Initial radiotherapy or chemotherapy achieved comparable results in patients with anaplastic gliomas. IDH1 mutations are a novel positive prognostic factor in anaplastic gliomas, with a favorable impact stronger than that of 1p/19q codeletion or MGMT promoter methylation.

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Purpose For clinical implementation, a chemical exchange saturation transfer (CEST) imaging sequence must be fast, with high signal‐to‐noise ratio (SNR), 3D coverage, and produce robust contrast. However, spectrally selective CEST contrast requires dense sampling of the Z‐spectrum, which increases scan duration. This article proposes a compromise: using a 3D snapshot gradient echo (GRE) readout with optimized CEST presaturation, sampling, and postprocessing, highly resolved Z‐spectroscopy at 3T is made possible with 3D coverage at almost no extra time cost. Methods A 3D snapshot CEST sequence was optimized for low‐power CEST MRI at 3T. Pulsed saturation was optimized for saturation power and saturation duration. Spectral sampling and postprocessing (B 0 correction, denoising) was optimized for spectrally selective Lorentzian CEST effect extraction. Reproducibility was demonstrated in 3 healthy volunteers and feasibility was shown in 1 tumor patient. Results Low‐power saturation was achieved by a train of 80 pulses of duration t p = 20 ms (total saturation time t sat = 3.2 seconds at 50% duty cycle) with B 1 = 0.6 μT at 54 irradiation frequency offsets. With the 3D snapshot CEST sequence, a 180 × 220 × 54 mm field of view was acquired in 7 seconds per offset. Spectrally selective CEST effects at +3.5 and –3.5 ppm were quantified using multi‐Lorentzian fitting. Reproducibility was high with an intersubject coefficient of variation below 10% in CEST contrasts. Amide and nuclear overhauser effect CEST effects showed similar correlations in tumor and necrosis as show in previous ultra‐high field work. Conclusion A sophisticated CEST tool ready for clinical application was developed and tested for feasibility.

Simultaneous PET and MRI using new hybrid PET/MRI systems promises optimal spatial and temporal coregistration of structural, functional, and molecular image data. In a pilot study of 10 patients with intracranial masses, the feasibility of tumor assessment using a PET/MRI system comprising lutetium oxyorthosilicate scintillators coupled to avalanche photodiodes was evaluated, and quantification accuracy was compared with conventional PET/CT datasets. Methods: All measurements were performed with a hybrid PET/MRI scanner consisting of a conventional 3-T MRI scanner in combination with an inserted MRI-compatible PET system. Attenuation correction of PET/MR images was computed from MRI datasets. Diagnoses at the time of referral were low-grade astrocytoma (n 5 2), suspicion of low-grade astrocytoma (n 5 1), anaplastic astrocytoma (World Health Organization grade III; n 5 1), glioblastoma (n 5 2), atypical neurocytoma (n 5 1), and meningioma (n 5 3). In the glial tumors, 11 C-methionine was used for PET; in the meningiomas, 68 Ga-DOTATOC was administered. Tumor-togray matter and tumor-to-white matter ratios were calculated for gliomas, and tracer uptake of meningiomas was referenced to nasal mucosa. PET/MRI was performed directly after clinically indicated PET/CT examination. Results: In all patients, the PET datasets showed similar diagnostic image quality on the hybrid PET/MRI and the PET/CT studies; however, slight streak artifacts were visible in coronal and sagittal sections when using the higher intrinsic resolution of the PET/MRI insert. Prefiltering of images with a 4-mm gaussian filter at a resolution comparable to that of the PET/CT system virtually eliminated these artifacts. Although acquisition of the PET/MR images started at 30-60 min after PET/CT (20.4-min half-life of 11 C) acquisition, the signal-to-noise ratio was good enough, thus underlining the high sensitivity of the PET insert, compared with whole-body PET systems. The computed tumor-to-reference tissue ratios exhibited an excellent accordance between the PET/MRI and PET/CT systems, with a Pearson correlation coefficient of 0.98. Mean paired relative error was 7.9% 6 12.2%. No significant artifacts or distortions were detected in the simultaneously acquired MR images using the PET/MRI scanner. Conclusion: Structural, functional, and molecular imaging in patients with brain tumors is feasible with diagnostic imaging quality using simultaneous hybrid PET/MR image acquisition.

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The IVIM-fitted post-processing of DWI-signal decay in human gliomas could show significantly different values of fractional perfusion-related volume and fast diffusion coefficient between low- and high-grade tumors, which might enable a noninvasive WHO grading in vivo.

Cross-sectional studies using diffusion tensor imaging (DTI) suggest decline of the integrity of intracortically projecting fiber tracts with aging and in neurodegenerative diseases, such as Alzheimer's disease (AD). Longitudinal studies on the change of fiber tract integrity in normal and pathological aging are still rare. Here, we prospectively studied 11 healthy elderly subjects and 14 subjects with amnestic mild cognitive impairment (MCI), a clinical risk group for AD, using high-resolution DTI and MRI at baseline and after 13 to 16 months follow-up. Fractional anisotropy (FA), a DTI measure of fiber tract integrity, was compared across time points and groups using a repeated measures linear model and tract based spatial statistics. Additionally, we determined rates of grey matter and white matter atrophy using automated deformation based morphometry. Healthy elderly subjects showed decline of FA in intracortical projecting fiber tracts, such as corpus callosum, superior longitudinal fasciculus, uncinate fasciculus, inferior fronto-occipital fasciculus, and cingulate bundle (p < 0.05, corrected for multiple comparisons). MCI subjects showed significant FA decline predominantly in the anterior corpus callosum (p < 0.05, corrected for multiple comparisons). Grey and white matter atrophy involved prefrontal, parietal, and temporal lobe areas in controls and prefrontal, cingulate, and parietal lobe areas in MCI subjects and agreed with the pattern of fiber tract changes. Our findings indicate that DTI allows detection of microstructural changes in subcortical fiber tracts over time that are related to aging as well as to early stages of AD type neurodegeneration. The underlying mechanisms for these changes are unknown.

Purpose: The aim of this study was to translate the T 1 ρ-based dynamic glucoseenhanced (DGEρ) experiment from ultrahigh magnetic field strengths to a clinical field strength of 3 T. Although the protocol would seem to be as simple as gadoliniumenhanced imaging, several obstacles had to be addressed, including signal-to-noise ratio (SNR), robustness of contrast, and postprocessing, especially motion correction. Methods: Spin-lock based presaturation and a 3D gradient-echo snapshot readout were optimized for 3 T with regard to robustness, chemical exchange saturation transfer effect strength, and SNR. Postprocessing steps, including dynamic B 0 and motion correction, were analyzed and optimized in 7 healthy volunteers. The final protocol, including glucose injection, was applied to 3 glioblastoma patients. Results: With appropriate postprocessing, motion-related artifacts could be drastically reduced, and an SNR of approximately 90 could be achieved for a single dynamic measurement. In 2 patients with blood-brain barrier breakdown, a significant glucose uptake could be observed with a DGEρ effect strength in the range of 0.4% of the water signal. Thorough analysis of possible residual motion revealed that the statistical evidence can decrease when tested against pseudo effects attributed to uncorrected motion. Conclusion: DGEρ imaging was optimized for clinical field strengths of 3 T, and a robust protocol was established for broader application. Early experience shows that DGEρ seems possible at 3 T and could not only be attributed to motion artifacts.Observed DGEρ maps showed unique patterns, partly matching with the T 1 -ce tumor ring enhancement. However, effect sizes are small and careful clinical application is necessary.