C; Ditunno, J F; Fehlings, M G; Guest, J D; Ellaway, P H; Kleitman, N; Blight, A R; Dobkin, B H; Grossman, R; Katoh, H; Privat, A; Kalichman, M
2007 Mar;45(3):232-242, Spinal cord
The International Campaign for Cures of Spinal Cord Injury Paralysis established a panel tasked with reviewing the methodology for clinical trials for spinal cord injury (SCI), and making recommendations on the conduct of future trials. This is the fourth of four papers. Here, we examine the phases of a clinical trial program, the elements, types, and protocols for valid clinical trial design. The most rigorous and valid SCI clinical trial would be a prospective double-blind randomized control trial utilizing appropriate placebo control subjects. However, in specific situations, it is recognized that other trial procedures may have to be considered. We review the strengths and limitations of the various types of clinical trials with specific reference to SCI. It is imperative that the design and conduct of SCI clinical trials should meet appropriate standards of scientific inquiry to insure that meaningful conclusions about efficacy and safety can be achieved and that the interests of trial subjects are protected. We propose these clinical trials guidelines for use by the SCI clinical research community
— id: 119264, year: 2007, vol: 45, page: 232, stat: Journal Article,

Serial whole-brain N-acetylaspartate concentration in healthy young adults
Rigotti, D J; Inglese, M; Babb, J S; Rovaris, M; Benedetti, B; Filippi, M; Grossman, R I; Gonen, O
2007 Oct;28(9):1650-1651, AJNR. American journal of neuroradiology
Although the concentration of N-acetylaspartate (NAA) is often used as a neuronal integrity marker, its normal temporal variations are not well documented. To assess them over the 1-2 year periods of typical clinical trials, the whole-brain NAA concentration was measured longitudinally, over 4 years, in a cohort of healthy young adults. No significant change (adjusted for both sex and age) was measured either interpersonally or intrapersonally over the entire duration of the study
— id: 75381, year: 2007, vol: 28, page: 1650, stat: Journal Article,

Correlation of diffusion tensor and dynamic perfusion MR imaging metrics in normal-appearing corpus callosum: support for primary hypoperfusion in multiple sclerosis
Saindane, A M; Law, M; Ge, Y; Johnson, G; Babb, J S; Grossman, R I
2007 Apr;28(4):767-772, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Hypoperfusion of the normal-appearing white matter in multiple sclerosis (MS) may be related to ischemia or secondary to hypometabolism from wallerian degeneration (WD). This study evaluated whether correlating perfusion and diffusion tensor imaging (DTI) metrics in normal-appearing corpus callosum could provide support for an ischemic mechanism for hypoperfusion. MATERIALS AND METHODS: Fourteen patients with relapsing-remitting MS (RRMS) and 17 control subjects underwent perfusion MR imaging and DTI. Absolute measures of cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) were calculated. Mean diffusivity (MD) and fractional anisotropy (FA) maps were computed from DTI data. After visual coregistration of perfusion and DTI images, regions of interest were placed in the genu, central body, and splenium of normal-appearing corpus callosum. Pearson product-moment correlation coefficients were calculated using mean DTI and perfusion measures in each region. RESULTS: In the RRMS group, CBF and CBV were significantly correlated with MD in the splenium (r = 0.83 and r = 0.63, respectively; both P < .001) and in the central body (r = 0.86 and r = 0.65, respectively; both P < .001), but not in the genu (r = 0.23 and 0.25, respectively; both P is nonsignificant). No significant correlations were found between MTT and DTI measures or between FA and any perfusion measure in the RRMS group. No significant correlations between diffusion and perfusion metrics were found in control subjects. CONCLUSION: In the normal-appearing corpus callosum of patients with RRMS, decreasing perfusion is correlated with decreasing MD. These findings are more consistent with what would be expected in primary ischemia than in secondary hypoperfusion from WD.
— id: 72816, year: 2007, vol: 28, page: 767, stat: Journal Article,

Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP panel: clinical trial outcome measures
Steeves, J D; Lammertse, D; Curt, A; Fawcett, J W; Tuszynski, M H; Ditunno, J F; Ellaway, P H; Fehlings, M G; Guest, J D; Kleitman, N; Bartlett, P F; Blight, A R; Dietz, V; Dobkin, B H; Grossman, R; Short, D; Nakamura, M; Coleman, W P; Gaviria, M; Privat, A
2007 Mar;45(3):206-221, Spinal cord
An international panel reviewed the methodology for clinical trials of spinal cord injury (SCI), and provided recommendations for the valid conduct of future trials. This is the second of four papers. It examines clinical trial end points that have been used previously, reviews alternative outcome tools and identifies unmet needs for demonstrating the efficacy of an experimental intervention after SCI. The panel focused on outcome measures that are relevant to clinical trials of experimental cell-based and pharmaceutical drug treatments. Outcome measures are of three main classes: (1) those that provide an anatomical or neurological assessment for the connectivity of the spinal cord, (2) those that categorize a subject's functional ability to engage in activities of daily living, and (3) those that measure an individual's quality of life (QoL). The American Spinal Injury Association impairment scale forms the standard basis for measuring neurologic outcomes. Various electrophysiological measures and imaging tools are in development, which may provide more precise information on functional changes following treatment and/or the therapeutic action of experimental agents. When compared to appropriate controls, an improved functional outcome, in response to an experimental treatment, is the necessary goal of a clinical trial program. Several new functional outcome tools are being developed for measuring an individual's ability to engage in activities of daily living. Such clinical end points will need to be incorporated into Phase 2 and Phase 3 trials. QoL measures often do not correlate tightly with the above outcome tools, but may need to form part of Phase 3 trial measures
— id: 119262, year: 2007, vol: 45, page: 206, stat: Journal Article,

Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP Panel: clinical trial inclusion/exclusion criteria and ethics
Tuszynski, M H; Steeves, J D; Fawcett, J W; Lammertse, D; Kalichman, M; Rask, C; Curt, A; Ditunno, J F; Fehlings, M G; Guest, J D; Ellaway, P H; Kleitman, N; Bartlett, P F; Blight, A R; Dietz, V; Dobkin, B H; Grossman, R; Privat, A
2007 Mar;45(3):222-231, Spinal cord
The International Campaign for Cures of Spinal Cord Injury Paralysis established a panel tasked with reviewing the methodology for clinical trials for spinal cord injury (SCI), and making recommendations on the conduct of future trials. This is the third of four papers. It examines inclusion and exclusion criteria that can influence the design and analysis of clinical trials in SCI, together with confounding variables and ethical considerations. Inclusion and exclusion criteria for clinical trials should consider several factors. Among these are (1) the enrollment of subjects at appropriate stages after SCI, where there is supporting data from animal models or previous human studies; (2) the severity, level, type, or size of the cord injury, which can influence spontaneous recovery rate and likelihood that an experimental treatment will clinically benefit the subject; and (3) the confounding effects of various independent variables such as pre-existing or concomitant medical conditions, other medications, surgical interventions, and rehabilitation regimens. An issue of substantial importance in the design of clinical trials for SCI is the inclusion of blinded assessments and sham surgery controls: every effort should be made to address these major issues prospectively and carefully, if clear and objective information is to be gained from a clinical trial. The highest ethical standards must be respected in the performance of clinical trials, including the adequacy and clarity of informed consent
— id: 119263, year: 2007, vol: 45, page: 222, stat: Journal Article,

Pattern of hemodynamic impairment in multiple sclerosis: dynamic susceptibility contrast perfusion MR imaging at 3.0 T
Adhya, Sumita; Johnson, Glyn; Herbert, Joseph; Jaggi, Hina; Babb, James S; Grossman, Robert I; Inglese, Matilde
2006 Dec;33(4):1029-1035, Neuroimage
This study aimed to determine regional pattern of tissue perfusion in the normal-appearing white matter (NAWM) of patients with primary-progressive (PP), relapsing-remitting (RR) multiple sclerosis (MS) and healthy controls, and to investigate the association between perfusion abnormalities and clinical disability. Using dynamic susceptibility contrast (DSC) perfusion MRI at 3 T, we studied 22 patients with clinically definite MS, 11 with PP-MS and 11 with RR-MS and 11 age- and gender-matched healthy volunteers. The MRI protocol included axial dual-echo, dynamic susceptibility contrast enhanced (DSC) T2*-weighted and post-contrast T1-weighted images. Absolute cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in the periventricular, frontal, occipital NAWM and in the splenium of the corpus callosum. Compared to controls, CBF and CBV were significantly lower in all NAWM regions in both PP-MS patients (p values from <0.0001 to 0.001) and RR-MS (p values from <0.0001 to 0.020). Compared to RR-MS, PP-MS patients showed significantly lower CBF in the periventricular NAWM (p=0.002) and lower CBV in the periventricular and frontal NAWM (p values: 0.0029 and 0.022). EDSS was significantly correlated with the periventricular CBF (r=-0.48, p=0.0016) and with the periventricular and frontal CBV (r=-0.42, p=0.015; r=-0.35, p=0.038, respectively). This study suggests that the hemodynamic abnormalities of NAWM have clinical relevance in patients with MS. DSC perfusion MRI might provide a relevant objective measure of disease activity and treatment efficacy
— id: 70833, year: 2006, vol: 33, page: 1029, stat: Journal Article,

The three and one-half year radiology residency
Grossman, Robert I; McGuinness, Georgeann
2006 Oct;27(9):1803-1803, AJNR. American journal of neuroradiology
— id: 70832, year: 2006, vol: 27, page: 1803, stat: Journal Article,

Diffusion tensor imaging in multiple sclerosis: assessment of regional differences in the axial plane within normal-appearing cervical spinal cord
Hesseltine, S M; Law, M; Babb, J; Rad, M; Lopez, S; Ge, Y; Johnson, G; Grossman, R I
2006 Jun-Jul;27(6):1189-1193, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Evaluation of the spinal cord is important in the diagnosis and follow-up of patients with multiple sclerosis. Our purpose was to investigate diffusion tensor imaging (DTI) changes in different regions of normal-appearing spinal cord (NASC) in relapsing-remitting multiple sclerosis (RRMS). METHODS: Axial DTI of the cervical spinal cord was performed in 24 patients with RRMS and 24 age- and sex-matched control subjects. Fractional anisotropy (FA) and mean diffusivity (MD) were calculated in separate regions of interest (ROIs) in the anterior, lateral, and posterior spinal cord, bilaterally, and the central spinal cord, at the C2-C3 level. Patients and control subjects were compared with respect to FA and MD with the use of an exact Mann-Whitney test. Logistic regression and receiver operating characteristic (ROC) curve analysis assessed the utility of each measure for the diagnosis of RRMS. RESULTS: DTI metrics in areas of NASC in MS were significantly different in patients compared with control subjects; FA was lower in the lateral (mean +/- SD of 0.56 +/- 0.10 versus 0.69 +/- 0.09 in control subjects, P < .0001), posterior (0.52 +/- 0.11 versus 0.63 +/- 0.10, P < .0001), and central (0.53 +/- 0.10 versus 0.58 +/- 0.10, P = .049) NASC ROIs. Assessing DTI metrics in the diagnosis of MS, a sensitivity of 87.0% (95% confidence interval [CI], 66.4 to 97.1) and a specificity of 91.7% (95% CI, 73.0 to 98.7) were demonstrated. CONCLUSION: The NASC in RRMS demonstrates DTI changes. This may prove useful in detecting occult spinal cord pathology, predicting clinical course, and monitoring disease progression and therapeutic effect in MS
— id: 67533, year: 2006, vol: 27, page: 1189, stat: Journal Article,

Clinical significance of dilated Virchow-Robin spaces in mild traumatic brain injury
Inglese, Matilde; Grossman, Robert I; Diller, Leonard; Babb, James S; Gonen, Oded; Silver, Jonathan M A; Rusinek, Henry
2006 Jan;20(1):15-21, Brain injury
PRIMARY OBJECTIVE: To investigate the relationship between the number of dilated Virchow-Robin spaces (VRS) and neurocognitive findings in patients with traumatic brain injury (TBI). RESEARCH DESIGN: Thirty-eight patients with TBI and 21 controls were studied. METHODS AND PROCEDURES: Fifteen patients underwent MRI within a mean interval of 5.4 (range 1-12) days from the brain injury and 23 after an average period of 5.5 (range 0.2-31) years. All subjects were examined with a battery of 13 neuropsychological tests (NP). MAIN OUTCOMES AND RESULTS: The average number of VRS was significantly higher in patients than in controls. There were no significant differences between patients and controls in terms of NP tests. The number of VRS showed a significant inverse correlation with processing speed and a positive correlation with visual perceptual of attention only in patients studied within a short delay of trauma. CONCLUSIONS: VRS are not directly associated to neurocognitive findings, suggesting that they may represent a result of the shear-strain injury
— id: 66693, year: 2006, vol: 20, page: 15, stat: Journal Article,

Advantages of parallel imaging in conjunction with hyperpolarized helium--a new approach to MRI of the lung
Lee, Ray F; Johnson, Glyn; Grossman, Robert I; Stoeckel, Bernd; Trampel, Robert; McGuinness, Georgeann
2006 May;55(5):1132-1141, Magnetic resonance in medicine
Hyperpolarized helium (3He) gas MRI has the potential to assess pulmonary function. The non-equilibrium state of hyperpolarized 3He results in the continual depletion of the signal level over the course of excitations. Under non-equilibrium conditions the relationship between the signal-to-noise ratio (SNR) and the number of excitations significantly deviates from that established in the equilibrium state. In many circumstances the SNR increases or remains the same when the number of data acquisitions decreases. This provides a unique opportunity for performing parallel MRI in such a way that both the temporal and spatial resolution will increase without the conventional decrease in the SNR. In this study an analytical relationship between the SNR and the number of excitations for any flip angle was developed. Second, the point-spread function (PSF) was utilized to quantitatively demonstrate the unconventional SNR behavior for parallel imaging in hyperpolarized gas MRI. Third, a 24-channel (24ch) receive and two-channel (2ch) transmit phased-array system was developed to experimentally prove the theoretical predictions with 3He MRI. The in vivo experimental results prove that significant temporal resolution can be gained without the usual SNR loss in an equilibrium system, and that the entire lung can be scanned within one breath-hold (approximately 13 s) by applying parallel imaging to 3D data acquisition
— id: 68279, year: 2006, vol: 55, page: 1132, stat: Journal Article,

Carotid artery stent implantation: evaluation with multi-detector row CT angiography and virtual angioscopy--initial experience
Orbach, Darren B; Pramanik, Bidyut K; Lee, Julie; Maldonado, Thomas S; Riles, Tom; Grossman, Robert I
2006 Jan;238(1):309-320, Radiology
Approval for this HIPAA-compliant study was obtained from the institutional review board; informed consent was not required for retrospective review of patient studies that had been performed for clinical evaluation. The purpose of this study was to retrospectively compare the accuracy of intrastent luminal diameter, as measured on transverse computed tomographic (CT) angiograms and virtual angioscopic views, with the manufacturer's specifications for phantom diameter and with digital subtraction angiographic (DSA) measurements of stent diameter obtained in patients. Intrastent diameter was measured by using standard and stent-optimized reconstruction kernels with three window settings. Endoluminal virtual angioscopic views of the stent-containing vessels were also generated. Measurements at CT angiography were compared with known specifications for the phantom and with DSA measurements in patients. Erroneous measurements of intrastent diameter occurred when a standard kernel and nonoptimized window settings were used. A set of parameters that minimized error relative to measurements obtained at DSA was also identified. Virtual angioscopy helped demonstrate morphologic aspects of stenosis that were otherwise difficult to appreciate
— id: 61246, year: 2006, vol: 238, page: 309, stat: Journal Article,

The variance of whole-brain N-Acetylaspartate quantification amongst sites and different MR scanners is statistically insignificant
Benedetti, B; Rigotti, DJ; Inglese, M; Filippi, M; Grossman, RI; Gonen, O
2005 MAR 22 ;64(6):A235-A235, Neurology
— id: 105099, year: 2005, vol: 64, page: A235, stat: Journal Article,

The variance of whole-brain N-acetylaspartate quantification amongst sites and different MR scanners is statistically insignificant
Benedetti, B; Rigotti, DJ; Inglese, M; Rovaris, M; Grossman, RI; Filippi, M; Gonen, O
2005 JUN ;252(2):58-58, Journal of neurology
— id: 98169, year: 2005, vol: 252, page: 58, stat: Journal Article,

Applications of Diffusion Tensor MR Imaging in Multiple Sclerosis
Ge, Yulin; Law, Meng; Grossman, Robert I
2005 Dec;1064:202-219, Annals of the New York Academy of Sciences
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system that is the most common cause of nontraumatic disability in young adults in the United States. In recent years, magnetic resonance imaging (MRI) has been established as an important paraclinical tool in MS for the assessment of clinical diagnosis, natural history, and treatment effects. In MS studies, there are many advantages to having a sensitive and reliable in vivo method for investigating the specific pathological changes of white matter and its integrity during the disease process. As a consequence, in the past decade, the application of MRI to the study of MS has been explored from conventional MRI to new advanced quantitative techniques with greater pathological specificity and sensitivity. Diffusion tensor imaging (DTI) is one of the most promising techniques with regard to MS. It quantifies the amount of nonrandom water diffusion within tissues and provides unique in vivo information about the pathological processes that affect water diffusion as a result of brain microstructural damage. This review outlines the current state of the art and future direction of DTI and fiber tractography in the study of MS disease
— id: 61244, year: 2005, vol: 1064, page: 202, stat: Journal Article,

Applications of Diffusion Tensor MR Imaging in Multiple Sclerosis
Ge, Yulin; Law, Meng; Grossman, Robert I
White matter in cognitive neuroscience: Advances in diffusion tensor imaging and its applications New York, NY, US: New York Academy of Sciences, 2005,
(from the chapter) Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system that is the most common cause of nontraumatic disability in young adults in the United States. In recent years, magnetic resonance imaging (MRI) has been established as an important paraclinical tool in MS for the assessment of clinical diagnosis, natural history, and treatment effects. In MS studies, there are many advantages to having a sensitive and reliable in vivo method for investigating the specific pathological changes of white matter and its integrity during the disease process. As a consequence, in the past decade, the application of MRI to the study of MS has been explored from conventional MRI to new advanced quantitative techniques with greater pathological specificity and sensitivity. Diffusion tensor imaging (DTI) is one of the most promising techniques with regard to MS. It quantifies the amount of nonrandom water diffusion within tissues and provides unique in vivo information about the pathological processes that affect water diffusion as a result of brain microstructural damage. This review outlines the current state of the art and future direction of DTI and fiber tractography in the study of MS disease.
— id: 4106, year: 2005, vol: , page: 202, stat: Chapter,

Prominent perivenular spaces in multiple sclerosis as a sign of perivascular inflammation in primary demyelination
Ge, Yulin; Law, Meng; Herbert, Joseph; Grossman, Robert I
2005 Oct;26(9):2316-2319, AJNR. American journal of neuroradiology
In this study, we describe prominent perivenular spaces as a sign that is seen on high-resolution (512 x 512) transverse T2-weighted MR images in patients with multiple sclerosis. The observed widening of perivenular space is depicted as a stringlike hyperintensity projecting radially and aligned with multiple sclerosis lesions (usually small), following the course and configuration of deep venular structures. This widening may be an important sign in differentiating primary (ie, in multiple sclerosis) from secondary causes of demyelination
— id: 61247, year: 2005, vol: 26, page: 2316, stat: Journal Article,

Dynamic susceptibility contrast perfusion MR imaging of multiple sclerosis lesions: characterizing hemodynamic impairment and inflammatory activity
Ge, Yulin; Law, Meng; Johnson, Glyn; Herbert, Joseph; Babb, James S; Mannon, Lois J; Grossman, Robert I
2005 Jun-Jul;26(6):1539-1547, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Perfusion measurement in multiple sclerosis (MS) may cast light on the disease pathogenesis and lesion development since vascular pathology is frequently demonstrated in the disease. This study was performed to investigate the perfusion characteristics in MS lesions using dynamic susceptibility contrast MR imaging (DSC-MRI) to better understand the hemodynamic changes in MS. METHODS: Seventeen patients with relapsing-remitting MS were studied with DSC-MRI. Perfusion measurements included cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT), were obtained in enhancing, non-enhancing lesions covered by DSC-MRI and contralateral normal appearing white matter (NAWM) in patients as well as normal white matter in seventeen control subjects. RESULTS: DSC-MRI data demonstrated reduced perfusion with significantly prolonged MTT (P < 0.001) in lesions and NAWM in patients compared with normal white matter in controls. Compared to contralateral NAWM, enhancing lesions demonstrate increased CBF (P = 0.007) and CBV (P < 0.0001), indicating inflammation-mediated vasodilatation. A K means cluster analysis was performed and identifies approximately 63.8% of non-enhancing lesions (Class 1) with significantly decreased perfusion (P < or = 0.0001) when compared with contralateral NAWM. In contrast, the remainder 36.2% non-enhancing lesions (Class 2) show increased CBV (P = 0.02) in a similar fashion to enhancing lesions and can be observed on quantitative color-coded maps even without blood-brain barrier breakdown. CONCLUSION: DSC-MRI measurements demonstrate potential for investigating hemodynamic abnormalities that are associated with inflammatory activity, lesion reactivity and vascular compromise in MS lesions. Non-enhancing lesions showed both low and high perfusion suggesting microvascular abnormalities with hemodynamic impairment and inflammatory reactivity that cannot be seen on conventional MRI
— id: 55965, year: 2005, vol: 26, page: 1539, stat: Journal Article,

Neuronal cell injury precedes brain atrophy in multiple sclerosis - Reply
Gonen, O; Ge, YL; Inglese, M; Grossman, RI
2005 JAN 11 ;64(1):176-176, Neurology
— id: 105100, year: 2005, vol: 64, page: 176, stat: Journal Article,

Introduction
Grossman RI
2005 ;Supplement:7-7 Jan, Applied radiology
— id: 51754, year: 2005, vol: Supplement, page: 7, stat: Journal Article,

"Andrei I. Holodny, MD, founding President of the American Society of Functional Neuroradiology"
Grossman, RI
2005 JAN ;26(1):186-186, AJNR. American journal of neuroradiology
— id: 48698, year: 2005, vol: 26, page: 186, stat: Journal Article,

Relapsing-remitting multiple sclerosis: metabolic abnormality in nonenhancing lesions and normal-appearing white matter at MR imaging: initial experience
He, Juan; Inglese, Matilde; Li, Belinda S Y; Babb, James S; Grossman, Robert I; Gonen, Oded
2005 Jan;234(1):211-217, Radiology
PURPOSE: To quantify, with three-dimensional proton magnetic resonance (MR) spectroscopy, metabolic characteristics of normal-appearing white matter and nonenhancing lesions in patients with relapsing-remitting multiple sclerosis (MS). MATERIALS AND METHODS: Institutional review board approval and informed patient consent were obtained. Nine patients with relapsing-remitting MS (six women, three men) and nine age-matched control subjects (seven women, two men) were studied with T1- and T2-weighted MR imaging and three-dimensional proton MR spectroscopy at spatial resolution less than a cubic centimeter. Absolute N-acetylaspartate (NAA), creatine (Cr), and choline (Cho) levels were obtained from 171 voxels: 66 from lesions on T2-weighted MR images (43 hypointense and 23 isointense on T1-weighted MR images), 31 from normal-appearing white matter, and 74 from analogous normal white matter regions on images in control subjects. RESULTS: Mean NAA level in hypointense lesions (5.30 mmol/L +/- 2.27 [standard deviation]) was significantly lower (P < or = .05) than that in isointense lesions (7.82 mmol/L +/- 2.28), normal-appearing white matter (7.37 mmol/L +/- 1.71), and normal white matter in control subjects (8.89 mmol/L +/- 1.54). Cho (1.79 mmol/L +/- 0.65) and Cr (5.64 mmol/L +/- 1.50) levels in isointense lesions were indistinguishable from those in normal-appearing white matter (1.74 mmol/L +/- 0.46 and 4.99 mmol/L +/- 0.97, respectively) but were significantly higher (Cho, 20%; Cr, 24%) than those in normal white matter in control subjects (1.44 mmol/L +/- 0.40 and 4.30 mmol/L +/- 1.32, respectively). NAA, Cho, and Cr levels in normal-appearing white matter were significantly different than those in normal white matter in control subjects (NAA, 20% lower; Cho, 14% higher; and Cr, 17% higher). CONCLUSION: Abnormal metabolic activity persists in all MS tissue types. Increased Cr and Cho levels suggest (a) ongoing gliosis and attempted remyelination in isointense lesions on T1-weighted MR images and (b) membrane turnover (de- and remyelination), in addition to increased cellularity (gliosis, inflammation) in normal-appearing white matter
— id: 48238, year: 2005, vol: 234, page: 211, stat: Journal Article,

Dilated perivascular spaces: hallmarks of mild traumatic brain injury
Inglese, Matilde; Bomsztyk, Elan; Gonen, Oded; Mannon, Lois J; Grossman, Robert I; Rusinek, Henry
2005 Apr;26(4):719-724, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Recent animal and human studies have shown an increased frequency of enlarged, high-convexity Virchow-Robin spaces (VRS) in several neurologic diseases, suggesting their role as neuroradiologic markers of inflammatory changes. The aim of this study was to determine the prevalence of high-convexity dilated VRS in mild traumatic brain injury (TBI). METHODS: T2-weighted, T1-weighted, fluid-attenuated inversion recovery, and T2*-weighted gradient-echo brain MR images were acquired in 24 patients with TBI (10 women, 14 men; mean age, 33.6; range, 18.1-50.8 years) and 17 age- and sex-matched healthy control subjects (nine women, eight men; mean age, 32.8; range, 18.4-47.8 years). The mean interval after TBI was 3.6 days (range, 1-9 days) in 15 patients and 3.7 years (range, 0.6-13.4 years) in nine patients. Axial T2-weighted images were used to identify dilated VRS and to measure CSF volume; T1-weighted images were used to measure brain volume. Dilated VRS were identified as punctuate areas with CSF-like signal intensity in the high-convexity white matter. RESULTS: Mean (+/- standard deviation) number of VRS was significantly higher in patients (7.1 +/- 4.6) than in controls (2.4 +/- 2.9, P < .0003). In controls, VRS were associated with age (R = 0.69, P < .001) whereas in patients, they neither correlated with brain and CSF volumes nor with age and the elapsed time from injury. CONCLUSION: Our results suggest that the increased number of dilated VRS is a radiologic marker of mild head injury that is readily detectable on T2-weighted images. Because their number does not vary with time from injury, VRS probably reflect early and permanent brain changes
— id: 56042, year: 2005, vol: 26, page: 719, stat: Journal Article,

Magnetic resonance imaging monitoring of multiple sclerosis lesion evolution
Inglese, Matilde; Grossman, Robert I; Filippi, Massimo
2005 Oct;15(4 Suppl):22S-29S, Journal of neuroimaging
The characteristic feature of multiple sclerosis (MS) pathology is the demyelinated plaque distributed throughout the central nervous system. Although MS is a primary demyelinating disease, acute axonal injury is common in actively demyelinating MS lesions and it is considered one of the major determinants of neurological deficit. Magnetic resonance imaging (MRI) has had a dramatic impact on MS in both the clinical practice and basic science settings. Techniques such as T2-weighted and gadolinium-enhanced T1-weighted MRI are very sensitive in detecting lesions and, thus, increase the level of certainty of MS diagnosis. Conventional MRI has also improved our understanding of the pathogenesis of the disease and has provided objective and reliable measures to monitor the effect of experimental treatments in clinical trials. However, conventional MR;I does not provide specific information on the heterogeneous pathologic substrate of MS lesions. Advanced MRI techniques, such as magnetization transfer imaging, diffusion tensor imaging, and proton MR spectroscopy, offer the unprecedented ability to observe and quantify pathological changes in lesions and normal-appearing brain tissue over time. The present review will discuss the major contributions of conventional MRI and quantitative MRI techniques to understand how individual MS lesions evolve
— id: 61245, year: 2005, vol: 15, page: 22S, stat: Journal Article,

Diffuse axonal injury in mild traumatic brain injury: a diffusion tensor imaging study
Inglese, Matilde; Makani, Sachin; Johnson, Glyn; Cohen, Benjamin A; Silver, Jonathan A; Gonen, Oded; Grossman, Robert I
2005 Aug;103(2):298-303, Journal of neurosurgery
OBJECT: Diffuse axonal injury (DAI) is a major complication of traumatic brain injury (TBI) that leads to functional and psychological deficits. Although DAI is frequently underdiagnosed by conventional imaging modalities, it can be demonstrated using diffusion tensor imaging. The aim of this study was to assess the presence and extent of DAI in patients with mild TBI. METHODS: Forty-six patients with mild TBI and 29 healthy volunteers underwent a magnetic resonance (MR) imaging protocol including: dual-spin echo, fluid-attenuated inversion recovery, T2-weighted gradient echo, and diffusion tensor imaging sequences. In 20 of the patients, MR imaging was performed at a mean of 4.05 days after injury. In the remaining 26, MR imaging was performed at a mean of 5.7 years after injury. In each case, mean diffusivity and fractional anisotropy were measured using both whole-brain histograms and regions of interest analysis. No differences in any of the histogram-derived measures were found between patients and control volunteers. Compared with controls, a significant reduction of fractional anisotropy was observed in patients' corpus callosum, internal capsule, and centrum semiovale, and there were significant increases of mean diffusivity in the corpus callosum and internal capsule. Neither histogram-derived nor regional diffusion tensor imaging metrics differed between the two groups. CONCLUSIONS: Although mean diffusivity and fractional anisotropy abnormalities in these patients with TBI were too subtle to be detected with the whole-brain histogram analysis, they are present in brain areas that are frequent sites of DAI. Because diffusion tensor imaging changes are present at both early and late time points following injury, they may represent an early indicator and a prognostic measure of subsequent brain damage.
— id: 58178, year: 2005, vol: 103, page: 298, stat: Journal Article,

Neuronal cell injury precedes brain atrophy in multiple sclerosis
Ge, Y; Gonen, O; Inglese, M; Babb, J S; Markowitz, C E; Grossman, R I
2004 Feb 24;62(4):624-627, Neurology
Global brain atrophy estimated using MRI and whole brain N-acetylaspartate (WBNAA) concentration measured with proton MR spectroscopy were obtained in 42 patients with relapsing-remitting multiple sclerosis and 41 matched control subjects. Patients exhibited cross-sectional atrophy (0.5%; p = 0.033) and WBNAA decline (1.8%/y; p = 0.005) vs disease duration. The 3.6-fold rate disparity between the two processes suggests that neuronal/axonal dysfunction (N-acetylaspartate decline) precedes parenchyma loss, not its consequence (i.e., is an earlier, more sensitive specific metric of the ongoing disease activity)
— id: 43785, year: 2004, vol: 62, page: 624, stat: Journal Article,

Preferential occult injury of corpus callosum in multiple sclerosis measured by diffusion tensor imaging
Ge, Yulin; Law, Meng; Johnson, Glyn; Herbert, Joseph; Babb, James S; Mannon, Lois J; Grossman, Robert I
2004 Jul;20(1):1-7, Journal of magnetic resonance imaging
PURPOSE: To investigate the feasibility of diffusion tensor imaging (DTI) assessment of microscopic fiber tract injury in the corpus callosum (CC) and other normal-appearing white matter (NAWM) in patients with early multiple sclerosis (MS). MATERIALS AND METHODS: DTI was performed in 12 healthy volunteers and 15 patients who have relatively short disease duration (mean = 2.7 years). Both fractional anisotropy (FA) and mean diffusivity (MD) were obtained in different regions of normal-appearing CC (NACC) and NAWM in frontal and occipital regions. RESULTS: The data showed significantly lower FA (P < 0.001) and higher MD (P < 0.04) for NACC regions, but not for frontal and occipital NAWM regions, in patients than in those in healthy volunteers after Bonferroni adjustment. The increase of MD in the entire NACC regions was correlated with the total cerebral lesion volume (r = 0.75, P = 0.001) in patients. CONCLUSION: The water diffusion changes indicate that in the early phase of disease there is a preferential occult injury of CC, which is likely due to the Wallerian degeneration from distant lesions
— id: 43221, year: 2004, vol: 20, page: 1, stat: Journal Article,

MRI spectroscopy of the normal appearing gray matter
Gonen O; inglese M; Grossman RI
Normal-appearing white and grey matter damage in multiple sclerosis Milan ; New York : Springer, 2004,
— id: 3797, year: 2004, vol: , page: ?, stat: Chapter,

Introduction
Grossman RI
2004 ;Supplement:5- Jan, Applied radiology
— id: 80320, year: 2004, vol: Supplement, page: 5, stat: Journal Article,

Introduction
Grossman RI; Marx L
2004 ;33(1 Suppl):5-5, Applied radiology
— id: 46352, year: 2004, vol: 33, page: 5, stat: Journal Article,

Incidental research imaging findings: Pandora's costly box
Grossman, Robert I; Bernat, James L
2004 Mar 23;62(6):849-850, Neurology
— id: 43944, year: 2004, vol: 62, page: 849, stat: Journal Article,

Three-dimensional proton spectroscopy of deep gray matter nuclei in relapsing-remitting MS
Inglese, M; Liu, S; Babb, J S; Mannon, L J; Grossman, R I; Gonen, O
2004 Jul 13;63(1):170-172, Neurology
The metabolic changes in the deep gray matter (GM) nuclei, thalamus, and basal ganglia of patients with relapsing-remitting multiple sclerosis were investigated with quantitative, multivoxel, three-dimensional proton MR spectroscopy. This technique facilitated the study of several bilateral structures in a single session at sub-cubic centimeter spatial resolution. Compared with 9 matched control subjects, the deep GM nuclei of 11 patients showed 7% lower N-acetylaspartate and 14% higher choline levels (p = 0.02 for both)
— id: 43793, year: 2004, vol: 63, page: 170, stat: Journal Article,

Indirect evidence for early widespread gray matter involvement in relapsing-remitting multiple sclerosis
Inglese, Matilde; Ge, Yulin; Filippi, Massimo; Falini, Andrea; Grossman, Robert I; Gonen, Oded
2004 Apr;21(4):1825-1829, Neuroimage
Multiple sclerosis (MS) has traditionally been viewed as an inflammatory demyelinating white matter (WM) disease of the central nervous system. However, recent pathology and MRI studies have shown lesions in the gray matter (GM) as well. To ascertain the extent of GM involvement, we obtained with nonlocalizing proton MR spectroscopy the concentration of N-acetylaspartate (NAA), a metabolite found almost exclusively in neuronal cells, T2-lesion loads, and GM and WM fractions in the entire brain of 71 relapsing-remitting (RR) MS patients (51 women, 20 men, 25-55 years old) and 41 healthy controls (27 women, 14 men, 23-55 years old). The average whole-brain NAA (WBNAA) difference between the patients and the controls was -2.9 mM (-22%, P < 0.0001); range: +1.2 to -7.8 mM (+8% to -63%). The patients' median T2 lesion volume was 5.5 (range: 0.140-28) cm(3). GM and WM comprised 50.4 +/- 3.8% and 30.4 +/- 5.0% (mean +/- standard deviation), respectively, of the total brain volume in the patients; 53.8 +/- 3.7% and 35.4 +/- 4.7% in the controls. Because WM and GM constitute approximately 40% and 60% of the brain parenchyma, respectively, and the NAA concentration in the former is 2/3 of the latter, WBNAA loss greater than 40% x 2/3 = 27% cannot be explained in terms of WM (axonal) pathology alone and must include widespread GM (neuronal) deficits. Therefore, the concept of MS, even at its earlier stages, as a WM disease might need to be reexamined
— id: 42809, year: 2004, vol: 21, page: 1825, stat: Journal Article,

Microvascular abnormality in relapsing-remitting multiple sclerosis: perfusion MR imaging findings in normal-appearing white matter
Law, Meng; Saindane, Amit M; Ge, Yulin; Babb, James S; Johnson, Glyn; Mannon, Lois J; Herbert, Joseph; Grossman, Robert I
2004 Jun;231(3):645-652, Radiology
PURPOSE: To prospectively determine hemodynamic changes in the normal-appearing white matter (NAWM) of patients with relapsing-remitting multiple sclerosis (RR-MS) by using dynamic susceptibility contrast material-enhanced perfusion magnetic resonance (MR) imaging. MATERIALS AND METHODS: Conventional MR imaging (which included acquisition of pre- and postcontrast transverse T1-weighted, fluid-attenuated inversion recovery, and T2-weighted images) and dynamic susceptibility contrast-enhanced T2*-weighted MR imaging were performed in 17 patients with RR-MS (five men and 12 women; median age, 38.4 years; age range, 27.6-56.9 years) and 17 control patients (seven men and 10 women; median age, 42.0 years; age range, 18.7-62.5 years). Absolute cerebral blood volume (CBV), absolute cerebral blood flow (CBF), and mean transit time (MTT) (referenced to an arterial input function by using an automated method) were determined in periventricular, intermediate, and subcortical regions of NAWM at the level of the lateral ventricles. Least-squares regression analysis (controlled for age and sex) was used to compare perfusion measures in each region between patients with RR-MS and control patients. Repeated-measures analysis of variance and the Tukey honestly significant difference test were used to perform pairwise comparison of brain regions in terms of each perfusion measure. RESULTS: Each region of NAWM in patients with RR-MS had significantly decreased CBF (P <.005) and prolonged MTT (P <.001) compared with the corresponding region in control patients. No significant differences in CBV were found between patients with RR-MS and control patients in any of the corresponding areas of NAWM examined. In control patients, periventricular NAWM regions had significantly higher CBF (P =.03) and CBV (P =.04) than did intermediate NAWM regions. No significant regional differences in CBF, CBV, or MTT were found in patients with RR-MS. CONCLUSION: The NAWM of patients with RR-MS shows decreased perfusion compared with that of controls
— id: 43784, year: 2004, vol: 231, page: 645, stat: Journal Article,

Diffusion-tensor MR imaging of intracranial neoplasia and associated peritumoral edema: introduction of the tumor infiltration index
Lu, Stanley; Ahn, Daniel; Johnson, Glyn; Law, Meng; Zagzag, David; Grossman, Robert I
2004 Jul;232(1):221-228, Radiology
PURPOSE: To determine whether diffusion-tensor magnetic resonance (MR) imaging metrics of peritumoral edema can be used to differentiate intra- from extraaxial lesions, metastatic lesions from gliomas, and high- from low-grade gliomas. MATERIALS AND METHODS: In this study, diffusion-tensor MR imaging was performed preoperatively in 40 patients with intracranial neoplasms, including meningiomas, metastatic lesions, glioblastomas multiforme, and low-grade gliomas. Histograms of mean diffusivity (MD) and fractional anisotropy (FA) were used to analyze both the tumor and the associated T2 signal intensity abnormality. An additional metric, the tumor infiltration index (TII), was evaluated. The TII is a measure of the change in FA presumably caused by tumor cells infiltrating the peritumoral edema. Student t test and least-squares linear regression analyses were performed. RESULTS: Peritumoral MD and FA values indicated no statistically significant difference between intra- and extraaxial lesions or between high- and low-grade gliomas. Regarding intraaxial tumors, the measured mean peritumoral MD of metastatic lesions, 0.733 x 10(-3) mm(2)/sec +/- 0.061 (SD), was significantly higher than that of gliomas, 0.587 +/- 0.093 x 10(-3) mm(2)/sec (P <.05). There was also a statistically significant difference between the TIIs of the edema surrounding meningiomas and metastases (mean, 0 +/- 35) and the TIIs of the edema surrounding gliomas (mean, 64 +/- 59) (P <.05). CONCLUSION: Peritumoral diffusion-tensor MR imaging metrics enable the differentiation of solitary intraaxial metastatic brain tumors from gliomas. In addition, the TII enables one to distinguish presumed tumor-infiltrated edema from purely vasogenic edema
— id: 43223, year: 2004, vol: 232, page: 221, stat: Journal Article,

[Quid? Ossification of the posterior common vertebral ligament]
Bonneville, F; Grossman, R I
2003 Dec;84(12 Pt 1):1991-1993, Journal de radiologie
— id: 43945, year: 2003, vol: 84, page: 1991, stat: Journal Article,

Evidence for widespread axonal damage at the earliest clinical stage of multiple sclerosis
Filippi, M; Bozzali, M; Rovaris, M; Gonen, O; Kesavadas, C; Ghezzi, A; Martinelli, V; Grossman, R I; Scotti, G; Comi, G; Falini, A
2003 Feb;126(Pt 2):433-437, Brain
Although axonal pathology is recognized as one of the major pathological features of multiple sclerosis, it is less clear how early in its course it occurs and how it correlates with MRI-visible lesion loads. To assess this early axonal pathology, we quantified the concentration of whole-brain N-acetylaspartate (WBNAA) in a group of patients at the earliest clinical stage of the disease and compared the results with those from healthy controls. Conventional brain MRI and WBNAA using unlocalized proton magnetic resonance spectroscopy were obtained from 31 patients at presentation with clinically isolated syndromes suggestive of multiple sclerosis and paraclinical evidence of dissemination in space, and from 16 matched controls. An additional conventional MRI scan was obtained in all patients 4-6 months later to detect dissemination of lesions in time. The mean WBNAA concentration was significantly lower in patients compared with the controls (P < 0.0001). It was not significantly different between patients with and without enhancing lesions at the baseline MRI or between patients with and without lesion dissemination in time. No correlation was found between WBNAA concentrations and lesion volumes. Widespread axonal pathology, largely independent of MRI-visible inflammation and too extensive to be completely reversible, occurs in patients even at the earliest clinical stage of multiple sclerosis. This finding lessens the validity of the current concept that the axonal pathology of multiple sclerosis is the end-stage result of repeated inflammatory events, and argues strongly in favour of early neuroprotective intervention
— id: 43794, year: 2003, vol: 126, page: 433, stat: Journal Article,

The utility of MRI in suspected MS: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology
Frohman, E M; Goodin, D S; Calabresi, P A; Corboy, J R; Coyle, P K; Filippi, M; Frank, J A; Galetta, S L; Grossman, R I; Hawker, K; Kachuck, N J; Levin, M C; Phillips, J T; Racke, M K; Rivera, V M; Stuart, W H
2003 Sep 9;61(5):602-611, Neurology
Advancements in imaging technologies and newly evolving treatments offer the promise of more effective management strategies for MS. Until recently, confirmation of the diagnosis of MS has generally required the demonstration of clinical activity that is disseminated in both time and space. Nevertheless, with the advent of MRI techniques, occult disease activity can be demonstrated in 50 to 80% of patients at the time of the first clinical presentation. Prospective studies have shown that the presence of such lesions predicts future conversion to clinically definite (CD) MS. Indeed, in a young to middle-aged adult with a clinically isolated syndrome (CIS), once alternative diagnoses are excluded at baseline, the finding of three or more white matter lesions on a T2-weighted MRI scan (especially if one of these lesions is located in the periventricular region) is a very sensitive predictor (>80%) of the subsequent development of CDMS within the next 7 to 10 years. Moreover, the presence of two or more gadolinium (Gd)-enhancing lesions at baseline and the appearance of either new T2 lesions or new Gd enhancement on follow-up scans are also highly predictive of the subsequent development of CDMS in the near term. By contrast, normal results on MRI at the time of clinical presentation makes the future development of CDMS considerably less likely
— id: 43946, year: 2003, vol: 61, page: 602, stat: Journal Article,

