Magnetization transfer (MT) imaging has been widely used for estimating myelin content in the brain. Recently, two other approaches, namely simultaneous tissue relaxometry of R1 and R2 relaxation rates and proton density (SyMRI) and the ratio of T1-weighted to T2-weighted images (T1w/T2w ratio), were also proposed as methods for measuring myelin. SyMRI and MT imaging have been reported to correlate well with actual myelin by histology. However, for T1w/T2w ratio, such evidence is limited. In 20 healthy adults, we examined the correlation between these three methods, using MT saturation index (MTsat) for MT imaging. After calibration, white matter (WM) to gray matter (GM) contrast was the highest for SyMRI among these three metrics. Even though SyMRI and MTsat showed strong correlation in the WM (r = 0.72), only weak correlation was found between T1w/T2w and SyMRI (r = 0.45) or MTsat (r = 0.38) (correlation coefficients significantly different from each other, with p values < 0.001). In subcortical and cortical GM, these measurements showed moderate to strong correlations to each other (r = 0.54 to 0.78). In conclusion, the high correlation between SyMRI and MTsat indicates that both methods are similarly suited to measure myelin in the WM, whereas T1w/T2w ratio may be less optimal.

Conventional magnetic resonance images are usually evaluated using the image signal contrast between tissues and not based on their absolute signal intensities. Quantification of tissue parameters, such as relaxation rates and proton density, would provide an absolute scale; however, these methods have mainly been performed in a research setting. The development of rapid quantification, with scan times in the order of 6 minutes for full head coverage, has provided the prerequisites for clinical use. The aim of this review article was to introduce a specific quantification method and synthesis of contrast-weighted images based on the acquired absolute values, and to present automatic segmentation of brain tissues and measurement of myelin based on the quantitative values, along with application of these techniques to various brain diseases. The entire technique is referred to as “SyMRI” in this review. SyMRI has shown promising results in previous studies when used for multiple sclerosis, brain metastases, Sturge-Weber syndrome, idiopathic normal pressure hydrocephalus, meningitis, and postmortem imaging.

BACKGROUND AND PURPOSE: Synthetic MR imaging enables the creation of various contrast-weighted images including double inversion recovery and phase-sensitive inversion recovery from a single MR imaging quantification scan. Here, we assessed whether synthetic MR imaging is suitable for detecting MS plaques.

Objectives: The aim of this study was to evaluate the linearity, bias, intrascanner repeatability, and interscanner reproducibility of quantitative values derived from a multidynamic multiecho (MDME) sequence for rapid simultaneous relaxometry. Materials and Methods: The NIST/ISMRM (National Institute of Standards and Technology/International Society for Magnetic Resonance in Medicine) phantom, containing spheres with standardized T1 and T2 relaxation times and proton density (PD), and 10 healthy volunteers, were scanned 10 times on different days and 2 times during the same session, using the MDME sequence, on three 3 T scanners from different vendors. For healthy volunteers, brain volumetry and myelin estimation were performed based on the measured T1, T2, and PD. The measured phantom values were compared with reference values; volunteer values were compared with their averages across 3 scanners. Results: The linearity of both phantom and volunteer measurements in T1, T2, and PD values was very strong (R 2 = 0.973-1.000, 0.979-1.000, and 0.982-0.999, respectively) The highest intrascanner coefficients of variation (CVs) for T1, T2, and PD were 2.07%, 7.60%, and 12.86% for phantom data, and 1.33%, 0.89%, and 0.77% for volunteer data, respectively. The highest interscanner CVs of T1, T2, and PD were 10.86%, 15.27%, and 9.95% for phantom data, and 3.15%, 5.76%, and 3.21% for volunteer data, respectively. Variation of T1 and T2 tended to be larger at higher values outside the range of those typically observed in brain tissue.The highest intrascanner and interscanner CVs for brain tissue volumetry were 2.50% and 5.74%, respectively, for cerebrospinal fluid. Conclusions: Quantitative values derived from the MDME sequence are overall robust for brain relaxometry and volumetry on 3 T scanners from different vendors. Caution is warranted when applying MDME sequence on anatomies with relaxometry values outside the range of those typically observed in brain tissue.

NODDI can be used to identify retrograde degeneration of the NSP in PD patients and might be useful for monitoring the disease progression of PD.

The symptoms of idiopathic normal pressure hydrocephalus (iNPH) can be improved by shunt surgery, but prediction of treatment outcome is not established. We investigated changes of the corticospinal tract (CST) in iNPH before and after shunt surgery by using diffusion microstructural imaging, which infers more specific tissue properties than conventional diffusion tensor imaging. Two biophysical models were used: neurite orientation dispersion and density imaging (NODDI) and white matter tract integrity (WMTI). In both methods, the orientational coherence within the CSTs was higher in patients than in controls, and some normalization occurred after the surgery in patients, indicating axon stretching and recovery. The estimated axon density was lower in patients than in controls but remained unchanged after the surgery, suggesting its potential as a marker for irreversible neuronal damage. In a Monte-Carlo simulation that represented model axons as undulating cylinders, both NODDI and WMTI separated the effects of axon density and undulation. Thus, diffusion MRI may distinguish between reversible and irreversible microstructural changes in iNPH. Our findings constitute a step towards a quantitative image biomarker that reflects pathological process and treatment outcomes of iNPH.

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BACKGROUND AND PURPOSE:Myelin and axon volume fractions can now be estimated via MR imaging in vivo, as can the g-ratio, which equals the ratio of the inner to the outer diameter of a nerve fiber. The purpose of this study was to evaluate WM damage in patients with MS via this novel MR imaging technique.