Dirty-appearing white matter in multiple sclerosis: volumetric MR imaging and magnetization transfer ratio histogram analysis
Ge, Yulin; Grossman, Robert I; Babb, James S; He, Juan; Mannon, Lois J
2003 Nov-Dec;24(10):1935-1940, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: In contrast to 'normal-appearing' white matter (NAWM) in patients with multiple sclerosis (MS), there are subtle, abnormal and diffuse signal intensity changes often seen on T2-weighted MR images, which we have referred to as 'dirty-appearing' white matter (DAWM). These areas of DAWM have slightly higher signal intensity than that of NAWM, but lower than that of lesion plaques. Our study was designed to determine the volumetric and magnetization transfer ratio (MTR) features of DAWM in patients with MS. METHODS: Dual-echo fast spin-echo MR imaging and magnetization transfer imaging were performed in 22 patients with relapsing-remitting MS. Slightly hyperintense DAWM areas were manually outlined on the basis of T2-weighted imaging findings. The volume and MTR of DAWM were calculated and compared with the volume and MTR of NAWM and T2 lesion plaques. RESULTS: The average volume of DAWM (18.3 mL) was greater than the average volume of T2 lesion plaques (11.0 mL, P =.04), and the mean MTR in DAWM (38.7%) differed significantly (P <.0001) from that in NAWM (40.7%) and plaques (33.3%). There was a modest negative correlation between either mean MTR (r = -0.60; P =.003) of DAWM or peak height (r = -0.50; P =.02) of DAWM with T2 lesion load. Neither DAWM volume nor total T2 abnormality (DAWM + plaques) volume correlates with the Expanded Disability Status Scale. CONCLUSION: The results of this study indicate that MTR is able to differentiate DAWM from lesion plaques and NAWM and that DAWM might be a different pathologic process of the disease. The notion and quantification of these subtle imaging findings of DAWM areas may improve our understanding of certain stages of disease progression and disease burden in patients with relapsing-remitting MS
— id: 43786, year: 2003, vol: 24, page: 1935, stat: Journal Article,

Whole brain imaging of HIV-infected patients: quantitative analysis of magnetization transfer ratio histogram and fractional brain volume
Ge, Yulin; Kolson, Dennis L; Babb, James S; Mannon, Lois J; Grossman, Robert I
2003 Jan;24(1):82-87, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Magnetization transfer ratio (MTR) histogram analysis and volumetric MR imaging are sensitive tools with which to quantify the tissue destructive effects in patients with white matter or neurodegenerative disease. Our purpose was to determine whether whole brain MTR and fractional brain parenchyma volume measurements are altered in HIV-1-infected patients who are neurologically symptomatic and in those who are asymptomatic. METHODS: We performed MR imaging and MTR studies of 15 neurologically symptomatic (seven patients) and asymptomatic (eight patients) HIV-1-seropositive patients and compared their findings with those of 10 seronegative normal control participants. MTR was computed on the basis of whole brain parenchyma segmented by using thin section dual echo MR images. RESULTS: The loss of brain tissue, indicated by fractional brain parenchyma volume, was more pronounced in neurologically symptomatic patients (P =.003) but not in asymptomatic patients (P =.23) when compared with control participants. As for whole brain MTR histogram analysis, both patient groups showed significant decrease in mean (P =.02) and median (P < or =.009) values, compared with normal control participants. There was a trend toward positive correlation (r > or = 0.56) between MTR histogram statistics and fractional brain parenchyma volume. CONCLUSION: Our results suggest that MTR histogram analysis is sensitive in detecting early involvement in neurologically asymptomatic patients with HIV and may, therefore, be used as a combined tool with volumetric measurement, which showed significant tissue loss only in symptomatic patients, to assess various stages of brain damage induced by HIV
— id: 39325, year: 2003, vol: 24, page: 82, stat: Journal Article,

Global brain proton MR spectroscopy in MS
Gonen O; Grossman RI
New frontiers of MR-based techniques in multiple sclerosis Milano ; New York : Springer, 2003,
— id: 3796, year: 2003, vol: , page: 47, stat: Chapter,

Neuroradiology : the requisites
Grossman RI; Yousem DM
Philadelphia : Mosby, 2003,
— id: 775, year: 2003, vol: , page: , stat: ,

Diffusely elevated cerebral choline and creatine in relapsing-remitting multiple sclerosis
Inglese, Matilde; Li, Belinda S Y; Rusinek, Henry; Babb, James S; Grossman, Robert I; Gonen, Oded
2003 Jul;50(1):190-195, Magnetic resonance in medicine
It is well known that multiple sclerosis (MS) pathogenesis continues even during periods of clinical silence. To quantify the metabolic characteristics of this activity we compared the absolute levels of N-acetylaspartate (NAA), creatine (Cr), and choline (Cho) in the normal-appearing white matter (NAWM) between relapsing-remitting (RR) MS patients and controls. Metabolite concentrations were obtained with 3D proton MR spectroscopy at 1.5 T in a 480 cm(3) volume-of-interest (VOI), centered on the corpus callosum of 11 MS patients and 9 matched controls. Gray/white-matter/cerebral-spinal-fluid (CSF) volumes were obtained from MRI segmentation. Patients' average VOI tissue volume (V(T)), 410.8 +/- 24.0 cm(3), and metabolite levels, NAA = 6.33 +/- 0.70, Cr = 4.67 +/- 0.52, Cho = 1.40 +/- 0.17 mM, were different from the controls by -8%, -9%, +22% and +32%. The Cho level was the only single metric differentiating patients from controls at 100% specificity and >90% sensitivity. Diffusely elevated Cho and Cr probably reflect widespread microscopic inflammation, gliosis, or de- and remyelination in the NAWM. Both metabolites are potential prognostic indicators of current disease activity, preceding NAA decline and atrophy
— id: 39190, year: 2003, vol: 50, page: 190, stat: Journal Article,

Brain metabolite profiles of T1-hypointense lesions in relapsing-remitting multiple sclerosis
Li, Belinda S Y; Regal, Juleiga; Soher, Brian J; Mannon, Lois J; Grossman, Robert I; Gonen, Oded
2003 Jan;24(1):68-74, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Persistent T1-hypointense lesions ('black holes') are thought to represent permanent damage of brain parenchyma. We attempted to ascertain whether the metabolic profiles of these hypointense areas support this hypothesis and whether these profiles correlate with these hypointense findings. METHODS: Four patients with relapsing-remitting multiple sclerosis and four matched control volunteers underwent MR imaging and 3D proton MR spectroscopy. Absolute levels of N-acetylaspartate (NAA), creatine, and choline (Cho) were obtained in 0.19 cm(3) voxels containing 14 T1-hypointense lesions (average volume, 0.4 cm(3); range, 0.2-1.0 cm(3)) in patients. Metabolite levels were analyzed, by using Pearson correlation, against their respective lesions' hypointensity relative to the surrounding normal-appearing white matter. RESULTS: Moderate correlation, r = 0.56, was found between the NAA level and MR imaging hypointensity. Of the 14 lesions studied, 12 were deficient in NAA and 11 had excess Cho compared with corresponding brain regions in control volunteers. Only one lesion was significantly deficient in all three metabolites, indicative of total damage or matrix loss. CONCLUSION: No relationship was found between the hypointensity of the lesions and their metabolic profile. Specifically, lesions with the same hypointensity on T1-weighted MR images were metabolically variable (ie, displayed disparate metabolite levels and behavior). Also, although 86% of the lesions exhibited abnormally low NAA, 71% also had increased Cho. This indicates that although neuronal damage had already occurred (lower NAA), these lesions were still 'smoldering' with active membrane turnover (high Cho), most likely because of de- and remyelination, indicative of shadow plaques (remyelinated lesions). Consequently, relapsing-remitting hypointense lesions represent neither final-stage nor static pathologic abnormality
— id: 39326, year: 2003, vol: 24, page: 68, stat: Journal Article,

Whole-brain N-acetylaspartate level and cognitive performance in HIV infection
Patel, Sohil H; Inglese, Matilde; Glosser, Guila; Kolson, Dennis L; Grossman, Robert I; Gonen, Oded
2003 Sep;24(8):1587-1591, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: In the brain of HIV-infected patients, proton MR spectroscopic studies are typically used to examine small volumes of tissue with single-voxel methods. Since brain disease is diffuse in patients with HIV, such studies preclude assessment of the true extent of the metabolic burden. To assess this extent, the relationship between global neuronal integrity, reflected by the whole-brain N-acetylaspartate (WBNAA) concentration, was correlated with neuropsychological function and the AIDS dementia complex (ADC) stage score. METHODS: WBNAA levels were compared between 15 HIV-infected patients (seven symptomatic, eight asymptomatic) and 13 age- and sex-matched healthy subjects. The patients' WBNAA level was correlated with cognitive performance, as measured with a battery of eight tests (NPZ-8), including the ADC stage score and four total-memory, mood, motor, and processing speed subtests. RESULTS: WBNAA levels were significantly different between patients and healthy subjects (mean +/- sigma, 11.82 +/- 1.40 and 12.91 +/- 1.03 mmol/L, respectively; P =.032) after we adjusted for age and sex effects. Intermediate negative correlations were found between the WBNAA level, the processing speed subtest score (r = -0.50, P =.03), and the ADC stage score (r = -0.44, P =.05). CONCLUSION: The WBNAA concentration complements brain atrophy data with information about the quality of the remaining neuronal and axonal tissue in patients with HIV infection. In HIV-infected patients, its correlation with processing speed and the ADC score indicates that the latter reflects pathologic deficits, which are extensive throughout the brain
— id: 39065, year: 2003, vol: 24, page: 1587, stat: Journal Article,

Whole-brain N-acetylaspartate concentration: correlation with T2-weighted lesion volume and expanded disability status scale score in cases of relapsing-remitting multiple sclerosis
Bonneville, Fabrice; Moriarty, David M; Li, Belinda S Y; Babb, James S; Grossman, Robert I; Gonen, Oded
2002 Mar;23(3):371-375, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: The T2-weighted MR imaging total lesion volume and Expanded Disability Status Scale (EDSS) score are two common measures of relapsing-remitting multiple sclerosis disability and pathologic abnormality. Because the whole-brain N-acetylaspartate concentration is considered to be a new marker of the disease burden, the purpose of this study was to evaluate the relationship among these three measures. METHODS: The whole-brain N-acetylaspartate concentration and T2-weighted lesion volume were quantified by using MR imaging and proton MR spectroscopy in 49 patients with relapsing-remitting multiple sclerosis (36 female and 13 male patients; average age, 39 years; age range, 24-55 years; average EDSS score, 2; range of EDSS scores, 0-6). Correlations among whole-brain N-acetylaspartate concentrations, T2-weighted lesion volumes, and EDSS scores were obtained. RESULTS: No correlation was found between whole-brain N-acetylaspartate levels and either T2-weighted lesion volumes or EDSS scores. A weak correlation was found between the EDSS scores and T2-weighted lesion volumes (P =.043, r(s) = 0.292). CONCLUSION: Despite the lack of correlation between whole-brain N-acetylaspartate concentration and the clinical disability reflected in the EDSS score, only the former evaluates the global neuronal cell disease in the entire brain, including those lesions that are occult to conventional imaging techniques
— id: 27732, year: 2002, vol: 23, page: 371, stat: Journal Article,

Whole brain N-acetylaspartate concentrations are reduced in patients at presentation with clinically isolated syndromes suggestive of MS
Filippi, M; Bozzali, M; Gambini, A; Rovaris, M; Falini, A; Ghezzi, A; Martinelli, V; Scotti, G; Gonen, O; Grossman, RI; Comi, G
2002 APR 9 ;58(7):A153-A154, Neurology
— id: 105109, year: 2002, vol: 58, page: A153, stat: Journal Article,

Role of magnetic resonance imaging in the diagnosis and monitoring of multiple sclerosis: consensus report of the White Matter Study Group
Filippi, M; Dousset, V; McFarland, H F; Miller, D H; Grossman, R I
2002 May;15(5):499-504, Journal of magnetic resonance imaging
On June 24-26, 2001, the first meeting of the White Matter Study Group (WMSG) of the International Society for Magnetic Resonance in Medicine (ISMRM) was held in Bordeaux, France. This paper is the report of the consensus reached among the delegates of the meeting on how to use magnetic resonance imaging (MRI) to make an early diagnosis of multiple sclerosis (MS), to measure MS activity accurately and reliably, and to monitor the effect of treatment on disease evolution
— id: 43950, year: 2002, vol: 15, page: 499, stat: Journal Article,

MRI techniques to monitor MS evolution: the present and the future
Filippi, Massimo; Grossman, Robert I
2002 Apr 23;58(8):1147-1153, Neurology
Conventional MRI (cMRI) is limited in its ability to provide specific information about pathology in MS. Measures commonly derived from cMRI include T2 lesions, T1-enhanced lesions, atrophy, and possibly T1-hypointense lesions, which have been extensively investigated in many clinical trials. Better MRI measures are needed to advance our understanding of MS and design ideal clinical trials. This article reviews the strengths and weaknesses of the major MRI-based methods used to monitor MS evolution and submits that 1) metrics derived from magnetization transfer MRI, diffusion-weighted MRI, and proton MRS should be implemented to achieve reliable specific in vivo quantification of MS pathology; 2) targeted multiparametric MRI protocols rather than generic application of cMRI should be used in all possible clinical circumstances and trials; and 3) reproducible quantitative MR measures should ideally be used for the assessment of patients but are essential for clinical trials
— id: 43951, year: 2002, vol: 58, page: 1147, stat: Journal Article,

Age-related total gray matter and white matter changes in normal adult brain. Part I: volumetric MR imaging analysis
Ge, Yulin; Grossman, Robert I; Babb, James S; Rabin, Marcie L; Mannon, Lois J; Kolson, Dennis L
2002 Sep;23(8):1327-1333, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: A technique of segmenting total gray matter (GM) and total white matter (WM) in human brain is now available. We investigated the effects of age and sex on total fractional GM (%GM) and total fractional WM (%WM) volumes by using volumetric MR imaging in healthy adults. METHODS: Fifty-four healthy volunteers (22 men, 32 women) aged 20-86 years underwent dual-echo fast spin-echo MR imaging. Total GM, total WM, and intracranial space volumes were segmented by using MR image-based computerized semiautomated software. Volumes were normalized as a percentage of intracranial volume (%GM and %WM) to adjust for variations in head size. Age and sex effects were then assessed. RESULTS: Both %GM and %WM in the intracranial space were significantly less in older subjects (> or =50 years) than in younger subjects (<50 years) (P <.0001 and P =.02, respectively). Consistently, %GM decreased linearly with age, beginning in the youngest subjects. %WM decreased in a quadratic fashion, with a greater rate beginning only in adult midlife. Although larger GM volumes were observed in men before adjustments for cranium size, no significant differences in %GM or %WM were observed between the sexes. CONCLUSION: GM volume loss appears to be a constant, linear function of age throughout adult life, whereas WM volume loss seems to be delayed until middle adult life. Both appear to be independent of sex. Quantitative analysis of %GM and %WM volumes can improve our understanding of brain atrophy due to normal aging; this knowledge may be valuable in distinguishing atrophy of disease patterns from characteristics of the normal aging process
— id: 43788, year: 2002, vol: 23, page: 1327, stat: Journal Article,

Age-related total gray matter and white matter changes in normal adult brain. Part II: quantitative magnetization transfer ratio histogram analysis
Ge, Yulin; Grossman, Robert I; Babb, James S; Rabin, Marcie L; Mannon, Lois J; Kolson, Dennis L
2002 Sep;23(8):1334-1341, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: The magnetization transfer ratio (MTR) is a sensitive and quantitative identifier of underlying structural changes in the brain. We quantitatively evaluated age- and sex-related MTR changes in global gray matter (GM) and global white matter (WM) in healthy adults. METHODS: Fifty-two healthy volunteers (21 men, 31 women) aged 20-86 years underwent dual-echo fast spin-echo and magnetization transfer imaging performed with and then without a saturation pulse. GM and WM were distinguished by using a computer-assisted semiautomated segmentation technique. MTR histograms were generated for each segmented tissue in each subject and compared among age and sex groups. RESULTS: The mean, median, first quartile, and peak height of the MTR histogram were significantly lower in the older group (> or =50 years) than those in the younger group (<50 years) for both GM and WM. The age dependency of these values can be expressed in a quadratic fashion over the entire span of adulthood. The MTRs started to decline only after the age of approximately 40 years in both tissues. No statistically significant differences in MTR histogram measurements between the sexes were observed. CONCLUSION: The different MTR values for both GM and WM in the two age groups suggest that notable microscopic changes occur in GM and WM with advancing age, yet no significant sex-related variations in MTR measurements were found in these neurologically healthy adults. Such normative data based on the inherent contrast in MTRs are essential in studies of specific disorders of aging, and they may have implications for our understanding of the gross structural changes in both GM and WM in the aging brain
— id: 43787, year: 2002, vol: 23, page: 1334, stat: Journal Article,

Magnetization transfer ratio histogram analysis of normal-appearing gray matter and normal-appearing white matter in multiple sclerosis
Ge, Yulin; Grossman, Robert I; Udupa, Jayaram K; Babb, James S; Mannon, Lois J; McGowan, Joseph C
2002 Jan-Feb;26(1):62-68, Journal of computer assisted tomography
PURPOSE: The purpose of this work was to determine the extent of disease and disease severity in the conventional MR normal-appearing gray matter (NAGM) and white matter (NAWM) in patients with relapsing-remitting (RR) and secondary progressive (SP) multiple sclerosis (MS) utilizing quantitative magnetization transfer ratio (MTR) histogram analysis. METHOD: Twenty-seven patients with MS (16 RR, 11 SP) and 16 healthy control subjects were studied. MTR was calculated in the totally segmented GM and WM without T2 lesions in each group. RESULTS: Each of the RR and SP MS patient groups had significantly smaller MTR histogram mean values in NAGM and NAWM than the healthy subjects (p </= 0.0015). SP MS patients had a significantly lower first quartile and MTR histogram peak height for NAGM only (p </= 0.004) when compared with both RR MS patients and healthy subjects. The T2 lesion load had a modest negative correlation with MTR values in both RR and SP MS, but only in NAGM. CONCLUSION: Separate analysis of GM and WM MTR histograms may allow better detection of subtle damage and better understanding of the natural history of MS disease and ultimately the response to therapeutics
— id: 39727, year: 2002, vol: 26, page: 62, stat: Journal Article,

Whole brain N-acetylaspartate proton MRS measurements in relapsing-remitting multiple sclerosis: Evidence for different clinical cohorts
Gonen, O; Li, BS; Babb, JS; He, J; Markowitz, CE; Grossman, RI
2002 NOV ;225(1):429-429, Radiology
— id: 105102, year: 2002, vol: 225, page: 429, stat: Journal Article,

Whole-brain N-acetylaspartate in relapsing-remitting multiple sclerosis? Evidence for different clinical cohorts
Gonen, O; Li, BSY; Babb, JS; He, J; Jacobs, D; Markowitz, CE; Grossman, RI
2002 SEP ;52(3):S41-S41, Annals of neurology
— id: 105108, year: 2002, vol: 52, page: S41, stat: Journal Article,

Relapsing-remitting multiple sclerosis and whole-brain N-acetylaspartate measurement: evidence for different clinical cohorts initial observations
Gonen, Oded; Moriarty, David M; Li, Belinda S Y; Babb, James S; He, Juan; Listerud, John; Jacobs, Dina; Markowitz, Clyde E; Grossman, Robert I
2002 Oct;225(1):261-268, Radiology
PURPOSE: To quantify the rate of concentration decline of neuronal marker N-acetylaspartate (NAA) in the entire brain of patients with relapsing-remitting multiple sclerosis (MS) in relation to healthy age-matched control subjects. MATERIALS AND METHODS: Whole-brain NAA (WBNAA) concentration was quantified in 49 patients with relapsing-remitting MS by using magnetic resonance (MR) imaging and proton MR spectroscopy. It was statistically analyzed by using Spearman rank correlation coefficients to test the intragroup relationship between WBNAA and Expanded Disability Status Scale (EDSS) score and Mann-Whitney analyses to test for differences between subgroups' EDSS scores versus previously published WBNAA values for healthy subjects, disease duration, and age. RESULTS: Analyses indicated three subgroups of WBNAA dynamics: Ten patients' conditions were 'stable,' exhibiting an insignificant change of about 0% (0.02/14.37) per year of clinically definite disease duration (P =.54); 27 patients showed 'moderate' decline, -2.8% (-0.34/12.18) per year (P <.01); and 12 patients experienced 'rapid' decline, -27.9% (-3.39/12.14) per year (P <.01). No correlation was found between WBNAA deficit, EDSS score, and age. CONCLUSION: Ascertaining an individual's NAA concentration dynamics might enable early forecast of disease course, reflect disease severity and thus influence treatment decisions, and improve clinical trial efficiency by allowing selection of candidates on the basis of WBNAA dynamics in addition to clinical status
— id: 33784, year: 2002, vol: 225, page: 261, stat: Journal Article,

Proton magnetic resonance spectroscopy of global metabolic variations as indicators of disease activity in relapsing remitting multiple sclerosis
Grossman, RI; Gonen, O
2002 NOV ;225(1):428-428, Radiology
— id: 105101, year: 2002, vol: 225, page: 428, stat: Journal Article,

Proton magnetic resonance spectroscopic characteristics of hypo- and iso-intense T1 lesions versus normal-appearing white matter in relapsing-remitting multiple sclerosis patients
He, J; Li, BS; Regal, J; Babb, JS; Grossman, RI; Gonen, O
2002 NOV ;225(1):667-667, Radiology
— id: 105106, year: 2002, vol: 225, page: 667, stat: Journal Article,

Proton magnetic resonance spectroscopy evidence for early gray matter involvement in relapsing remitting MS
Inglese, M; Ge, Y; Filippi, M; Falini, A; Grossman, RI; Gonen, O
2002 NOV ;225(1):429-429, Radiology
— id: 105103, year: 2002, vol: 225, page: 429, stat: Journal Article,

Evidence for early widespread gray matter involvement in relapsing remitting multiple sclerosis
Inglese, M; Ge, YL; Filippi, M; Falini, A; Grossman, RI; Gonen, O
2002 SEP ;52(3):S40-S40, Annals of neurology
— id: 105107, year: 2002, vol: 52, page: S40, stat: Journal Article,

Brain atrophy in mild or moderate traumatic brain injury: a longitudinal quantitative analysis
MacKenzie, John D; Siddiqi, Faez; Babb, James S; Bagley, Linda J; Mannon, Lois J; Sinson, Grant P; Grossman, Robert I
2002 Oct;23(9):1509-1515, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Although mild or moderate traumatic brain injury (TBI) is known to cause persistent neurologic sequelae, the underlying structural changes remain elusive. Our purpose was to assess decreases in the volume of brain parenchyma (VBP) in patients with TBI and to determine if clinical parameters are predictors of the extent of atrophy. METHODS: We retrospectively assessed the total VBP in 14 patients with mild or moderate TBI at more than 3 months after injury and in seven patients at two time points more than 3 months apart. VBP was calculated from whole-brain MR images and then normalized by calculating the percent VBP (%VBP) to correct for intraindividual variations in cranial size. Clinical parameters at the time of trauma were evaluated for potential predictors of atrophy. Findings were compared with those of control subjects of similar ages. RESULTS: In the single time-point analysis, brain volumes, CSF volumes, and %VBP were not significantly different between patients and control subjects. In the longitudinal analysis, the rate of decline in %VBP (0.02 versus 0.0064 U/day, P =.05) and the change in %VBP between the first and second time points (-4.16 +/- 1.68 versus -1.49 +/- 1.7, P =.022 [mean +/-SD]) were significantly greater in patients. Change in %VBP was significantly greater in patients with loss of consciousness (LOC) than in those without LOC (P =.023). CONCLUSION: Whole-brain atrophy occurs after mild or moderate TBI and is evident at an average of 11 months after trauma. Injury that produces LOC leads to more atrophy. These findings may help elucidate an etiology for the persistent or new neurologic deficits that occur months after injury
— id: 43947, year: 2002, vol: 23, page: 1509, stat: Journal Article,

Correlation between percentage of brain parenchymal volume and neurocognitive performance in HIV-infected patients
Patel, Sohil H; Kolson, Dennis L; Glosser, Guila; Matozzo, Isabel; Ge, Yulin; Babb, James S; Mannon, Lois J; Grossman, Robert I
2002 Apr;23(4):543-549, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: This study was designed to determine whether neuropsychological function in HIV-infected persons is correlated with loss of brain volume (as measured by percentage of brain parenchymal volume [PBV]). We hypothesized that whole-brain parenchymal volume might correlate with neuropsychologic performance, even before overt clinical dysfunction is apparent. METHODS: A computer-assisted segmentation technique with thin section MR imaging was used for 15 patients with HIV infection (seven symptomatic, eight asymptomatic) and for five HIV-negative control participants to quantify whole brain and CSF volumes. To determine the degree of brain atrophy, the PBV relative to that of intracranial content was calculated. Neuropsychological performance was assessed by using a standard battery of eight tests (NPZ-8 test battery). RESULTS: HIV-infected patients had significantly lower NPZ-8 scores (t[18] = 2.26, P <.05) and lower PBV (t[18] = 1.79, P <.01) than those of healthy control participants. With the Spearman rank order correlation coefficients, data analyzed for all 20 study participants (15 HIV-infected patients and five noninfected control participants) showed a significant (r = -0.50, P <.05) negative correlation between PBV and NPZ-8 test battery score. In addition, there was a significant negative correlation between subtest score of motor impairment and PBV (r = -0.69, P <.01) and between AIDS dementia complex score (r = -0.64) and PBV (P <.01). CONCLUSION: These correlations suggest that quantitation of PBV may offer an objective, easily acquired surrogate predictor of neuropsychological impairment and clinically apparent cognitive/motor dysfunction among HIV-infected persons
— id: 43789, year: 2002, vol: 23, page: 543, stat: Journal Article,

Transient central nervous system white matter abnormality in X-linked Charcot-Marie-Tooth disease
Paulson, Henry L; Garbern, James Y; Hoban, Timothy F; Krajewski, Karen M; Lewis, Richard A; Fischbeck, Kenneth H; Grossman, Robert I; Lenkinski, Robert; Kamholz, John A; Shy, Michael E
2002 Oct;52(4):429-434, Annals of neurology
X-linked Charcot-Marie-Tooth disease (CMTX) is a hereditary demyelinating neuropathy caused by mutations in the connexin 32 (Cx32) gene. Cx32 is widely expressed in brain and peripheral nerve, yet clinical manifestations of CMTX mainly arise from peripheral neuropathy. We have evaluated two male patients with CMTX who on separate occasions developed transient ataxia, dysarthria, and weakness within 3 days of returning from ski trips at altitudes above 8,000 feet. Magnetic resonance imaging studies in both patients showed nonenhancing, confluent, and symmetrical white matter abnormalities that were more pronounced posteriorly and that resolved over several months. Magnetic transfer images in one patient demonstrated increased magnetization transfer ratios distinct from that seen in demyelination or edema. Both patients returned to their normal baseline within 2 to 3 weeks. These cases suggest that CMTX patients are at risk for developing an acute, transient, neurological syndrome when they travel to places at high altitudes and return to sea level. Cx32 mutations may cause central nervous system dysfunction by reducing the number of functioning gap junctions between oligodendrocytes and astrocytes, making both cells more susceptible to abnormalities of intercellular exchange of ions and small molecules in situations of metabolic stress
— id: 43948, year: 2002, vol: 52, page: 429, stat: Journal Article,

Development of a posterior cerebral artery aneurysm subsequent to occlusion of the contralateral internal carotid artery for giant cavernous aneurysm
Wolf, R L; Imbesi, S G; Galetta, S L; Hurst, R W; Sinson, G P; Grossman, R I
2002 May;44(5):443-446, Neuroradiology
We report a case of a patient who developed a left posterior cerebral artery aneurysm 5 years after balloon occlusion of the right internal carotid artery for a giant cavernous aneurysm. The location of the new aneurysm was outside of the primary collateral pathways to the contralateral, proximally occluded, anterior circulation, illustrating the complexity of hemodynamic factors contributing to the development of intracranial saccular aneurysms. The appearance of an aneurysm in this setting supports the hypothesis that degenerative factors and hemodynamic stresses are important in the etiology of intracranial aneurysms
— id: 43949, year: 2002, vol: 44, page: 443, stat: Journal Article,

Magnetization transfer ratio histogram analysis of gray matter in relapsing-remitting multiple sclerosis
Ge Y; Grossman RI; Udupa JK; Babb JS; Kolson DL; McGowan JC
2001 Mar;22(3):470-475, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Gray matter may be affected by multiple sclerosis (MS), a white matter disease. Magnetization transfer ratio (MTR) is a sensitive and quantitative marker for structural abnormalities, and has been used frequently in the imaging of MS. In this study, we evaluated the amount of MTR of gray matter among patients with relapsing-remitting MS and healthy control subjects as well as the correlation between gray matter MTR abnormality and neurologic disability associated with relapsing-remitting MS. METHODS: We obtained fast spin-echo dual-echo and magnetization transfer (with and without MT saturation pulses) images from eighteen patients with relapsing-remitting MS and 18 age-matched healthy control subjects. Gray matter was segmented using a semiautomated system. Gray matter MTR histogram parameters, Kurtzke Expanded Disability Status Scale (EDSS), total T2 lesion volume, and gray matter volumes were obtained for statistical analysis. RESULTS: A significant difference was found in gray matter MTR between patients with relapsing-remitting MS and healthy subjects (mean and median). Gray matter MTR histogram normalized peak heights in patients inversely correlated with EDSS (r = -0.65, P =.01). There was also an inverse correlation between mean MTR of gray matter and total T2 lesion volume. CONCLUSION: The MTR of gray matter significantly differed between patients with relapsing-remitting MS and healthy control subjects, suggesting that MS is a more diffuse disease affecting the whole brain, and neuronal damage accumulates in step with T2 lesion volume. Our finding of the relationship between gray matter MTR and EDSS indicates that measurement of gray matter abnormality may be a potentially useful tool for assessing clinical disability in MS
— id: 24400, year: 2001, vol: 22, page: 470, stat: Journal Article,

Brain atrophy in relapsing-remitting multiple sclerosis: fractional volumetric analysis of gray matter and white matter
Ge Y; Grossman RI; Udupa JK; Babb JS; Nyul LG; Kolson DL
2001 Sep;220(3):606-610, Radiology
PURPOSE: To determine the fractional brain tissue volume changes in the gray matter and white matter of patients with relapsing-remitting multiple sclerosis (MS) and to correlate these measurements with clinical disability and total lesion load. MATERIALS AND METHODS: Thirty patients with relapsing-remitting MS and 25 healthy control subjects underwent magnetic resonance imaging. Fractional brain tissue volumes (tissue volume relative to total intracranial volume) were obtained from the total segmented gray matter and white matter in each group and were analyzed. RESULTS: The fractional volume of white matter versus that of gray matter was significantly lower (-6.4%) in patients with MS (P <.0001) than in control subjects. Neither gray matter nor white matter fractional volume measurements correlated with clinical disability in the patients with MS. CONCLUSION: Loss of brain parenchymal volume in patients with relapsing-remitting MS is predominantly confined to white matter. Analysis of fractional brain tissue volumes provides additional information useful in characterizing MS and may have potential in evaluating treatment strategies
— id: 24396, year: 2001, vol: 220, page: 606, stat: Journal Article,

New magnetic resonance spectroscopy strategies
Gonen O; Grossman RI
Magnetic resonance spectroscopy in multiple sclerosis Milano ; New York : Springer, 2001,
— id: 3795, year: 2001, vol: , page: 97, stat: Chapter,

ADEM: distinct disease or part of the MS spectrum?
Hartung HP; Grossman RI
2001 May 22;56(10):1257-1260, Neurology
— id: 43952, year: 2001, vol: 56, page: 1257, stat: Journal Article,

Enhancing patterns in multiple sclerosis: evolution and persistence
He J; Grossman RI; Ge Y; Mannon LJ
2001 Apr;22(4):664-669, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Contrast enhancement on MR images of patients with multiple sclerosis (MS) is known to be associated with abnormalities of the blood-brain barrier (BBB). However, little is known about diagnostic patterns and common features of enhanced MS lesions. This study was designed to evaluate initial enhancement patterns, changes in these enhancing patterns, and duration of enhancement in a cohort of patients with MS. METHODS: Twenty-five patients with clinically definite MS were studied retrospectively. The appearance of enhancing lesions and sequential changes in the appearance on axial contrast-enhanced spin-echo images were evaluated. The enhancing lesions were classified as nodular, ringlike, or 'other' (eg, arclike). RESULTS: Of 301 new enhancing lesions, 205 (68%) showed nodular enhancement, 70 (23%) a ring pattern, and 26 (9%) a pattern neither nodular nor ringlike (eg, arclike). Two hundred eighty (93%) of 301 enhancing lesions disappeared within 6 months, and seven (2%) lesions showed persistent enhancement longer than 6 months. The other 14 (5%) lesions, which disappeared by the time of the next scan, were excluded, because the course between two examinations was longer than 6 months. Of nine persisting nodular enhancing lesions on the follow-up images, seven were decreased in size, whereas all of two persisting ringlike enhancing lesions on the follow-up images were larger than before. CONCLUSION: Nodular enhancement is the predominant enhancement pattern for new MS lesions, and the temporal course of enhancement is usually shorter than 6 months. The appreciation of the evolution of MS-enhanced lesions aids in both identifying new MS lesions and distinguishing these lesions from other pathologic entities. This may be helpful in clinically evaluating the stage of MS lesions
— id: 24397, year: 2001, vol: 22, page: 664, stat: Journal Article,

Future applications of DWI in MS
Maldjian JA; Grossman RI
2001 May 1;186 Suppl 1(10):S55-S57, Journal of the neurological sciences
Diffusion imaging is a noninvasive technique for measuring the movement of water molecules. Although it has had its greatest impact thus far in the area of stroke imaging, the information garnered from diffusion experiments can provide an indication of myelin injury and perhaps axonal integrity. In this paper, we describe some current and potential future applications of diffusion imaging in multiple sclerosis. These include the use of global indices such as diffusion trace and anisotropy, as well as implementation of axonal fiber tracking methodologies for assessment of axonal integrity and connectivity between cortical regions
— id: 43953, year: 2001, vol: 186 Suppl 1, page: S55, stat: Journal Article,

Investigation of global absolute N-acetyl aspartate levels in Alzheimer's disease
McGowan, JC; Clark, CC; Ge, Y; Udupa, J; Grossman, RI; Gonen, O
2001 MAR-APR ;22(2):33-33, Neurobiology of aging
— id: 105111, year: 2001, vol: 22, page: 33, stat: Journal Article,

Magnetization transfer imaging and proton MR spectroscopy in the evaluation of axonal injury: correlation with clinical outcome after traumatic brain injury
Sinson G; Bagley LJ; Cecil KM; Torchia M; McGowan JC; Lenkinski RE; McIntosh TK; Grossman RI
2001 Jan;22(1):143-151, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Current imaging does not permit quantification of neural injury after traumatic brain injury (TBI) and therefore limits both the development of new treatments and the appropriate counseling of patients concerning prognosis. We evaluated the utility of magnetization transfer ratio (MTR) and proton MR spectroscopy in identifying patients with neuronal injury after TBI. METHODS: Thirty patients with TBI (21-77 years old; mean age, 42 years; admission Glasgow Coma Scale (GOS) scores 3-15; mean score, 11) were studied on a 1.5-T system with magnetization transfer imaging and MR spectroscopy of the splenium. Magnetization transfer imaging was also performed in the brain stem in all patients, and other areas of the brain were sampled in one patient. The splenium of the corpus callosum and brain stem were studied because these are often affected by diffuse axonal injury. Scans were obtained 2 to 1129 days after injury (median, 41 days). MTR was considered abnormal if it was more than 2 SD below normal. Proton MR spectroscopy was used to calculate the N-acetylaspartate (NAA)/creatine (Cr) ratio. GOS was determined at least 3 months after injury. RESULTS: In 10 patients with a GOS of 1 to 4, the mean NAA/Cr was 1.24 +/- 0.28; two of these patients had abnormal MTR in normal-appearing white matter (NAWM). In 20 patients with a GOS of 5, the mean NAA/Cr was 1.53 +/- 0.37 (P < .05); four of these patients had abnormal MTR in NAWM. MTR abnormalities in NAWM were identified in six patients, but these changes did not correlate with GOS or MR spectroscopy changes. CONCLUSION: MTR and MR spectroscopy can quantify damage after TBI, and NAA levels may be a sensitive indicator of the neuronal damage that results in a worse clinical outcome
— id: 24402, year: 2001, vol: 22, page: 143, stat: Journal Article,

Multiprotocol MR image segmentation in multiple sclerosis: experience with over 1,000 studies
Udupa JK; Nyul LG; Ge Y; Grossman RI
2001 Nov;8(11):1116-1126, Academic radiology
RATIONALE AND OBJECTIVES: Multiple sclerosis (MS) is an acquired disease of the central nervous system. Several clinical measures are commonly used to express the severity of the disease, including the Expanded Disability Status Scale and the ambulation index. These measures are subjective and may be difficult to reproduce. The aim of this research is to investigate the possibility of developing more objective measures derived from MR imaging. MATERIALS AND METHODS: Various magnetic resonance (MR) imaging protocols are being investigated for the study of MS. Seeking to replace the Expanded Disability Status Scale and ambulation index with an objective means to assess the natural course of the disease and its response to therapy, the authors have developed multiprotocol MR image segmentation methods based on fuzzy connectedness to quantify both macrosopic features of the disease (lesions, gray matter, white matter, cerebrospinal fluid, and brain parenchyma) and the microscopic appearance of diseased white matter. Over 1,000 studies have been processed to date. RESULTS: By far the strongest correlations with the clinical measures were demonstrated by the magnetization transfer ratio histogram parameters obtained for the various segmented tissue regions. These findings emphasize the importance of considering the microscopic and diffuse nature of the disease in the individual tissue regions. Brain parenchymal volume also demonstrated a strong correlation with clinical measures, which suggests that brain atrophy is an important disease indicator. CONCLUSION: Fuzzy connectedness is a viable, highly reproducible segmentation method for studying MS
— id: 24395, year: 2001, vol: 8, page: 1116, stat: Journal Article,

Magnetization transfer imaging of traumatic brain injury
Bagley LJ; McGowan JC; Grossman RI; Sinson G; Kotapka M; Lexa FJ; Berlin JA; McIntosh TK
2000 Jan;11(1):1-8, Journal of magnetic resonance imaging
Magnetization transfer imaging (MTI) has been shown to be sensitive for the detection of white matter abnormalities in entities such as multiple sclerosis, progressive multifocal leukoencephalopathy, and wallerian degeneration. Our hypothesis was that MTI would detect traumatic white matter abnormalities (TWMA) and provide information additional to that obtainable with routine spin- and gradient-echo imaging. We hypothesized that the presence of TWMA defined by MTI would correlate with outcome following TBI. Twenty-eight victims of head trauma and 15 normal controls underwent magnetic resonance imaging including MTI. Magnetization transfer ratios (MTR) were calculated for areas of shearing injury and for normal-appearing white matter (NAWM) in locations frequently subject to diffuse axonal injury. Abnormal MTRs were detected in NAWM in eight patients. All eight had persistent neurologic deficits, including cognitive deficits, aphasia, and extremity weakness. Seven of the 28 patients had no abnormal findings on neurologic exam at discharge, transfer, or follow-up. None of these patients had an abnormal MTR in NAWM. In the remaining 13 patients, who had persistent neurologic deficits, no regions of abnormal MTR were detected in NAWM. MTI is a sensitive method for the detection of TWMA. Detection of abnormal MTR in NAWM that is prone to axonal injury may predict a poor patient outcome. The presence of normal MTR in NAWM in these areas does not necessarily confer a good outcome, however
— id: 43958, year: 2000, vol: 11, page: 1, stat: Journal Article,

Multiple sclerosis: magnetization transfer histogram analysis of segmented normal-appearing white matter
Catalaa I; Grossman RI; Kolson DL; Udupa JK; Nyul LG; Wei L; Zhang X; Polansky M; Mannon LJ; McGowan JC
2000 Aug;216(2):351-355, Radiology
PURPOSE: To investigate and characterize the global distribution of magnetization transfer (MT) ratio values of normal-appearing white matter (NAWM) in patients with relapsing-remitting multiple sclerosis (MS) and test the hypothesis that the MT histogram for NAWM reflects disease progression. MATERIALS AND METHODS: Conventional and MT magnetic resonance (MR) images were obtained in 23 patients and 25 healthy volunteers. Clinical tests for comparison with the MT histogram parameters included the Extended Disability Status Scale and the ambulation index. Lesion load calculated with T2-weighted MR images and whole-brain and white matter volumes were measured. RESULTS: The location of the MT histogram peak and the mean MT ratio for NAWM were significantly lower in patients with MS than in control subjects. In longitudinal studies, the histogram peak location and mean MT ratio shifted in the direction of normal values as the duration of disease increased. A mean of 26.5% of the volume of new lesions identified on the later studies were demonstrated to have originated in NAWM corresponding to 'lost' pixels on the histogram. CONCLUSION: MT histogram analysis of NAWM, including longitudinal analysis, may provide new prognostic information regarding lesion formation and increase understanding of the course of the disease
— id: 24405, year: 2000, vol: 216, page: 351, stat: Journal Article,

The representation of the horizontal meridian in the primary visual cortex
Galetta SL; Grossman RI
2000 Jun;20(2):89-91, Journal of neuroophthalmology
The authors report the findings of two patients that confirm the location of the horizontal meridian in the human visual cortex. The first patient had an inferior quadrant defect with a band of horizontal meridian sparing. Magnetic resonance imaging showed a lesion concentrated along the medial striate cortex. The second patient had a homonymous horizontal defect that resulted from removal of an arteriovenous malformation located in the lateral striate cortex. The findings of these two patients demonstrate that the horizontal meridian is represented at the calcarine fissure base in the primary visual cortex
— id: 43956, year: 2000, vol: 20, page: 89, stat: Journal Article,

The contribution of MRI in the differential diagnosis of posterior fossa damage
Gass A; Filippi M; Grossman RI
2000 Jan 15;172 Suppl 1(1):S43-S49, Journal of the neurological sciences
In multiple sclerosis patients, magnetic resonance imaging (MRI) frequently detects lesions in the brain stem and cerebellum. However various pathologies that have a predelection to occur in posterior fossa parenchyma may share similar features with inflammatory-demyelinating lesions. In this paper, we review the contribution of MRI to the differential diagnosis of posterior fossa pathology. Vascular lesions due to chronic hypoperfusion and arteriolosclerosis or occlusion of the main supplying arteries of the posterior circulation leading to acute infarction frequently produce characteristic pontine or cerebellar lesions. Neoplastic disease, in particular pontine gliomas in younger patients may have similar MRI features and may be difficult to distinguish from inflammatory-demyelinating lesions. Central pontine myelinolysis usually occurs in severely ill patients but the pontine MRI changes have an overlapping profile with inflammatory demyelination. Diffuse axonal injury of the midbrain and brainstem after head trauma and atrophy of posterior fossa structures in degenerative diseases may appear similar on MRI to tissue changes also seen frequently in MS. Analysis of the MRI appearance and clinical information is most often useful to narrow the fairly long list of differential diagnoses of posterior fossa pathology
— id: 43962, year: 2000, vol: 172 Suppl 1, page: S43, stat: Journal Article,

Glatiramer acetate (Copaxone) treatment in relapsing-remitting MS: quantitative MR assessment
Ge Y; Grossman RI; Udupa JK; Fulton J; Constantinescu CS; Gonzales-Scarano F; Babb JS; Mannon LJ; Kolson DL; Cohen JA
2000 Feb 22;54(4):813-817, Neurology
OBJECTIVE: To evaluate the efficacy of glatiramer acetate (GA, Copaxone; Teva Pharmaceutical Industries, Ltd., Petah Tiqva, Israel) by MRI-based measures in patients with relapsing-remitting (RR) MS. METHODS: Twenty-seven patients with clinically definite RR-MS were treated with either 20 mg of GA by daily subcutaneous self-injection (n = 14) or placebo (n = 13) for approximately 24 months. Axial dual-echo fast-spin-echo T2-weighted images and T1-weighted images before and after gadolinium (Gd) were acquired at 1.5 tesla and transferred into an image processing computer system. The main outcome measures were the number of Gd-enhanced T1 and T2 lesions and their volume as well as brain parenchyma volume. RESULTS: The values of age, disease duration, Expanded Disability Status Scale (EDSS) score, the number of T1- and T2-weighted lesions, and their volume were similar between GA- and placebo-receiving groups at the entry of this study. There was a decrease in the number of T1-enhanced lesions (p = 0.03) and a significant percent annual decrease of their volume in GA recipients compared with those of placebo recipients. There were no significant differences between changes in the two groups in the number of T2 lesions and their volume. The loss of brain tissue was significantly smaller in the GA group compared with that of the placebo group. CONCLUSIONS: These results show that GA treatment may decrease both lesion inflammation and the rate of brain atrophy in RR-MS
— id: 43792, year: 2000, vol: 54, page: 813, stat: Journal Article,

Brain atrophy in relapsing-remitting multiple sclerosis and secondary progressive multiple sclerosis: longitudinal quantitative analysis
Ge Y; Grossman RI; Udupa JK; Wei L; Mannon LJ; Polansky M; Kolson DL
2000 Mar;214(3):665-670, Radiology
PURPOSE: To determine annual rates of volumetric changes in the whole-brain parenchyma of patients with relapsing-remitting and secondary progressive multiple sclerosis (MS) and test the hypothesis that these changes correlate with clinical disability. MATERIALS AND METHODS: A computer-assisted segmentation technique with thin-section magnetic resonance (MR) imaging was used in 36 patients with MS (27 relapsing-remitting, nine secondary progressive) and in 20 control subjects to quantify brain and cerebrospinal fluid volumes. To determine the degree of brain atrophy, the percentage brain parenchyma volume (PBV) relative to that of intracranial contents was calculated. RESULTS: At the beginning of the study, the PBV was smaller in the MS group than in the control group (P = .007); brain parenchyma volumes were similar. The median rate of brain volume loss was 17.3 mL per year in patients with relapsing-remitting MS and 23.6 mL per year in those with secondary progressive MS. There was a negative correlation between brain atrophy and Expanded Disability Status Scale (EDSS) score in patients with secondary progressive MS (r = -0.69, P = .004) and no correlation in patients with relapsing-remitting MS. T2 lesion volume did not correlate with brain atrophy in either group. CONCLUSION: The correlation between brain atrophy and EDSS score was better in patients with secondary progressive MS than in those with relapsing-remitting MS
— id: 43791, year: 2000, vol: 214, page: 665, stat: Journal Article,

Numerical tissue characterization in MS via standardization of the MR image intensity scale
Ge Y; Udupa JK; Nyul LG; Wei L; Grossman RI
2000 Nov;12(5):715-721, Journal of magnetic resonance imaging
Image intensity standardization is a recently developed postprocessing method that is capable of correcting the signal intensity variations in MR images. We evaluated signal intensity of healthy and diseased tissues in 10 multiple sclerosis (MS) patients based on standardized dual fast spin-echo MR images using a numerical postprocessing technique. The main idea of this technique is to deform the volume image histogram of each study to match a standard histogram and to utilize the resulting transformation to map the image intensities into standard scale. Upon standardization, the coefficients of variation of signal intensities for each segmented tissue (gray matter, white matter, lesion plaques, and diffuse abnormal white matter) in all patients were significantly smaller (2.3-9.2 times) than in the original images, and the same tissues from different patients looked alike, with similar intensity characteristics. Numerical tissue characterizability of different tissues in MS achieved by standardization offers a fixed tissue-specific meaning for the numerical values and can significantly facilitate image segmentation and analysis
— id: 24403, year: 2000, vol: 12, page: 715, stat: Journal Article,

Total brain N-acetylaspartate: a new measure of disease load in MS
Gonen O; Catalaa I; Babb JS; Ge Y; Mannon LJ; Kolson DL; Grossman RI
2000 Jan 11;54(1):15-19, Neurology
OBJECTIVE: To quantitate the extent of neuronal cell loss in MS via the whole brain's N-acetylaspartate (NAA) concentration (WBNAA). METHODS: Because NAA is assumed to be present only in neuronal cell bodies and their axons, we measured WBNAA as a marker for viable neurons in 12 patients (9 women and 3 men, 26 to 53 years of age) suffering from relapsing-remitting (RR) MS for at least 5 years and compared them with 13 age- and sex-matched normal controls. Total brain NAA was determined with proton MR spectroscopy, and WBNAA was obtained by dividing it by the total brain volume, calculated from high resolution MRI. RESULTS: The WBNAA of the RR MS patients was lower than their matched controls (p<0.005). This difference was greater among older than younger subjects. The linear prediction equations of WBNAA with age indicate a faster, x10, decline in the patients, approximately 0.8% per year of age (p = 0.022). CONCLUSION: The age-dependent decrease of whole brain N-acetylaspartate (WBNAA) in the patients suggests that progressive neuronal cell loss is a cardinal feature of this disease. WBNAA offers a quick, highly reproducible measure of disease progression and may be an important marker of treatment efficacy in MS as well as other neurodegenerative diseases
— id: 27737, year: 2000, vol: 54, page: 15, stat: Journal Article,

The accuracy of whole brain N-acetylaspartate quantification
Gonen O; Grossman RI
2000 Dec;18(10):1255-1258, Magnetic resonance imaging
A non-localizing pulse sequence to quantify the total amount of N-acetylaspartate (NAA) in the whole brain (WBNAA) was introduced recently [Magn. Reson. Med. 40, 684-689 (1998)]. However, it is known that regional magnetic field inhomogeneities, deltaB0s, arising from susceptibility differences at tissue interfaces, shift and broaden local resonances to outside the integration window, leading to an underestimation of the true amount of NAA in the entire brain. To quantify the upper limit of this loss, the whole-head proton MR spectrum (1H-MRS) of the water was integrated over the same frequency width as the NAA. The ratio of this area/total-water-line was 75 +/- 5% in 5 volunteers. The procedure was repeated with the brain-only water peak, obtained by summing signals only from voxels within that organ from a three-dimensional chemical-shift-imaging (3D CSI) set. It indicated that <10% of the water signal loss occurred in the brain. Therefore, by analogy, WBNAA accounts for >90% of that metabolite
— id: 24401, year: 2000, vol: 18, page: 1255, stat: Journal Article,

Brain imaging
Grossman RI
2000 Jan;21(1):9-18, AJNR. American journal of neuroradiology
— id: 43959, year: 2000, vol: 21, page: 9, stat: Journal Article,

Radiologic imaging procedures
Grossman RI
Cecil textbook of medicine Philadelphia : W.B. Saunders, 2000,
— id: 3794, year: 2000, vol: , page: ?, stat: Chapter,

Assessment of spinal cord damage in MS using MRI
Grossman RI; Barkhof F; Filippi M
2000 Jan 15;172 Suppl 1(1):S36-S39, Journal of the neurological sciences
Spinal cord imaging is important in the evaluation of patients with MS. There are several techniques available which provide satisfactory images of lesions in the spinal cord. Conventional measures used in the assessment of damage to the spinal cord include quantification of: (1) high intensity on T2 weighted images; (2) spinal cord enhancement; and (3) spinal cord atrophy. Although not presently implemented, newer methods including magnetization transfer, diffusion, and proton spectroscopy offer the potential for more specific classification of spinal cord MS. Assessment of spinal cord damage using MR still remains behind the development of brain methodology and represents both a challenge and an opportunity
— id: 43963, year: 2000, vol: 172 Suppl 1, page: S36, stat: Journal Article,

The contribution of magnetic resonance imaging in the differential diagnosis of the damage of the cerebral hemispheres
Grossman RI; Kappos L; Wolinsky JS
2000 Jan 15;172 Suppl 1(1):S57-S62, Journal of the neurological sciences
There are presently many magnetic resonance (MR) measures that can aid the assessment of damage to the brain. The conventional measures include T2 lesion volume, T1 enhanced lesion volume, and brain atrophy. Newer methodologies include magnetization transfer measures and proton spectroscopy. These methods have the potential for improving the specificity of MR with respect to the underlying pathology. MR spectroscopy offers the ability to quantitate the component of axonal loss in multiple sclerosis. MR techniques can be implemented to assess the effectiveness of treatment algorithms
— id: 43960, year: 2000, vol: 172 Suppl 1, page: S57, stat: Journal Article,

Magnetic resonance imaging in patients with central nervous system pathology: a comparison of OptiMARK (Gd-DTPA-BMEA) and Magnevist (Gd-DTPA)
Grossman RI; Rubin DL; Hunter G; Haughton VM; Lee D; Sze G; Kuhn MJ; Maravilla K; Tu R; Heindel W; Wippold FJ 2nd; Leeds N; Zelch J; Jinkins JR; Grodd W; Truwit C; Kanal E; Provenzale JM; Ramsey R; Simon J; Brunberg JA; Stevens GR; Kristy RM
2000 Jul;35(7):412-419, Investigative radiology
RATIONALE AND OBJECTIVES: The objective of the two pivotal phase 3 studies was to evaluate the safety and efficacy of OptiMARK (Gd-DTPA-bis(methoxyethylamide) [Gd-DTPA-BMEA]) compared with Magnevist (Gd-DTPA) in magnetic resonance imaging of the central nervous system. METHODS: Two multicenter, randomized, double-blind, parallel group studies were conducted in 395 patients with known or suspected central nervous system pathology. Subjects were randomized to receive a single 0.1 mmol/kg intravenous injection of either Gd-DTPA-BMEA or Gd-DTPA. The safety of Gd-DTPA-BMEA and Gd-DTPA was monitored for up to 72 hours after study drug administration. Precontrast and postcontrast administration magnetic resonance scans were acquired using identical imaging planes and techniques. RESULTS: No deaths or unexpected adverse events were reported in either group. A comparison of adverse events by intensity and relation demonstrated no statistically significant differences between the two groups. Gd-DTPA-BMEA and Gd-DTPA were equivalent with respect to confidence in diagnosis, conspicuity, and border delineation. CONCLUSIONS: Gd-DTPA-BMEA and Gd-DTPA demonstrated comparable efficacy profiles, and the safety profiles were considered similar
— id: 24406, year: 2000, vol: 35, page: 412, stat: Journal Article,

Reduced dorsal and orbital prefrontal gray matter volumes in schizophrenia
Gur RE; Cowell PE; Latshaw A; Turetsky BI; Grossman RI; Arnold SE; Bilker WB; Gur RC
2000 Aug;57(8):761-768, Archives of general psychiatry
BACKGROUND: Converging neuroanatomic, neurophysiological, and neurobehavioral evidence implicate prefrontal subregions in schizophrenia. Neuroanatomic studies with magnetic resonance (MR) imaging enable regional volume parcellation. Inconsistent reports may relate to variable methods and small samples. We attempted to resolve volume differences within sectors of the prefrontal lobe in a large sample, relating volumes to clinical and neurocognitive features. METHODS: Magnetic resonance imaging was performed in 70 patients with schizophrenia (40 men and 30 women; 29 neuroleptic naive and 41 previously treated) and 81 healthy controls (34 men and 47 women). Gray and white matter volumes of the dorsolateral, dorsomedial, orbitolateral, and orbitomedial prefrontal cortex were quantified. Symptoms, functioning, and neurocognition were assessed concurrently. RESULTS: Reduced prefrontal gray matter volume was observed in patients. The reduction was evident for the dorsolateral area in men (9%) and women (11%), for the dorsomedial area only in men (9%), and for orbital regions only in women (23% and 10% for lateral and medial, respectively). The reduction of orbital volume in women was associated with poorer premorbid functioning, more severe negative symptoms, and depression. Volume of dorsal cortex was positively associated with better performance on abstraction and attention tasks across all groups. CONCLUSIONS: Schizophrenia is associated with reduced gray matter volume in prefrontal cortex, which affects men and women in the dorsolateral sector. The effects are moderated by sex for dorsomedial and orbital regions and are related to symptom severity and cognitive function. This is not a by-product of treatment, since the differences are evident in neuroleptic-naive patients
— id: 43955, year: 2000, vol: 57, page: 761, stat: Journal Article,

Temporolimbic volume reductions in schizophrenia
Gur RE; Turetsky BI; Cowell PE; Finkelman C; Maany V; Grossman RI; Arnold SE; Bilker WB; Gur RC
2000 Aug;57(8):769-775, Archives of general psychiatry
BACKGROUND: Neuroanatomic studies of schizophrenia have reported temporolimbic abnormalities. Most magnetic resonance imaging studies have evaluated small samples of primarily men with chronic schizophrenia. Our goal was to evaluate sex differences in segmented temporal lobe subregions with reliable parcellation methods, relating volume with clinical and neurocognitive parameters. METHODS: Magnetic resonance imaging was performed in 100 patients with schizophrenia (58 men, 42 women; 39 neuroleptic naive, 61 previously treated) and 110 healthy controls (51 men, 59 women). Gray and white matter volumes of temporolimbic (hippocampus and amygdala) and neocortical regions (superior temporal gyrus and temporal pole) were examined. Symptoms, functioning, and neurocognition were assessed concurrently. RESULTS: Hippocampal gray matter volume was reduced in men (7%) and women (8.5%) with schizophrenia. In the amygdala, however, decreased volume was evident for men (8%) whereas women (10.5%) had increased volume. Magnetic resonance imaging of the temporal pole showed decreased gray matter in men (10%) and women (8.5%). For the superior temporal gyrus, the decrease exceeded that of whole-brain only in men (11.5%). Volumes were largely uncorrelated with clinical measures, but higher hippocampal volumes were associated with better memory performance for all groups. Cortical volumes were associated with better memory performance in healthy women. CONCLUSIONS: Schizophrenia is associated with reduced gray matter volume in temporolimbic structures. In men, reduction was manifested in all regions, whereas women showed decreased hippocampal volumes but increased amygdala volumes. The abnormalities are evident in patients with first-episode schizophrenia and correlate more strongly with cognitive performance than with symptom severity
— id: 43954, year: 2000, vol: 57, page: 769, stat: Journal Article,

Peripheral spinal cord hypointensity on T2-weighted MR images: a reliable imaging sign of venous hypertensive myelopathy
Hurst RW; Grossman RI
2000 Apr;21(4):781-786, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: MR findings reported in conjunction with spinal dural arteriovenous fistula (SDAVF) include cord swelling, increased T2 signal within the spinal cord, and parenchymal enhancement, each of which is nonspecific. Enlarged vessels on the cord surface, the most specific MR finding, is noted in only half of SDAVF patients. Nevertheless, we have frequently observed MR peripheral hypointensity of the spinal cord in SDAVF on T2-weighted images, which is not characteristic of nonvascular or nonhemorrhagic causes of myelopathy and which has not been described in association with SDAVF. We hypothesized that peripheral cord hypointensity might reliably suggest the diagnosis of SDAVF or other causes of venous hypertensive myelopathy. METHODS: We reviewed the MR findings in 11 consecutive cases of angiographically confirmed symptomatic SDAVF and in four cases of intracranial dural arteriovenous fistula with spinal drainage, a lesion that also causes spinal cord deficits mediated by venous hypertensive myelopathy. RESULTS: In each case, T2 hypointensity involving the cord periphery was present. This sign has not been previously described in association with either SDAVF or other causes of venous hypertensive myelopathy. It appears, however, to be a relatively constant imaging feature of SDAVF. CONCLUSION: In the absence of spinal hemorrhage, T2 hypointensity involving the periphery of the spinal cord suggests venous hypertensive myelopathy as a cause of spinal cord dysfunction
— id: 43957, year: 2000, vol: 21, page: 781, stat: Journal Article,

Magnetization transfer histogram analysis of monosymptomatic episodes of neurologic dysfunction: preliminary findings
Kaiser JS; Grossman RI; Polansky M; Udupa JK; Miki Y; Galetta SL
2000 Jun-Jul;21(6):1043-1047, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Patients presenting with a monosymptomatic episode of neurologic dysfunction (MEND) have a high probability of developing multiple sclerosis (MS). Our study was designed to determine whether magnetization transfer (MT) histogram analysis could predict the development of MS for a cohort of patients presenting with a MEND. METHODS: Eleven patients with a MEND and 21 age-matched control volunteers underwent MR imaging. Six patients underwent serial MR examinations. MT ratio histogram peak height (MTRHPH) and the location of the MT ratio histogram peak (LOC MTRHP) were determined for patients and control volunteers. T2 lesion volume was also calculated. Patients were clinically followed up for 587 +/- 308 days to determine or rule out the development of MS. RESULTS: Three patients went on to develop MS. There was no statistically significant difference in the MTRHPH (P = .65) and the LOC MTRHP (P = .71) between patients and control volunteers. For those patients who underwent multiple examinations, no statistically significant differences in the MTRHPH (P = .64), LOC MTRHP (P =.58), and T2 lesion volume (P = .47) were seen. There were no statistically significant correlations between any of the parameters studied. CONCLUSION: We found no difference in MT histogram parameters among control volunteers, patients with a MEND without MS, and patients with a MEND who went on to a diagnosis of MS. Our preliminary findings suggest that there may not be a substrate of disease in the normal-appearing white matter that is predictive of the development of MS
— id: 24408, year: 2000, vol: 21, page: 1043, stat: Journal Article,

Patterns of disease spread in metastatic breast carcinoma: influence of estrogen and progesterone receptor status
Maki DD; Grossman RI
2000 Jun-Jul;21(6):1064-1066, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: It is widely recognized that tumor hormone receptor status correlates with overall survival in metastatic breast carcinoma; however, the influence of hormone receptors on the pattern of disease spread is not well known. PURPOSE: We set out to determine the common distributions of metastatic disease spread in metastatic breast carcinoma, and to evaluate tumor hormone receptor status as predictor of disease spread. METHODS: Thirty-six patients being imaged for possible metastatic breast carcinoma between 1995 and 1998, in whom the presence or absence of tumor estrogen and progesterone receptors (ER+ or ER- / PR+ or PR-) was known, who underwent both contrast-enhanced MR of the brain and total body skeletal scintigraphy, were studied retrospectively. RESULTS: Of twelve patients with skeletal metastases but no brain metastases, 83% were ER+/PR+. Ten patients had brain metastases but no skeletal involvement, 80% of which were ER-/PR-. Seven patients had no brain or osseous metastases, but had metastatic disease in the chest or abdomen. Eighty-six percent of patients in this group were ER-/PR-. The tumor receptor status was statistically different between these three distribution groups (P = .01). A final group, consisting of seven patients, showed widespread disease, with diffuse metastases to the brain, viscera, and skeleton. In this group, no patients were ER+/PR+. CONCLUSION: There are two major patterns of disease spread in metastatic breast carcinoma, excluding patients with extensive diffuse metastases. Patients with ER+/PR+ tumors tend to develop osseous but not brain metastases. Patients with ER-/PR- tumors tend to develop brain but not osseous metastases. Appreciation of these distributions can aid the radiologist in detecting metastatic lesions, and will help the clinician to estimate the likelihood of metastases to various organ systems, as well as to potentially target therapy
— id: 24407, year: 2000, vol: 21, page: 1064, stat: Journal Article,

Magnetization transfer imaging in the detection of injury associated with mild head trauma
McGowan JC; Yang JH; Plotkin RC; Grossman RI; Umile EM; Cecil KM; Bagley LJ
2000 May;21(5):875-880, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Most traumatic brain injuries are classified as mild, yet in many instances cognitive deficits result. The purpose of this study was to investigate possible relationships between quantitative magnetization transfer imaging (MTI) and neurocognitive findings in a cohort of patients with mild head trauma but negative findings on conventional MR images. METHODS: We examined 13 patients and 10 healthy volunteers with a standard MR protocol including fast spin-echo and gradient-echo imaging, to which was added quantitative MTI. MTI was performed with a modified gradient-echo sequence incorporating pulsed, off-resonance saturation. Both region-of-interest analysis and contour plots were obtained from the MTI data. A subgroup of nine patients was examined with a battery of neuropsychological tests, comprising 25 measures of neurocognitive ability. RESULTS: The magnetization transfer ratio (MTR) in the splenium of the corpus callosum was lower in the patient group as compared with the control group, but no significant reduction in MTR was found in the pons. Individual regional MTR values were significantly reduced in two cases, and contour plot analysis revealed focal areas of abnormality in the splenium of four patients. All the patients showed impairment on at least three measures of the neuropsychological test battery, and in two cases a significant correlation was found between regional MTR values and neuropsychological performance. CONCLUSION: Our results suggest that MTI and contour plot analysis may add sensitivity to the MR imaging examination of patients with traumatic brain injury
— id: 24409, year: 2000, vol: 21, page: 875, stat: Journal Article,

The costs of CT procedures in an academic radiology department determined by an activity-based costing (ABC) method
Nisenbaum HL; Birnbaum BA; Myers MM; Grossman RI; Gefter WB; Langlotz CP
2000 Sep-Oct;24(5):813-823, Journal of computer assisted tomography
PURPOSE: The purpose of this work was to determine the costs of computed tomography (CT) procedures in a large academic radiology department, including both professional (PC) and technical (TC) components, by analyzing actual resource consumption using an activity-based costing (ABC) method and comparing them with Medicare payments. METHOD: Over a 12 month period from July 1, 1996, to June 30, 1997, 1,011 CT procedures, representing 16 Physicians' Current Procedural Terminology (CPT) codes and 98.3% of CT studies performed, were carefully observed by a research assistant trained in ABC methodology. Information collected during these time and motion studies included personnel/machine time and direct materials used. Actual resource units used during the different activities in each CT procedure were valued using appropriate cost drivers. Unit values for both direct and overhead costs were calculated: the cost of an individual procedure equaled the sum of component costs. Costs were compared with PC and TC payments according to the 1997 Medicare Fee Schedule. RESULTS: Total costs of CPT codes 70450 (CT Head unenhanced), 71260 (CT Chest enhanced), and 74160 (CT Abdomen enhanced), which represented 71.2% of CT studies performed, were $189.19, $273.53, and $343.20, respectively. For all 16 nonmodified CPT codes analyzed, Medicare's professional reimbursement was less than the professional cost, whereas its technical reimbursement exceeded respective cost in 14 of the 16 codes. CONCLUSION: In the setting and time period studied, Medicare underreimbursed professional costs while overreimbursing technical costs
— id: 24404, year: 2000, vol: 24, page: 813, stat: Journal Article,

Multiple sclerosis: comparison of trace apparent diffusion coefficients with MR enhancement pattern of lesions
Roychowdhury S; Maldjian JA; Grossman RI
2000 May;21(5):869-874, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Diffusion-weighted MR imaging and the trace apparent diffusion coefficient (ADC) provide important structural information about tissues. The purpose of this study was to investigate the relationship between trace ADC values and the enhancement pattern of multiple sclerosis (MS) lesions. METHODS: Ninety-six lesions, identified in 24 patients with MS, were characterized by their enhancement pattern on contrast-enhanced T1-weighted MR images. There were 57 nonenhancing lesions (NELs), 28 homogeneously enhancing lesions (HELs), and 11 ring-enhancing lesions (RELs). The trace ADC means for each type of lesion and for normal-appearing white matter (NAWM) were calculated and compared using Student's t-test. RESULTS: The mean trace ADC values for HELs (mean, 7.7 x 1(-10) m2s(-1); SD, 1.4 x 10(-10) m2s(-1)) were less than those for RELs (mean, 1.2 x 10(-9) m2s(-1); SD, 3.5 x 10(-10)m2s(-1)) and NELs (mean, 1.3 x 10(-9) m2(s-1); SD, 2.6 x 10(-10) m2(s-1)). There was a significant difference between the mean trace ADC values of HELs and RELs as well as between those for HELs and NELs. There was also a significant difference in the mean trace ADC values between all lesion types and NAWM (mean, 6.9 x 10(-10) m2s(-1); SD, 5.0 x 10(-11) m2s(-1)). CONCLUSION: We found a predictable relationship between mean trace ADC and the pattern of enhancement in MS lesions, corresponding to reported histopathologic differences in myelination between lesion types and magnetization transfer ratios
— id: 24410, year: 2000, vol: 21, page: 869, stat: Journal Article,

The effect of gadolinium-enhancing lesions on whole brain atrophy in relapsing-remitting MS
Saindane AM; Ge Y; Udupa JK; Babb JS; Mannon LJ; Grossman RI
2000 Jul 12;55(1):61-65, Neurology
OBJECTIVE: To determine the relationship between gadolinium-enhancing lesions and changes in whole brain parenchymal volume in patients with relapsing-remitting MS, and to test the hypothesis that gadolinium enhancement is a predictor of whole brain atrophy. METHODS: Twenty-four patients with clinically definite MS were imaged over 2 years. A computer-assisted segmentation technique based on high-resolution MRI was used to quantify gadolinium-enhancing T1 lesion volume and brain parenchyma and CSF volumes. Percent brain parenchymal volume (PBV) relative to the total intracranial volume was calculated, and changes in PBV were used to represent the degree of whole brain atrophy over 2 years. RESULTS: PBV at baseline was dependent on duration of MS, and a significant decrease in PBV was observed over the course of the study. Changes in enhanced T1 lesion load failed to correlate with changes in PBV, and multiple regression analyses determined that enhanced T1 lesion load at baseline was not a significant predictor of subsequent change in PBV. CONCLUSIONS: MR visible inflammation as demonstrated by enhanced T1 lesions is not a significant factor in the pathogenesis of whole brain atrophy in relapsing-remitting MS, suggesting that a more global pathologic process is responsible for the loss of brain parenchymal volume
— id: 43790, year: 2000, vol: 55, page: 61, stat: Journal Article,

Assessment of posterior fossa damage in MS using MRI
Yousry TA; Grossman RI; Filippi M
2000 Jan 15;172 Suppl 1(1):S50-S53, Journal of the neurological sciences
In multiple sclerosis (MS), brain stem and cerebellum are frequent sites of damage in clinically isolated syndromes at presentation and it is likely that lesions located in such structures can have an important impact on the development of disability in the definite forms of the disease. In patients presented with isolated brain stem syndromes, the symptomatic lesion was often not detected by magnetic resonance (MR) imaging. But patients with asymptomatic infratentorial lesions progressed to clinically definite MS in 65% of cases. Infratentorial lesions are included in various MR criteria designed to assist in the differential diagnosis of MS lesions from incidental lesions, to differentiate MS from subcortical encephalopathic arteriopathy. The preferred MR sequence to visualize infratentorial lesions is the fast spin echo sequence. It is preferred to conventional spin echo and fast fluid attenuated inversion recovery sequences because of its relatively short acquisition time and good sensitivity. The correlation between disability and infratentorial lesion load on T2 weighted sequences is controversial. However, it was recently shown that the correlations between clinical measures and T1 lesion load, histogram magnetization transfer ratio and peak positions, and infratentorial volume measurements are strong. These findings suggest that one of the major factors in the development of disability in patients with MS is the pathological damage in clinically eloquent sites such as the brain stem and cerebellum
— id: 43961, year: 2000, vol: 172 Suppl 1, page: S50, stat: Journal Article,

Characterization of white matter lesions in multiple sclerosis and traumatic brain injury as revealed by magnetization transfer contour plots
Bagley LJ; Grossman RI; Galetta SL; Sinson GP; Kotapka M; McGowan JC
1999 Jun-Jul;20(6):977-981, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Magnetization transfer imaging provides information about the structural integrity of macromolecular substances, such as myelin. Our objective was to use this imaging technique and contour plotting to characterize and to define the extent of white matter lesions in multiple sclerosis and traumatic brain injury. METHODS: Magnetization transfer imaging was performed of 30 multiple sclerosis plaques and 10 traumatic white matter lesions. Magnetization transfer ratios (MTRs) were calculated for the lesions, for the normal- or abnormal-appearing surrounding white matter, and for remote normal-appearing white matter. MTR contour plots were constructed about these lesions. RESULTS: The contour plot appearance of MS plaques differed from that of traumatic white matter lesions. There was a gradual increase in MTR values at points at increasing distances from the center of the MS plaques; this was true for those lesions with and without surrounding T2 signal abnormality (halos). In contrast, there was an abrupt transition in MTR values between traumatic lesions and normal-appearing surrounding white matter. Additionally, the size of the MTR abnormality exceeded the size of the T2 signal abnormality for the MS plaques. CONCLUSION: MTR contour plots permit characterization and border definition of white matter lesions. Analysis of the contour plots suggests that MS is a centrifugal process with the lowest MTR within the center of the lesion. In contrast, traumatic white matter injuries are discrete lesions with abrupt transitions between the abnormal lesion and normal brain
— id: 43974, year: 1999, vol: 20, page: 977, stat: Journal Article,

Magnetization transfer contrast: its utility as a technique and its application to central nervous system pathology
Bagley LJ; Grossman RI; McGowan JC
1999 ;53(5 Suppl 3):S49-S51, Neurology
Magnetic resonance (MR) imaging is the pre-eminent modality for the detection and characterization of central nervous system pathology. However, in a variety of disease processes, histopathologic studies have often shown more extensive abnormalities in the brain and spinal cord than could be detected on conventional MR images. Magnetization transfer contrast (MTC) can be used qualitatively to augment differences between tissues and to accentuate gadolinium enhancement. Additionally, MTC may be used quantitatively to characterize tissues and potentially to detect otherwise microscopic disease
— id: 43970, year: 1999, vol: 53, page: S49, stat: Journal Article,

MR imaging quantitation of gray matter involvement in multiple sclerosis and its correlation with disability measures and neurocognitive testing
Catalaa I; Fulton JC; Zhang X; Udupa JK; Kolson D; Grossman M; Wei L; McGowan JC; Polansky M; Grossman RI
1999 Oct;20(9):1613-1618, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Multiple sclerosis (MS) is the most common inflammatory disease of the central nervous system and manifests both physical and neurocognitive disabilities. Although predominantly a disease of the white matter, MS is also characterized by lesions in the gray matter. Previous pathologic studies have found that cortical and deep gray matter lesions comprised 5% and 4%, respectively, of total lesions. Using software for lesion detection and quantitation, our study was designed to determine MS involvement in the cortical and deep gray matter and to correlate gray matter lesion load with neurocognitive function and the Kurtzke Expanded Disability Status Scale. METHODS: Using a semiautomated segmentation algorithm that detected and delineated all possible brain MS lesions on MR images, we investigated gray matter lesion volume in 18 patients with untreated relapsing-remitting MS. Cortical and deep gray matter lesions then were correlated with the neurocognitive and physical disability measurements. RESULTS: We found that cortical gray matter lesions comprised approximately 5.7% of the total lesion volume, whereas deep gray matter lesions comprised another 4.6% in this patient cohort. No strong correlations were found between gray matter lesions and disability status or neurocognitive function. CONCLUSION: These results are similar to those found in previous pathologic studies. The cortical lesion load in cases of relapsing-remitting MS, as measured by MR imaging, represents less than 6% of the total lesion volume and does not correlate with disability measures or neurocognitive tests
— id: 43968, year: 1999, vol: 20, page: 1613, stat: Journal Article,

The contribution of magnetic resonance imaging to the diagnosis of multiple sclerosis
Fazekas F; Barkhof F; Filippi M; Grossman RI; Li DK; McDonald WI; McFarland HF; Paty DW; Simon JH; Wolinsky JS; Miller DH
1999 Aug 11;53(3):448-456, Neurology
MRI is very sensitive in showing MS lesions throughout the CNS. Using MRI for diagnostic purposes, however useful, is a complex issue because of limited specificity of findings and a variety of options as to when, how, and which patients to examine. Comparability of data and a common view regarding the impact of MRI are needed. Following a review of the typical appearance and pattern of MS lesions including differential diagnostic considerations, we suggest economic MRI examination protocols for the brain and spine. Recommendations for referral to MRI consider the need to avoid misdiagnosis and the probability of detecting findings of diagnostic relevance. We also suggest MRI classes of evidence for MS to determine the diagnostic weight of findings and their incorporation into the clinical evaluation. These proposals should help to optimize and standardize the use of MRI in the diagnosis of MS
— id: 43973, year: 1999, vol: 53, page: 448, stat: Journal Article,

Familial multiple sclerosis: volumetric assessment in clinically symptomatic and asymptomatic individuals
Fulton JC; Grossman RI; Mannon LJ; Udupa J; Kolson DL
1999 Apr;5(2):74-77, Multiple sclerosis
A genetic basis for clustering of multiple sclerosis (MS) cases, based on studies of MS families, has been proposed for decades. Few reports provide detailed neurological as well as neuroradiological findings on these patients. We report total T2-weighted intracranial lesion volumes on members of three familial MS cohorts: a mother and father with conjugal MS with one affected son and a neurologically normal son and daughter, one pair of monozygotic twin sisters with MS, and a female sibling pair with MS. We hypothesized that asymptomatic siblings in a family with two affected parents and another affected child might demonstrate clinically silent T2-weighted lesions; and that monozygotic twins with MS are more likely to express similar T2-weighted lesion volumes than non-twin sibling pairs. We found clinically silent lesions in unaffected children of the symptomatic parent couple, with a significant difference in total T2 lesion volume between these unaffected siblings and their parents, as well as their affected brother. In our other sibling pairs, T2 lesion volumes were similar between the twins and significantly different in the non-twin pair, despite similar levels of clinical functioning as determined by EDSS scoring. These results suggest that foci of demyelination might be expected in clinically normal offspring of parents with MS, possibly reflecting a genetic predisposition to subsequent development of MS
— id: 43977, year: 1999, vol: 5, page: 74, stat: Journal Article,

MR lesion load and cognitive function in patients with relapsing-remitting multiple sclerosis
Fulton JC; Grossman RI; Udupa J; Mannon LJ; Grossman M; Wei L; Polansky M; Kolson DL
1999 Nov-Dec;20(10):1951-1955, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Multiple sclerosis (MS) is a demyelinating disease most often associated with progressive physical impairment; however, its effects are noted to extend beyond physical disability. Our purpose was to determine the relationship between T2 lesion volume and neurocognitive and physical disability in relapsing-remitting multiple sclerosis. METHODS: We studied a cohort of 19 patients with relapsing-remitting MS. Of this group, there were 15 women and four men from varying socioeconomic backgrounds. This volunteer sample was selected from a larger group of 53 patients with MS in our longitudinal MS study because they had been untreated with any beta-interferon medications, had been followed for at least 12 months, and had a clinical status of relapsing-remitting MS. RESULTS: Of 12 neurocognitive parameters tested, two correlated significantly with lesion loads. The correlation of the Symbol-Digit Modalities test, which analyzes information-processing speed, was significant (P = .0204). The correlation of the fifth trial of the Rey Auditory Verbal Learning test, which tests verbal long-term memory, was also significant (P = .0348). None of the other 10 neurocognitive examinations, however, showed a significant correlation with total lesion volume (Paced Auditory Serial Addition test-1.6, P = .7381; Paced Auditory Serial Addition test-2.0, P = .4180; Controlled Oral Word Association test, P = .8906; Category Fluency test, P = .4423; Bells test, P = .9097; Rey Auditory Verbal Learning test-delay, P = .9843, Rey Auditory Verbal Learning test-recognition, P = .7467; Word Span test, P = .4939; Road Map test, P = 0.4939). The lesion load also did not correlate with the physical disability scales as rated according to the Expanded Disability Status Scale (P = .68) or Ambulation Index (P = .95). CONCLUSION: Our results indicate that T2 lesion volume does not seem to be a robust surrogate marker of neuropsychological impairment in patients with MS. We think that global measurements of parameters that are more specific to the disease process may offer more precise correlation with cognitive dysfunction and other disability parameters
— id: 43964, year: 1999, vol: 20, page: 1951, stat: Journal Article,

Total brain N-acetylaspartate concentration decline with age in relapsing-remitting multiple-sclerosis
Gonen, O; Catalaa, I; Mannon, LJ; Swaminathan, SV; Kolson, DL; Grossman, RI
1999 NOV ;213P(1):1473-1473, Radiology
— id: 105116, year: 1999, vol: 213P, page: 1473, stat: Journal Article,

Non T1 or T2-weighted whole brain N-acetylaspartate quantitation using proton magnetic resonance spectroscopy
Gonen, O; Viswanathan, KA; Babb, JS; Udupa, JK; Grossman, RI
1999 NOV ;213P(1):1307-1307, Radiology
— id: 105115, year: 1999, vol: 213P, page: 1307, stat: Journal Article,

Application of magnetization transfer imaging to multiple sclerosis
Grossman RI
1999 ;53(5 Suppl 3):S8-11, Neurology
The evolution of our understanding of multiple sclerosis (MS) has been facilitated by the technique of magnetization transfer, which has the ability to detect and categorize lesions that are both visible and occult by conventional magnetic resonance (MR) imaging. The methodology can be applied to individual MS lesions as well as to the global brain disease. The results of studies performed in centers throughout the world reveal multiple correlations with clinical parameters as well as greater specificity and sensitivity to lesion than other presently available MR measures
— id: 43972, year: 1999, vol: 53, page: S8, stat: Journal Article,

Traumatic brain injury: diffusion-weighted MR imaging findings
Liu AY; Maldjian JA; Bagley LJ; Sinson GP; Grossman RI
1999 Oct;20(9):1636-1641, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Diffuse axonal injury (DAI) accounts for a significant portion of primary intra-axial lesions in cases of traumatic brain injury. The goal of this study was to use diffusion-weighted MR imaging to characterize DAI in the setting of acute and subacute traumatic brain injury. METHODS: Nine patients ranging in age from 26 to 78 years were examined with conventional MR imaging (including fast spin-echo T2-weighted, fluid-attenuated inversion-recovery, and gradient-echo sequences) as well as echo-planar diffusion-weighted MR imaging 1 to 18 days after traumatic injury. Lesions were characterized as DAI on the basis of their location and their appearance on conventional MR images. Trace apparent diffusion coefficient (ADC) maps were computed off-line with the diffusion-weighted and base-line images. Areas of increased signal were identified on the diffusion-weighted images, and regions of interests were used to obtain trace ADC values. RESULTS: In the nine patients studied, isotropic diffusion-weighted images showed areas of increased signal with correspondingly decreased ADC. In one case, decreased ADC was seen 18 days after the initial event. CONCLUSION: Decreased ADC can be demonstrated in patients with DAI in the acute setting and may persist into the subacute period, beyond that described for cytotoxic edema in ischemia
— id: 43967, year: 1999, vol: 20, page: 1636, stat: Journal Article,

Diffuse axonal pathology detected with magnetization transfer imaging following brain injury in the pig
McGowan JC; McCormack TM; Grossman RI; Mendonca R; Chen XH; Berlin JA; Meaney DF; Xu BN; Cecil KM; McIntosh TK; Smith DH
1999 Apr;41(4):727-733, Magnetic resonance in medicine
This study was designed to evaluate with magnetization transfer imaging (MTI) and conventional magnetic resonance (MR) imaging the manifestation of diffuse axonal injury (DAI) in an animal model of injury via nonimpact coronal plane rotational acceleration. A second objective was to investigate the diagnostic use of quantitative MTR imaging based on statistical parameters in a single subject, as opposed to grouped analysis. Seven mini-swine were subjected to brain trauma known to produce isolated DAI and to MR imaging at two time points. Following sacrifice, the brains were harvested for histopathologic examination. Magnetization transfer ratio (MTR) maps were generated for double-blinded comparison of regions with abnormal MTR values and regions with documented DAI. Positive and negative predictive values for MTR detection of DAI were 67 and 56%, respectively, and in acute studies alone, 89 and 61%. Gains in sensitivity over conventional imaging for detection of DAI were demonstrated
— id: 43978, year: 1999, vol: 41, page: 727, stat: Journal Article,

Differences between relapsing-remitting and chronic progressive multiple sclerosis as determined with quantitative MR imaging
Miki Y; Grossman RI; Udupa JK; van Buchem MA; Wei L; Phillips MD; Patel U; McGowan JC; Kolson DL
1999 Mar;210(3):769-774, Radiology
PURPOSE: To investigate the cross-sectional relationships among multiple quantitative brain magnetic resonance (MR) imaging measurements in patients with relapsing-remitting versus chronic progressive multiple sclerosis (MS). MATERIALS AND METHODS: Thirty-eight patients with MS (relapsing-remitting, 26, chronic progressive, 12) were examined. Lesion volume on T2-weighted MR images, contrast material-enhancing lesion volume, percentage of brain parenchymal volume (brain volume/[brain volume + cerebrospinal fluid volume), and magnetization transfer ratio histogram peak height for the whole brain were calculated. RESULTS: Significant negative correlation was noted between volume on T2-weighted images and magnetization transfer ratio histogram peak height for both the relapsing-remitting and chronic progressive groups (P < .001 for both). A positive correlation was demonstrated for lesion volume on T2-weighted images and enhancing lesion volume in the relapsing-remitting group (P < .01) but not in the chronic progressive group. Negative correlations were demonstrated for enhancing lesion volume and magnetization transfer ratio histogram peak height (P = .02), for Expanded Disability Status Scale score and magnetization transfer histogram peak height (P = .02), and for Expanded Disability Status Scale score and percentage of brain parenchymal volume in the relapsing-remitting group (P = .004) but not in the chronic progressive group. CONCLUSION: The cross-sectional relationships among multiple quantitative brain MR imaging measurements are different between relapsing-remitting and chronic progressive MS
— id: 43979, year: 1999, vol: 210, page: 769, stat: Journal Article,

Relapsing-remitting multiple sclerosis: longitudinal analysis of MR images--lack of correlation between changes in T2 lesion volume and clinical findings
Miki Y; Grossman RI; Udupa JK; Wei L; Polansky M; Mannon LJ; Kolson DL
1999 Nov;213(2):395-399, Radiology
PURPOSE: To determine the relationship between T2 lesion volume and either disability measurements or change in T2 lesion volume over time in multiple sclerosis (MS). MATERIALS AND METHODS: Eighteen patients (age range, 26-53 years) with clinically proved relapsing-remitting MS were examined every 6 months for over 2 years. Three-millimeter-thick contiguous images of the whole brain were obtained. T2 lesion volume was calculated with a highly reproducible volumetric computer method. RESULTS: A substantial annual increase in T2 lesion volume, with a median annual increase of approximately 8%, was demonstrated. However, there was no significant correlation between absolute T2 lesion volume and either the absolute expanded disability status scale (EDSS) grade (P = .32) or the absolute ambulation index (AI) (P = .20). In addition, no significant correlation between change in T2 lesion volume and change in EDSS grade (P = .42) or AI (P = .37) was found. There was no significant correlation between T2 lesion volume and duration of disease (P = .08). CONCLUSION: There is no significant correlation between T2 lesion volume and standardized disability measurements despite a substantial increase in T2 lesion volume over time. Patients have an increase in total T2 lesion volume in the brain regardless of their clinical status or disability measurements. T2 lesion volumes as outcomes in therapeutic clinical trials on MS should be viewed as secondary outcomes rather than as surrogate markers of clinical responses
— id: 43966, year: 1999, vol: 213, page: 395, stat: Journal Article,

Serial analysis of magnetization-transfer histograms and Expanded Disability Status Scale scores in patients with relapsing-remitting multiple sclerosis
Patel UJ; Grossman RI; Phillips MD; Udupa JK; McGowan JC; Miki Y; Wei L; Polansky M; van Buchem MA; Kolson D
1999 Nov-Dec;20(10):1946-1950, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Magnetization transfer ratio histogram peak height (MTR-HPH) has been shown to correlate with macroscopic and microscopic brain disease in patients with multiple sclerosis (MS). We studied the changes in MTR-HPH and in Kurtzke's Expanded Disability Status Scale (EDSS) scores over time in a group of patients with relapsing-remitting MS. METHODS: Twenty adult patients with relapsing-remitting MS (four men and 16 women) were followed up for a period of 334 to 1313 days. In all, 86 MR imaging studies of the brain were obtained, and MTR-HPH was calculated for each MR examination by using a semiautomated technique. Changes in MTR-HPH were compared between patients over the study's duration. A neurologist specialized in the care of MS patients assessed the EDSS score for each patient as a measure of clinical disability. RESULTS: Serial MR data showed a subtle but significant decline in MTR-HPH with time. No significant changes in EDSS scores were noted over the same period. CONCLUSION: Patients with relapsing-remitting MS have a significant progressive decline in normalized MTR-HPH, which is independent of EDSS score. MTR-HPH measurements can be used to monitor subclinical disease in patients with relapsing-remitting MS over a short time frame of 1 to 4 years. This parameter might be applied in future therapeutic trials to assess its usefulness
— id: 43965, year: 1999, vol: 20, page: 1946, stat: Journal Article,

Evidence for preganglionic pupillary involvement in superficial siderosis
Pelak VS; Galetta SL; Grossman RI; Townsend JJ; Volpe NJ
1999 Sep 22;53(5):1130-1132, Neurology
A 36-year-old man presented with spinal myoclonus, ataxia, hearing loss, and unilateral pupillary dilation. MRI demonstrated hemosiderin deposition along the superficial surfaces of the brain, brainstem, cerebellum, and spine. The pupillary changes were localized to the preganglionic oculomotor nerve. In contrast to vasculopathic oculomotor nerve palsies, superficial siderosis may cause selective involvement of the superficially located pupillary fibers
— id: 43969, year: 1999, vol: 53, page: 1130, stat: Journal Article,

New reasons for early use of MRI in stroke
Prichard JW; Grossman RI
1999 Jun 10;52(9):1733-1736, Neurology
— id: 43976, year: 1999, vol: 52, page: 1733, stat: Journal Article,

A double-blind, placebo-controlled trial of extracorporeal photopheresis in chronic progressive multiple sclerosis
Rostami AM; Sater RA; Bird SJ; Galetta S; Farber RE; Kamoun M; Silberberg DH; Grossman RI; Pfohl D
1999 Jun;5(3):198-203, Multiple sclerosis
Extracorporeal photopheresis is a safe therapy for cutaneous T-cell lymphoma and may have efficacy in certain autoimmune disorders. We performed a randomized, double-blinded, placebo-controlled trial of monthly photopheresis therapy in 16 patients with clinically definite multiple sclerosis (MS). All patients had progressed during the preceding year with entry Expanded Disability Status Scale (EDSS) scores between 3.0 and 7.0. Patients received photopheresis or sham therapy for 1 year and were followed for an additional 6 to 12 months. Patients were clinically evaluated by three disability scales: (1) EDSS; (2) Ambulation index and (3) Scripp's quantitative neurologic assessment. No serious side effects occurred in either group. There were no differences between the photopheresis and sham therapy groups by the disability measures. Additionally, there were no differences in progression of MRI plaque burden or evoked potential latencies. In this limited study, photopheresis was found to be safe but did not significantly alter the course of chronic progressive MS
— id: 43975, year: 1999, vol: 5, page: 198, stat: Journal Article,

Magnetization transfer histogram methodology: its clinical and neuropsychological correlates
van Buchem MA; McGowan JC; Grossman RI
1999 ;53(5 Suppl 3):S23-S28, Neurology
OBJECTIVE: To review studies on the assessment of correlations between magnetization transfer ratio (MTR) histogram analysis and measures of clinical and neuropsychological function. BACKGROUND: Since its recent introduction, MTR histogram analysis has attracted attention in the field of multiple sclerosis (MS). METHODS: In this paper, studies are discussed that deal with MTR histogram analysis. The principles of MTR, application of MTR methodology as regional and volumetric MTR analysis, clinical and neuropsychological correlates, and potential use of MTR histogram analysis as an estimate of cerebral lesion load in MS are discussed respectively. RESULTS: In several preliminary studies, it has been shown that in MS patients, measures derived from MTR histograms correlate with measures of clinical and particularly neuropsychological function. CONCLUSION: MTR histogram analysis is a promising method to estimate cerebral lesion load in MS patients. Before it can be routinely used as an outcome measure in clinical trials, a number of questions about this technique have to be addressed
— id: 43971, year: 1999, vol: 53, page: S23, stat: Journal Article,

Hypointense multiple sclerosis lesions on T1-weighted spin echo magnetic resonance images: their contribution in understanding multiple sclerosis evolution
Barkhof F; McGowan JC; van Waesberghe JH; Grossman RI
1998 May;64 Suppl 1(6):S77-S79, Journal of neurology neurosurgery & psychiatry
The predictive value of T2-weighted imaging in multiple sclerosis is only moderate, due to low specificity of high signal on such images. Among new MR techniques with acclaimed higher pathological specificity, hypointense lesions on moderately T1-weighted spin echo images show improved correlation with disability. The degree of hypointensity of so called black holes correlates with loss of magnetisation transfer, a marker of matrix destruction. Severe tissue loss is also shown histopathologically in a post-mortem MR study of black holes. In this review unresolved issues regarding black holes are discussed including standardisation of sequences, definition of hypointensity, interobserver variation in measuring lesion load with this technique, and significance of acute black holes. The role of black holes in monitoring treatment efficacy is as yet unexplored
— id: 43985, year: 1998, vol: 64 Suppl 1, page: S77, stat: Journal Article,

Proton magnetic resonance spectroscopy for detection of axonal injury in the splenium of the corpus callosum of brain-injured patients
Cecil KM; Hills EC; Sandel ME; Smith DH; McIntosh TK; Mannon LJ; Sinson GP; Bagley LJ; Grossman RI; Lenkinski RE
1998 May;88(5):795-801, Journal of neurosurgery
OBJECT: This study was conducted to determine whether proton magnetic resonance spectroscopy (MRS) is a sensitive method for detecting diffuse axonal injury, which is a primary sequela of traumatic brain injury (TBI). Diffuse axonal injury is characterized by selective damage to white matter tracts that is caused in part by the severe inertial strain created by rotational acceleration and deceleration, which is often associated with motor vehicle accidents. This axonal injury is typically difficult to detect by using conventional imaging techniques because it is microscopic in nature. The splenium was selected because it is a site vulnerable to shearing forces that produce diffuse axonal injury. METHODS: The authors used proton MRS to evaluate the splenium, the posterior commissure of the corpus callosum, in normal control volunteers and in patients with TBI. Proton MRS provided an index of neuronal and axonal viability by measuring levels of N-acetyl aspartate (NAA). CONCLUSIONS: A majority of mildly brain injured patients, as well as those more severely injured, showed diminished NAA/creatine (Cr) levels in the splenium compared with normal control volunteers. The patients displaying lowered NAA/Cr in the splenium were also likely to exhibit lowered NAA/Cr in lobar white matter. Also, the levels of NAA/Cr in the splenium of normal volunteers were higher compared with those found in lobar white matter. Decreases in NAA/Cr levels in the splenium may be a marker for diffuse injury. A proton MRS examination may be particularly useful in evaluating mildly injured patients with unexplained neurological and cognitive deficits. It is concluded that MRS is a sensitive tool in detecting axonal injury
— id: 43989, year: 1998, vol: 88, page: 795, stat: Journal Article,

Guidelines for using quantitative measures of brain magnetic resonance imaging abnormalities in monitoring the treatment of multiple sclerosis
Filippi M; Horsfield MA; Ader HJ; Barkhof F; Bruzzi P; Evans A; Frank JA; Grossman RI; McFarland HF; Molyneux P; Paty DW; Simon J; Tofts PS; Wolinsky JS; Miller DH
1998 Apr;43(4):499-506, Annals of neurology
The change of brain lesion load, measured on T2-weighted magnetic resonance imaging (MRI) using computer-assisted techniques, is a widely used secondary endpoint for phase III clinical trials in multiple sclerosis (MS). Collection, transfer, and analysis of the electronic data across multiple centers have all proved challenging and give rise to potential errors. However, many new acquisition schemes and postprocessing techniques have been developed; these may reduce scan times and result in better lesion conspicuity or lessen the human interaction needed for data analysis. This review considers many aspects of the use of MRI in clinical trials for MS and provides international consensus guidelines, derived from a task force of the European Magnetic Resonance Networks in Multiple Sclerosis (MAGNIMS) together with a group of North American experts. The main points considered are the organization of correctly powered trials and selection of participating sites; the appropriate choice of pulse sequences and image acquisition protocol given the current state of technology; quality assurance for data acquisition and analysis; accuracy and reproducibility of lesion load assessments; and the potential for the application of quantitative methods to other MRI-derived measures of disease burden
— id: 43991, year: 1998, vol: 43, page: 499, stat: Journal Article,

Total brain N-acetylaspartate concentration in normal, age-grouped females: quantitation with non-echo proton NMR spectroscopy
Gonen O; Viswanathan AK; Catalaa I; Babb J; Udupa J; Grossman RI
1998 Nov;40(5):684-689, Magnetic resonance in medicine
The intra-individual and inter-individual variations of the global N-acetylaspartate (NAA) concentration were measured in a cohort of five 42+/-5 year-old normal females. The total NAA signal from the whole head was obtained with non-localized non-echo proton spectroscopy (1H-MRS) and converted into absolute mole amounts using phantom replacement. Since NAA is assumed to be present only in neurons, its concentration was obtained by dividing these mole amounts with the brains' volume, calculated from high resolution MRI. The key feature of the procedure is its near-complete suppression of the intense subcutaneous and bone marrow lipids' signals, whose chemical shifts neighbor and underlay the NAA. This was achieved by exploiting the lipids' much shorter T1s, compared to that of NAA, for destructive interference of their signals in co-addition following alternating, nonselective 180 degrees inversions. The average global, inter-individual NAA concentration in that group was found to be 10.63 mM with a 95% confidence interval of 10.43-10.82 mM
— id: 27742, year: 1998, vol: 40, page: 684, stat: Journal Article,

3D multivoxel proton NMR spectroscopy in multiple sclerosis using an 8th order 1D-Hadamard/2D-CSI hybrid
Gonen, O; Viswanathan, KA; Grossman, RI
1998 NOV ;209P(7):431-431, Radiology
— id: 105117, year: 1998, vol: 209P, page: 431, stat: Journal Article,

Perspectives on multiple sclerosis
Grossman RI; McGowan JC
1998 Aug;19(7):1251-1265, AJNR. American journal of neuroradiology
— id: 43983, year: 1998, vol: 19, page: 1251, stat: Journal Article,

Gadolinium-enhanced fat-suppressed T1-weighted imaging of the head and neck: comparison of gradient and conventional SE sequences
Hirsch JA; Loevner LA; Yousem DM; Siegelman ES; Keiper MD; Marquis RP; Grossman RI
1998 Sep-Oct;22(5):771-776, Journal of computer assisted tomography
PURPOSE: The purpose of this study was to compare contrast-enhanced GRE and conventional SE (CSE) fat-suppressed T1-weighted techniques in the evaluation of head and neck lesions. A hybrid, opposed phase, frequency-selective, fat-suppressed fast multiplanar spoiled GRE (FMPSPGR) sequence was compared with a fat-suppressed CSE sequence. METHOD: Thirty-two patients with head and neck pathology were evaluated with both fat-suppressed CSE and FMPSPGR sequences. Regions of interest obtained by two viewers in consensus were used to establish contrast-to-noise (CNR) and signal-to-noise ratios for both sequences. Three neuroradiologists also independently reviewed the images for quality of fat suppression, lesion conspicuity, and potential pitfalls. RESULTS: The CNR of the FMPSPGR sequence was superior to that of the fat-suppressed CSE sequence. Subjectively, all three reviewers rated the FMPSPGR sequence as having fat suppression equal to or better than that in the CSE sequence in 94% of cases. Imaging times for the FMPSPGR sequence were 60-75% faster than those for the CSE sequence. CONCLUSION: Enhanced imaging of the head and neck region using an opposed phase, fat-suppressed GRE sequence results in improved fat suppression compared with the CSE technique, with substantial savings in imaging time
— id: 43982, year: 1998, vol: 22, page: 771, stat: Journal Article,

MR identification of white matter abnormalities in multiple sclerosis: a comparison between 1.5 T and 4 T
Keiper MD; Grossman RI; Hirsch JA; Bolinger L; Ott IL; Mannon LJ; Langlotz CP; Kolson DL
1998 Sep;19(8):1489-1493, AJNR. American journal of neuroradiology
BACKGROUND AND PURPOSE: Although MR spectroscopy and functional MR imaging of the brain have been successful at 4 T, conventional fast spin-echo imaging of the brain at 4 T has not been adequately evaluated. The purpose of this study was to compare the detection of white matter abnormalities in multiple sclerosis (MS) at 1.5 T and 4 T. METHODS: Fifteen patients with clinically definite MS were imaged at both 1.5 T and 4 T within a 1-week period. Comparison was made between fast spin-echo long-TR images at both field strengths. Pulse sequences were tailored to maximize resolution and signal-to-noise ratio in clinically relevant imaging times (< 7 min). Four interpreters independently reviewed the images obtained at both field strengths in separate sessions and evaluated them for lesion identification, size, characterization, and subjective resolution. Differences in interpretations at 1.5 T and 4 T were subsequently recorded. RESULTS: Images obtained at 4 T showed a mean of 88 more lesions as compared with images obtained at 1.5 T. All the lesions measured less than 5 mm and were typically aligned along perivascular spaces. Twenty-five consensually identified lesions on 4-T images were not seen at all on 1.5-T images. Moreover, 4-T images showed 56 additional consensually identified lesions, which were indistinct and seen only in retrospect on 1.5-T images. These lesions were frequently (n = 48) identified in large confluent areas of white matter signal intensity abnormality at 1.5 T. All observers also agreed that 4-T images subjectively enhanced the perception of normal perivascular spaces and small perivascular lesions. CONCLUSION: MR imaging at 4 T can depict white matter abnormalities in MS patients not detectable at 1.5 T through higher resolution with comparable signal-to-noise ratio and imaging times
— id: 43981, year: 1998, vol: 19, page: 1489, stat: Journal Article,

Case of the month: April 1997--a 32 year old man with mental status changes and a severe occipital headache
Lieberman AP; Grossman RI; Lavi E
1998 Jan;8(1):229-230, Brain pathology
A 32 year old man with symptoms of an upper respiratory infection one week prior presented with mental status changes, diffuse hyperreflexia, and bilateral extensor plantar responses. An MRI scan showed multifocal areas of high signal intensity predominantly in the parietal and occipital white matter, unassociated with mass affect. Despite aggressive treatment, the patient's symptoms rapidly progressed and he was declared brain dead. Post-mortem examination revealed acute hemorrhagic leukoencephalopathy. The clinical and pathologic features of this disorder are reviewed
— id: 43992, year: 1998, vol: 8, page: 229, stat: Journal Article,

Magnetisation transfer imaging: theory and application to multiple sclerosis
McGowan JC; Filippi M; Campi A; Grossman RI
1998 May;64 Suppl 1(6):S66-S69, Journal of neurology neurosurgery & psychiatry
Magnetic resonance imaging techniques based on magnetisation transfer exploit the inherent heterogeneity of tissue with respect to relaxation times T1 and T2. Contrast reflecting the interactions between distinct relaxation 'environments' may be exploited via novel quantitative analysis for potential gains in specificity of the MR examination in multiple sclerosis
— id: 43986, year: 1998, vol: 64 Suppl 1, page: S66, stat: Journal Article,

Isolated U-fiber involvement in MS: preliminary observations
Miki Y; Grossman RI; Udupa JK; Wei L; Kolson DL; Mannon LJ; Grossman M
1998 May;50(5):1301-1306, Neurology
We studied the frequency and location of isolated U-fiber involvement in MS and correlated these findings exploratively with physical disability and neuropsychological impairment. Fifty-three MS patients were examined. Three-millimeter-thick, fast spin-echo T2-weighted MR images and spin-echo postgadolinium T1-weighted images were obtained. Computer software that which had been validated previously for quantitation of MS lesions was used to detect lesions on the T2-weighted images. The Expanded Disability Status Scale (EDSS), Ambulation Index (AI), and a battery of neurocognitive tests were performed on each patient. Forty-two arcuate hyperintensities along the U-fiber were detected by the software in 28 patients (53%). Twenty-seven lesions (64.3%) were seen in the frontal lobe, eight (19.0%) in the temporal lobe, three (7.1%) in the parietal lobe, three (7.1%) in the occipital lobe, and one (2.4%) in both frontal and parietal lobes. Four lesions (9.5%) showed gadolinium enhancement. Seventeen lesions (40%) were hypointense on the T1-weighted images. Scores of three of the 11 neuropsychological tests reflecting performance in executive control and memory were significantly different at least at the p = 0.05 level between the eight patients with multiple, isolated U-fiber lesions and the 45 patients without any or with only a single U-fiber lesion. No significant difference was noted for EDSS or AI. Isolated U-fiber involvement is an underappreciated MR finding in MS. Our preliminary hypothesis is that U-fiber lesions may contribute to neuropsychological impairment, although our observation requires confirmation
— id: 43988, year: 1998, vol: 50, page: 1301, stat: Journal Article,

The role of magnetic resonance techniques in understanding and managing multiple sclerosis
Miller DH; Grossman RI; Reingold SC; McFarland HF
1998 Jan;121 ( Pt 1)(5):3-24, Brain
Magnetic resonance (MR) techniques have had a major impact in the last 10-15 years in understanding and managing multiple sclerosis. This review summarizes the current uses of MR in multiple sclerosis, based on the proceedings of a recent international workshop, under four headings: (i) technical issues; (ii) role in diagnosis; (iii) natural history studies in understanding the disease; (iv) application in clinical trials. The theory and methodology of relevant technical issues is outlined, in order to provide a framework with which to understand the potential and limitations of MR in addressing biological and clinical questions in multiple sclerosis. The principles underlying signal-to-noise and contrast-to-noise ratio are discussed, along with the techniques and clinical results for conventional and fast spin echo T2-weighted imaging, fluid-attenuated inversion recovery, detection of blood-brain barrier break down and hypointense lesions on T1-weighted images, magnetization transfer, T2 decay-curve analysis, MR spectroscopy, spinal cord imaging, diffusion imaging, and quantification of lesion load and atrophy. MRI has an extremely valuable role in confirming the clinical diagnosis of multiple sclerosis. T2-weighted brain imaging remains the standard diagnostic tool, but in some instances it is usefully complemented with gadolinium enhancement and spinal imaging. The caveat that the diagnosis of multiple sclerosis remains primarily a clinical one cannot be over-emphasized. Serial MRI studies have added much to our understanding of the natural history and pathophysiology of the disease. Blood-brain barrier breakdown is a consistent early feature of new lesion development in relapsing-remitting and secondary progressive multiple, sclerosis, and this usually correlates with active inflammation and myelin breakdown. A number of the acute MR changes are reversible, but chronic persistent abnormalities in a number of MR parameters, such as reduced N-acetyl aspartate, low magnetization transfer ratios, atrophy and T1-hypointensity, suggest the presence of demyelination and/or axonal degeneration in many chronic lesions. The presence and extent of T2-weighted MRI abnormalities at first presentation with a clinically isolated syndrome suggestive of demyelination strongly predicts the risk of developing clinically definite multiple sclerosis in the next few years. In established multiple sclerosis, however, the correlations between T2 abnormalities and disability are modest. This poor relationship partly relates to the discrepancy between lesion site and function in attempting to correlate locomotor disability with brain MRI findings. However, the correlations between brain lesion load and cognitive dysfunction in multiple sclerosis, whilst more evident, are still modest. A more important limitation is the low pathological specificity of abnormalities seen on T2-weighted images. Stronger correlations have been found between disability and new putative MR markers for demyelination and/or axonal degeneration. Serial studies using multiple MR techniques are now needed to further clarify pathophysiological mechanisms in multiple sclerosis. Serial MR has become an important tool in monitoring treatment efficacy. It provides data which can be readily analysed in a blinded fashion and which directly inspects the pathological evolution; it also enables a rapid and sensitive measure of treatment outcome in early relapsing-remitting and secondary progressive disease. Because of the modest clinical correlations it is, however, still appropriate that the definitive determinant of treatment efficacy remains a clinical one. Further work is needed to address issues of quality control in serial studies, statistical calculation of appropriate sample sizes, and optimization of the nature and frequency of MR outcomes measured
— id: 43990, year: 1998, vol: 121 ( Pt 1), page: 3, stat: Journal Article,

Comparison of T2 lesion volume and magnetization transfer ratio histogram analysis and of atrophy and measures of lesion burden in patients with multiple sclerosis
Phillips MD; Grossman RI; Miki Y; Wei L; Kolson DL; van Buchem MA; Polansky M; McGowan JC; Udupa JK
1998 Jun-Jul;19(6):1055-1060, AJNR. American journal of neuroradiology
PURPOSE: The purpose of this study was twofold: first, to compare two different measures of lesion burden in patients with multiple sclerosis (MS), the magnetization transfer ratio (MTR) histogram and T2 lesion volume; and, second, to investigate the relationship between lesion burden and atrophy in patients with MS. METHODS: Thirty patients with MS were examined with MR imaging, including fast spin-echo T2- and proton density-weighted sequences as well as magnetization transfer sequences. The lesion burden in each subject was quantitated by MTR histographic analysis and by a computer-based method for calculating the total volume of lesions on T2-weighted images. Additionally, the CSF volume, the brain parenchymal volume, and the percentage of brain parenchymal volume were determined in all patients by using this method and were compared with measurements in eight control subjects. RESULTS: Significant loss of parenchymal volume was seen in patients with MS as determined by increased CSF volume and decreased percentage of brain parenchymal volume relative to that in age-matched control subjects. An inverse correlation was observed between the peak height of the MTR histogram and T2 lesion volume. T2 lesion volume corresponded positively with CSF volume and inversely with percentage of brain parenchymal volume. The peak height of the MTR histogram corresponded positively with percentage of brain parenchymal volume and inversely with CSF volume. CONCLUSION: MS patients sustain a significant loss of parenchymal volume (atrophy), which corresponds strongly with increasing lesion burden. T2 lesion volume and peak height of the MTR histogram show good correlation, and the peak height of the MTR histogram shows a superior correlation with measures of brain atrophy as compared with measurements of T2 lesion volume, suggesting that the MTR histogram may be a better indicator of global disease burden than is T2 lesion volume
— id: 43984, year: 1998, vol: 19, page: 1055, stat: Journal Article,

Postanoxic encephalopathy: diffusion MR findings
Roychowdhury S; Maldjian JA; Galetta SL; Grossman RI
1998 Nov-Dec;22(6):992-994, Journal of computer assisted tomography
— id: 43980, year: 1998, vol: 22, page: 992, stat: Journal Article,

Correlation of volumetric magnetization transfer imaging with clinical data in MS
van Buchem MA; Grossman RI; Armstrong C; Polansky M; Miki Y; Heyning FH; Boncoeur-Martel MP; Wei L; Udupa JK; Grossman M; Kolson DL; McGowan JC
1998 Jun;50(6):1609-1617, Neurology
We examined the relations between quantitative volumetric estimates of cerebral lesion load based on magnetization transfer imaging (MTI), clinical data, and measures of neuropsychological function in 44 patients with clinically diagnosed MS. In this population we assessed the correlation between several volumetric MTI measures, measures of neurologic function (Kurtzke Expanded Disability Status Scale and Ambulation Index), and disease duration using Spearman's correlation coefficient. Patients were classified on the basis of neuropsychological test performance as severely impaired, moderately impaired, and normal. We assessed differences between these groups with respect to MTI results using the Kruskal-Wallis test. MTI measures corrected for brain volume were found to correlate with disease duration (p < 0.01) and showed suggestive correlations with measures of neurologic impairment (p < 0.05). Individual neuropsychological tests correlated with MTI measures corrected and not corrected for brain volume (p < 0.001). An MTI measure not corrected for brain volume differed (p < 0.05) between severely impaired, moderately impaired, and normal patients. These preliminary results suggest that volumetric MTI analysis provides new measures that reflect more accurately the global lesion load in the brain of MS patients, and they may serve as a method to study the natural course of the disease and as an outcome measure to evaluate the effect of drugs
— id: 43987, year: 1998, vol: 50, page: 1609, stat: Journal Article,

Gliomas: correlation of magnetic susceptibility artifact with histologic grade
Bagley LJ; Grossman RI; Judy KD; Curtis M; Loevner LA; Polansky M; Detre J
1997 Feb;202(2):511-516, Radiology
PURPOSE: To determine whether magnetic susceptibility artifact on magnetic resonance (MR) images can be used to grade gliomas. MATERIALS AND METHODS: Twenty-nine patients with gliomas were prospectively examined with spin-echo T1-weighted MR imaging without and with contrast material enhancement, spin-echo or fast spin-echo T2- and proton-density-weighted MR imaging, and gradient-echo T2*-weighted MR imaging. Images were reviewed by two neuroradiologists, and susceptibility artifacts in the tumor region were graded. Heterogeneity, mass effect, contrast enhancement, and necrosis were also graded. Tumors were graded according to the World Health Organization classification. RESULTS: Increased susceptibility artifact was detected by at least one observer on gradient-echo MR images of 19 tumors. This feature was seen on only 10 of the spin-echo or fast spin-echo T2-weighted MR images of lesions. Fifteen neoplasms with increased susceptibility artifact detected on MR images by at least one observer were high-grade lesions (anaplastic astrocytoma or glioblastoma multiforme). Lesion susceptibility artifact detected on T2*-weighted MR images was associated with tumor grade (P < .05). CONCLUSION: Susceptibility artifacts on T2*-weighted gradient-echo MR images appear to be valuable in the preoperative evaluation of gliomas
— id: 44000, year: 1997, vol: 202, page: 511, stat: Journal Article,

Serum angiotensin-converting enzyme in multiple sclerosis
Constantinescu CS; Goodman DB; Grossman RI; Mannon LJ; Cohen JA
1997 Aug;54(8):1012-1015, Archives of neurology
OBJECTIVE: To determine the extent and significance of serum angiotensin-converting enzyme (ACE) elevation in multiple sclerosis (MS) and the correlation between serum ACE activity and clinical and magnetic resonance imaging (MRI) indicators of disease activity. DESIGN: A retrospective cross-sectional study of 45 consecutive patients with clinically definite MS and a longitudinal study of 30 additional patients with clinically definite MS involved in a long-term study of neurologic function and MRI in MS. SETTING: Comprehensive MS center of a tertiary care university hospital. SUBJECTS: A total of 75 patients with clinically definite MS and 31 healthy controls. METHODS: Serum ACE activity was measured using a spectrophotometric assay and correlated with clinical indicators of disease activity and with total cerebral MS lesion volume measured by MRI. RESULTS: An elevated ACE activity was found in 17 (23%) of 75 patients with MS as compared with 2 (6%) of 31 healthy controls. Changes in serum ACE activity correlated with changes in total plaque volume on MRI. CONCLUSIONS: Serum ACE activity may be an indicator of disease activity in longitudinal analysis. Also, elevated ACE activity in a patient with otherwise typical MS need not raise suspicions of alternative diagnoses
— id: 43996, year: 1997, vol: 54, page: 1012, stat: Journal Article,

Magnetization transfer imaging in progressive multifocal leukoencephalopathy
Kasner SE; Galetta SL; McGowan JC; Grossman RI
1997 Feb;48(2):534-536, Neurology
We report a patient with biopsy-proven progressive multifocal leukoencephalopathy (PML) who was serially imaged with MRI and magnetization transfer imaging. The magnetization transfer ratio (MTR) was profoundly and significantly diminished when compared with normal control subjects. The pattern of MTR was distinct from that of MS and periventricular ischemic white matter disease. Magnetization transfer imaging techniques may aid in the differential diagnosis of PML
— id: 43999, year: 1997, vol: 48, page: 534, stat: Journal Article,

The low sensitivity of fluid-attenuated inversion-recovery MR in the detection of multiple sclerosis of the spinal cord
Keiper MD; Grossman RI; Brunson JC; Schnall MD
1997 Jun-Jul;18(6):1035-1039, AJNR. American journal of neuroradiology
PURPOSE: To confirm the expected superiority of fluid-attenuated inversion-recovery (FLAIR) over conventional fast spin-echo MR imaging in the detection of multiple sclerosis (MS) of the spinal cord. METHODS: Fifteen subjects with known MS involving the spinal cord and brain were studied prospectively. The entire cord was imaged with a phased-array coil on a 1.5-T MR system. Sagittal T1-weighted and fast spin-echo proton density- and T2-weighted images were followed by fast FLAIR images. FLAIR parameters were varied to optimize lesion conspicuity with optimal inversion times (TIs) ranging from 2400 to 2600. Lesion conspicuity and detection were compared between the fast spin-echo and FLAIR images by three radiologists who reached agreement by consensus. RESULTS: The FLAIR technique effectively suppressed cerebrospinal fluid (CSF) signal and reduced CSF pulsation and truncation artifacts in all cases. Shorter imaging parameters (repetition time of 4000 to 6000, TI of 1500 to 2000) uniformly decreased lesion conspicuity in all subjects. Of 11 cord lesions in five subjects imaged with the longer parameters (repetition time of 8000 to 11,000, TI of 2400 to 2600), three were not seen on FLAIR images, four were less conspicuous on FLAIR images, and four were seen equally or better on FLAIR images. CONCLUSION: Although successful in suppressing CSF signal and reducing imaging artifacts, fast FLAIR imaging appears unreliable in the detection of MS lesions in the spinal cord
— id: 43997, year: 1997, vol: 18, page: 1035, stat: Journal Article,

Computer-assisted quantitation of enhancing lesions in multiple sclerosis: correlation with clinical classification
Miki Y; Grossman RI; Udupa JK; Samarasekera S; van Buchem MA; Cooney BS; Pollack SN; Kolson DL; Constantinescu C; Polansky M; Mannon LJ
1997 Apr;18(4):705-710, AJNR. American journal of neuroradiology
PURPOSE: To study the utility of a computer-assisted method of quantitating enhancing multiple sclerosis (MS) lesions and to correlate this quantitation with the type and duration of disease. METHODS: Forty untreated patients with MS were studied. The patients had been classified clinically as having either relapsing-remitting (n = 27) or chronic-progressive (n = 13) disease. Postcontrast contiguous 3-mm-thick MR images of the brain were obtained for up to 3 years. The computer program selected potential lesion sites automatically on the basis of the theory of 'fuzzy connectedness,' which was incorporated into 3DVIEWNIX software. True lesions were selected from these previously detected potential lesions by means of yes/no responses to the program query. The number of enhancing lesions and the enhancing lesions volume were subsequently computed. RESULTS: The enhancing lesion volume in patients with relapsing-remitting disease was statistically significantly higher than that of patients with chronic-progressive disease. There was a strong positive correlation between the number of enhancing lesions and the enhancing lesion volume. No significant correlation was noted between the change in score on the expanded disability status scale (EDSS) and the change in the number of enhancing lesions, or between the change in EDSS score and the change in enhancing lesion volume. A negative correlation was found between enhancing lesion volume and duration of disease, and between the number of enhancing lesions and duration of disease in the patients who had enhancing lesions. CONCLUSIONS: Our data suggest that enhancing lesion volume reflects differences in the classification of clinical MS and in the disease activity over time. Computer-assisted quantitation of enhancing lesion volume is a robust, practical, and objective measure of MS activity
— id: 43998, year: 1997, vol: 18, page: 705, stat: Journal Article,

A new computer-assisted method for the quantification of enhancing lesions in multiple sclerosis
Samarasekera S; Udupa JK; Miki Y; Wei L; Grossman RI
1997 Jan-Feb;21(1):145-151, Journal of computer assisted tomography
PURPOSE: Our goal is to describe a new computerized method for the detection and quantification of enhanced multiple sclerosis (MS) lesions. METHOD: Gd-DTPA-enhanced, thin section, T1-weighted images of seven patients (involving 336 slice images) with definite MS were analyzed using a new method based on the theory of 'fuzzy connected components,' developed and implemented on the 3DVIEWNIX software system. Four neuroradiologists selected 'true' lesions from the computer-detected potential lesions with a yes/no response to the program query on 2 different days. The enhanced lesion volume and number of enhancing lesions for each image and each observer were subsequently computed. Additional studies involving 720 slices were conducted to determine lesions that were missed by the system. RESULTS: The intra- and interobserver variability in the system was 0%. It took approximately 1 min of operator time per 3D study. The system output has no false positives and a mean false-negative volume of 1.3%. CONCLUSION: The novel system calculates enhancing lesion volume and the number of enhancing lesions with very little operator time, inter- and intraoperator variability, or false-positive and false-negative volumes. Computer-based quantification of enhancing lesion volume is an important objective measure of the activity of MS. The system is now in routine use in clinical investigations that study the role of enhancing lesions in the MS disease
— id: 44001, year: 1997, vol: 21, page: 145, stat: Journal Article,

Multiple sclerosis lesion quantification using fuzzy-connectedness principles
Udupa JK; Wei L; Samarasekera S; Miki Y; van Buchem MA; Grossman RI
1997 Oct;16(5):598-609, IEEE Transactions on medical imaging
Multiple sclerosis (MS) is a disease of the white matter. Magnetic resonance imaging (MRI) is proven to be a sensitive method of monitoring the progression of this disease and of its changes due to treatment protocols. Quantification of the severity of the disease through estimation of MS lesion volume via MR imaging is vital for understanding and monitoring the disease and its treatment. This paper presents a novel methodology and a system that can be routinely used for segmenting and estimating the volume of MS lesions via dual-echo fast spin-echo MR imagery. A recently developed concept of fuzzy objects forms the basis of this methodology. An operator indicates a few points in the images by pointing to the white matter, the grey matter, and the cerebro-spinal fluid (CSF). Each of these objects is then detected as a fuzzy connected set. The holes in the union of these objects correspond to potential lesion sites which are utilized to detect each potential lesion as a three-dimensional (3-D) fuzzy connected object. These objects are presented to the operator who indicates acceptance/rejection through the click of a mouse button. The number and volume of accepted lesions is then computed and output. Based on several evaluation studies, we conclude that the methodology is highly reliable and consistent, with a coefficient of variation (due to subjective operator actions) of 0.9% (based on 20 patient studies, three operators, and two trials) for volume and a mean false-negative volume fraction of 1.3%, with a 95% confidence interval of 0%-2.8% (based on ten patient studies)
— id: 43993, year: 1997, vol: 16, page: 598, stat: Journal Article,

Global volumetric estimation of disease burden in multiple sclerosis based on magnetization transfer imaging
van Buchem MA; Udupa JK; McGowan JC; Miki Y; Heyning FH; Boncoeur-Martel MP; Kolson DL; Polansky M; Grossman RI
1997 Aug;18(7):1287-1290, AJNR. American journal of neuroradiology
We report a semiautomated postprocessing method based on magnetization transfer MR imaging that can quantify the extent of global disease in patients with multiple sclerosis. The technique combines segmentation and quantitative analysis of imaging data reflecting the structural integrity of white matter. Applications of this technique may include assessment of disease progress and of the efficacy of experimental therapeutic intervention. The height of the histogram peak corresponding to white matter was found to be lowered in patients with multiple sclerosis and the overall distribution of magnetization transfer ratios was shifted to lower values
— id: 43995, year: 1997, vol: 18, page: 1287, stat: Journal Article,

Frequency of magnetic resonance imaging abnormalities in patients with migraine
Cooney BS; Grossman RI; Farber RE; Goin JE; Galetta SL
1996 Nov-Dec;36(10):616-621, Headache
BACKGROUND: The frequency of magnetic resonance imaging (MRI) abnormalities in patients with migraine has been reported at 12% to 46%. We examined a series of patients to determine the frequency of MRI abnormalities, and any relationship of frequency with patient age, sex, migraine type, duration of symptoms, and other medical conditions. METHODS: Magnetic resonance imaging findings were reviewed retrospectively with respect to presence of focal white matter hyperintensities in 185 consecutive patients. Patients had been diagnosed with migraine by a neurologist. All images had been interpreted by a neuroradiologist. Clinical information was obtained by chart review. RESULTS: Sixteen percent had focal white matter abnormalities. Among patients less than 50 years old, and without other medical problems such as hypertension, atherosclerotic heart disease, diabetes mellitus, autoimmune disorder or demyelinating disease, only 6% had white matter abnormalities. Increased frequency of white matter abnormalities was associated with age and medical risk factors, but not with sex, migraine subtype, or duration of migraine symptoms. CONCLUSION: The observed frequency of MRI abnormalities in our series is lower than has been previously reported. In many cases, these abnormalities may be unrelated to migraine. When such changes are discovered in a patient with migraine, other etiologies should be considered
— id: 44002, year: 1996, vol: 36, page: 616, stat: Journal Article,

A randomized comparison of iodixanol and iohexol in adult intracranial computed tomography scanning
Grossman RI; Modic MT
1996 Sep;3 Suppl 3(8):S488-S494, Academic radiology
RATIONALE AND OBJECTIVES: Nonionic iodinated contrast media have proved effective for computed tomography (CT) of the head and have demonstrated greater tolerability than their ionic counterparts. Iodixanol is a new nonionic agent with the added attribute of being isosmolar to blood and having less than half the osmolality of iohexol. Phase I safety, tolerance, and pharmacokinetic studies have indicated that iodixanol may be associated with fewer adverse effects than iohexol while providing equivalent diagnostic information. METHODS: We compared the safety and efficacy of iodixanol at 270 mg I/ ml (IOD-270) and at 320 mg I/ml (IOD-320) with iohexol 300 mg I/ml (IOH-300). RESULTS: No statistically significant differences in the quality of images or in the occurrence of adverse events were found among the three treatment groups. Pairwise comparisons of injection-associated discomfort revealed that significantly more patients in the IOH-300 group experienced discomfort than in either the IOD-270 or IOD-320 groups. CONCLUSION: Iodixanol at 270 or 320 mg I/ml was found to be safe and effective when administered intravenously at a volume of 100 ml for intracranial CT scans in adult patients
— id: 44007, year: 1996, vol: 3 Suppl 3, page: S488, stat: Journal Article,

Clinical assessment of MR of the brain in nonsurgical inpatients
Hirsch JA; Langlotz CP; Lee J; Tanio CP; Grossman RI; Schulman KA
1996 Aug;17(7):1245-1253, AJNR. American journal of neuroradiology
PURPOSE: To evaluate the effect of MR imaging of the brain on four domains of patient care: diagnosis, diagnostic workup, therapy, and prognosis. METHODS: Pre- and post-MR written questionnaires and oral interviews were administered to the referring clinicians of 103 medical and neurologic inpatients at a tertiary care institution. Additional information was obtained from radiologic reports and records. RESULTS: The study population had a diverse array of signs and symptoms and of presumptive clinical diagnoses, reflecting the breadth of disease seen at our institution. The vast majority of physicians (89%) reported that MR imaging added significant diagnostic information, playing an important role in guiding diagnostic workup (24%), planning treatment (34%), and estimating prognosis (47%). MR imaging was significantly more likely to decrease than to increase confidence in the presumptive clinical diagnosis. Thus, MR imaging may be most useful in the setting of diagnostic uncertainty. CONCLUSION: Our results show that MR imaging of the brain has important effects on each of the four domains of care for medical inpatients
— id: 44008, year: 1996, vol: 17, page: 1245, stat: Journal Article,

MR spectroscopy in the evaluation of enhancing lesions in the brain in multiple sclerosis
Hirsch JA; Lenkinski RE; Grossman RI
1996 Nov-Dec;17(10):1829-1836, AJNR. American journal of neuroradiology
PURPOSE: To compare proton MR spectroscopic alterations with the degree of contrast enhancement in multiple sclerosis (MS) lesions. METHODS: Thirty-five patients with clinically diagnosed MS were studied with MR spectroscopy. A total of 47 lesions were examined. Solvent-suppressed proton spectra were acquired with an echo time of 16 milliseconds using the point-resolved spectroscopic localization method from 1.5 cm3 voxels. Marker peaks/creatine (Cr) ratios obtained from these spectra were plotted against the relative enhancement of the lesion seen after administration of contrast material. The relative enhancement was defined as S(contrast) -S0/S0, where S0 is the signal intensity of a T1-weighted image and S(contrast) is the signal intensity after administration of gadopentetate dimeglumine. RESULTS: We found a positive linear relationship between the marker peaks/Cr ratio and the degree of enhancement of the lesion. That is, the marker peaks/Cr ratio was higher in the lesions that showed the greatest enhancement. CONCLUSION: The MR/Cr ratio obtained with the use of short-echo-time proton MR spectroscopy correlates with the degree of contrast enhancement. This ratio may therefore serve as a means for evaluating and quantifying the level of inflammatory activity within the plaques of patients with MS
— id: 44004, year: 1996, vol: 17, page: 1829, stat: Journal Article,

Proton MR spectroscopy and magnetization transfer ratio in multiple sclerosis: correlative findings of active versus irreversible plaque disease
Kimura H; Grossman RI; Lenkinski RE; Gonzalez-Scarano F
1996 Sep;17(8):1539-1547, AJNR. American journal of neuroradiology
PURPOSE: To characterize plaques of multiple sclerosis (MS) using both proton MR spectroscopy and magnetization transfer (MT) imaging. METHODS: The magnetization transfer ratio (MTR) was calculated from two series of three-dimensional gradient-recalled acquisition in the steady state (GRASS) images obtained with and without an MT saturation pulse. Proton spectra were acquired using the point-resolved spectroscopy (PRESS) sequence with a voxel size of 1.5 x 1.5 x 1.5 cm3. A total of 28 spectra were obtained in 13 patients who had clinically definitive MS. The spectra were analyzed together with the MTR. RESULTS: A positive relationship was found between the N-acetylaspartate (NAA)/creatine (Cr) ratio and the MTR in MS plaques, whereas no significant correlation was found between the metabolite ratios and the signal intensity on fast spin-echo T2-weighted MR images. CONCLUSION: Small changes in the MTR of MS plaques relative to the MTR of normal white matter may reflect inflammatory changes and edema, whereas larger changes in MTR correlate with decreased NAA/Cr ratio and therefore suggest demyelination and irreversible damage from chronic MS plaques
— id: 44006, year: 1996, vol: 17, page: 1539, stat: Journal Article,

Magnetization transfer imaging of diffuse axonal injury following experimental brain injury in the pig: characterization by magnetization transfer ratio with histopathologic correlation
Kimura H; Meaney DF; McGowan JC; Grossman RI; Lenkinski RE; Ross DT; McIntosh TK; Gennarelli TA; Smith DH
1996 Jul-Aug;20(4):540-546, Journal of computer assisted tomography
PURPOSE: Our goal was to evaluate the use of the magnetization transfer ratio (MTR) in the detection of diffuse axonal injury (DAI) resulting from traumatic brain injury in a swine model. METHOD: DAI was created by applying a nonimpact, coronal plane, rotational acceleration to the heads of miniature swine (n = 4). GE imaging was performed with and without off-resonance MT saturation. Histologic correlation of axonal injury with MRI was performed 7 days postinjury. Thirty-one subcortical white matter regions and 10 deep white matter regions were selected for the direct comparison of histologic data and MTR measurements. RESULTS: Nineteen of 41 examined locations exhibited histologic evidence of axonal injury. The mean MTR in regions with axonal damage was significantly less than in regions without axonal damage. These changes were observed both in regions demonstrating high signal intensity on T2-weighted images (T2WI) (p <0.0001, n = 6) and in regions with no signal intensity change on T2WI (p < 0.05, n = 13). CONCLUSION: These results suggest that the measurement of MTR may have the potential for evaluation axonal damage in DAI following traumatic brain injury even when conventional T2WI does not demonstrate the lesion
— id: 44009, year: 1996, vol: 20, page: 540, stat: Journal Article,

White matter changes associated with deletions of the long arm of chromosome 18 (18q- syndrome): a dysmyelinating disorder?
Loevner LA; Shapiro RM; Grossman RI; Overhauser J; Kamholz J
1996 Nov-Dec;17(10):1843-1848, AJNR. American journal of neuroradiology
PURPOSE: To evaluate the MR findings in the central nervous systems of patients with deletions of the long arm of chromosome 18 (18q- syndrome). METHODS: Sixteen patients with 18q- syndrome ranging in age from 3 to 46 years (mean, 17 years) were studied with high-field-strength MR imaging. Images were analyzed for abnormal T2 hyperintensity in the white matter, abnormal T2 hypointensity in the deep gray matter, and atrophy. RESULTS: Ten of 16 patients had abnormal white matter. Diffuse, bilaterally symmetric deep white matter T2 hyperintensity, most pronounced in the periventricular regions, was most common, noted in eight cases. Focal deep white matter lesions and/or abnormalities involving the subcortical white matter were also noted in four cases. The cerebellum, brain stem, and corpus callosum were spared. Ventriculomegally associated with volume loss, and abnormal T2 hypointensity in the basal ganglia and/or thalami were each present in 11 patients. CONCLUSIONS: The 18q- syndrome is associated with white matter disease and abnormal T2 hypointensity in the deep gray matter. The basis for the white matter abnormalities is unknown, but may be related to one of the two genes for myelin basic protein included in the deleted segment of chromosome 18
— id: 44003, year: 1996, vol: 17, page: 1843, stat: Journal Article,

Multiple sclerosis lesions: relationship between MR enhancement pattern and magnetization transfer effect
Petrella JR; Grossman RI; McGowan JC; Campbell G; Cohen JA
1996 Jun-Jul;17(6):1041-1049, AJNR. American journal of neuroradiology
PURPOSE: To investigate the relationship between the enhancement pattern of a multiple sclerosis lesion and its magnetization transfer effect. METHODS: Fifty-four lesions were chosen from 29 patients with multiple sclerosis on the basis of enhancement pattern on contrast-enhanced T1-weighted MR images. They included 14 homogeneously enhancing lesions, 26 nonenhancing lesions, and 14 ring-enhancing lesions. Magnetization transfer ratios of the homogeneously enhancing lesions, nonenhancing lesions, and central portion of the ring-enhancing lesions were measured. Means were calculated and compared. RESULTS: The magnetization transfer ratios for homogeneously enhancing lesions were higher (mean, 32.2%; SD, 3.4%) than those for nonenhancing lesions (mean 29.4%; SD, 4.3%) and for the central portion of ring-enhancing lesions (mean, 24.5%; SD, 4.0%). Significant differences were found between the ring-enhancing lesions and the homogeneously enhancing lesions and between the ring-enhancing lesions and the nonenhancing lesions. CONCLUSION: We found a relationship between decreased magnetization transfer ratios and those enhancement patterns in which myelin is known to be decreased histopathologically. Thus, use of the magnetization transfer technique may increase the specificity of MR imaging in assessing the extent of residual myelination in multiple sclerosis lesions
— id: 44010, year: 1996, vol: 17, page: 1041, stat: Journal Article,

Quantitative volumetric magnetization transfer analysis in multiple sclerosis: estimation of macroscopic and microscopic disease burden
van Buchem MA; McGowan JC; Kolson DL; Polansky M; Grossman RI
1996 Oct;36(4):632-636, Magnetic resonance in medicine
Magnetization transfer imaging (MTI) has been shown to be sensitive to both macroscopic and microscopic disease in multiple sclerosis (MS). In this study three-dimensional MTI was used to estimate the global burden of disease in large volumes of brain tissue. MTI was performed in 15 MS patients and 11 normal controls. In seven MS patients MTI was performed on two different occasions. MTI data were displayed as magnetization transfer ratio (MTR) histograms and analyzed. The peak height of the histograms, presumably reflecting the residual amount of normal brain tissue, was lower in MS patients as compared with normal controls (P < 0.001), and was found to correlate with the duration of disease (P < 0.05). A decrease of the MTR histogram peak height was observed in the course of the disease (P < 0.01). These findings suggest that in MS, volumetric MTI provides quantitative information reflecting the global burden of disease
— id: 44005, year: 1996, vol: 36, page: 632, stat: Journal Article,

CT diagnosis of unsuspected traumatic cataracts in patients with complicated eye injuries: significance of attenuation value of the lens
Boorstein JM; Titelbaum DS; Patel Y; Wong KT; Grossman RI
1995 Jan;164(1):181-184, American journal of roentgenology
OBJECTIVE. The purpose of this study was to determine whether the CT attenuation value of the lens is helpful in diagnosing acute traumatic cataracts in patients with complicated eye injuries that preclude evaluation by any other means. SUBJECTS AND METHODS. The CT attenuation values of the lenses of 69 patients with acute orbital trauma, including 24 patients with clinically and surgically diagnosed acute traumatic cataracts, were compared with attenuation values of their own contralateral lens and with the attenuation values of the lenses of 103 consecutive asymptomatic control subjects. The study group was composed of consecutive patients with unilateral orbital trauma who were clinically evaluated and referred for CT examination within 48 hr after their initial injury. In all patients, attenuation measurements of the injured lenses were obtained and compared with those of the contralateral lens as an internal control. All surgically diagnosed cataracts were histologically confirmed. RESULTS. The CT attenuation measurement of a lens in any asymptomatic control subject was identical (within the range of the standard deviation) to the measurement of the contralateral lens of that control patient. In patients with orbital injury, the CT attenuation of the patient's cataractous lens was markedly lower than in the contralateral lens (mean density difference, 30 H, p < .0001). This decreased attenuation corresponds to acute cataract formation with increased fluid within the lens. No patient with normal attenuation values of the lens in the traumatized globe (as compared with the contralateral lens) was found to have an acute traumatic cataract or have a cataract develop within a 1-year follow-up period. CONCLUSION. CT may be useful in the examination of patients with acute traumatic cataracts, unsuspected lens injury, opacification of the anterior chamber, or other injuries of the globe with complications that preclude lens evaluation by any other means. This prompt diagnosis may allow timely removal of the lens in appropriate clinical circumstances, preventing damage to the anterior chamber of the globe and other complications of delayed diagnosis and treatment. Further, normal CT findings at the time of trauma suggest that the lens will not undergo acute traumatic cataract formation
— id: 44018, year: 1995, vol: 164, page: 181, stat: Journal Article,

Clinical and subclinical neurological involvement in children of conjugal multiple sclerosis patients
Constantinescu CS; Grossman RI; Finelli PF; Kamoun M; Zmijewski C; Cohen JA
1995 Nov;1(3):170-172, Multiple sclerosis
We report the occurrence of clinically definite multiple sclerosis in an offspring of a couple with conjugal multiple sclerosis. Extensive investigation of all members of this family, which includes two additional asymptomatic children, eliminated the possibility of alternative neurological diagnoses. All family members were studied with magnetic resonance imaging (MRI), evoked potentials, and human leukocyte antigen (HLA) typing. An asymptomatic child had subtle white matter abnormalities on MRI, suggesting subclinical neurological involvement. This study documents the third case of multiple sclerosis in the child of conjugal multiple sclerosis patients and provides the first report of MRI lesions in an asymptomatic offspring of the same parents. Neurodiagnostic and immunogenetic investigations of such rare family clusters may contribute to the elucidation of the pathogenesis of multiple sclerosis
— id: 43994, year: 1995, vol: 1, page: 170, stat: Journal Article,

Magnetization transfer effects in MR-detected multiple sclerosis lesions: comparison with gadolinium-enhanced spin-echo images and nonenhanced T1-weighted images
Hiehle JF Jr; Grossman RI; Ramer KN; Gonzalez-Scarano F; Cohen JA
1995 Jan;16(1):69-77, AJNR. American journal of neuroradiology
PURPOSE: To define the relationship between magnetization transfer and blood-brain-barrier breakdown in multiple sclerosis lesions using gadolinium enhancement as an index of the latter. METHODS: Two hundred twenty lesions (high-signal abnormalities on T2-weighted images) in 35 multiple sclerosis patients were studied with gadolinium-enhanced spin-echo imaging and magnetization transfer. Lesions were divided into groups having nodular or uniform enhancement, ring enhancement, or no enhancement after gadolinium administration. For 133 lesions, T1-weighted images without contrast enhancement were also analyzed. These lesions were categorized as isointense or hypointense based on their appearance on the unenhanced T1-weighted images. RESULTS: There was no difference between the magnetization transfer ratio (MTR) of lesions as a function of enhancement. MTR of hypointense lesions on unenhanced T1-weighted images was, however, lower than the MTR of isointense lesions. CONCLUSION: We speculate that diminished MTR may reflect diminished myelin content and that hypointensity on T1-weighted images corresponds to demyelination. Central regions of ring-enhancing lesions had a lower MTR than the periphery, suggesting that demyelination in multiple sclerosis lesions occurs centrifugally. In addition, the short-repetition-time pulse sequence seems useful in the evaluation of myelin loss in patients with multiple sclerosis
— id: 44019, year: 1995, vol: 16, page: 69, stat: Journal Article,

Penetrating neck trauma: sensitivity of clinical examination and cost-effectiveness of angiography
Jarvik JG; Philips GR 3rd; Schwab CW; Schwartz JS; Grossman RI
1995 Apr;16(4):647-654, AJNR. American journal of neuroradiology
PURPOSE: To evaluate penetrating neck trauma for (a) sensitivity of the clinical examination as an indicator of clinically significant vascular injury, and (b) cost-effectiveness of performing screening diagnostic angiography. METHODS: The medical records of all patients with penetrating neck trauma presenting at our institution over 4 years were retrospectively reviewed. Injuries were classified into one of three anatomic zones and classified into four mutually exclusive groups based on the extent of vascular injury; (a) no vascular injury; (b) minor vascular abnormality; (c) major vascular abnormality without a change in clinical management; or (d) any injury requiring a change in clinical management. Cost data were also obtained for each patient's hospitalization. RESULTS: There were 111 patients with penetrating neck trauma. No statistically significant difference between the sensitivities of the clinical examination or angiography for the detection of vascular injury were detected. Of the 48 patients who had vascular injuries, 45 had an abnormal clinical findings (93.7% sensitivity). None of the remaining 3 patients with vascular injury and normal clinical findings would have had their treatment altered by the results of angiography. The calculated cost of using angiography as a screening tool for vascular injury in patients with normal clinical findings was approximately $3.08 million per central nervous system event prevented. CONCLUSION: Our study suggests that in patients with zone II penetrating neck injuries the clinical examination is sufficient to detect significant vascular lesions and that screening angiography may not be indicated. Because our sample size was relatively small and the mean follow-up only 13.3 days, further investigation is needed to demonstrate definitively the lack of usefulness of screening angiography
— id: 44016, year: 1995, vol: 16, page: 647, stat: Journal Article,

Subcortical hemorrhage: marker for radiographically occult cerebral vein thrombosis on CT
Keiper MD; Ng SE; Atlas SW; Grossman RI
1995 Jul-Aug;19(4):527-531, Journal of computer assisted tomography
OBJECTIVE: Cerebral vein thrombosis (CVT) is a potentially life-threatening entity with a protean clinical presentation that can lead to delays in diagnosis and treatment. Computed tomography of the brain is often the initial imaging tool in evaluation of these patients, but is frequently nondiagnostic. This study identifies subcortical hemorrhage (SCH) as an indicator of radiographically occult CVT on CT. MATERIALS AND METHODS: A retrospective analysis of all subjects (n = 24) with CVT proven by MRI over a 4 year period was performed. The CT examinations of all subjects were evaluated for the presence of SCH and signs of CVT. An evaluation of the correlation between findings on CT and MRI as well as the delay in diagnosis and treatment secondary to unrecognized CVT on CT was also performed. RESULTS: Subcortical hemorrhage was noted in 9 of 24 (38%) subjects with CVT by MRI. The CT antedated MRI in eight of these subjects as the initial evaluation for presenting neurological symptoms. Subcortical hemorrhage was noted in six of eight of these subjects as the sole CT finding. Subcortical hemorrhage as well as CVT was seen in one subject, and no abnormality was seen in the final subject. Cerebral vein thrombosis was not suggested as a diagnosis in any of the six subjects with SCH as the sole radiographic finding. In all six of these cases, a delay in diagnosis occurred pending MRI obtained subsequently secondary to clinical deterioration. CONCLUSION: Subcortical hemorrhage can be seen in association with acute CVT and can be the sole abnormality on head CT. SCH as an isolated finding on CT suggests the possibility of unrecognized CVT, warranting further investigation by MRI
— id: 44015, year: 1995, vol: 19, page: 527, stat: Journal Article,

Microscopic disease in normal-appearing white matter on conventional MR images in patients with multiple sclerosis: assessment with magnetization-transfer measurements
Loevner LA; Grossman RI; Cohen JA; Lexa FJ; Kessler D; Kolson DL
1995 Aug;196(2):511-515, Radiology
PURPOSE: To assess for the presence of microscopic abnormalities in otherwise normal-appearing white matter on T2-weighted images in patients with multiple sclerosis (MS) by using magnetization-transfer (MT) measurements. MATERIALS AND METHODS: Twenty-three patients with MS and nine healthy control subjects underwent magnetic resonance (MR) imaging with a 1.5-T system. MT ratios (MTRs) were measured in 16 areas of normal-appearing white matter identified on conventional T2-weighted images in patients with MS. MTRs in the same white-matter locations in control subjects were determined. The two groups were compared. RESULTS: The mean whole-brain MTR of normal-appearing white matter in patients was 40.13% +/- 1.37 (standard deviation; range, 36.31%-42.09%); in control subjects, 42.93% +/- 0.95 (range, 41.62%-44.50%). The difference was statistically significant (P < or = .001). Except for the internal capsules, the difference in mean MTRs in each sublocation of the brain between patients and control subjects was statistically significant (P < or = .05). CONCLUSION: MT measurements are more sensitive than conventional MR imaging in the detection of abnormalities beyond the resolution of T2-weighted imaging
— id: 44012, year: 1995, vol: 196, page: 511, stat: Journal Article,

Characterization of multiple sclerosis plaques with T1-weighted MR and quantitative magnetization transfer
Loevner LA; Grossman RI; McGowan JC; Ramer KN; Cohen JA
1995 Aug;16(7):1473-1479, AJNR. American journal of neuroradiology
PURPOSE: To investigate the relationship between the appearance of multiple sclerosis lesions identified on unenhanced T1-weighted images and their corresponding magnetization transfer ratios. METHODS: A total of 119 white matter lesions seen on T2-weighted images in 17 patients with multiple sclerosis were evaluated. Axial T1-weighted images were used to classify the lesions as isointense to white matter (10 lesions), hypointense to white matter but hyperintense to gray matter (44 lesions), hypointense to gray matter (59 lesions), and relatively isointense to cerebrospinal fluid (6 lesions). The magnetization transfer ratio of each lesion was calculated, and an average magnetization transfer ratio for each subcategory was determined. RESULTS: The magnetization transfer ratio values became progressively lower with increasing hypointensity of lesions on T1-weighted images. The average magnetization transfer ratio for lesions isointense to white matter, hypointense to white matter but hyperintense to gray matter, hypointense to gray matter, and relatively isointense to cerebrospinal fluid was 34.90 +/- 2.67 mean +/- SD), 30.93 +/- 3.57, 27.27 +/- 3.56, and 23.62 +/- 2.83, respectively. All groups were significantly different from each other. CONCLUSION: Lesions isointense to white matter exhibited higher magnetization transfer ratio values than lesions that were hypointense. These findings are consistent with relative preservation of the myelin structure in the former, perhaps indicating that these lesions are predominantly inflammatory (edematous) in nature. The proportionately lower magnetization transfer ratio values of lesions that appear progressively more hypointense on T1-weighted images may reflect varying degrees of demyelination, with increasing lesion hypointensity corresponding to more breakdown in the macromolecular structure. These results suggest that T1-weighted images may be useful in characterizing the underlying pathologic substrate in multiple sclerosis plaques
— id: 44013, year: 1995, vol: 16, page: 1473, stat: Journal Article,

Cavernous malformations of the third ventricle
Sinson G; Zager EL; Grossman RI; Gennarelli TA; Flamm ES
1995 Jul;37(1):37-42, Neurosurgery
CAVERNOUS MALFORMATIONS ARE uncommon lesions that are usually present in the cerebral hemispheres. Less frequently, these malformations are seen in the brain stem, basal ganglia, or paraventricular regions. We report four cases of cavernous malformations of the third ventricle. Patients presented with symptoms of hydrocephalus, memory loss, and signs of hypothalamic dysfunction. Magnetic resonance imaging and computed tomography provided characteristic images of the three lesions preoperatively. All patients underwent direct surgical excision of the malformations. Two patients had a transcallosal, transventricular approach, the third underwent a transcortical, transventricular approach, and the fourth had an infratentorial supracerebellar approach. Postoperatively, the patient with hypothalamic dysfunction has not improved and underwent ventriculoperitoneal shunting. The second patient did well initially; however, 8 days postoperatively, she became comatose and later died. The presumed cause of her deterioration was a hypothalamic venous infarction. The third and fourth patients have returned to their normal neurological baseline. The presenting signs and symptoms, magnetic resonance imaging and computed tomography findings, and treatment options for this rare lesion are discussed and illustrated
— id: 44014, year: 1995, vol: 37, page: 37, stat: Journal Article,

Frontal and temporal lobe brain volumes in schizophrenia. Relationship to symptoms and clinical subtype
Turetsky B; Cowell PE; Gur RC; Grossman RI; Shtasel DL; Gur RE
1995 Dec;52(12):1061-1070, Archives of general psychiatry
BACKGROUND: Quantitative magnetic resonance imaging (MRI) studies demonstrate reduced brain volumes in schizophrenics, but specific structural abnormalities have not been clearly delineated. The structural abnormalities of this disorder are likely to be heterogeneous, consistent with its diverse clinical presentation. To investigate the relationship between structural abnormality and clinical symptoms, we examined regional brain and cerebral spinal fluid (CSF) volumes in a large sample of schizophrenic patients and controls, with patients aggregated into clinical subtypes. METHODS: Right and left hemisphere frontal and temporal lobe brain and CSF volumes were quantified from 5-mm axial spin-echo MRIs for 71 schizophrenic patients and 77 age- and sex-matched controls. The following four standardized rating scales were used to assess symptom severity: Negative Symptoms, Disorganization, Schneiderian Delusions and Hallucinations, and Suspicion-Hostility. Patients were also subtyped as either deficit or nondeficit on the basis of enduring negative symptoms. RESULTS: Schizophrenic patients overall exhibited abnormal brain asymmetry, with selective decrease in brain volume in the left temporal and right frontal regions. Left temporal lobe parenchymal volume reduction and CSF volume increase were correlated with the severity of negative symptoms. Consistent with this, the subtype analysis revealed abnormal temporal lobe asymmetry for the deficit subgroup only. Right frontal lobe volume reduction correlated with the duration of illness, independent of symptom severity or schizophrenic subtype. CONCLUSIONS: Abnormal lateral asymmetry suggests selective structural deficits in schizophrenia, rather than diffusely undifferentiated CNS abnormalities. The pattern of regional abnormalities is related to clinical symptoms, with negative symptoms being associated with left temporal lobe rather than frontal lobe abnormality. This is consistent with suggestions of a temporolimbic prefrontal network abnormality in schizophrenia. Further longitudinal studies are warranted, using higher-resolution MRI technology and gray matter-white matter segmentation to confirm and extend these findings
— id: 44011, year: 1995, vol: 52, page: 1061, stat: Journal Article,

Magnetization transfer imaging of periventricular hyperintense white matter in the elderly
Wong KT; Grossman RI; Boorstein JM; Lexa FJ; McGowan JC
1995 Feb;16(2):253-258, AJNR. American journal of neuroradiology
PURPOSE: To characterize with magnetization transfer imaging the pathologic substrate of the nonspecific periventricular hyperintense white matter changes seen on T2-weighted images of elderly patients. METHODS: Twenty-one elderly patients with periventricular hyperintense white matter on T2-weighted MR images and eleven control subjects were studied using MT technique. Magnetization transfer ratios (MTRs) were calculated for the periventricular hyperintense white matter and normal-appearing white matter. These MTRs were correlated with histopathologic changes that have previously been reported as well as with established MTRs for other lesions. RESULTS: The MTRs (mean, 35.2; SD, 1.2) in the periventricular hyperintense white matter are lower than those in the normal white matter of the patient (mean, 40.8; SD, 1.4) and control (mean, 41.3; SD, 1.8) groups. These MTRs are much higher than those of demyelinating lesions but are similar to those of experimental lesions with just edema. CONCLUSION: Because MTR may reflect to some extent histopathologic changes and thus provide more specificity than conventional pulse sequences, the main pathologic substrate accounting for the lower MTR in periventricular hyperintense white matter is probably the increased water content in reactive astrocytes
— id: 44017, year: 1995, vol: 16, page: 253, stat: Journal Article,

Metastatic lesions of the brain: imaging with magnetization transfer
Boorstein JM; Wong KT; Grossman RI; Bolinger L; McGowan JC
1994 Jun;191(3):799-803, Radiology
PURPOSE: To study solitary metastatic lesions of the brain with routine spin-echo (SE) and magnetization transfer (MT) magnetic resonance (MR) imaging. MATERIALS AND METHODS: In 15 patients with such lesions, the MT ratio (MTR) was calculated in the center and at the periphery of the metastatic lesion, and distally in adjacent white matter, from the periphery of the lesion radially to the most distant cortex. It also was calculated for mirror-image locations in the opposite hemisphere to provide control values. RESULTS: MTRs were decreased in and immediately around the site of the metastatic focus. MTRs also were lower than control values far distal to the metastatic focus, even when no abnormality was seen on SE MR images obtained before and those obtained after administration of gadopentetate dimeglumine. CONCLUSION: MT enables demonstration of white matter abnormalities in patients with metastatic lesions not seen on SE MR images. These changes can be found in white matter far distal to the lesion and surrounding areas of edema
— id: 44025, year: 1994, vol: 191, page: 799, stat: Journal Article,

Proton MR spectroscopy of brain abnormalities in neonates born to HIV-positive mothers
Cortey A; Jarvik JG; Lenkinski RE; Grossman RI; Frank I; Delivoria-Papadopoulos M
1994 Nov;15(10):1853-1859, AJNR. American journal of neuroradiology
PURPOSE: To examine the sensitivity of proton MR spectroscopy for detecting early central nervous system abnormalities in neonates born to human immunodeficiency virus (HIV)-positive mothers. METHODS: Asleep, unsedated, and continuously monitored by electrocardiography, 10 newborns, 5 with HIV-positive and 5 with HIV-negative mothers, were studied within the first 10 days of life in a 1.5-T scanner. After T1- and T2-weighted images were obtained, proton spectra were performed using voxels of interest (3.4 cm3) in the deep parietooccipital white matter. Peaks were identified as N-acetyl-aspartate (2.0 ppm), creatine and phosphocreatine (3.0 ppm), choline (3.2 ppm), and inositol (3.5 ppm). Peak areas were used to calculate metabolic ratios: N-acetyl-aspartate to creatine, inositol to creatine, and creatine to choline. RESULTS: All newborns of HIV-positive mothers had abnormal proton spectra compared with control infants; a nonspecific amino acid peak in the 2.1- to 2.6-ppm area was elevated, broad, and overlapping the N-acetyl-aspartate peak in all the HIV-exposed newborns and in only 1 of the 5 control newborns. The choline-to-creatine ratio was higher in HIV-exposed newborns at 2.3 +/- 0.4 (normal term, 0.9 +/- 0.3), as was the N-acetyl-aspartate-to-creatine ratio at 2.6 +/- 0.9 (for control subjects, 1.2 +/- 0.4). MR images from these brain regions were all considered normal. Because acquired immunodeficiency syndrome develops in only a small fraction of neonates born to HIV-seropositive mothers, the above spectral abnormalities found in all our subjects may result from indirect effects of HIV, such as intrauterine growth retardation. CONCLUSIONS: These findings indicate that proton MR spectroscopy might play an important role in detecting early central nervous system complications in newborns of HIV-seropositive mothers
— id: 44021, year: 1994, vol: 15, page: 1853, stat: Journal Article,

Sex differences in aging of the human frontal and temporal lobes
Cowell PE; Turetsky BI; Gur RC; Grossman RI; Shtasel DL; Gur RE
1994 Aug;14(8):4748-4755, Journal of neuroscience
This study investigated effects of age and sex on regional brain structure in humans, focusing on the frontal and temporal lobes. Hemispheric volumes were obtained from magnetic resonance images (MRIs) of 96 young (53 men, 43 women; aged 18-40 years) and 34 older (17 men, 17 women; aged 41-80) healthy volunteers. Images (5 mm axial spin-echo, repetition time of 3000 msec and echo times of 30 and 80 msec) were resliced along the anterior commissure-posterior commissure (AC-PC) axis to standardize for difference in head tilt, and imported into a computer program where borders of the frontal and temporal lobes were delineated. The program calculated regional brain volumes based on slice data from which CSF was segmented out. An age x sex x hemisphere x region interaction indicated that age-related reductions in brain volume were sexually dimorphic, lateralized, and region specific. Greater decrements in brain volume occurred with age in the frontal lobe than in the temporal lobe. Age-related reductions in both regions were greater in men than in women, demonstrating that sexual dimorphisms in human neuroanatomy are not fixed, but continue to change throughout adulthood. The possibility that gonadal hormones play a role in the promotion and/or prevention of neural atrophy with aging is discussed
— id: 44024, year: 1994, vol: 14, page: 4748, stat: Journal Article,

Magnetization transfer in multiple sclerosis
Grossman RI
1994 ;36 Suppl(2):S97-S99, Annals of neurology
Magnetization transfer (MT) is a technique that has the potential for detecting changes in myelin. The rigid macromolecular structure of myelin is the physical basis of MT. By using off-resonance irradiation, macromolecular protons can be saturated. These protons then exchange with free-water protons and produce a decrease in signal intensity of the free-water protons. This can be quantitated by using a magnetization transfer ratio (MTR) of signal intensities (Mo-Ms/Mo. Mo represents the signal intensity without off-resonance irradiation, and Ms represents the signal intensity with off-resonance irradiation). This method has been sensitive to changes in a spectrum of white-matter lesions, including an edema model (EAE), and regions of apparent myelin loss in patients with multiple sclerosis (MS). Furthermore, MTRs may be abnormal in patients with normal-appearing white matter, demonstrated by standard MR imaging. MTRs may enable subcategorization of MS lesions into lesions with low MTRs (presumed to be demyelinating lesions) and lesions with higher values (primarily edematous lesions). Another important use of MT is, in conjunction with gadolinium, to increase the number and extent of enhancing MS lesions. This can improve the detection of blood-brain barrier abnormalities in patients with MS
— id: 44029, year: 1994, vol: 36 Suppl, page: S97, stat: Journal Article,

Magnetization transfer: theory and clinical applications in neuroradiology
Grossman RI; Gomori JM; Ramer KN; Lexa FJ; Schnall MD
1994 Mar;14(2):279-290, Radiographics
Magnetization transfer, a new technique for improving image contrast in magnetic resonance (MR) imaging, is based on application of off-resonance radio-frequency pulses and observing their effects on MR images, as well as measuring the signal intensity with and without application of the pulses (ie, magnetization transfer ratio [MTR]). MTRs can be used to detect changes in the structural status of brain parenchyma that may or may not be visible with standard MR techniques. Use of MTRs may allow subcategorization of multiple sclerosis lesions into those with very low MTR (demyelinated lesions) and slightly decreased MTR (edematous lesions). In cases of wallerian degeneration, use of MTRs appears to allow reliable detection of changes undetectable with MR imaging or even light microscopy. In cases of infection with human immunodeficiency virus, MTRs seem to indicate that the macromolecular structure of white matter remains intact until relatively late in the course of disease. In cases of metastatic disease, MTRs of brain lesions indicate structural changes beyond the extent of the lesions seen on standard MR images. These findings may be due to chronic edema, myelin loss, and perhaps previous undetected tumor. In addition to being a new method of providing contrast, the magnetization transfer technique enables semi-quantitative, reproducible characterization of tissue and pathologic entities, which could substantially improve the specificity of MR imaging
— id: 44027, year: 1994, vol: 14, page: 279, stat: Journal Article,

Neuroradiology : the requisites
Grossman RI; Yousem DM
St. Louis : Mosby, 1994,
— id: 776, year: 1994, vol: , page: , stat: ,

Correlation of spectroscopy and magnetization transfer imaging in the evaluation of demyelinating lesions and normal appearing white matter in multiple sclerosis
Hiehle JF Jr; Lenkinski RE; Grossman RI; Dousset V; Ramer KN; Schnall MD; Cohen JA; Gonzalez-Scarano F
1994 Sep;32(3):285-293, Magnetic resonance in medicine
Magnetization transfer imaging (MT) and localized proton spectroscopy (1H-MRS) were utilized in the evaluation of lesions (high signal abnormalities on T2-weighted images) and normal-appearing white matter (NAWM) in multiple sclerosis (MS). Eleven patients with a clinical diagnosis of MS were independently evaluated with both 1H-MRS and MT. The magnetization transfer ratio (MTR) of lesions was compared with the relative concentration of N-acetyl-aspartate (NAA) and a composite peak at 2.1 to 2.6 ppm termed 'marker peaks.' The MTR of white matter lesions in the MS patients was markedly decreased (6-34%; normal approximately 42%), and correlated well with increase in the marker peaks region (0.94-3.89). There was no correlation between the relative concentration of NAA and MTR. Increased resonance peaks in the 2.1 to 2.6 ppm range and marked decreases in MTR may be a relatively specific indicators of demyelination
— id: 44023, year: 1994, vol: 32, page: 285, stat: Journal Article,

Neuroradiology of central nervous system vasculitis
Hurst RW; Grossman RI
1994 Dec;14(4):320-340, Seminars in neurology
Evaluation of the patient with suspected vasculitis affecting the nervous system requires consideration of a broad range of differential diagnostic possibilities. Appreciating pertinent neuroradiologic findings as well as understanding the capabilities and limitations of the imaging methods employed is a prerequisite for proper evaluation. Most importantly, integration of the imaging features with clinical and laboratory findings is necessary to maximize the chance of a correct diagnosis
— id: 44020, year: 1994, vol: 14, page: 320, stat: Journal Article,

MR of sarcoidosis in the head and spine: spectrum of manifestations and radiographic response to steroid therapy
Lexa FJ; Grossman RI
1994 May;15(5):973-982, AJNR. American journal of neuroradiology
PURPOSE: To evaluate the role of MR in the diagnosis and treatment of patients with neurosarcoidosis. METHODS: The MR studies of 24 patients who satisfied stringent criteria for the diagnosis of sarcoid were retrospectively reviewed. All patients had signs and symptoms referable to the head and/or spine. The majority, 17 patients (71% of the total), were examined at least once with gadolinium enhancement. Fifteen of 24 patients (63%) underwent serial examinations during steroid therapy. RESULTS: A wide spectrum of findings was noted: white matter and periventricular high signal intensity on long-repetition-time/long-echo-time sequences, mimicking multiple sclerosis (11 patients); leptomeningeal enhancement (11 patients); brain parenchymal mass (seven patients)--six demonstrated enhancement, one did not receive contrast; lacrimal gland mass (three patients); hydrocephalus (three patients); enlarged ventricles, apparently atrophic (one patient); periventricular enhancement (three patients); extraaxial mass, mimicking meningioma (two patients); chiasmal enhancement or swelling (one patient); enhancing nerve roots (two patients); enlarged pituitary stalk (two patients); pontine infarct (one patient); and enhancing parenchymal spinal cord mass (three patients). Partial or complete resolution of the radiographic abnormality occurred in 13 of 15 cases (87%), which paralleled clinical improvement. No response was detected in the remaining two. Abnormal enhancement was the finding that was most responsive to steroid therapy, with response seen in nine of 10 patients with leptomeningeal enhancement, in six of six patients with enhancing brain parenchymal masses, in three of three patients with enhancing cord masses, and in all three patients with periventricular enhancement. CONCLUSIONS: 1) MR shows a spectrum of protean central nervous system abnormalities associated with neurosarcoidosis. 2) This high sensitivity for associated abnormalities aids in differentiating central nervous system sarcoid from the many diseases that it can mimic. In particular, enhancement was a useful clue to the diagnosis in 15 of 17 cases in which it was used (88%). 3) MR demonstrates regression of central nervous system abnormalities during steroid therapy, in particular abnormal meningeal, periventricular, and parenchymal enhancement
— id: 44026, year: 1994, vol: 15, page: 973, stat: Journal Article,

Dyke Award paper. MR of wallerian degeneration in the feline visual system: characterization by magnetization transfer rate with histopathologic correlation
Lexa FJ; Grossman RI; Rosenquist AC
1994 Feb;15(2):201-212, AJNR. American journal of neuroradiology
PURPOSE: To examine the utility of measuring magnetization transfer ratio for for delineating the dynamic changes of wallerian degeneration which occur after controlled injury in a feline model in which anatomic pathways are well understood. METHODS: Using standard neurosurgical techniques, discrete lesions were made to ablate the visual cortex. Gradient imaging was performed serially at 1.5 T, with and without a saturation pulse to create a magnetization transfer effect. At varying intervals, the animals were killed for histologic analysis. RESULTS: Within the first 2 weeks there is a statistically significant increase in magnetization transfer ratio relative to the control hemisphere within the white matter connections between the lateral geniculate nucleus and the visual cortex at a time when no effects are visually detectable on spin-echo images. Between 16 and 28 days, this reverses to a decrease in magnetization transfer ratio in both the lateral geniculate nucleus itself and the adjacent superolateral white matter. More remote white matter tracts remained stable, without significant change. CONCLUSIONS: Magnetization transfer ratio seems to be more sensitive for early detection of degeneration than conventional spin-echo imaging. Moreover, temporal changes in magnetization transfer ratio seem to correspond well with known histologic phases of wallerian degeneration
— id: 44028, year: 1994, vol: 15, page: 201, stat: Journal Article,

Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT findings
Mittl RL; Grossman RI; Hiehle JF; Hurst RW; Kauder DR; Gennarelli TA; Alburger GW
1994 Sep;15(8):1583-1589, AJNR. American journal of neuroradiology
PURPOSE: To assess the prevalence of MR evidence for diffuse axonal injury at 1.5 T in patients with normal head CT findings after mild head injury. METHODS: Twenty consecutive patients with mild head injury (Glasgow Coma Scale, 13 to 15; no subsequent deterioration, loss of consciousness < 20 minutes) and normal head CT findings were examined with MR at 1.5 T. Pulse sequences included a conventional T2-weighted spin-echo sequence (2500-3000/30,80/1[repetition time/echo time/excitations]) and a T2*-weighted gradient-echo sequence (750/40/2, 10 degrees flip angle). Each sequence was read independently by two blinded readers. RESULTS: The readers agreed that abnormalities compatible with diffuse axonal injury were present in the white matter of 6 (30%) of 20 patients (95% confidence interval, 12% to 54%). Both readers agreed that foci of high signal intensity were present on the T2-weighted spin-echo sequence in 3 (15%) of the 20 cases (95% confidence interval, 3% to 38%) and that foci of hypointensity compatible with hemorrhagic shear injury were present on the T2*-weighted sequence in 4 (20%) of the 20 patients (95% confidence interval, 6% to 44%). Both types of abnormality were noted by the readers in one patient. CONCLUSIONS: MR shows evidence of diffuse axonal injury in some patients with normal head CT findings after mild head injury. These lesions may represent the pathologic substrate underlying the postconcussion syndrome that occurs in many patients with moderate to severe head injury
— id: 44022, year: 1994, vol: 15, page: 1583, stat: Journal Article,

Magnetic resonance imaging of the cauda equina in chronic inflammatory demyelinating polyneuropathy
Crino PB; Grossman RI; Rostami A
1993 Mar;33(3):311-313, Annals of neurology
We report a patient with biopsy proven chronic inflammatory demyelinating polyneuropathy whose magnetic resonance imaging demonstrated abnormal enhancement of the cauda equina after administration of gadolinium. Enhancement may reflect alteration of the blood-nerve barrier secondary to inflammation. Magnetic resonance imaging of the cauda equina could be a useful adjunct in the early diagnosis of chronic inflammatory demyelinating polyneuropathy
— id: 44038, year: 1993, vol: 33, page: 311, stat: Journal Article,

Unilateral ptosis and contralateral eyelid retraction from a thalamic-midbrain infarction. Magnetic resonance imaging correlation
Galetta SL; Gray LG; Raps EC; Grossman RI; Schatz NJ
1993 Dec;13(4):221-224, Journal of clinical neuroophthalmology
We report a patient with a third nerve palsy and contralateral eyelid retraction from a thalamic-midbrain infarction. Magnetic resonance imaging confirms that this unusual clinical combination, previously termed 'the plus-minus lid syndrome,' results from a lesion in the region of the nucleus of the posterior commissure with extension to the third nerve fascicle
— id: 44030, year: 1993, vol: 13, page: 221, stat: Journal Article,

The relation between regional brain iron and T2 shortening
Gomori JM; Grossman RI
1993 Sep-Oct;14(5):1049-1050, AJNR. American journal of neuroradiology
— id: 44032, year: 1993, vol: 14, page: 1049, stat: Journal Article,

An in vitro study of magnetization transfer and relaxation rates of hematoma
Gomori JM; Grossman RI; Asakura T; Schnall MD; Atlas S; Holland G; Mittl RL Jr
1993 Jul-Aug;14(4):871-880, AJNR. American journal of neuroradiology
PURPOSE: To assess, in an in vitro model of acute hematoma, whether hemoglobin immobilization by clot and red cell membrane aging can account for the T2 shortening usually attributed to deoxyhemoglobin. METHODS: Clotted and heparinized blood samples were packed (100% hematocrit). The apparent magnetization transfer rate (AMTR), T1 and T2 relaxation rates of the samples, and images with a volunteer's head were obtained at 1.5 T. RESULTS: The AMTR and T1 and T2 relaxation rates were unaffected by the presence of clot. The AMTR was unaffected by red cell aging. The diamagnetic packed blood samples, which are much denser than brain, were isointense to gray matter on T2-weighted images and had about one-fifth the AMTR of white matter. CONCLUSIONS: Hemoglobin immobilization by clot structure or red cell contraction with aging is insignificant and does not contribute to the T2 shortening of acute hematoma. The low AMTR and T2 relaxation rates of diamagnetic blood appear to be caused by the mobility of hemoglobin and by the red cell's lack of immobile macromolecular structures such as those associated with nucleated brain cells
— id: 44034, year: 1993, vol: 14, page: 871, stat: Journal Article,

Superficial siderosis of the central nervous system: magnetic resonance imaging and pathological correlation. Case report
Janss AJ; Galetta SL; Freese A; Raps EC; Curtis MT; Grossman RI; Gomori JM; Duhaime AC
1993 Nov;79(5):756-760, Journal of neurosurgery
The authors report a 32-year-old woman who had undergone repair of an occipital encephalocele in infancy and who experienced a 20-year history of progressive hearing loss and intermittent vertigo. After parturition, she developed a rapidly progressive quadriparesis and brain-stem dysfunction associated with persistent intraventricular and subarachnoid hemorrhage. Serial magnetic resonance (MR) images showed progressive deposition of hemosiderin along the surface of the brain, brain stem, and spinal cord, and enhanced thickened membranes at the site of the original encephalocele repair. Posterior fossa exploration disclosed hemorrhagic membranes, which were resected; despite removal of this tissue, the patient deteriorated and died. Postmortem examination confirmed iron-containing pigment along the meninges, cerebral hemispheres, brain stem, spinal cord, and cranial nerves accompanied by atrophy of the superficial cerebellar cortex. It is concluded that superficial siderosis may accompany encephalocele repair. This is believed to be the first report in the literature of superficial siderosis of the central nervous system to correlate in vivo MR images with autopsy results
— id: 44031, year: 1993, vol: 79, page: 756, stat: Journal Article,

Proton MR spectroscopy of HIV-infected patients: characterization of abnormalities with imaging and clinical correlation
Jarvik JG; Lenkinski RE; Grossman RI; Gomori JM; Schnall MD; Frank I
1993 Mar;186(3):739-744, Radiology
The purpose of this study was to characterize the proton magnetic resonance (MR) spectroscopic findings in the brains of patients infected with human immunodeficiency virus (HIV). Peak areas were used to calculate metabolite ratios. Spectra were analyzed by blinded readers who calculated areas under metabolite peaks. MR images were evaluated by blinded readers, with both white and gray matter being rated as normal or abnormal. An aggregate index that combined N-acetylaspartate/creatine (Cr), choline/Cr, and marker peak/Cr ratios resulted in mean scores for patients and control subjects of 4.4 +/- 1.5 (standard deviation [SD]) and 2.5 +/- 0.4, respectively (P = .001). Eight of 11 patients (73%) had abnormal MR images versus four of 11 control subjects. Thirteen of 15 patient spectra (87%) were abnormal (> 2 SDs from the mean of the control subjects), while only one of 10 control spectra was abnormal. These initial results indicate that proton MR spectroscopy is a potentially useful modality for detecting HIV involvement in the central nervous system
— id: 44037, year: 1993, vol: 186, page: 739, stat: Journal Article,

Detection of early axonal degeneration in the mammalian central nervous system by magnetization transfer techniques in magnetic resonance imaging
Lexa FJ; Grossman RI; Rosenquist AC
1993 May 28;679(4):336-340, Annals of the New York Academy of Sciences
— id: 44035, year: 1993, vol: 679, page: 336, stat: Journal Article,

New technique for quantitation of pituitary adenoma size: use in evaluating treatment of gonadotroph adenomas with a gonadotropin-releasing hormone antagonist
McGrath GA; Goncalves RJ; Udupa JK; Grossman RI; Pavlou SN; Molitch ME; Rivier J; Vale WW; Snyder PJ
1993 May;76(5):1363-1368, Journal of clinical endocrinology & metabolism
Because administration for 1 week of the GnRH antagonist Nal-Glu GnRH had been shown to decrease FSH secretion from supranormal to normal in men with gonadotroph adenomas, we investigated the effect of prolonged administration of Nal-Glu on the size of gonadotroph adenomas. To quantitate the effect of Nal-Glu GnRH on gonadotroph adenoma size, we first developed a technique for calculating adenoma volume. The technique involved collecting magnetic resonance (MR) imaging data from each adenoma at 1-mm slice intervals in the coronal, axial, and sagittal views and using the Softvu computer program to calculate adenoma volume from the MR data. The precision of this technique, as judged by the coefficients of variation of the calculations of the same view of the same study three times, was 1.7%, 1.0%, and 1.0% for each of three studies. When Nal-Glu GnRH (5 mg, sc, every 12 h) was self-administered for 3-12 months to five men with gonadotroph adenomas and supra-normal serum FSH concentrations, the serum FSH concentrations decreased to normal or below normal for the entire treatment period. Adenoma size, however, did not change during treatment in any of the five men. We conclude that calculating pituitary adenoma volume from MR data using the Softvu computer program is a highly reproducible technique, but that Nal-Glu GnRH is not an effective treatment for reducing gonadotroph adenoma size. The failure of Nal-Glu to reduce adenoma size despite its success in reducing FSH secretion suggests that FSH secretion from gonadotroph adenomas is dependent on endogenous GnRH, but growth of gonadotroph adenomas is not
— id: 44036, year: 1993, vol: 76, page: 1363, stat: Journal Article,

Magnetization transfer effects in MR imaging of in vivo intracranial hemorrhage
Mittl RL Jr; Gomori JM; Schnall MD; Holland GA; Grossman RI; Atlas SW
1993 Jul-Aug;14(4):881-891, AJNR. American journal of neuroradiology
PURPOSE: Recent papers have hypothesized that diamagnetic effects of clotting and conformational changes in aging red blood cells immobilize the hemoglobin protein and thus are responsible for the marked hypointensity of acute hematomas on T2-weighted spin-echo MR images. To test that hypothesis, the authors evaluated 24 hemorrhagic components of intracranial hemorrhagic lesions using accepted criteria based on spin-echo images as the definitions of the stage of the hemorrhage. METHODS: As a measure of the effects of macromolecular (hemoglobin protein) immobility, magnetization transfer contrast was elicited using a pulsed saturation magnetization transfer experiment. The apparent magnetization transfer contrast (AMTC) was determined by comparing the signal intensities of saturated with unsaturated images and quantified for acute isolated hemorrhages, acute nonisolated hemorrhagic lesions, and subacute-to-chronic hemorrhages. RESULTS: The AMTC of isolated acute hemorrhage was significantly less than that of normal, white matter and gray matter, indicating the lack of significant magnetization transfer and therefore the lack of effects of restriction of hemoglobin mobility on the signal intensity of acute hemorrhage. Acutely hemorrhagic tissue (nonisolated acute hemorrhage) has significantly more AMTC than isolated acute hemorrhage, but still not exceeding that of brain parenchyma. CONCLUSION: This in vivo data concurs with in vitro data and reinforces the concept that the marked hypointensity of acute hematomas is mainly a magnetic susceptibility effect
— id: 44033, year: 1993, vol: 14, page: 881, stat: Journal Article,

Experimental allergic encephalomyelitis and multiple sclerosis: lesion characterization with magnetization transfer imaging
Dousset V; Grossman RI; Ramer KN; Schnall MD; Young LH; Gonzalez-Scarano F; Lavi E; Cohen JA
1992 Feb;182(2):483-491, Radiology
Magnetization transfer imaging (MTI) was initially performed in normal guinea pigs and human volunteers. A magnetization transfer ratio (MTR) was calculated in the normal white matter and was found to be 42%-44%, with less than 2.5% variation, which indicates the high reproducibility of the measurement. MTI was then applied to an animal model of white matter disease, acute experimental allergic encephalomyelitis (EAE). In this model of EAE, pathologically proved lesions were edematous with essentially no demyelination. MTRs decreased slightly but significantly (5%-8%) compared with the MTRs of the same tissue region measured before the onset of the lesion [corrected]. Fifteen patients with multiple sclerosis (MS) also underwent MTI. In the 15 patients with MS, all lesions (209 plaques) had a significantly decreased MTR (average, 26%). The authors believe that demyelination produced the lower MTR, and, thus, lesions varied in transfer ratio on the basis of the extent of myelin loss. In patients with MS, particularly those with chronic and/or progressive MS, the MTR of the normal-appearing white matter was significantly decreased. The data suggest that calculated MTR obtained with in vivo MTI may enable differentiation of edema from demyelination, and that MTI can demonstrate white matter abnormalities that cannot be seen with standard spin-echo or gradient-echo magnetic resonance imaging
— id: 44042, year: 1992, vol: 182, page: 483, stat: Journal Article,

Cerebral vasculitis: MR imaging and angiographic correlation
Greenan TJ; Grossman RI; Goldberg HI
1992 Jan;182(1):65-72, Radiology
Cerebral vasculitis is an unusual disorder with numerous causes. One such entity, noninfectious granulomatous angiitis of the nervous system (GANS), is an extremely rare disease with a predilection for leptomeningeal and parenchymal arteries and veins. Isolated involvement of the central nervous system is characteristic of GANS, which has also been referred to as primary angiitis of the central nervous system (PACNS). The results of magnetic resonance (MR) imaging and angiography in seven patients with presumed PACNS were retrospectively analyzed and correlated. MR images were positive in every case. Characteristically, lesions were multiple, bilateral, and supratentorial. Both gray- and white-matter infarcts were identified in four of seven patients; infarcts were most common in the deep white matter. PACNS can also appear as primary parenchymal hemorrhage or simulate low-grade glioma. All lesions identified on MR images were associated with positive angiographic findings of cerebral vasculitis in the corresponding vascular distribution. However, for 12 of 33 vascular distributions with angiographic evidence of cerebral vasculitis, no lesions were identified on MR images. These correlative observations suggest that some patients with proved PACNS may have normal MR imaging results
— id: 44044, year: 1992, vol: 182, page: 65, stat: Journal Article,

Frank J. Lexa, MD: corecipient of the Cornelius Dyke Award for 1992
Grossman RI
1992 Nov-Dec;13(6):1668-1668, AJNR. American journal of neuroradiology
— id: 44039, year: 1992, vol: 13, page: 1668, stat: Journal Article,

Meningeal enhancement in multiple sclerosis truth or coincidence?
Grossman RI
1992 Jan-Feb;13(1):401-402, AJNR. American journal of neuroradiology
— id: 44045, year: 1992, vol: 13, page: 401, stat: Journal Article,

MR proton spectroscopy in multiple sclerosis
Grossman RI; Lenkinski RE; Ramer KN; Gonzalez-Scarano F; Cohen JA
1992 Nov-Dec;13(6):1535-1543, AJNR. American journal of neuroradiology
PURPOSE: To elucidate the natural history of visualized MR abnormalities in patients with multiple sclerosis using proton spectroscopy. METHODS: MR imaging and proton spectroscopy (1H spectroscopy) were performed on 16 patients with clinically definite multiple sclerosis. All patients received gadopentetate dimeglumine (Gd-DTPA). RESULTS: Decreased levels of N-acetylaspartate (NAA) were demonstrated in 17 out of 21 lesions. No correlation was found between decreased NAA and Gd-DTPA enhancement. In five out of seven enhancing lesions, abnormal 1H spectra with extra peaks (termed marker peaks) at 2.1-2.6 ppm (ranging in absolute concentration from 10-50 mM protons) were observed. In nine out of 14 unenhancing lesions, no elevated marker peaks were observed. In the five other unenhancing lesions, the levels of these marker peaks were generally lower than the enhancing group. No correlation was found between the NAA levels and the levels of the marker peaks. We suggest two distinct biochemical processes: 1) decreased NAA reflecting neuronal cell loss, and 2) elevated marker peaks reflecting ongoing demyelination. CONCLUSIONS: Based upon these observations we infer that 1) the majority of enhancing lesions are demyelinating with extra peaks at 2.1-2.6 ppm representing a marker of this process, 2) enhancing lesions without this marker most likely represent edematous regions without significant demyelination, and 3) demyelination may be long in duration compared with transient blood-brain barrier disruption manifested by Gd-DTPA enhancement. Our results suggest that 1H spectroscopy has the ability to further categorize MR-demonstrated enhancing and unenhancing lesions in patients with multiple sclerosis and that it may be more sensitive than contrast enhancement in revealing the true time course of demyelination
— id: 44040, year: 1992, vol: 13, page: 1535, stat: Journal Article,

Memory in a case of bilateral thalamic infarction
Malamut BL; Graff-Radford N; Chawluk J; Grossman RI; Gur RC
1992 Jan;42(1):163-169, Neurology
The role of individual structures within the diencephalon for memory functioning is unknown. We present anatomic localization of lesions and a longitudinal neuropsychological profile of a young man who had a bilateral diencephalic stroke in the interpeduncular profundus arterial territory. MRI localized the lesions to the mamillothalamic tracts and inferior thalamic peduncle. The amnesia was characterized by severe impairment in explicit recall of new facts and events, while word-completion priming and remote memory were intact. We suggest that the memory deficit results from a disconnection of the diencephalon from the medial temporal region
— id: 44043, year: 1992, vol: 42, page: 163, stat: Journal Article,

Proton MR spectroscopy of experimental radiation-induced white matter injury
Yousem DM; Lenkinski RE; Evans S; Allen D; O'Brien R; Curran W; Schnall M; Bennett M; Wehrli SL; Grossman RI
1992 Jul-Aug;16(4):543-548, Journal of computer assisted tomography
We studied the spectroscopic appearance of radiation-induced myelinolysis in cats to understand the characteristics of proton MR spectroscopy of demyelinating disorders. Eight cats received 5,000 rads to a 1.5 x 1.5 cm area of the right cerebral hemisphere. Eight to 9 months after irradiation, a gross area of abnormal postcontrast enhancement and/or high MR signal intensity was detected in the irradiated hemisphere of six of the eight cats. Proton spectra of a 1.0 cm3 voxel in the affected region demonstrated depressed N-acetyl aspartate/creatine-phosphocreatine and N-acetyl aspartate/choline-containing compound peak ratios compared with the contralateral non-irradiated brain in all cats. Elevated amino acid resonances in the 2.0-2.5 ppm range were not consistently seen in irradiated zones of the brain with pathologic findings of demyelination. In vivo proton MR spectroscopy may show differences between irradiated brain and nonirradiated brain even when histopathologic lesions are not apparent yet
— id: 44041, year: 1992, vol: 16, page: 543, stat: Journal Article,

Postoperative lumbar spine: contrast-enhanced chemical shift MR imaging
Bobman SA; Atlas SW; Listerud J; Grossman RI
1991 May;179(2):557-562, Radiology
A modified fat-suppression pulse sequence (consisting of combined frequency-selective fat presaturation followed by a spin-echo acquisition when fat and water magnetization vectors have opposite phase) was used to optimize the conspicuity of intravenous enhancement by gadopentetate dimeglumine on magnetic resonance images in 10 patients previously operated on for lumbar discogenic disease as well as in two patients with herniated disks who had not previously undergone surgery. This technique produced the greatest degree of fat suppression in the phantom study. In six of the patients who had previously undergone surgery, epidural enhancement was more obvious on the fat-suppressed images than on conventional spin-echo images, while in four patients, enhancement was equivalent. The herniated disks in two patients not previously operated on were not enhanced with either technique. Contrast enhancement was universally distinguishable from fat signal and from nonenhancing water-containing tissue on the fat-suppressed images obtained after contrast material administration. This technique may reduce the need for precontrast imaging. Furthermore, postoperative enhancement of nerve roots was more obvious on fat-suppressed images in seven of eight patients. This finding might represent previously undiagnosed degrees of arachnoidal inflammation, which may be a factor in the failed back syndrome
— id: 44047, year: 1991, vol: 179, page: 557, stat: Journal Article,

In vitro modeling of the magnetic resonance appearance of cerebral hemorrhage
Janick PA; Hackney DB; Grossman RI; Asakura T
1991 Jan;7(1):57-76, Magnetic resonance quarterly
In vitro studies provide a framework for understanding the biophysical mechanisms in the evolution of the magnetic resonance (MR) appearance of cerebral hematomas. Varying concentrations of oxyhemoglobin, deoxyhemoglobin and methemoglobin in saline or in concentrated bovine serum albumin solutions were imaged at 1.5 T, allowing assessment of the relative relaxation effects of heme oxidation state, oxygenation, and protein concentration. The findings demonstrate the importance of susceptibility effects arising from local field heterogeneity in producing T2 shortening upon varying hemoglobin concentration for intracellular deoxyhemoglobin and methemoglobin. Correlation between the clinically observed MR appearance of acute and subacute hematomas with these in vitro models is presented
— id: 44050, year: 1991, vol: 7, page: 57, stat: Journal Article,

MR imaging of various oxidation states of intracellular and extracellular hemoglobin
Janick PA; Hackney DB; Grossman RI; Asakura T
1991 Sep-Oct;12(5):891-897, AJNR. American journal of neuroradiology
The in vitro behavior of various states of hemoglobin was examined over a wide range of concentrations. Solutions of increasing concentrations of oxyhemoglobin displayed significant increases in T1 and T2 relaxation rates that were insensitive to pH values between 6.0 and 6.9. Bovine serum albumin, which displayed a relaxation behavior nearly identical to that of oxyhemoglobin, was used to normalize for the protein concentration of the deoxyhemoglobin and methemoglobin samples. Concentrated protein solutions with increasing proportions of deoxyhemoglobin yielded little change in the T1 relaxation rate. In these samples, however, the T2 relaxation rate displayed a parabolic dependence on the concentration of intracellular deoxyhemoglobin paralleling the inhomogeneity of the sample; this was not observed with extracellular deoxyhemoglobin. Similar T2 relaxation behavior was observed for intracellular methemoglobin, except that the magnitude of the T2 shortening was smaller than that for deoxyhemoglobin. The magnitude of the T2 shortening was pH dependent, roughly paralleling the change in the equilibrium between the high-spin acid form of methemoglobin and the low-spin basic form of methemoglobin. Marked increase in the T1 relaxation rate is observed with increasing concentrations of methemoglobin, again with greater relaxation enhancement at lower pH. The results of our study emphasize the importance of normalizing for protein concentration when assessing the effects of paramagnetic forms of hemoglobin
— id: 44046, year: 1991, vol: 12, page: 891, stat: Journal Article,

Degenerative narrowing of the cervical spine neural foramina: evaluation with high-resolution 3DFT gradient-echo MR imaging
Yousem DM; Atlas SW; Goldberg HI; Grossman RI
1991 Mar-Apr;12(2):229-236, AJNR. American journal of neuroradiology
Conventional two-dimensional Fourier transform (2DFT) MR evaluation of osteophytic disease of the cervical neural foramina is limited by section thickness, signal-to-noise problems, and CSF flow artifacts. We evaluated the role of thin-section, high-resolution, gradient-refocused three-dimensional Fourier transform (3DFT) MR imaging in assessing degenerative foraminal narrowing in the cervical spine. Contiguous 1.5-mm axial 3DFT gradient-recalled acquisition in the steady state MR images of 120 neural foramina at 60 disk levels were evaluated blindly and independently by three neuroradiologists. High-resolution axial CT was used as the gold standard in all patients. 3DFT MR was found to agree with CT in the detection of neural foraminal narrowing and in the determination of the cause of the narrowing in approximately 76% of neural foramina. The accuracy for the assessment of neural foraminal narrowing on 3DFT MR ranged from 73% to 82% when a 5 degrees-flip-angle, high-intensity CSF technique was used. When using the 30 degrees-flip-angle, low-intensity CSF technique, the accuracy ranged from 66% to 86%. When the cause of narrowing was evaluated, the 5 degrees and 30 degrees studies agreed with CT in 70-92% and 48-88% of the levels, respectively. When lesions were missed on MR, it was usually because of osteophytic disease. The interobserver concordance of MR and CT interpretations was higher for detecting the presence of narrowing than its cause. This MR technique is a useful method in the evaluation of foraminal stenosis since contrast between disk, cord, osteophyte, and CSF is high without the need for intrathecal injections.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 44049, year: 1991, vol: 12, page: 229, stat: Journal Article,

Proliferative retinopathy: absence of white matter lesions at MR imaging
Yousem DM; Tasman WS; Grossman RI
1991 Apr;179(1):229-230, Radiology
One form of retinopathy associated with diabetes is a proliferative small vessel process thought to be mediated by biochemical, hemodynamic, and endocrinologic factors. The authors conducted a prospective study to determine whether patients with diabetes who had proliferative retinopathy had evidence of intracranial microangiopathy visible at magnetic resonance (MR) imaging. Twenty-five patients under 40 years of age with proliferative retinopathy and insulin-dependent diabetes mellitus and 10 age-matched control subjects were studied with MR imaging. Axial images were reviewed by two neuroradiologists for the presence of white matter foci of high signal intensity. No patients demonstrated evidence of these foci. There was no evidence of ischemic foci in any of the patients (all patients were neurologically asymptomatic). The vasculopathy associated with proliferative retinopathy does not appear to affect the intracranial circulation to the extent detectable with MR imaging. The presence of white matter foci of high signal intensity or ischemic changes in the brains of insulin-dependent diabetic patients under 40 years of age should not be attributed to diabetic vasculopathy. Other causes should be considered
— id: 44048, year: 1991, vol: 179, page: 229, stat: Journal Article,

MR evaluation of brain iron in children with cerebral infarction
Cross PA; Atlas SW; Grossman RI
1990 Mar-Apr;11(2):341-348, AJNR. American journal of neuroradiology
Young children and infants normally have essentially no detectable brain iron. We evaluated brain iron patterns on 23 MR scans in 20 patients under 6 years of age with clinical and MR-documented cerebral infarctions in an attempt to further understand the neuropathologic phenomenon of increased iron deposition, which has been observed in other disease states. MR was performed at 1.5 T with spin-echo sequences from 1 day to 4 years after infarction. MR scans were interpreted without knowledge of clinical information and were assessed for (1) location and character (i.e., bland or hemorrhagic) of infarct, and (2) nonheme iron (i.e., marked hypointensity on long TR/TE images) in the basal ganglia, red nuclei, substantia nigra, thalami, dentate nuclei, and deep white matter. Sixteen of 20 infarctions were associated with increased iron. Six of seven cases with unilateral iron deposition had ipsilateral infarctions. The location (deep versus cortical) and age of the infarction had no apparent bearing on iron patterns. We conclude that increased brain iron is commonly associated with cerebral infarction and is nonspecific, rather than a marker of movement disorders. Since iron may arise from either interruption of transport pathways or directly from cell injury and, in fact, iron itself may propagate the tissue injury, this finding may have important clinical and pathophysiologic implications in ischemic brain injury
— id: 44056, year: 1990, vol: 11, page: 341, stat: Journal Article,

Horizontal homonymous sectoral field defect after ischemic infarction of the occipital cortex
Grossman M; Galetta SL; Nichols CW; Grossman RI
1990 Feb 15;109(2):234-236, American journal of ophthalmology
— id: 44057, year: 1990, vol: 109, page: 234, stat: Journal Article,

Personality changes associated with thalamic infiltration
Gutmann DH; Grossman RI; Mollman JE
1990 Jun;8(3):263-267, Journal of neuro-oncology
Mood and behavioral changes have been reported in patients with thalamic tumors. We report a case in which an infiltrating mass lesion of both thalami was manifested by an alteration in personality with relative motor and sensory sparing. These personality changes, unlike many such cases reported in the literature, were not related to increased intracranial pressure and hydrocephalus. Magnetic resonance imaging (MRI) demonstrated the lesion that was subtle and nearly inapparent on contrast-enhanced computerized tomography (CT)
— id: 44051, year: 1990, vol: 8, page: 263, stat: Journal Article,

Biopsy-confirmed CNS Lyme disease: MR appearance at 1.5 T
Rafto SE; Milton WJ; Galetta SL; Grossman RI
1990 May;11(3):482-484, AJNR. American journal of neuroradiology
— id: 44052, year: 1990, vol: 11, page: 482, stat: Journal Article,

Pediatric brainstem glioma. Post-radiation clinical and MR follow-up
Smith RR; Zimmerman RA; Packer RJ; Hackney DB; Bilaniuk LT; Sutton LN; Goldberg HI; Grossman RI; Schut L
1990 ;32(4):265-271, Neuroradiology
Thirty-four pediatric patients, twenty with presumed and fourteen with biopsy or autopsy proven brainstem gliomas were imaged by CT and MR before radiation therapy. Twenty-eight patients received radiotherapy. Of these, eighteen fit the protocol for combined clinical and MR post-treatment evaluation. No cases of radionecrosis were seen at autopsy. This study shows that MR can demonstrate tumor response to radiation therapy, tumor progression prior to clinical deterioration, post-treatment cyst formation and hemorrhage. Although MR clinical correlation was not optimal on six week post-treatment evaluation, 4-10 month post-treatment MR scanning correlated well with clinical evaluation. MR appears useful in post-therapeutic monitoring of tumor response
— id: 44058, year: 1990, vol: 32, page: 265, stat: Journal Article,

MR imaging of Tolosa-Hunt syndrome
Yousem DM; Atlas SW; Grossman RI; Sergott RC; Savino PJ; Bosley TM
1990 Jan;154(1):167-170, American journal of roentgenology
The Tolosa-Hunt syndrome consists of painful ophthalmoplegia caused by cavernous sinus inflammation, which is responsive to steroid therapy. The MR features of 11 patients with the clinical diagnosis of Tolosa-Hunt syndrome were studied. Two patients had normal MR studies of the orbit and cavernous sinuses. In nine patients, abnormal signal and/or mass lesions were seen in the cavernous sinuses; in eight cases, the abnormality was hypointense relative to fat and isointense with muscle on short TR/TE images and isointense with fat on long TR/TE scans. Extension into the orbital apex was seen in eight cases. In six of nine cases the affected cavernous sinus was enlarged; in five of nine it had a convex outer margin. One patient had a thrombosed cavernous sinus and superior ophthalmic vein in addition to a cavernous sinus soft-tissue mass. The signal intensity of Tolosa-Hunt syndrome in this limited series was similar to that of orbital pseudotumor and is confined to a limited differential diagnosis, which includes meningioma, lymphoma, and sarcoidosis
— id: 44059, year: 1990, vol: 154, page: 167, stat: Journal Article,

Pseudoatrophy of the cervical portion of the spinal cord on MR images: a manifestation of the truncation artifact?
Yousem DM; Janick PA; Atlas SW; Hackney DB; Glasser SA; Wehrli FW; Grossman RI
1990 May;154(5):1069-1073, American journal of roentgenology
Routine evaluation of axial MR images of the cervical spine with high-intensity CSF (long TR/TE spin-echo or gradient-echo images) revealed apparent narrowing of the cord's anteroposterior diameter when these images were compared with corresponding postmyelography CT scans. This discrepancy was believed to be due to the truncation artifact at the CSF-cord boundary. To examine the truncation effect, we compared cord diameters in 12 patients on postmyelography CT scans and MR images and then compared these with MR scans of normal volunteers and of an agar-saline spine phantom. There was an artifactual diminution of the cord diameter in the 128-step phase-encoding axis of the 128 x 256-matrix MR scan as compared with the diameter of the cord in the patients' postiohexol CT scans and in the 256 phase-encoded axis MR scan in the volunteer study. A similar discrepancy was noted in the spine phantom study, in which the cord diameter in the 256-step phase-encoded MR scan, the CT scan, and direct measurement exceeded that in the 128-step phase-encoded axis MR scan. The range of differences between the measurements was as large as 2.3 mm (patients), 1.7 mm (volunteers), and 1.8 mm (phantom) for the three studies. In all three studies, varying the photographic window width and level produced variation in the apparent cord diameter of up to 1.5 mm. To eliminate this effect, the cord diameters in the phantom and the normal control subjects were measured at identical window levels. The truncation artifact, coupled with standard window settings used in photography, may lead to inaccurate display of the diameter of the cervical spinal cord
— id: 44053, year: 1990, vol: 154, page: 1069, stat: Journal Article,

Pseudoatrophy of the cervical portion of the spinal cord on MR images: a manifestation of the truncation artifact?
Yousem DM; Janick PA; Atlas SW; Hackney DB; Glasser SA; Wehrli FW; Grossman RI
1990 Mar-Apr;11(2):373-377, AJNR. American journal of neuroradiology
Routine evaluation of axial MR images of the cervical spine with high-intensity CSF (long TR/TE spin-echo or gradient-echo images) revealed apparent narrowing of the cord's anteroposterior diameter when these images were compared with corresponding postmyelography CT scans. This discrepancy was believed to be due to the truncation artifact at the CSF-cord boundary. To examine the truncation effect, we compared cord diameters in 12 patients on postmyelography CT scans and MR images and then compared these with MR scans of normal volunteers and of an agar-saline spine phantom. There was an artifactual diminution of the cord diameter in the 128-step phase-encoding axis of the 128 x 256-matrix MR scan as compared with the diameter of the cord in the patients' postiohexol CT scans and in the 256 phase-encoded axis MR scan in the volunteer study. A similar discrepancy was noted in the spine phantom study, in which the cord diameter in the 256-step phase-encoded MR scan, the CT scan, and direct measurement exceeded that in the 128-step phase-encoded axis MR scan. The range of differences between the measurements was as large as 2.3 mm (patients), 1.7 mm (volunteers), and 1.8 mm (phantom) for the three studies. In all three studies, varying the photographic window width and level produced variation in the apparent cord diameter of up to 1.5 mm. To eliminate this effect, the cord diameters in the phantom and the normal control subjects were measured at identical window levels. The truncation artifact, coupled with standard window settings used in photography, may lead to inaccurate display of the diameter of the cervical spinal cord
— id: 44055, year: 1990, vol: 11, page: 373, stat: Journal Article,

Leptomeningeal metastases: MR evaluation
Yousem DM; Patrone PM; Grossman RI
1990 Mar-Apr;14(2):255-261, Journal of computer assisted tomography
Forty patients with positive CSF cytology for subarachnoid dissemination of neoplasms were examined by magnetic resonance (MR) imaging for the detection of intracranial or intraspinal CSF metastases. The MR evidence of cerebral leptomeningeal metastases was noted in 12 of 54 unenhanced (22.2%) and 7 of 20 (35%) gadolinium-enhanced studies. However, in only 2 of the 20 (10%) gadolinium-enhanced scans did the enhanced brain images alone demonstrate the presence of CSF seeding. Four of 29 (13.8%) unenhanced studies of the spine and 6 of 16 (37.5%) gadolinium-enhanced spine studies were positive for neoplastic deposits on the spinal nerves or cord. Magnetic resonance without and with gadolinium enhancement was most likely to be positive in studies of patients with a non-CNS primary malignancy (16/51 = 31.4%) and least accurate with lymphoma or leukemia (1/18 = 5.6%). Although gadolinium administration increases the ability of MR to detect leptomeningeal metastases (particularly in the spine), the overall sensitivity of unenhanced and enhanced MR examinations is low (19.3 and 36.1%, respectively) in patients with proven cytological evidence of neoplastic seeding
— id: 44054, year: 1990, vol: 14, page: 255, stat: Journal Article,

MR imaging of Parkinson disease with spin-echo and gradient-echo sequences
Braffman BH; Grossman RI; Goldberg HI; Stern MB; Hurtig HI; Hackney DB; Bilaniuk LT; Zimmerman RA
1989 Jan;152(1):159-165, American journal of roentgenology
High-field MR with both spin-echo and gradient-echo sequences was performed in 21 patients with (idiopathic, drug-responsive) Parkinson disease. The use of gradient echoes allowed more sensitive detection than did spin echoes of susceptibility changes in the putamina and substantia nigra. No statistically significant difference in putaminal hypointensity on long TR/long TE spin-echo sequences or on T2*-weighted images using gradient-echo sequences was observed between Parkinson patients and controls. There was also no statistically significant difference in the frequency of restoration of the signal intensity of the substantia nigra between the two groups of patients. The width of the pars compacta of the substantia nigra in patients with Parkinson disease was 2.12 + 0.82 mm (mean +/- SD). This value in age- and gender-matched controls was 2.67 +/- 0.5. Comparing these two groups with an unpaired t test resulted in a p value less than or equal to .005. Our MR study with spin-echo and gradient-echo images in Parkinson and control patients was able to substantiate and elaborate on previously described MR features of Parkinson disease
— id: 44068, year: 1989, vol: 152, page: 159, stat: Journal Article,

MR characteristics of subdural hematomas and hygromas at 1.5 T
Fobben ES; Grossman RI; Atlas SW; Hackney DB; Goldberg HI; Zimmerman RA; Bilaniuk LT
1989 Sep;153(3):589-595, American journal of roentgenology
MR images of 24 patients with 33 subdural collections were retrospectively reviewed to determine the spectrum of MR findings associated with such lesions. The lesions were dated by history, when available. Hematomas were grouped as follows: acute, four; early subacute, four; late subacute, four; chronic, 13. Six collections were classified as rehemorrhage; and two patients had CSF hygromas. Subdural hematomas evolved in a pattern similar to intracerebral hemorrhage with the exception of chronic subdural hematomas, in which isointensity of hypointensity relative to gray matter was observed on short TR/TE images compared with the persistent very high signal intensity noted in chronic parenchymal hematomas. Hemosiderin was rarely seen in chronic hematomas. These findings are most likely the result of the absence of a blood-brain barrier, which allowed clearance and dilution of blood products. Subdural hematomas with repeat hemorrhage demonstrated multiple phases of bleeding with layering phenomenon and more frequent hemosiderin deposition. It is possible that the clearance of blood products, as observed in chronic subdural hematomas, is impaired or poorly functional when rehemorrhage occurs. The persistence of high signal from methemoglobin in a hematoma that is expected to be in the chronic phase also suggests repeated hemorrhage. Acute CSF subdural hygromas had signal intensities identical to CSF without MR evidence of blood products. At surgery, clear fluid under pressure was found. MR imaging, with its unique ability to delineate the various phases of hemorrhage, is well suited to the evaluation of subdural hemorrhage
— id: 44063, year: 1989, vol: 153, page: 589, stat: Journal Article,

Reversal of white matter edema in hypertensive encephalopathy
Gibby WA; Stecker MM; Goldberg HI; Hackney DB; Bilaniuk LT; Grossman RI; Zimmerman RA
1989 Sep-Oct;10(5 Suppl):S78-S78, AJNR. American journal of neuroradiology
— id: 44064, year: 1989, vol: 10, page: S78, stat: Journal Article,

Isthmic spondylolysis of the lumbar spine: MR imaging at 1.5 T
Grenier N; Kressel HY; Schiebler ML; Grossman RI
1989 Feb;170(2):489-493, Radiology
The appearance on magnetic resonance (MR) images of the normal pars interarticularis in 13 patients was reviewed and contrasted with that of the pars in eight patients with spondylolysis. The pars defect usually had an intermediate signal intensity with all pulse sequences; however, this intensity was somewhat variable depending on the exact ratio of cartilage, fat, and fluid within each bone defect. The pars defect was best seen with spin-echo 600/20 (repetition time msec/echo time msec) images. In three cases, out-of-phase images showed the spondylolysis best, because of extension of fat to the borders of the defect. The sagittal view allowed one to separate spondylolysis from the joint space of posterior facets since the orientation of the defects is perpendicular to the facets; thus, a common pitfall encountered with cross-sectional axial imaging techniques is avoided. MR imaging poorly delineated bone fragments around the defect, which may produce nerve root impingement, but revealed other numerous complications that occur with spondylolysis, including spondylolisthesis and herniation of the disk above
— id: 44067, year: 1989, vol: 170, page: 489, stat: Journal Article,

Sanguinary efforts
Grossman RI
1989 Jul;172(1):13-14, Radiology
— id: 44065, year: 1989, vol: 172, page: 13, stat: Journal Article,

MR imaging of Lhermitte-Duclos disease: a case report
Smith RR; Grossman RI; Goldberg HI; Hackney DB; Bilaniuk LT; Zimmerman RA
1989 Jan-Feb;10(1):187-189, AJNR. American journal of neuroradiology
— id: 44069, year: 1989, vol: 10, page: 187, stat: Journal Article,

Magnetic resonance imaging in Parkinson's disease and parkinsonian syndromes
Stern MB; Braffman BH; Skolnick BE; Hurtig HI; Grossman RI
1989 Nov;39(11):1524-1526, Neurology
High field strength magnetic resonance imaging (MRI) provides a noninvasive means of evaluating patients with parkinsonism. Using strict clinical criteria, we began a prospective study of patients with Parkinson's disease (PD) and parkinsonian syndromes (PS) including progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and atypical parkinsonism (ATYP). We detected moderate to severe putaminal hypointensity more frequently in PS than in PD and controls, although putaminal hypointensity did not distinguish between MSA, PSP, or ATYP. Signal intensity in the lateral substantia nigra did not differ significantly among patients with PD, PS, or controls and was therefore not a useful MRI marker. Pars compacta width was significantly narrower in both PD and PS. Subcortical and periventricular hyperintense foci were more abundant in PD and PS than controls. Atrophy of the brainstem occurred only in patients with PS
— id: 44060, year: 1989, vol: 39, page: 1524, stat: Journal Article,

Wallerian degeneration and inflammation in rat peripheral nerve detected by in vivo MR imaging
Titelbaum DS; Frazier JL; Grossman RI; Joseph PM; Yu LT; Kassab EA; Hickey WF; LaRossa D; Brown MJ
1989 Jul-Aug;10(4):741-746, AJNR. American journal of neuroradiology
To investigate the role of MR imaging in wallerian degeneration, a series of animal models of increasingly complex peripheral nerve injury were studied by in vivo MR. Proximal tibial nerves in brown Norway rats were either crushed, transected (neurotomy), or transected and grafted with Lewis rat (allograft) or brown Norway (isograft) donor nerves. The nerves distal to the site of injury were imaged at intervals of 0-54 days after surgery. Subsequent histologic analysis was obtained and correlated with MR findings. Crush injury, neurotomy, and nerve grafting all resulted in high signal intensity along the course of the nerve observed on long TR/TE sequences, corresponding to edema and myelin breakdown from wallerian degeneration. The abnormal signal intensity resolved by 30 days after crush injury and by 45-54 days after neurotomy, when the active changes of wallerian degeneration had subsided. These changes were not seen in sham-operated rats. Our findings suggest that MR is capable of identifying traumatic neuropathy in a peripheral nerve undergoing active wallerian degeneration. The severity of injury may be reflected by the corresponding duration of signal abnormality. With the present methods, MR did not distinguish inflammatory from simple posttraumatic neuropathy
— id: 44066, year: 1989, vol: 10, page: 741, stat: Journal Article,

MR imaging of Tolosa-Hunt syndrome
Yousem DM; Atlas SW; Grossman RI; Sergott RC; Savino PJ; Bosley TM
1989 Nov-Dec;10(6):1181-1184, AJNR. American journal of neuroradiology
The Tolosa-Hunt syndrome consists of painful ophthalmoplegia caused by cavernous sinus inflammation, which is responsive to steroid therapy. The MR features of 11 patients with the clinical diagnosis of Tolosa-Hunt syndrome were studied. Two patients had normal MR studies of the orbit and cavernous sinuses. In nine patients, abnormal signal and/or mass lesions were seen in the cavernous sinuses; in eight cases, the abnormality was hypointense relative to fat and isointense with muscle on short TR/TE images and isointense with fat on long TR/TE scans. Extension into the orbital apex was seen in eight cases. In six of nine cases the affected cavernous sinus was enlarged; in five of nine it had a convex outer margin. One patient had a thrombosed cavernous sinus and superior ophthalmic vein in addition to a cavernous sinus soft-tissue mass. The signal intensity of Tolosa-Hunt syndrome in this limited series was similar to that of orbital pseudotumor and is confined to a limited differential diagnosis, which includes meningioma, lymphoma, and sarcoidosis
— id: 44061, year: 1989, vol: 10, page: 1181, stat: Journal Article,

Comparison of MR imaging with clinical history in the identification of hemorrhage in patients with cerebral arteriovenous malformations
Yousem DM; Flamm ES; Grossman RI
1989 Nov-Dec;10(6):1151-1154, AJNR. American journal of neuroradiology
Twenty-nine patients with true arteriovenous malformations as diagnosed by MR imaging or angiography were examined by MR to detect the presence of hemosiderin deposition, a marker for remote hemorrhage. The resulting information was compared with the clinical record to determine the frequency with which MR demonstrated prior hemorrhagic episodes where no clinical evidence for such episodes existed. Twenty (69%) of 29 patients with arteriovenous malformations showed evidence of acute or older hemorrhage. In four (14%) of 29 cases MR showed a hypointense signal on long TR images, suggesting hemosiderin, but no clinical history could account for prior hemorrhage. Additionally, six (21%) of 29 patients had a clinical history suggestive of acute hemorrhage, but no evidence of bleeding was found on MR. The presence of prior or current hemorrhage is critical to deciding whether to surgically resect the arteriovenous malformation or to treat it conservatively, because of the high rate of rebleeding in patients presenting with hemorrhage or those with a history of this disorder. For this reason, MR imaging has an important role in the management of patients with arteriovenous malformations
— id: 44062, year: 1989, vol: 10, page: 1151, stat: Journal Article,

STIR MR imaging of the orbit
Atlas SW; Grossman RI; Hackney DB; Goldberg HI; Bilaniuk LT; Zimmerman RA
1988 Nov;151(5):1025-1030, American journal of roentgenology
Fifteen patients with CT-documented orbital lesions were evaluated with MR imaging at 1.5 T with both conventional spin-echo (SE) and short inversion time inversion recovery (STIR) sequences. Fat signal was reliably nulled at inversion times of approximately 120-200 msec in all cases, thereby allowing clear detection of all retrobulbar lesions and normal structures on STIR images as markedly hyperintense relative to fat. All lesions were also clearly depicted on SE images; in fact, short repetition time/short echo time SE sequences were at least as useful as STIR images for illustrating anatomic structures and mass lesions, and in a much shorter scanning time. Separation of optic nerve from perioptic subarachnoid space was clear on SE images, but often difficult or impossible on STIR images owing to the relatively high intensity of normal optic nerves on STIR images. The synergism of relaxation prolongation with STIR actually resulted in loss of information, as any ability to separate the effects of T1 from T2 on signal intensity was impossible when STIR was the sole pulse sequence. We believe that more information is obtained with standard SE sequences than with STIR sequences, and therefore SE remains the method of choice for orbital MR imaging
— id: 44070, year: 1988, vol: 151, page: 1025, stat: Journal Article,

Calcified intracranial lesions: detection with gradient-echo-acquisition rapid MR imaging
Atlas SW; Grossman RI; Hackney DB; Gomori JM; Campagna N; Goldberg HI; Bilaniuk LT; Zimmerman RA
1988 Jun;150(6):1383-1389, American journal of roentgenology
Seventeen patients with partially calcified intracranial lesions, as documented by CT, were evaluated with MR imaging at 1.5 T. All patients were imaged with both conventional spin-echo techniques and reduced flip-angle gradient-echo-acquisition (GEA) sequences, during which a signal is acquired in the absence of a 180 degrees radiofrequency pulse. GEA parameters were implemented so that T2* effects were maximized on these scans. In all 17 patients GEA images showed marked hypointensity throughout the entire area of calcification, matching the calcified region as seen on CT. In contrast, spin-echo findings in the calcified portions of the lesions were extremely variable, precluding confident identification of calcification on these images. The depiction of regions of calcification as marked hypointensity on GEA images can be ascribed to T2* shortening from static local magnetic field gradients at interfaces of regions differing in magnetic susceptibility, a phenomenon that is well documented in vitro, when various diamagnetic solids are placed in aqueous suspension. However, we cannot exclude the possible additional role of accompanying paramagnetic ions, which sometimes are present with diamagnetic calcium salts in various intracranial calcifications. Since the hypointensity due to calcification on GEA images is not specific, noncontrast CT could be used to confirm its presence. Although this lack of specificity and the artifacts that emanate from diamagnetic susceptibility gradients at or near air-brain interfaces somewhat limit the application of GEA techniques, we suggest that rapid MR imaging using GEA sequences can consistently demonstrate intracranial calcification, and that this technique thus seems to be a useful adjunct to conventional spin-echo imaging
— id: 44078, year: 1988, vol: 150, page: 1383, stat: Journal Article,

Hemorrhagic intracranial retinoblastoma metastases: MR-pathology correlation
Atlas SW; Kemp SS; Rorke L; Grossman RI
1988 Mar-Apr;12(2):286-289, Journal of computer assisted tomography
Retinoblastoma is a highly curable tumor unless extraocular extension or metastases have occurred. Intracranial retinoblastoma metastases usually result from either contiguous or hematogenous spread and are rapidly fatal. We report two cases of pathologically proven, hemorrhagic intracranial retinoblastoma metastases and correlate magnetic resonance images with pathologic findings. Magnetic resonance with its high sensitivity and specificity for blood extravasation can document the associated hemorrhagic component of the tumor and help in the differentiation of nonmetastatic second neoplasms in retinoblastoma patients
— id: 44083, year: 1988, vol: 12, page: 286, stat: Journal Article,

Vascular intracranial lesions: applications of gradient-echo MR imaging
Atlas SW; Mark AS; Fram EK; Grossman RI
1988 Nov;169(2):455-461, Radiology
To investigate the role of the gradient-echo (GRE) technique in clinical intracranial magnetic resonance (MR) imaging, 63 patients with a variety of vascular intracranial lesions were examined at 1.5 T with the use of spin-echo (SE) and GRE sequences. In all cases, the sequential section acquisition technique called gradient recalled acquisition in the steady state (GRASS) was employed; a repetition time of 150-200 msec, an echo time of 13-16 msec, and a flip angle of 50 degrees-60 degrees were used to optimize the depiction of blood flow as high intensity and the depiction of stationary fluid as low intensity. In 61 of 63 cases, gradient moment nulling was utilized to compensate for first-order flow effects. Although GRE images rapidly demonstrated flow in vascular intracranial lesions as high intensity, the vascular nature of these lesions was also clearly evident on SE images in most cases. In some cases, GRE images can be used to clarify the vascular nature of a lesion or to characterize a neoplasm. Other applications include the detection of vascular thrombosis, occult vascular malformations, and hemorrhagic complications of vascular lesions
— id: 44071, year: 1988, vol: 169, page: 455, stat: Journal Article,

Intracranial hemorrhage: gradient-echo MR imaging at 1.5 T. Comparison with spin-echo imaging and clinical applications
Atlas SW; Mark AS; Grossman RI; Gomori JM
1988 Sep;168(3):803-807, Radiology
Fifty-seven patients with hemorrhagic intracranial lesions were examined with magnetic resonance (MR) imaging at 1.5 T with use of both spin-echo (SE) and gradient-echo-acquisition (GEA) techniques to assess the clinical applications and limitations of GEA in evaluation of intracranial hemorrhage at high field strength. All GEA images were obtained with a long echo time and short flip angle to emphasize T2*-based contrast. In 30 of 61 cases, GEA images demonstrated more hemorrhagic lesions than SE images. In 14 of 61 cases, GEA images failed to depict the lesion or obscured the specific diagnosis (as depicted by SE MR imaging). The authors believe that GEA imaging in its current form has a limited but definite adjunctive role in the evaluation of intracranial hemorrhage at high field strength
— id: 44075, year: 1988, vol: 168, page: 803, stat: Journal Article,

Neurofibromatosis and agenesis of the corpus callosum in identical twins: MR diagnosis
Atlas SW; Zimmerman RA; Bruce D; Schut L; Bilaniuk LT; Hackney DB; Goldberg HI; Grossman RI
1988 May-Jun;9(3):598-601, AJNR. American journal of neuroradiology
— id: 44081, year: 1988, vol: 9, page: 598, stat: Journal Article,

Mechanisms responsible for the MR appearance and evolution of intracranial hemorrhage
Gomori JM; Grossman RI
1988 May;8(3):427-440, Radiographics
The sequential degradation of hemoglobin in an evolving hemorrhage has been reviewed. Physical mechanisms of proton relaxation enhancement that contribute to the clinical MR appearances of hemorrhage have been described, and the dependence of relaxation rates on field strength and interecho interval in spin-echo imaging techniques has been defined
— id: 44080, year: 1988, vol: 8, page: 427, stat: Journal Article,

MR relaxation times and iron content of thalassemic spleens: an in vitro study
Gomori JM; Grossman RI; Drott HR
1988 Mar;150(3):567-569, American journal of roentgenology
To determine the relationship between MR relaxation times and the iron content of the spleens in patients with thalassemia, we measured these parameters at 0.19 and 1.18 T in 19 thalassemic spleen specimens in vitro. The correlation was best between iron content and the dependence between the interecho interval and the 1/T2 (T2 relaxation rate) at 1.18 T(r = .9361, p less than .001). No statistically significant correlation was found between T1 and iron content at either field strength. The variation of the 1/T2 with interecho interval may be useful for measuring iron content in vivo. It supports the theory that the T2 relaxation of iron deposits occurs via cellular field gradients produced by intralysosomal granules of hemosiderin
— id: 44084, year: 1988, vol: 150, page: 567, stat: Journal Article,

Variable appearances of subacute intracranial hematomas on high-field spin-echo MR
Gomori JM; Grossman RI; Hackney DB; Goldberg HI; Zimmerman RA; Bilaniuk LT
1988 Jan;150(1):171-178, American journal of roentgenology
Subacute intracranial hematomas have variable appearances on high-field MR images. They are hyperintense on T1-weighted images owing to methemoglobin, but have variable intensities on T2-weighted images. Observation of the different high-field spin-echo MR intensity patterns of five subacute hematomas suggests that further subcategorization into different methemoglobin states may be possible. In particular, undiluted intracellular methemoglobin is hyperintense on T1-weighted images and markedly hypointense on T2-weighted images, undiluted free methemoglobin should be hyperintense on T1-weighted images and isointense or slightly hypointense on T2-weighted images, and dilute free methemoglobin is hyperintense on both T1- and T2-weighted images. However, it appears that certain regions of subacute hematomas may be difficult to differentiate, by intensity patterns alone, from melanotic melanomas or fat. We believe that, despite some limitations, MR is useful in dividing subacute intracranial hematomas into their respective methemoglobin states, and also that further subcategorization is possible
— id: 44089, year: 1988, vol: 150, page: 171, stat: Journal Article,

High-field magnetic resonance imaging of intracranial hematomas
Gomori JM; Grossman RI; Steiner I
1988 Apr-May;24(4-5):218-223, Israel journal of medical sciences
One hundred intracranial hematomas aged 1 day to greater than 4 years old were imaged at 1.5 Tesla using T1- and T2-weighted spin-echo pulse sequences. Characteristic intensity patterns seen in the evolution of hematomas were identical to those preliminarily reported in 20 hematomas. They allow staging of a hematoma into acute (less than 1 week old), subacute (between 1 week and 1 month old), and chronic (several months to several years old). The mechanisms suspected to be responsible for these intensity patterns were confirmed by in vitro nuclear magnetic relaxometry of blood, ferritin and hemosiderotic spleen samples performed on a variable field spectrometer at 0.19 to 1.4 Tesla. High-field magnetic resonance imaging is sensitive and specific for hemorrhage in all of its stages of evolution as well as to the ambient oxygen tension of acute hematomas
— id: 44082, year: 1988, vol: 24, page: 218, stat: Journal Article,

Fat suppression by section-select gradient reversal on spin-echo MR imaging. Work in progress
Gomori JM; Holland GA; Grossman RI; Gefter WB; Lenkinski RE
1988 Aug;168(2):493-495, Radiology
A method to decrease the intensity of fat by reversal of the section-select gradient is demonstrated. This technique takes advantage of the chemical shift in section location
— id: 44076, year: 1988, vol: 168, page: 493, stat: Journal Article,

Multiple sclerosis: serial study of gadolinium-enhanced MR imaging
Grossman RI; Braffman BH; Brorson JR; Goldberg HI; Silberberg DH; Gonzalez-Scarano F
1988 Oct;169(1):117-122, Radiology
Thirteen patients with definite multiple sclerosis (MS), studied 16-24 months previously with magnetic resonance (MR) imaging with and without enhancement by intravenously administered gadolinium diethylenetriaminepentaacetic acid (DTPA) dimeglumine, were reexamined with a similar protocol. Assessment of enhancement and clinical activity in both studies revealed that enhancement was observed in 13 of 14 cases in which clinical activity had changed within 4 weeks of the study and thus appeared more sensitive than clinical examination in determining active disease. The 3-minute postinjection, short repetition time image (TR) was the most efficient for depicting enhancement. Enhancing lesions (active plaques) arose from previously hyper- or isointense regions on long TR images. Previously active lesions reverted to areas of iso- or hyperintensity on long TR images. Serial comparison of long TR images in this population reveals a decrease in high-intensity lesions on long TR images in some cases and an increase in others. The findings of high-intensity regions on long TR images and previously enhancing lesions both becoming isointense suggests that transient inflammatory changes with concomitant edema without demyelination and/or with significant remyelination may occur in some MS lesions. MS lesions are dynamic; both active and inactive lesions may show dramatic change on longitudinal MR imaging studies
— id: 44074, year: 1988, vol: 169, page: 117, stat: Journal Article,

MR imaging of hemorrhagic conditions of the head and neck
Grossman RI; Gomori JM; Goldberg HI; Hackney DB; Atlas SW; Kemp SS; Zimmerman RA; Bilaniuk LT
1988 May;8(3):441-454, Radiographics
1. There is a constant sequence of signal intensity patterns that characterize 1.5 T, spin echo MR images of hemorrhagic lesions. 2. The MRI appearance of intraparenchymal hemorrhage is determined by the sequential chemical degradation of Hb, by the paramagnetic properties of the degradation products and by certain biologic factors including pO2, edema formation, hematocrit and BBB. 3. Acute intraparenchymal hemorrhage is characterized by markedly diminished signal intensity centrally relative to surrounding white matter (hypointensity) on T2 weighted images and often by a moderately increased signal intensity (hyperintensity) of the adjacent white matter produced by surrounding edema on proton density and T2 weighted images. 4. Early subacute intraparenchymal hemorrhage is characterized centrally by moderate hypointensity on T2 weighted images, and peripherally, by moderate hyperintensity on T1 weighted and marked hypointensity on T2 weighted images. Hyperintensity on proton density and T2 weighted images of nearby white matter owing to edema may again be seen. 5. Late subacute intraparenchymal hemorrhage is characterized by marked peripheral and central hyperintensity on both T1 and T2 weighted images. Also, marked hypointensity of the adjacent brain rim on T2 weighted images owing to hemosiderin deposition may be seen. 6. Chronic intraparenchymal hemorrhage is characterized by marked hyperintensity both centrally and peripherally on both T1 and T2 weighted images and by marked hypointensity of the adjacent brain rim on T2 weighted images owing to hemosiderin deposition. Surrounding edema is no longer present. 7. The integrity of the blood-brain barrier appears to be important in determining whether or not hemosiderin accumulations consistently occur in subacute and chronic hemorrhage. 8. Hemorrhagic conditions in which the defined sequence of signal intensity patterns may be seen include: venous thrombosis, hemorrhagic infarction, occult vascular malformation and intracranial aneurysm
— id: 44079, year: 1988, vol: 8, page: 441, stat: Journal Article,

Experimental radiation injury: combined MR imaging and spectroscopy
Grossman RI; Hecht-Leavitt CM; Evans SM; Lenkinski RE; Holland GA; Van Winkle TJ; McGrath JT; Curran WJ; Shetty A; Joseph PM
1988 Nov;169(2):305-309, Radiology
A model of radiation injury to the brain was developed in the cat. Definite radiation changes were demonstrated at magnetic resonance (MR) imaging in four of six cats. These changes consisted of high-intensity abnormalities on images obtained with a long repetition time (TR) and a long echo time (TE), which were initially noted 208-285 days after irradiation. These changes were associated with gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) enhancement on short TR and inversion-recovery (IR) pulse sequences. Gd-DTPA enhancement and the high intensity on the long TR/TE images were identified at the same time and became more prominent throughout the study. Chemical-shift imaging and phosphorus spectroscopy demonstrated no notable changes despite clear-cut MR evidence of abnormalities. Sodium imaging was positive in one case. Correlation of MR and pathologic findings revealed areas of radiation necrosis and wallerian degeneration that corresponded to areas of Gd-DTPA enhancement on short TR and IR images and to areas of high intensity on long TR/TE images. Peripheral to the areas of Gd-DTPA enhancement were nonenhanced zones of high-signal-intensity abnormality on long TR/TE images, which represented regions of demyelination without necrosis. Gd-DTPA-enhanced proton imaging was the most sensitive method for detecting radiation damage in this animal model
— id: 44072, year: 1988, vol: 169, page: 305, stat: Journal Article,

Initial experience with fast low-angle multiecho (FLAME) imaging of the central nervous system
Hackney DB; Lenkinski RE; Grossman RI; Zimmerman RA; Goldberg HI; Bilaniuk LT; Young SC; Nowell MA; Kemp SS
1988 Jan-Feb;12(1):171-174, Journal of computer assisted tomography
Fast low-angle multiecho (FLAME) imaging uses partial flip angles of less than 90 degrees with 180 degrees radiofrequency refocusing pulses. The partial flip angle permits imaging with shorter repetition time (TR) values on the order of 750-1,000 ms for 30 degrees angles with image contrast characteristics identical to those obtained with conventional 90-180 degrees schemes and TRs on the order of 2,500 ms. The approximately threefold reduction in imaging time is accompanied by a decrease in signal-to-noise ratio. In many circumstances, however, this trade-off may produce entirely acceptable images of the CNS at a significant reduction in imaging time
— id: 44088, year: 1988, vol: 12, page: 171, stat: Journal Article,

Magnetic resonance imaging and degree of disability in multiple sclerosis
Kiel MK; Greenspun B; Grossman RI
1988 Jan;69(1):11-13, Archives of physical medicine & rehabilitation
Sixteen patients with multiple sclerosis were evaluated by magnetic resonance imaging (MRI) to determine if number of brain lesions correlated with the amount of functional disability, as described by the Incapacity Status Scale contained in the Minimal Record of Disability. Although no correlation existed, the statistical analysis did indicate a trend toward correlation, which warrants a study with a larger number of subjects
— id: 44087, year: 1988, vol: 69, page: 11, stat: Journal Article,

Integrated MR imaging and spectroscopy with chemical shift imaging of P-31 at 1.5 T: initial clinical experience
Lenkinski RE; Holland GA; Allman T; Vogele K; Kressel HY; Grossman RI; Charles HC; Engeseth HR; Flamig D; MacFall JR
1988 Oct;169(1):201-206, Radiology
A section-selective three-dimensional phosphorus-31 chemical shift imaging (CSI) experiment was evaluated as the spatial localization method for spectroscopy in an integrated clinical magnetic resonance (MR) imaging and spectroscopy examination. The results of a CSI experiment can be displayed as either spectra related to specific voxels or 'metabolite maps,' in which the relative concentration of a given metabolite is displayed as an overlay of the MR image. This method was applied to the study of a soft-tissue mass and to a meningioma. The total imaging time in each case was 17 minutes with a voxel size of 27 cm3 in the extremity and 64 cm3 in the brain. The total time to set up this part of the study was about 10 minutes. No additional shimming was necessary when the center of the field of view selected for the CSI experiment was located at or near isocenter. The promising results obtained with this approach make the CSI method an attractive choice of spatial localization method
— id: 44073, year: 1988, vol: 169, page: 201, stat: Journal Article,

Dural carotid-cavernous sinus vascular malformation with facial nerve paresis
Moster ML; Sergott RC; Grossman RI
1988 Feb;23(1):27-29, Canadian journal of ophthalmology
Facial nerve paresis is rarely seen in dural cavernous sinus arteriovenous malformations or carotid-cavernous sinus fistulae. A patient with an otherwise typical presentation of a spontaneous carotid-cavernous sinus malformation was found to have ipsilateral infranuclear facial nerve paresis. Angiography revealed a dural arteriovenous malformation with early petrosal sinus filling. Possible mechanisms for the paresis include compression of the facial nerve by increased venous pressure and 'stealing' of the arterial supply by the malformation
— id: 44085, year: 1988, vol: 23, page: 27, stat: Journal Article,

MR imaging of white matter disease in children
Nowell MA; Grossman RI; Hackney DB; Zimmerman RA; Goldberg HI; Bilaniuk LT
1988 Aug;151(2):359-365, American journal of roentgenology
Twenty-three pediatric patients with white matter abnormalities on MR images were evaluated retrospectively to assess the contribution of MR compared with CT in diagnosing these conditions. In addition, the MR findings in major categories of white matter diseases were analyzed for sensitivity in detecting the presence of an abnormality. White matter disease categories included demyelinating disease (five cases), dysmyelinating disease (eight cases), developmental white matter abnormalities (four cases), and white matter abnormalities of unknown origin (idiopathic) (six cases), as seen on long TR images. We found that MR is not more sensitive than CT in detecting disease in the demyelinating or dysmyelinating categories, although it is more sensitive than CT in detecting the degree of disease present. In cases of developmental delay, MR is distinctly more useful than CT in demonstrating abnormalities of myelination. And in the idiopathic group, MR detected the presence of focal white matter abnormalities on long TR images in children with neurologic complaints and normal CT. MR may serve to redefine and broaden the spectrum of reported imaging abnormalities in pediatric patients
— id: 44077, year: 1988, vol: 151, page: 359, stat: Journal Article,

Focal cortical dysplasia on magnetic resonance imaging: a case report
Nowell MA; Grossman RI; Packer R; Hackney DB; Goldberg HI; Bilaniuk LT; Zimmerman RA
1988 Jan;12(1):61-63, Journal of computed tomography
A case report of an 11 years old boy with new onset of a seizure disorder is presented. A computed tomography scan demonstrated a noncalcified, nonenhancing focal region of abnormal cortex. A magnetic resonance imaging scan delineated both an isointense area of abnormally thickened gyri and linear areas of abnormal high signal intensity in the subjacent white matter. A review of the radiologic and pathologic literature suggests that this lesion represents the entity focal cortical dysplasia as described by Taylor, et al. This abnormality is part of a spectrum of disorders including hamartomas (of tuberous sclerosis), focal cortical dysplasia and heterotopias
— id: 44086, year: 1988, vol: 12, page: 61, stat: Journal Article,

Graduate primary care training: a collaborative alternative for family practice, internal medicine, and pediatrics
Strelnick AH; Bateman WB; Jones C; Shepherd SD; Massad RJ; Townsend JM; Grossman R; Korin E; Schorow M
1988 Aug 15;109(4):324-334, Annals of internal medicine
The Residency Program in Social Medicine at Montefiore Medical Center is a collaborative, integrated training program for primary care pediatricians, internists, and family physicians within one interdisciplinary organization. Since 1970 we have trained more than 200 physicians, prepared them for board certification in their specialty, emphasized the psychosocial aspects and social determinants of health and illness, and shared a faculty, curriculum, and commitment to provide medical care for inner-city, underserved populations. We discuss the program's history and curriculum, administrative and academic structure, shared "cross-track" faculty units (psychosocial; social medicine; and research, education, and evaluation), and graduates' practice outcomes. The interdisciplinary character of the Residency Program in Social Medicine helps physicians successfully serve the underserved and exemplifies that interdisciplinary medical education succeeds when interdisciplinary health care teams are organized for optimal patient care. Only the federal government has the perspective and power to foster more interdisciplinary collaboration and strengthen primary care education in a period of shrinking resources.
— id: 21070, year: 1988, vol: 109, page: 324, stat: Journal Article,

MR of vascular encasement in parasellar masses: comparison with angiography and CT
Young SC; Grossman RI; Goldberg HI; Spagnoli MV; Hackney DB; Zimmerman RA; Bilaniuk LT
1988 Jan-Feb;9(1):35-38, AJNR. American journal of neuroradiology
The relationship between tumor mass and vascular involvement as seen on MR imaging was examined in 11 patients with masses in the parasellar region, and the findings were correlated with CT and angiography. In six cases, MR was superior to CT and angiography in depicting the relationship of the tumor to adjacent blood vessels. In these cases, MR demonstrated tumor surrounding the blood vessel without changing the diameter of its lumen. Angiography did not reveal encasement in these cases. In four cases, both MR and angiography showed signs of vascular encasement with narrowing of the vessel's lumen. In two cases, MR was equivocal while angiography revealed vascular encasement in one case and was negative for encasement in the other. CT was less sensitive than MR in defining vascular encasement since there is usually little contrast between an enhancing tumor and the major blood vessels. Coronal scanning appeared to be the best plane of imaging and correlated well with the anteroposterior angiogram. We propose that MR is the method of choice for evaluating arterial encasement by tumors and may obviate the need for angiography in those cases in which MR is positive for a basal lesion
— id: 44090, year: 1988, vol: 9, page: 35, stat: Journal Article,

Orbit: initial experience with surface coil spin-echo MR imaging at 1.5 T
Atlas SW; Bilaniuk LT; Zimmerman RA; Hackney DB; Goldberg HI; Grossman RI
1987 Aug;164(2):501-509, Radiology
Fifty-nine cases in which surface coil MR imaging of the orbit was performed were reviewed. MR imaging was performed with spin-echo techniques at 1.5 T with both short repetition time/echo time (TR/TE) and long TR/TE sequences in all cases. In all patients short TR/TE images were obtained with small-diameter surface coils; long TR/TE images were usually obtained with a standard head coil. Surface coil MR appears to be an important adjunct in state-of-the-art orbital imaging. Orbital MR imaging may be most useful, providing information not available on computed tomography (CT), in identifying lesions in the orbital apex, superior orbital fissure, and optic canal; differentiating inflammatory pseudotumor from malignancy in clinically similar patients; characterizing lesions containing hemorrhage or other paramagnetic material; defining the posterior extent of optic pathway gliomas; and detecting abnormal flow in intraorbital vascular structures. CT seems to be superior to MR imaging in the evaluation of small perioptic meningiomas, especially those that are calcified
— id: 44098, year: 1987, vol: 164, page: 501, stat: Journal Article,

Orbital lesions: proton spectroscopic phase-dependent contrast MR imaging
Atlas SW; Grossman RI; Axel L; Hackney DB; Bilaniuk LT; Goldberg HI; Zimmerman RA
1987 Aug;164(2):510-514, Radiology
Thirteen orbital lesions in 12 patients were evaluated with both conventional spin-echo magnetic resonance (MR) imaging and phase-dependent proton spectroscopic imaging. This technique, which makes use of small differences in the resonant frequencies of water and fat protons, provides excellent high-resolution images with simultaneous chemical shift information. In this method, there is 180 degrees opposition of phase between fat protons and water protons at the time of the gradient echo, resulting in signal cancellation in voxels containing equal signals from fat and water. In this preliminary series, advantages of spectroscopic images in orbital lesions included better lesion delineation, with superior anatomic definition of orbital apex involvement; more specific characterization of high-intensity hemorrhage with a single pulse sequence; elimination of potential confusion from chemical shift misregistration artifact; further clarification of possible intravascular flow abnormalities; and improved apparent intralesional contrast
— id: 44097, year: 1987, vol: 164, page: 510, stat: Journal Article,

Partially thrombosed giant intracranial aneurysms: correlation of MR and pathologic findings
Atlas SW; Grossman RI; Goldberg HI; Hackney DB; Bilaniuk LT; Zimmerman RA
1987 Jan;162(1 Pt 1):111-114, Radiology
Two patients with surgically and angiographically proved partially thrombosed giant aneurysms of the middle cerebral artery were studied with computed tomography (CT) and magnetic resonance (MR) imaging. MR and histopathologic findings were correlated. The central location of methemoglobin, with its high intensity (surrounding the patent lumen, seen as signal void), in giant aneurysms is directly opposite the initial peripheral appearance of methemoglobin in extra-aneurysmal intracerebral hematomas. More peripherally, the thrombosed portion of the lumen is layered with intensities that represent stages of clot (methemoglobin and hemosiderin). Three characteristics enable differentiation of giant aneurysms from intracerebral hematoma: signal void in residual patent lumen; laminated, staged thrombus with intervening layers of hemosiderin and methemoglobin that is initially centrally, rather than only peripherally, located; and signal void in the vessel from which the aneurysm arises. Hemorrhage from prior bleeding can be readily identified and separated from perianeurysmal edema on MR images. MR appears to be a specific, noninvasive method for diagnosing partially thrombosed giant intracranial aneurysms and is superior to CT and angiography in characterizing these lesions
— id: 44114, year: 1987, vol: 162, page: 111, stat: Journal Article,

MR imaging of intracranial metastatic melanoma
Atlas SW; Grossman RI; Gomori JM; Guerry D; Hackney DB; Goldberg HI; Zimmerman RA; Bilaniuk LT
1987 Jul-Aug;11(4):577-582, Journal of computer assisted tomography
Ten patients with intracerebral metastases from malignant melanoma were evaluated with magnetic resonance (MR) imaging performed at 1.5 T using spin-echo techniques. On the basis of histopathologic findings in three of 10 cases and CT appearances in all 10 cases, three patterns were identified on analysis of MR signal intensities in both short repetition time/echo time (TR/TE) and long TR/TE spin-echo scans. In comparison to normal cortex, nonhemorrhagic melanotic melanoma appeared markedly hyperintense on short TR/TE images and isointense, mildly hypointense on long TR/TE images. Nonhemorrhagic, amelanotic melanoma appeared isointense or mildly hypointense on short TR/TE and isointense or mildly hyperintense on long TR/TE images. Hemorrhagic melanoma varied in appearance, depending on the stage of hemorrhage. Melanotic, nonhemorrhagic melanoma can be distinguished from early and late subacute hemorrhage by its signal intensity on long TR/TE images. Spin-echo MR appears to be the method of choice for diagnosing melanotic metastases
— id: 44100, year: 1987, vol: 11, page: 577, stat: Journal Article,

Hemorrhagic intracranial malignant neoplasms: spin-echo MR imaging
Atlas SW; Grossman RI; Gomori JM; Hackney DB; Goldberg HI; Zimmerman RA; Bilaniuk LT
1987 Jul;164(1):71-77, Radiology
Twelve patients with 15 separate, spontaneously hemorrhagic, intracranial malignant lesions (seven primary gliomas, eight metastatic lesions) were examined with spin-echo magnetic resonance imaging at 1.5 T, and with computed tomography. The signal intensity patterns of these lesions, as seen on both short repetition time (TR)/short echo time (TE) and long-TR/long-TE spin-echo pulse sequences, were compared with the previously described appearance at 1.5 T of non-neoplastic intracerebral hematomas. The images of hemorrhagic intracranial malignancies showed notable signal heterogeneity, often with identifiable nonhemorrhagic tissue corresponding to tumor; diminished, irregular, or absent hemosiderin deposition; delayed hematoma evolution; and pronounced or persistent edema, compared with non-neoplastic hematomas. The demonstration of these characteristics in the appropriate clinical setting may suggest malignancy as the cause of an intracranial hematoma
— id: 44101, year: 1987, vol: 164, page: 71, stat: Journal Article,

Magnetic resonance imaging diagnosis of disseminated necrotizing leukoencephalopathy
Atlas SW; Grossman RI; Packer RJ; Goldberg HI; Hackney DB; Zimmerman RA; Bilaniuk LT
1987 Jan;11(1):39-43, Journal of computed tomography
Disseminated necrotizing leukoencephalopathy is a rare syndrome of progressive neurologic deterioration seen most often in patients who have received central nervous system irradiation combined with intrathecal or systemic chemotherapy in the treatment or prophylaxis of various malignancies. Magnetic resonance imaging was more sensitive than computed tomography in detecting white matter abnormalities in the case of disseminated necrotizing leukoencephalopathy reported here. Magnetic resonance imaging may be useful in diagnosing incipient white matter changes in disseminated necrotizing leukoencephalopathy, thus permitting early, appropriate therapeutic modifications
— id: 44112, year: 1987, vol: 11, page: 39, stat: Journal Article,

Internuclear ophthalmoplegia: MR-anatomic correlation
Atlas SW; Grossman RI; Savino PJ; Schatz NJ; Sergott RC; Bosley TM; Hackney DB; Goldberg HI; Bilaniuk LT; Zimmerman RA
1987 Mar-Apr;8(2):243-247, AJNR. American journal of neuroradiology
Internuclear ophthalmoplegia is a gaze disorder characterized by impaired adduction on the side of a lesion involving the medial longitudinal fasciculus with dissociated nystagmus of the abducting eye. Eleven patients with internuclear ophthalmoplegia (nine with clinical multiple sclerosis, two with clinical infarction) underwent MR imaging with spin-echo techniques on a 1.5-T system. Nine patients also had CT. MR showed focal or nodular areas of high signal intensity on T2-weighted images in the region of the medial longitudinal fasciculus in 10 of 11 patients. In one of four patients with internuclear ophthalmoplegia who had MR after intravenous gadolinium-DTPA, an enhancing ring lesion was seen in the region of the medial longitudinal fasciculus on short TR/TE images, indicating active blood-brain-barrier disruption, which correlated with this patient's recent-onset internuclear ophthalmoplegia. CT failed to show the lesions in all nine patients examined. This report demonstrates the superiority of MR in evaluating gaze disorders attributable to brainstem dysfunction, such as internuclear ophthalmoplegia, and correlates MR findings with the relevant neuroanatomy of the medial longitudinal fasciculus
— id: 44108, year: 1987, vol: 8, page: 243, stat: Journal Article,

Surface-coil MR of orbital pseudotumor
Atlas SW; Grossman RI; Savino PJ; Sergott RC; Schatz NJ; Bosley TM; Hackney DB; Goldberg HI; Bilaniuk LT; Zimmerman RA
1987 Apr;148(4):803-808, American journal of roentgenology
Fifteen patients with clinical presentations compatible with idiopathic inflammatory orbital pseudotumor were examined by CT and MR imaging to determine if MR could add specificity to the CT appearance of this entity. MR was performed on a 1.5 T system, using surface-coil and head-coil techniques. Idiopathic pseudotumor was confirmed in nine patients on the basis of response to steroid therapy in the absence of local cause or systemic illness. One other patient had biopsy-proven idiopathic pseudotumor. Five patients proved to have other orbital entities, including metastases, infectious myositis, hemorrhage, and orbital sarcoid. In all 10 patients with confirmed pseudotumor, CT and MR were abnormal. MR abnormalities in 10 of 10 patients with pseudotumor were hypointense to fat and isointense to muscle on T1-weighted images. On T2-weighted images the lesions of pseudotumor were isointense or only minimally hyperintense to fat in nine of 10 cases; in one case, the enlarged muscle was markedly hyperintense to fat. The MR signal intensity of pseudotumor was similar to that found in infectious myositis and sarcoid. These findings contrasted to the MR appearance of the other disease entities examined. Metastases appeared markedly hyperintense to fat on T2-weighted images, while hematoma was hyperintense to muscle and isointense to fat on T1-weighted images and markedly hyperintense to fat on T2-weighted images. In our preliminary series, surface-coil MR appears to add specificity to the CT appearance of orbital pseudotumor
— id: 44105, year: 1987, vol: 148, page: 803, stat: Journal Article,

MR imaging of a carcinoid tumor metastatic to the orbit
Braffman BH; Bilaniuk LT; Eagle RC Jr; Savino PJ; Hackney DB; Grossman RI; Goldberg HI; Zimmerman RA
1987 Sep-Oct;11(5):891-894, Journal of computer assisted tomography
This is a report of the magnetic resonance study in a case of orbital metastasis from a carcinoid tumor. A rather unusual feature of this lesion was its relatively short T2 as compared with other metastatic orbital lesions
— id: 44095, year: 1987, vol: 11, page: 891, stat: Journal Article,

High-field magnetic resonance imaging of Wilson's disease
De Haan J; Grossman RI; Civitello L; Hackney DB; Goldberg HI; Bilaniuk LT; Zimmerman RA
1987 Apr;11(2):132-135, Journal of computed tomography
A single case of Wilson's hepatolenticular degeneration was imaged by computed tomography and magnetic resonance (1.5 Tesla). Findings included generalized cerebral atrophy seen both on computed tomography and magnetic resonance images. T1-weighted images revealed a slight symmetric hypointensity in the lentiform nuclei and thalamus. T2-weighted images demonstrated marked symmetric hypointensity in the lentiform nuclei. These hypointensities are ascribed to the deposition of intracellular hemosiderin (and perhaps copper), which produce heterogeneous magnetic susceptibility and preferential T2-proton relaxation. Areas of increased signal activity on T2-weighted images were also seen in areas of presumed demyelination known to occur in Wilson's disease
— id: 44103, year: 1987, vol: 11, page: 132, stat: Journal Article,

Head and neck hemorrhage
Gomori JM; Grossman RI
1987 ;29(5):71-112, Magnetic resonance annual
— id: 44120, year: 1987, vol: 29, page: 71, stat: Journal Article,

High-field spin-echo MR imaging of superficial and subependymal siderosis secondary to neonatal intraventricular hemorrhage
Gomori JM; Grossman RI; Goldberg HI; Hackney DB; Zimmerman RA; Bilaniuk LT
1987 ;29(4):339-342, Neuroradiology
Two cases of superficial siderosis with subependymal siderosis, secondary to neonatal intraventricular hemorrhage, are presented. High-field spin-echo MR imaging (1.5 Tesla) showed marginal hypointensity of the ventricular walls as well as of the subpial regions. These findings were most evident on T2 weighted images, characteristic of hemosiderotic deposits
— id: 44116, year: 1987, vol: 29, page: 339, stat: Journal Article,

NMR relaxation times of blood: dependence on field strength, oxidation state, and cell integrity
Gomori JM; Grossman RI; Yu-Ip C; Asakura T
1987 Jul-Aug;11(4):684-690, Journal of computer assisted tomography
The variation with field strength or interecho interval of the T1 and T2 relaxation times of oxyhemoglobin (HbO2), deoxyhemoglobin (Hb), and methemoglobin (MHb) in either intact or lysed red blood cells was studied with a variable field (0.19-1.4 T) nuclear magnetic resonance spectroscopy unit. The T2 relaxation time of intracellular HbO2 decreased slightly with increasing field strength and interecho interval. The T2 relaxation times of intracellular Hb and MHb decreased markedly with increasing field strength and interecho interval. This T2 proton relaxation enhancement increased as the square of the applied field strength and was 1.6 times stronger for intracellular MHb than for intracellular Hb. The T2 relaxation enhancement is secondary to the loss of transverse phase coherence of water protons that diffuse across cellular magnetic field gradients. These field gradients occur when an external field is applied to a region with gradients of magnetic susceptibility. The heterogeneity of magnetic susceptibility is caused by the heterogeneous distribution (only intracellular) of the paramagnetic molecules (Hb or MHb). The T2 relaxation times of red cell lysates (homogeneous magnetic susceptibility) were independent of field strength or interecho interval. There was a decrease in the T1 relaxation times when the red cells were lysed. This may be due to an increase in the slow motional components of water molecules, because of the decrease in the average distance between water and hemoglobin molecules in the lysate. The T1 relaxation times of all the MHb samples were shortened because of proton-electron dipolar-dipolar relaxation enhancement. All the T1 relaxation times increased with increasing field strength
— id: 44099, year: 1987, vol: 11, page: 684, stat: Journal Article,

Multiple sclerosis disease activity correlates with gadolinium-enhanced magnetic resonance imaging
Gonzalez-Scarano F; Grossman RI; Galetta S; Atlas SW; Silberberg DH
1987 Mar;21(3):300-306, Annals of neurology
Magnetic resonance imaging provides a method of visualizing multiple sclerosis plaques, but the age and activity of these plaques cannot be determined with routine magnetic resonance images. Gadolinium DTPA is a paramagnetic contrast agent that does not cross an intact blood-brain barrier. We studied 16 patients with multiple sclerosis, using magnetic resonance imaging, gadolinium-enhanced magnetic resonance imaging, and computed tomographic scans. Gadolinium enhancement of multiple sclerosis plaques correlated with the clinical activity of the disease and corresponded anatomically with the symptoms and signs. We conclude that gadolinium enhancement of magnetic resonance images is a promising tool in the investigation of multiple sclerosis lesions and that it may provide a method for objective follow-up in clinical trails
— id: 44106, year: 1987, vol: 21, page: 300, stat: Journal Article,

Degenerative lumbar disk disease: pitfalls and usefulness of MR imaging in detection of vacuum phenomenon
Grenier N; Grossman RI; Schiebler ML; Yeager BA; Goldberg HI; Kressel HY
1987 Sep;164(3):861-865, Radiology
Magnetic resonance (MR) images of the lumbar spine from 150 patients were retrospectively reviewed. In 14 of these patients, at 18 disk levels, a vacuum phenomenon (VP) had been identified on plain radiographs and/or computed tomographic scans. The MR imaging appearance of these gas collections in 17 disks was an area without signal, best seen on spin-echo sequences with short repetition time and echo time in the sagittal view. MR imaging precisely located the VP in the anulus fibrosus, the nucleus pulposus, and Schmorl nodes. In all but one case, degeneration of the disk was complete and associated with adjacent changes in vertebral bone. Pitfalls of MR imaging detection of VP included chemical shift artifact, calcifications, and tears without gas in the disk
— id: 44096, year: 1987, vol: 164, page: 861, stat: Journal Article,

Normal and degenerative posterior spinal structures: MR imaging
Grenier N; Kressel HY; Schiebler ML; Grossman RI; Dalinka MK
1987 Nov;165(2):517-525, Radiology
A retrospective study of the magnetic resonance (MR) images of the lumbar spines of 13 healthy subjects and 30 patients with degenerative changes was done. In the healthy subjects, the vertebral facets, thickness of the cartilage and ligamentum flavum, signal characteristics of the bone marrow, and size of the spinal canal were studied. In the patients with degenerative changes in one of these structures, MR images in the sagittal plane were useful in demonstrating hypertrophy of the ligamentum flavum or the vertebral facets, in grading the degree of foraminal stenosis, and in measuring the sagittal diameter of the spinal cord. MR images in the axial plane facilitated detailed analysis of the facet joint and more accurate measurements of the thickness of the ligamentum flavum and spinal canal diameter. MR images were compared with computed tomography scans in 12 patients
— id: 44091, year: 1987, vol: 165, page: 517, stat: Journal Article,

MR of acute experimental allergic encephalomyelitis
Grossman RI; Lisak RP; Macchi PJ; Joseph PM
1987 Nov-Dec;8(6):1045-1048, AJNR. American journal of neuroradiology
Acute experimental allergic encephalomyelitis, an animal model of CNS inflammatory and demyelinating disease, was produced in guinea pigs and imaged with MR. Correlation of histopathology with MR revealed acute mononuclear perivascular inflammatory changes and edema corresponding to the high-intensity abnormalities observed on long repetition time (TR) images. Our results suggest that in acute multiple sclerosis the high intensity noted on long TR images may be secondary to associated inflammatory changes rather than to demyelination
— id: 44092, year: 1987, vol: 8, page: 1045, stat: Journal Article,

Subacute intracranial hemorrhage: contribution of spin density to appearance on spin-echo MR images
Hackney DB; Atlas SW; Grossman RI; Gomori JM; Goldberg HI; Zimmerman RA; Bilaniuk LT
1987 Oct;165(1):199-202, Radiology
The T2 and pseudodensity (proportional to proton density) of intracranial hemorrhages and normal white matter were calculated. The mean T2 (+/- standard deviation) was 120 +/- 62 for hemorrhage and 61 +/- 11 for white matter. Pseudodensity values were normalized to a white matter value of 1, and the value for hemorrhage was 1.56 +/- 0.28. These values were used to determine which components of hemorrhage-white matter contrast are due to T1, T2, and density. The results indicate that on spin-echo (SE) images obtained with a long repetition time (TR)/short echo time (TE) (2,500/0-20 [TR msec/TE msec]), the contrast is mainly due to density differences, with a modest T2 contribution on 20-msec-TE images and nearly no T1 component. At 600/0-20, the contrast continues to be largely determined by density differences, again with a modest T2 component on 20-msec-TE images. If the T1 of hemorrhage is extremely short, the T1 component of contrast on 600/0-20 SE images will be somewhat greater than the density component. Because contrast on short TR/short TE images may be largely or entirely determined by pseudodensity or T2, it is inaccurate to refer to 600/20 images as 'T1-weighted'. The assumption that high signal intensity at this sequence implies a 'short T1' will lead to misleading conclusions
— id: 44094, year: 1987, vol: 165, page: 199, stat: Journal Article,

Low sensitivity of clinical MR imaging to small changes in the concentration of nonparamagnetic protein
Hackney DB; Grossman RI; Zimmerman RA; Joseph PM; Goldberg HI; Bilaniuk LT; Spagnoli MV
1987 Nov-Dec;8(6):1003-1008, AJNR. American journal of neuroradiology
This study attempts to determine the magnitude of change in the concentration of a nonparamagnetic protein (human serum albumin) required to effect a detectable change in signal intensity on a clinical imaging unit. For a range of protein concentrations from 0-6100 mg/dl the concentration could not be predicted by inspecting the images. Measurement of displayed signal intensity failed to distinguish concentrations of 0.09-3700 mg/dl, while 6100 mg/dl gave slightly higher intensity signals. Although this low sensitivity represents expected behavior for low concentrations, the failure to differentiate the higher concentrations implies limitations imposed by clinical imaging techniques. Our results suggest that additional factors, such as paramagnetic material and motion as well as differences in protein concentration, may be involved in the MR signal intensities observed in pathologic CSF and cystic CNS collections
— id: 44093, year: 1987, vol: 8, page: 1003, stat: Journal Article,

MR of brain radiation injury: experimental studies in cats
Hecht-Leavitt C; Grossman RI; Curran WJ Jr; McGrath JT; Biery DN; Joseph PM; Nelson DF
1987 May-Jun;8(3):427-430, AJNR. American journal of neuroradiology
Two of six cats receiving small-field, single-dose, brain irradiation of 35 Gy with 6 MeV photons developed brain abnormalities in the irradiated area on MR images at 6 and 8 months, respectively, after treatment. The lesions were of high intensity on T2-weighted images and did not enhance after IV administration of gadolinium-DTPA. An additional lesion in one of these cats displayed high signal on T2-weighted images and enhanced on T1-weighted images after IV gadolinium-DTPA. Pathologic correlation revealed that the nonenhancing T2-weighted lesions consisted of edema or demyelinated regions without inflammation while the gadolinium-enhanced lesion demonstrated necrosis with inflammatory infiltrate. Focal brain irradiation may produce noninflammatory demyelination and necrosis. These histologic entities may be potentially distinguished on MR with IV gadolinium-DTPA
— id: 44102, year: 1987, vol: 8, page: 427, stat: Journal Article,

Magnetic resonance imaging of the cerebral aqueduct
Kemp SS; Zimmerman RA; Bilaniuk LT; Hackney DB; Goldberg HI; Grossman RI
1987 ;29(5):430-436, Neuroradiology
1.5 Tesla MRI examinations were evaluated for aqueductal configuration, hydrocephalus and flow-related signal void in 70 patients with juxtaaqueductal pathology and in 20 normal controls. In the 70 cases with pathology, the aqueduct was obliterated or distorted in 34, dilated in 3, normal in 29 and not evaluable in 4. A definite flow-related signal void indicated CSF movement within the aqueduct in all normal examinations. Flow-related signal void was absent in some, but not all, patients with aqueductal obliteration and distortion. CSF turbulence can create an intra-aqueductal signal void in the dilated proximal aqueduct, despite more distal obstruction. Thus hydrocephalus related to aqueductal obstruction is frequently, but not always, associated with absence of signal void
— id: 44115, year: 1987, vol: 29, page: 430, stat: Journal Article,

MR imaging of fetal brain
Mintz MC; Grossman RI; Isaacson G; Thickman DI; Kundel H; Joseph P; DeSimone D
1987 Jan-Feb;11(1):120-123, Journal of computer assisted tomography
Magnetic resonance (MR) imaging was used to evaluate normal fetal intracranial anatomy in axial, coronal, and sagittal planes. The T1 and T2 weighted images (WI) of aborted fetuses of varying gestational ages were correlated with anatomic sections. In the premature fetus three distinct intensity zones were seen on MR that were not visualized on gross specimens. Unmyelinated white matter displays low intensity on T1 W1 and high intensity on T2 W1. Maturational changes of the brain were observed with advancing fetal age
— id: 44111, year: 1987, vol: 11, page: 120, stat: Journal Article,

Immature brain: spin-echo pulse sequence parameters for high-contrast MR imaging
Nowell MA; Hackney DB; Zimmerman RA; Bilaniuk LT; Grossman RI; Goldberg HI
1987 Jan;162(1 Pt 1):272-273, Radiology
Appropriate spin-echo (SE) pulse sequence parameters generate magnetic resonance (MR) images with very high gray matter/white matter contrast in neonates and young infants. In these young patients, long SE sequences with a repetition time of 3,000-3,500 msec and multiple echoes with the longest echo time of 120-160 msec are employed to yield high-contrast images. A high-contrast MR image of a 1-month-old infant is presented
— id: 44113, year: 1987, vol: 162, page: 272, stat: Journal Article,

High-field MR imaging of extracranial hematomas
Rubin JI; Gomori JM; Grossman RI; Gefter WB; Kressel HY
1987 Apr;148(4):813-817, American journal of roentgenology
The MR features of 20 extracranial hematomas studied on a 1.5-T system and imaged with both short repetition-time/echo-time (TR/TE) and long TR/TE pulse sequences were reviewed. In four of five acute hematomas (those less than 7 days of age), signal intensity was markedly decreased on long TR/TE images and was either intermediate or slightly decreased on short TR/TR images. Fourteen subacute hematomas (7 days to 7 weeks of age) and one chronic hematoma (9 months) were studied. The appearance of the subacute lesions varied from intermediate to high intensity on short TR/TE sequences, but all demonstrated increased signal on long TR/TE sequences. A low-signal rim was noted at the margin of nine subacute lesions. In one patient with this finding, pathologic examination showed that the low-signal margin corresponded to a region containing hemosiderin-laden macrophages at the periphery of the hematoma. These results correlate well with those reported for intracranial hematomas examined at this field strength. We conclude that analysis of signal-intensity patterns at 1.5 T is useful in staging the evolution of hematomas
— id: 44104, year: 1987, vol: 148, page: 813, stat: Journal Article,

The syndrome of paradoxical worsening of dural-cavernous sinus arteriovenous malformations
Sergott RC; Grossman RI; Savino PJ; Bosley TM; Schatz NJ
1987 Mar;94(3):205-212, Ophthalmology
Three patients with dural arteriovenous malformations contiguous with the cavernous sinus had marked worsening of their neuro-ophthalmic symptoms. Such clinical deterioration has been attributed traditionally to increased blood flow through the malformations into the superior ophthalmic vein. However, arteriography in all three patients and magnetic resonance imaging (MR) in two patients demonstrated thrombosis of the entire superior ophthalmic vein. All patients subsequently underwent spontaneous, complete resolution of symptoms. This report describes a clinical syndrome of paradoxical worsening of cavernous sinus malformations and indicates that MR will aid in the management of these vascular malformations
— id: 44107, year: 1987, vol: 94, page: 205, stat: Journal Article,

Magnetic resonance imaging determination of gliomatosis cerebri
Spagnoli MV; Grossman RI; Packer RJ; Hackney DB; Goldberg HI; Zimmerman RA; Bilaniuk LT
1987 ;29(1):15-18, Neuroradiology
Gliomatosis cerebri is a rare condition characterized by diffuse overgrowth of large portions of the brain and spinal cord by glial cells in varying stages of differentiation. The tumor process is primarily an infiltrative, rather than a destructive one. Hence, pre-operative diagnosis by traditional imaging studies, including computed tomography (CT), has been difficult. Magnetic resonance imaging (MRI), with its unique sensitivity for cerebral pathology, is an ideal modality for demonstrating this lesion. We present three cases of gliomatosis cerebri in which high-field MRI clearly delineates the extent of the pathologic process
— id: 44110, year: 1987, vol: 29, page: 15, stat: Journal Article,

Giant cystic craniopharyngiomas
Young SC; Zimmerman RA; Nowell MA; Bilaniuk LT; Hackney DB; Grossman RI; Goldberg HI
1987 ;29(5):468-473, Neuroradiology
Three cases of giant cystic craniopharyngiomas with large areas of extension beyond the suprasellar area are presented. The magnetic resonance (MR) appearance in one case is described. These giant tumors had large, multilobulated cysts that comprised the bulk of the tumors. In one case, there was an unusual extension of the large tumor cyst into the lateral ventricle. In two cases, the tumors extended to the level of the foramen magnum. On CT, the cyst contents of these two tumors were hyperdense and became hypodense postoperatively. All three tumors harbored calcifications in the form of clumps in the suprasellar region and rim calcifications around the cysts. None of the tumors exhibited contrast enhancement. A literature review of the radiographic features of craniopharyngiomas is discussed
— id: 44119, year: 1987, vol: 29, page: 468, stat: Journal Article,

Magnetic resonance imaging in temporal bone fracture
Zimmerman RA; Bilaniuk LT; Hackney DB; Goldberg HI; Grossman RI
1987 ;29(3):246-251, Neuroradiology
In seven patients with temporal bone fractures examined by both CT and MRI, thin section CT proved superior to MRI in demonstrating the full extent of the fractures and the status of the ossicular chain. MR studies were able to demonstrate fractures, when these fractures contained blood or CSF, and the presence of ossicular dislocation in one case where the middle ear was completely filled with CSF or blood. Admixture of air in the middle ear gave a false impression of ossicular dislocation, while air in the fracture obscured portions of it. MR proved superior to CT in the evaluation of intracranial contents by showing 5 additional subdural hematomas, 2 epidural hematomas and 2 hemorrhagic contusions
— id: 44117, year: 1987, vol: 29, page: 246, stat: Journal Article,

Paranasal sinus hemorrhage: evaluation with MR imaging
Zimmerman RA; Bilaniuk LT; Hackney DB; Goldberg HI; Grossman RI
1987 Feb;162(2):499-503, Radiology
Computed tomography (CT) and magnetic resonance (MR) imaging were performed in ten patients with paranasal sinus hemorrhage after trauma. Acute or subacute hemorrhage was detected on MR images by using T1- and T2-weighted imaging to identify the chemical state of the blood and to differentiate blood from mucosal thickening and sinus effusion. Surgical proof of intrasinus hemorrhage was obtained in only two cases. Displaced fractures, associated cerebral contusions, and traumatic encephalocele were well shown on MR imaging. Nondisplaced and minimally displaced fractures were better evaluated with CT
— id: 44109, year: 1987, vol: 162, page: 499, stat: Journal Article,

MRI of sickle cell cerebral infarction
Zimmerman RA; Gill F; Goldberg HI; Bilaniuk LT; Hackney DB; Johnson M; Grossman RI; Hecht-Leavitt C
1987 ;29(3):232-237, Neuroradiology
Eleven patients with sickle cell disease and neurological symptoms underwent MRI examination. Cerebral infarcts of two types were found, those in the vascular distribution of the middle cerebral artery and those in the deep white matter. In the patient whose hydration and whose oxygenation of erythrocytes has been treated, MRI offers diagnostic advantages over arteriography and CT
— id: 44118, year: 1987, vol: 29, page: 232, stat: Journal Article,

MR diagnosis of acute disseminated encephalomyelitis
Atlas SW; Grossman RI; Goldberg HI; Hackney DB; Bilaniuk LT; Zimmerman RA
1986 Sep-Oct;10(5):798-801, Journal of computer assisted tomography
High-field magnetic resonance (MR) imaging was performed in three patients with clinically diagnosed acute disseminated encephalomyelitis (ADEM). Contrast enhanced CT was normal in all cases. Magnetic resonance demonstrated multiple foci of demyelination in the brain stem, cerebrum, and cerebellum. Lesions were characteristic, in that they were relatively few in number, frequently present in the brain stem and posterior fossa, nonhemorrhagic, asymmetric, and easily correlated with clinical symptoms and signs. Follow-up MR in one patient who had clinically improved after steroid therapy showed marked resolution of previously documented lesions. Typical MR findings in combination with the appropriate clinical presentation can confirm the diagnosis of ADEM, obviate other more invasive diagnostic tests, identify the extent and sites of involvement, and follow response to therapy
— id: 44127, year: 1986, vol: 10, page: 798, stat: Journal Article,

Corpus callosum and limbic system: neuroanatomic MR evaluation of developmental anomalies
Atlas SW; Zimmerman RA; Bilaniuk LT; Rorke L; Hackney DB; Goldberg HI; Grossman RI
1986 Aug;160(2):355-362, Radiology
Agenesis of the corpus callosum is a complex malformation of the brain that has been associated with varying degrees of limbic system maldevelopment. We retrospectively reviewed the records of 11 patients with callosal agenesis (seven total, four partial) who underwent magnetic resonance (MR) imaging, with particular attention to the associated malformations of the limbic system. Comparison was made with selected images from MR examinations of healthy volunteers and with necropsy specimens from other patients with callosal agenesis. Ten of 11 patients demonstrated limbic anomalies (severe motion artifact precluded evaluation of these structures in one patient). MR depicted not only the abnormalities intrinsic to callosal agenesis but also the frequently associated malformations of the limbic system
— id: 44128, year: 1986, vol: 160, page: 355, stat: Journal Article,

Cervical internal carotid artery dissecting hemorrhage: diagnosis using MR
Goldberg HI; Grossman RI; Gomori JM; Asbury AK; Bilaniuk LT; Zimmerman RA
1986 Jan;158(1):157-161, Radiology
Two men underwent high-resolution magnetic resonance (MR) imaging of the internal carotid artery (ICA) 12 and 16 days after spontaneous dissection of this vessel. One underwent follow-up MR imaging 7 weeks later. T1-weighted images were obtained in both cases, and T2-weighted images were obtained in one patient. In both cases, the MR findings corresponded to the angiographic abnormalities. On both the T1- and T2-weighted images, there was a hyperintense lesion expanding the wall and narrowing the lumen of the ICAs. Follow-up MR imaging showed complete resolution of the mural lesion. Axial images best demonstrated the anatomic and MR signal alterations. The hyperintensity of the lesion on both T1- and T2-weighted images indicated a short T1 and a long T2 as expected in a subacute hematoma. High-resolution MR imaging, therefore, can specifically demonstrate a thrombosed carotid dissection noninvasively at least as early as 12 days. The potential to diagnose carotid dissection in the acute phase using high-field-strength MR imaging and its importance for the prevention of embolic strokes are also discussed
— id: 44137, year: 1986, vol: 158, page: 157, stat: Journal Article,

High field magnetic resonance evaluation of acoustic neurinomas
Goldberg HI; Spagnoli MV; Grossman RI; Hackney DB; Zimmerman RA; Bilaniuk LT
1986 ;369(1):173-175, Acta radiologica. Supplementum
Eight acoustic neurinomas were studied with magnetic resonance imaging (MRI) at 1.5 tesla utilizing spin-echo T1 and T2 weighted images (WI). T1 WI identified the tumors best and provided more exacting anatomic relationships particularly for small lesions than did T2 WI. Intracanalicular tumors are well defined. All tumors were hypointense on T1 WI but were usually heterogeneous and had variable intensity on T2 WI. Several lesions became obscured on T2 WI because of isointensity with the adjacent cerebellum or CSF. High signal to noise ratio at 1.5 tesla permits thin section imaging (3 mm) at relatively short imaging times. T1 MRI was considerably superior to CT for the detection and anatomic definition of acoustic neurinomas
— id: 44142, year: 1986, vol: 369, page: 173, stat: Journal Article,

Occult cerebral vascular malformations: high-field MR imaging
Gomori JM; Grossman RI; Goldberg HI; Hackney DB; Zimmerman RA; Bilaniuk LT
1986 Mar;158(3):707-713, Radiology
Occult cerebral vascular malformations (OCVMs) have characteristic appearances on high-field magnetic resonance (MR) images. These consist of circumscribed regions of low intensity, most prominent on T2-weighted images and representing hemosiderin deposits. Interspersed within most of these lesions are multiple areas of various signal intensity patterns, which correspond to hematomas in different stages of evolution and to fibrous regions containing calcium as well as hemosiderin. Forty-six lesions were found in 19 patients (34 supratentorial and 12 infratentorial). The supratentorial lesions tended to be subcortical or periventricular. Computed tomography depicted 24 of the 46 lesions demonstrated by high-field MR. Comparison of images obtained with both low-field MR (0.12 T and 0.35 T) and high-field MR (1.5 T) revealed that high-field MR imaging was superior in depicting OCVMs. High-field MR appears to be both sensitive and specific for OCVMs and may obviate the need for possible biopsy of these lesions
— id: 44134, year: 1986, vol: 158, page: 707, stat: Journal Article,

Choroidal melanomas: correlation of NMR spectroscopy and MR imaging
Gomori JM; Grossman RI; Shields JA; Augsburger JJ; Joseph PM; DeSimeone D
1986 Feb;158(2):443-445, Radiology
Six freshly enucleated, unfixed human eyes with choroidal melanomas were imaged on a 1.4-T superconducting magnetic resonance (MR) imaging system. Immediately thereafter the eyes were sectioned, and tumor samples were removed for study on a variable-field (0.19-1.4 T) nuclear MR spectroscopy unit. Shorter T1 and T2 relaxation times were observed in those tumors with the greater concentrations of melanin. This is believed to result from the paramagnetic effect of radicals known to exist in melanin. High magnetic field MR imaging can enable one to distinguish between pigmented melanomas; proteinaceous effusions; fresh and subacute hematomas; and nonmelanotic tumors, including amelanotic melanomas; but may not enable melanotic melanoma to be distinguished from fat or amelanotic melanoma from other nonpigmented tumors
— id: 44135, year: 1986, vol: 158, page: 443, stat: Journal Article,

Ocular MR imaging and spectroscopy: an ex vivo study
Gomori JM; Grossman RI; Shields JA; Augsburger JJ; Joseph PM; DeSimeone D
1986 Jul;160(1):201-205, Radiology
Six eyes, freshly enucleated because of choroidal melanoma, were imaged on a 1.4-T superconducting magnetic resonance (MR) imaging system, and relaxation times were calculated for various parts of the eye. Unfixed fresh tissue samples were obtained for nuclear magnetic resonance spectroscopy (NMRS) on a variable-field (0.19-1.4 T) resistive unit. Detailed ocular anatomy was demonstrated. The NMRS relaxation times correlated with the MR imaging intensity patterns. The sensitivity of MR imaging to states of hydration provides an excellent window for appreciation of ocular anatomy
— id: 44129, year: 1986, vol: 160, page: 201, stat: Journal Article,

Magnetic resonance imaging of hemorrhagic conditions
Grossman RI; Gomori JM; Goldberg HI; Hackney DB; Macchi PJ; Hecht-Leavitt C; Zimmerman RA; Bilaniuk LT
1986 ;369(1):53-55, Acta radiologica. Supplementum
There is a stereotyped progression in the appearance of hemorrhage or thrombosis in magnetic resonance imaging performed at 1.5 tesla (T). This progression begins with low intensity on T2 weighted images (WI), and progresses to high intensity on T1 and T2 WI associated eventually, in some cases, with peripheral low intensity on T2 WI. Depending upon the etiology and location of hemorrhage or thrombosis the latter hypointensity on T2 WI may or may not be present. Hemorrhages occurring in regions of the brain not having an intact blood-brain barrier do not usually display persistence of low intensity. Regardless of etiology, consistent patterns in the evolution of hemorrhage may be observed on MR
— id: 44140, year: 1986, vol: 369, page: 53, stat: Journal Article,

Multiple sclerosis: gadolinium enhancement in MR imaging
Grossman RI; Gonzalez-Scarano F; Atlas SW; Galetta S; Silberberg DH
1986 Dec;161(3):721-725, Radiology
Magnetic resonance (MR) images--both nonenhanced and enhanced with gadolinium DTPA/dimeglumine (Gd)--were compared with high-iodine (88.1 g I) computed tomographic (HICT) scans in demonstrating lesions in 15 patients known to have multiple sclerosis (MS). T1-weighted, mixed (T1, proton density, and T2), and T2-weighted MR pulse sequences were used. More than 20 lesions in each of 14 patients were demonstrated by pre-Gd mixed images and T2WI. Nine patients had clinical symptoms of active disease. Gd-enhanced T1WI showed at least one lesion that appeared to correspond with newly reported symptoms or signs. In addition, three clinically stable patients showed enhancement. Enhancement was best seen on 3-minute T1WI. HICT scans showed enhancement in four of the nine patients with active disease and in none of five clinically stable patients. Gd-enhanced MR imaging appears to be more sensitive than HICT in the detection of the transient abnormalities of the blood-brain barrier that occur in patients with active MS and appears capable of distinguishing active lesions that may correspond to the anatomic regions responsible for abnormal clinical findings
— id: 44121, year: 1986, vol: 161, page: 721, stat: Journal Article,

Importance of oxygenation in the appearance of acute subarachnoid hemorrhage on high field magnetic resonance imaging
Grossman RI; Kemp SS; Ip CY; Fishman JE; Gomori JM; Joseph PM; Asakura T
1986 ;369(1):56-58, Acta radiologica. Supplementum
The ability to detect acute hemorrhage by magnetic resonance (MR) is related to the oxygen saturation of hemoglobin. This experiment measured the relaxation times of solutions of cerebrospinal fluid containing a 5 per cent hematocrit at various pO2's on a 1.4 tesla (T) MR imaging system. The results demonstrate that the state of oxygen saturation of hemoglobin determines the extent of T2 relaxation at this field strength. The T2 relaxation rate varies quadratically with the concentration of deoxyhemoglobin. There were no significant changes in the T1 relaxation rate with variations in pO2. These findings may, in part, explain the inability of MR to detect subarachnoid hemorrhage, and the MR appearance of blood in intratumoral hemorrhage, hemorrhagic cortical infarction and neonatal hemorrhage
— id: 44139, year: 1986, vol: 369, page: 56, stat: Journal Article,

Hemorrhage and edema in acute spinal cord compression: demonstration by MR imaging
Hackney DB; Asato R; Joseph PM; Carvlin MJ; McGrath JT; Grossman RI; Kassab EA; DeSimone D
1986 Nov;161(2):387-390, Radiology
Until the development of magnetic resonance (MR) imaging there was no nondestructive technique for monitoring the pathologic response to acute spinal cord trauma. The characteristic findings of hemorrhage, necrosis, and edema have been well described in animal models. We used a 1.4-T, animal imaging system to study acute cord contusions in rats. Contusions were induced by means of extradural aneurysm clip compression, and imaging was performed 3-5 hours after injury with short and long spin-echo (SE) sequences. Animals were killed immediately after imaging, and the gross anatomic and histologic findings were correlated with image appearances. On long SE sequences edema appeared as an area of high signal intensity that extended proximal and distal to the site of contusion. At the contusion site there was focal intraparenchymal hemorrhage which had low signal intensity on T2-weighted images, presumably owing to deoxyhemoglobin. MR imaging can be used to assess pathologic changes resulting from acute cord contusion and to aid in differentiating irreversible damage (hemorrhage) from potentially reversible edema
— id: 44123, year: 1986, vol: 161, page: 387, stat: Journal Article,

MR characteristics of iophendylate (Pantopaque)
Hackney DB; Grossman RI; Zimmerman RA; Joseph PM; Goldberg HI; Bilaniuk LT
1986 May-Jun;10(3):401-403, Journal of computer assisted tomography
Although iophendylate (Pantopaque) has been largely replaced by water soluble agents for myelography, retained intracranial or intraspinal Pantopaque remains a common occurrence. Pantopaque has signal characteristics similar to fat with both short T1 and T2 relaxation times. In vitro measurements revealed T1 = 170 ms and T2 = 27 ms. Spine radiography is recommended in patients with a history of previous myelography and magnetic resonance abnormalities similar to fat
— id: 44133, year: 1986, vol: 10, page: 401, stat: Journal Article,

MR identification of bleeding site in subarachnoid hemorrhage with multiple intracranial aneurysms
Hackney DB; Lesnick JE; Zimmerman RA; Grossman RI; Goldberg HI; Bilaniuk LT
1986 Sep-Oct;10(5):878-880, Journal of computer assisted tomography
We report a case of multiple aneurysms with subarachnoid hemorrhage in which CT was inconclusive as to the source of bleeding and in which the angiographic criteria were misleading. Magnetic resonance demonstrated a focal subarachnoid hematoma adjacent to the ruptured aneurysm
— id: 44126, year: 1986, vol: 10, page: 878, stat: Journal Article,

High-field MRI of hemorrhagic cortical infarction
Hecht-Leavitt C; Gomori JM; Grossman RI; Goldberg HI; Hackney DB; Zimmerman RA; Bilaniuk LT
1986 Jul-Aug;7(4):581-585, AJNR. American journal of neuroradiology
High-field MRI is capable of differentiating acute, subacute, and chronic hemorrhagic cortical infarctions. In eight of nine patients, hemorrhage occurred in a vascular watershed zone. Acute hemorrhagic cortical infarction produces mild cortical low intensity on T2-weighted images outlined by subcortical edema (high intensity) and isointensity with normal cortex on T1-weighted images. Subacute hemorrhagic cortical infarction shows cortical high intensity first on T1-weighted images and later on T2-weighted images; it is also associated with subcortical edema. In the chronic stage, there is a marked persistent cortical low intensity on T2-weighted images. This is most prominent in the deeply infolded cortical gyri. The low intensity noted in acute and chronic hemorrhagic cortical infarction with T2 weighting appears to be related to two separate underlying histochemical states. The characteristic cortical low intensity observed on T2-weighted images in acute and chronic hemorrhagic cortical infarction is proportional to the square of the magnetic field strength
— id: 44131, year: 1986, vol: 7, page: 581, stat: Journal Article,

Computerized tomography, magnetic resonance imaging, and positron emission tomography in the study of brain trauma. Preliminary observations
Langfitt TW; Obrist WD; Alavi A; Grossman RI; Zimmerman R; Jaggi J; Uzzell B; Reivich M; Patton DR
1986 May;64(5):760-767, Journal of neurosurgery
Results of computerized tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), xenon-133 measurement of cerebral blood flow (CBF), and neuropsychological assessments are described in three head-injured patients. The patients were selected because they presented with intracranial hemorrhage diagnosed by CT. Two of the patients were studied acutely and again approximately 6 months later. In the acute stage, MRI was superior to CT in identifying the precise location and extent of intracranial hemorrhage and associated edema. Small subdural hematomas diagnosed on MRI were missed with CT scanning. The extent of apparent encephalomalacia in the chronic stages of injury was also better defined with MRI. Positron emission tomography showed disturbances of glucose metabolism that extended beyond the structural abnormalities demonstrated by MRI and CT; anterior temporal lobe dysfunction was particularly evident in all three patients. Regional CBF studies failed to detect a number of the abnormalities seen on MRI and CT, and even ignored the metabolic dysfunction evident on PET that should have been accompanied by changes in regional CBF. The neuropsychological studies localized frontal lesions, but did not reveal abnormalities attributable to the structural lesions and the reduced metabolism in the anterior temporal lobes
— id: 44132, year: 1986, vol: 64, page: 760, stat: Journal Article,

High field MR imaging of cerebral venous thrombosis
Macchi PJ; Grossman RI; Gomori JM; Goldberg HI; Zimmerman RA; Bilaniuk LT
1986 Jan-Feb;10(1):10-15, Journal of computer assisted tomography
High field magnetic resonance (MR) imaging enables us to demonstrate the evolution of cerebral venous thrombosis. Initially, absence of a flow void and collateral venous channels are seen on T1 weighted images (WI). On T2WI thrombus appears hypointense. Hyperintensity is noted in an intermediate stage of thrombosis first on T1WI and later on T2WI. In the late stages recanalization of the vessel occurs with reappearance of the flow void. These findings are specific for venous thrombosis. High field MR may be the imaging modality of choice in the diagnosis of venous thrombosis
— id: 44136, year: 1986, vol: 10, page: 10, stat: Journal Article,

High-field magnetic resonance imaging in the diagnosis of cavernous sinus thrombosis
Savino PJ; Grossman RI; Schatz NJ; Sergott RC; Bosley TM
1986 Oct;43(10):1081-1082, Archives of neurology
— id: 44125, year: 1986, vol: 43, page: 1081, stat: Journal Article,

Intracranial meningiomas: high-field MR imaging
Spagnoli MV; Goldberg HI; Grossman RI; Bilaniuk LT; Gomori JM; Hackney DB; Zimmerman RA
1986 Nov;161(2):369-375, Radiology
Twenty-five newly diagnosed intracranial meningiomas were evaluated with magnetic resonance (MR) imaging at 1.5 T, and findings were correlated with those of computed tomography (CT), angiography, and tumor histology. Meningiomas were generally hypointense on T1-weighted images and hyperintense on T2-weighted images relative to cerebral white matter. In comparison with the cortex, they were hypointense or isointense on T1-weighted images and isointense or hyperintense on T2-weighted images. A heterogeneous texture produced by tumor vascularity, calcifications, cystic foci, or an intrinsic speckled or mottled pattern was observed in all but the smallest lesions. An interface between meningioma and brain was uniformly present and consisted of a cerebro-spinal fluid cleft, vascular rim, or dural margin. Large meningiomas were associated with arcuate displacement and compression of adjacent gyri. MR imaging was superior to CT in defining extracerebral tumor location, tumor vascularity, arterial encasement, and venous sinus invasion. No correlation was found between the appearance on MR images and the pathologic classification
— id: 44124, year: 1986, vol: 161, page: 369, stat: Journal Article,

Magnetic resonance imaging of cerebral aneurysm
Zimmerman RA; Atlas S; Bilaniuk LT; Hackney DB; Goldberg HI; Grossman RI
1986 ;369(1):107-109, Acta radiologica. Supplementum
Twenty patients with congenital cerebral aneurysms, studied on a 1.5 tesla MR unit, were also evaluated by angiography and/or computed tomography (CT) in order to establish the relative sensitivity of magnetic resonance imaging (MRI) in the demonstration of such aneurysms. Of the 27 aneurysms found on MRI, all but 4 were seen without the aid of the angiographic study. The four seen in retrospect included 3 out of 4 in the smallest size category (less than 5 x 5 mm) and one in next larger (5 x 5 mm to 10 x 10 mm). When more than one aneurysm was present or when an aneurysm and an arteriovenous malformation was present, MRI proved to be useful in demonstrating which bled. The presence of both subacute and acute clot identified the lesions that had bled
— id: 44144, year: 1986, vol: 369, page: 107, stat: Journal Article,

Head injury: early results of comparing CT and high-field MR
Zimmerman RA; Bilaniuk LT; Hackney DB; Goldberg HI; Grossman RI
1986 Dec;147(6):1215-1222, American journal of roentgenology
The sensitivity and specificity of CT and high-field MR (1.5 T) were compared in an evaluation of 30 patients with head injuries (eight acute, 15 subacute, and seven chronic). By using T1- and T2-weighted images, it was possible to detect various stages of hemorrhages and their separation from edema. In the acute category, both CT and MR showed acute hemorrhagic lesions, but only MR demonstrated coexisting chronic hematomas or small hypothalamic or brainstem infarctions. MR was far superior to CT in the detection and characterization of subacute injuries, including shearing injuries, hemorrhagic and nonhemorrhagic contusions, and subdural hematomas. In chronic injury, atrophy was demonstrated by both techniques, but only MR showed parenchymal abnormalities and old hemorrhages. Its ease in monitoring patients and its greater speed make CT the procedure of choice for the evaluation of acute cases. CT also provides information that is useful in deciding between surgery and medical management. However, the more precise anatomic depiction of MR and its sensitivity to parenchymal abnormalities make MR the key to correct prognosis in patients with subacute or chronic injury
— id: 44122, year: 1986, vol: 147, page: 1215, stat: Journal Article,

Magnetic resonance imaging of dural venous sinus invasion, occlusion and thrombosis
Zimmerman RA; Bilaniuk LT; Hackney DB; Goldberg HI; Grossman RI
1986 ;369(1):110-112, Acta radiologica. Supplementum
Seventeen patients were found to have involvement of the dural venous sinuses on magnetic resonance imaging (MRI). In 7, there was tumor invasion through the dural coverings and in 10 thrombosis occurred as a result of various causes. MRI shows tumor in the sinus as a signal producing mass replacing the normal hypointensity of rapidly flowing blood. Disruption of the hypointense leaves of the enveloping dura is also well shown by MRI. Intravascular clotting, whether in the chemical state of deoxyhemoglobin or intra- or extracellular methemoglobin can be characterized by MRI operating at high field (1.5 tesla). MRI is now the non-invasive diagnostic modality of choice in evaluation of the dural venous sinuses
— id: 44143, year: 1986, vol: 369, page: 110, stat: Journal Article,

Magnetic resonance imaging of the pediatric spinal cord and canal
Zimmerman RA; Bilaniuk LT; Hackney DB; Goldberg HI; Grossman RI
1986 ;369(1):649-650, Acta radiologica. Supplementum
Of 105 pediatric patients studied on a 1.5 tesla MR unit for clinical suspicion of spinal disease 69.5 per cent of studies were positive. Magnetic resonance imaging (MRI) was successfully performed on all patients, from newborn up. MRI replaced invasive studies such as myelography and intrathecally enhanced computed tomography (CT) in all disease categories except for subarachnoid drop metastasis, spinal arteriovenous malformation and arachnoiditis. Conventional CT and radiography of the spine were complementary in disease processes where bony detail was important
— id: 44138, year: 1986, vol: 369, page: 649, stat: Journal Article,

Magnetic resonance imaging of traumatic sinus and mastoid bleeding
Zimmerman RA; Bilaniuk LT; Hackney DB; Goldberg HI; Grossman RI
1986 ;369(1):367-369, Acta radiologica. Supplementum
Magnetic resonance imaging (MRI) characterized intrasinus hemorrhage in 8 out of 10 patients with computed tomography (CT) evidence of post-traumatic sinus opacification. Fractures of sinus walls were demonstrated as disruptions in the hypointense line of the bony wall, as displacement of this line, or by increased signal from blood or sinus effusion within the fracture. Seven patients with fractures of the temporal bone were more difficult to evaluate because of the hypointensity of air trapped within the fracture line mimicing the bony wall and that within the middle ear mimicing the ossicles; 1.5 tesla MR proved superior to CT in demonstrating associated extra- and intracerebral hemorrhage
— id: 44141, year: 1986, vol: 369, page: 367, stat: Journal Article,

MRI of central nervous system: early clinical results
Zimmerman RA; Bilaniuk LT; Johnson MH; Hershey B; Jaffe S; Gomori JM; Goldberg HI; Grossman RI
1986 Jul-Aug;7(4):587-594, AJNR. American journal of neuroradiology
In patients with central nervous system problems, a comparison of the results obtained with high-field MRI (1.5 T) to those achieved with more conventional imaging studies, primarily CT, reveals significant improvement in the demonstration of various abnormalities by MRI (56.5%), with increased specificity in some (29.5%). High-field MRI provides advantages over CT by providing both multiplanar images and superior contrast resolution. The diagnostic specificity of MRI is increased when acute, subacute, and chronic hematomas are visualized and when flowing blood within vessels is demonstrated in addition to the location and extent of the disease process. In this series, MRI produced a more accurate diagnosis in 8.7% of cases, revealed clinically unexpected abnormalities in 3.9% of cases, and was less invasive or avoided the risk of complications in 17.4% of cases. Despite the success of MRI, CT continues to play an important role in demonstrating calcification and contrast enhancement, and in evaluating patients in whom MRI is contraindicated or impossible because of an unsuitable clinical state
— id: 44130, year: 1986, vol: 7, page: 587, stat: Journal Article,

Ocular and orbital lesions: surface coil MR imaging
Bilaniuk LT; Schenck JF; Zimmerman RA; Hart HR Jr; Foster TH; Edelstein WA; Goldberg HI; Grossman RI
1985 Sep;156(3):669-674, Radiology
Nine lesions, four ocular (three melanomas, one hemangioma) and five orbital (two perioptic meningiomas, one hemangioma, one pseudotumor, one mucocele), were evaluated by magnetic resonance surface coil imaging at 1.5 T. Small ocular lesions with 3.9-4.5-mm-elevation were demonstrated. The use of two different pulse sequences resulted in separation of melanoma from adjacent retinal detachment. Contrast obtained between orbital lesions and the adjacent normal structures was better than that demonstrated with high-resolution computed tomography
— id: 44147, year: 1985, vol: 156, page: 669, stat: Journal Article,

High-field MR imaging of superficial siderosis of the central nervous system
Gomori JM; Grossman RI; Bilaniuk LT; Zimmerman RA; Goldberg HI
1985 Sep-Oct;9(5):972-975, Journal of computer assisted tomography
A case of superficial siderosis of the central nervous system secondary to bleeding from an ependymoma is presented. High-field magnetic resonance imaging showed marginal hypointensity of the cervical cord, medulla oblongata, pons, mesencephalon, anterior cerebellar and basal cerebral surfaces, and cranial nerves (II, V, VIII). These findings were evident in the T2 weighted images
— id: 44146, year: 1985, vol: 9, page: 972, stat: Journal Article,

Wall of infundibular recess: a CT and MR study
Gomori JM; Grossman RI; Goldberg HI; Bilaniuk LT; Zimmerman RA
1985 Jul-Aug;9(4):705-707, Journal of computer assisted tomography
A ring of enhancement immediately posterior to the optic chiasm has been observed on postcontrast, thin section, axial CT. This ring represents enhancement of the infundibular recess' wall and does not have any pathologic significance. Magnetic resonance confirmed this anatomic interpretation
— id: 44150, year: 1985, vol: 9, page: 705, stat: Journal Article,

Intracranial hematomas: imaging by high-field MR
Gomori JM; Grossman RI; Goldberg HI; Zimmerman RA; Bilaniuk LT
1985 Oct;157(1):87-93, Radiology
Twenty intracranial hematomas between 1 day and over 1 year old were imaged using magnetic resonance at 1.5 T, with T1- and T2-weighted spin-echo pulse sequences. Characteristic intensity patterns were observed in the evolution of the hematomas, which could be staged as acute (less than 1 week old), subacute (greater than 1 week and less than 1 month old), or chronic (greater than 1 month old). Acute hematomas were characterized by central hypointensity on T2-weighted images (WIs). Subacute hematomas had peripheral hyperintensity on T1-WIs and then on T2-WIs. This hyperintensity proceeded to fill in the hematoma in the chronic stage. In subacute and chronic hematomas, there was hypointensity on T2-WIs in the immediately adjacent part of the brain. On T2-WIs of acute and subacute hematomas, the nearby white matter was characterized by hyperintensity, consistent with edema. A different mechanism is proposed for each of the three characteristic intensity patterns. Two of these mechanisms increase in proportion to the square of the magnetic field magnitude
— id: 44145, year: 1985, vol: 157, page: 87, stat: Journal Article,

Experimental intracranial septic infarction: magnetic resonance enhancement
Grossman RI; Joseph PM; Wolf G; Biery D; McGrath J; Kundel HL; Fishman JE; Zimmerman RA; Goldberg HI; Bilaniuk LT
1985 Jun;155(3):649-653, Radiology
Intracranial brain abscess was produced in three monkeys by embolization of a small pledget of polyvinyl alcohol (PVA) soaked in a broth of Staphylococcus aureus. Imaging of the chronic stable abscess was performed on the General Electric 8800 CT unit (Milwaukee, Wis.) and a 1.4 T superconducting small bore imaging system. Magnetic resonance imaging included saturation recovery, inversion recovery, and spin echo techniques. MR imaging was also performed after paramagnetic enhancement using gadolinium-DPTA (Gd-DTPA). Our results show that paramagnetic enhancement with T1-weighted imaging adds specificity and enables rapid assessment of abnormalities of the blood-brain barrier. T2-weighted imaging without paramagnetic enhancement was very sensitive in defining areas of abnormality in the brain but in our experiment lacked specificity. T2-weighted imaging with Gd-DTPA demonstrated no obvious change in the appearance of the lesion. The combination of T1-weighted Gd-DTPA and T2-weighted imaging appeared complementary in our experiment, and these images correlated well with the pathologic findings
— id: 44151, year: 1985, vol: 155, page: 649, stat: Journal Article,

Dural malformations with ophthalmic manifestations: results of particulate embolization in seven patients
Grossman RI; Sergott RC; Goldberg HI; Savino PJ; Zimmerman RA; Bilaniuk LT; Schatz NJ; Bosley TM
1985 Sep-Oct;6(5):809-813, AJNR. American journal of neuroradiology
Seven patients with proptosis, chemosis, diplopia, and elevated intraocular pressure were found to have dural arteriovenous malformations with drainage into the cavernous sinus and superior ophthalmic vein. These patients had sufficient symptoms to justify therapeutic embolization with polyvinyl alcohol. Five of seven patients had complete resolution of their ophthalmic symptoms after embolization; the other two had transient improvement. Follow-up was 9-29 months. When 50% or more of the vessels supplying a malformation were embolized, complete relief of symptoms was obtained. Particulate embolization is an effective therapeutic approach in patients with significant ophthalmologic symptoms from dural malformations
— id: 44148, year: 1985, vol: 6, page: 809, stat: Journal Article,

Head and facial trauma
Levine RS; Grossman RI
1985 Aug;3(3):447-473, Emergency medicine clinics of North America
Computed tomography (CT) plays a vital role in the evaluation of head and facial trauma. This article describes various lesions in such patients and details their CT findings
— id: 44149, year: 1985, vol: 3, page: 447, stat: Journal Article,

Containing the AIDS epidemic
Marmor, M; Lyden, M; Grossman, R
1985 ;254(15):2059-2059, JAMA
— id: 30836, year: 1985, vol: 254, page: 2059, stat: Journal Article,

Brain stem necrosis after preradiation high-dose methotrexate
Packer RJ; Grossman RI; Rorke LB; Sutton LN; Siegel KR; Littman P
1985 ;1(6):355-358, Child's nervous system : ChNS
Both cranial radiation therapy (RT) and high-dose systemic methotrexate (MTX) are used to treat intracranial neoplasmas, but both may cause neurologic damage. MTX may be less neurotoxic if given before rather than after radiotherapy. We cared for a 5-year-old girl with a pineocytoma who had progressive brain stem dysfunction 4 months after MTX therapy, followed by local radiation therapy. CT studies were consistent with radiation necrosis that was confirmed at autopsy. MTX used in conjunction with cranial irradiation can result in severe neurotoxicity, even if the drug is given first
— id: 44155, year: 1985, vol: 1, page: 355, stat: Journal Article,

Cerebral NMR: diagnostic evaluation of brain tumors by partial saturation technique with resistive NMR
Zimmerman RA; Bilaniuk LT; Grossman RI; Goldberg HI; Edelstein W; Bottomley P; Redington RW
1985 ;27(1):9-15, Neuroradiology
One hundred and forty patients with cerebral neoplasms were examined in a 0.12-Tesla prototype resistive NMR proton imaging device by partial saturation technique. NMR was superior to CT in tumor and edema localization and equal to CT in tumor and edema detection. NMR, however, was not able to clearly separate tumor from edema, a separation that contrast enhanced CT achieved
— id: 44152, year: 1985, vol: 27, page: 9, stat: Journal Article,

Resistive NMR of intracranial hematomas
Zimmerman RA; Bilaniuk LT; Grossman RI; Levine RS; Lynch R; Goldberg HI; Samuel L; Edelstein W; Bottomley P; Redington RW
1985 ;27(1):16-20, Neuroradiology
Comparison between computed tomography and nuclear magnetic resonance imaging in 17 patients with intracranial hematomas indicates a distinct role for NMR in evaluating the stable patient with hematoma. NMR is useful for delineating the extent of the hematoma, the relationship of the hematoma to brain anatomy, and the presence of hematoma at a time when the hematoma is isodense on CT
— id: 44154, year: 1985, vol: 27, page: 16, stat: Journal Article,

Resistive NMR of brain stem gliomas
Zimmerman RA; Bilaniuk LT; Packer R; Sutton L; Samuel L; Johnson MH; Grossman RI; Goldberg HI
1985 ;27(1):21-25, Neuroradiology
The NMR and CT findings in 22 patients with primary brain stem tumors were compared to determine the value of each study in identifying, and delineating the extent and relationships of the tumor to brain anatomy. NMR was found to be distinctly superior to CT in showing involvement of the medulla and upper cervical cord. NMR eliminates the need for intrathecal enhanced metrizamide CT, and in the future should be the only initial diagnostic test needed for the evaluation of intrinsic brain stem tumors
— id: 44153, year: 1985, vol: 27, page: 21, stat: Journal Article,

Proton imaging and phosphorus spectroscopy in a malignant glioma
Zimmerman RA; Bottomley PA; Edelstein WA; Hart HR; Redington RW; Bilaniuk LT; Grossman RI; Goldberg HI; Bruno L; Kressel H
1985 Jan-Feb;6(1):109-110, AJNR. American journal of neuroradiology
— id: 44156, year: 1985, vol: 6, page: 109, stat: Journal Article,

Cerebral magnetic resonance: comparison of high and low field strength imaging
Bilaniuk LT; Zimmerman RA; Wehrli FW; Goldberg HI; Grossman RI; Bottomley PA; Edelstein WA; Glover GH; MacFall JR; Redington RW; et al.
1984 Nov;153(2):409-414, Radiology
Low field strength (0.12 Tesla resistive) and high field strength (1.0, 1.4, or 1.5 Tesla superconductive) magnetic r