Aim Heart failure (HF) patients show significant lateralized neural injury, accompanied by autonomic, mood, and cognitive deficits. Both gray and white matter damage appears, and likely develops from altered cerebral blood flow (CBF), a consequence of impaired cardiac output. However, the distribution of regional CBF changes in HF patients is unknown, but is an issue in determining mechanisms of neural injury. Our aim was to examine regional CBF changes in HF over control subjects using non-invasive pseudo-continuous arterial spin labeling (pCASL) procedures. Methods and results We collected pCASL data from 19 HF (age, 55.5±9.1 years; body-mass-index, 27.7±5.3 kg/m2; 13 male) and 29 control subjects (51.4±5.3 years; 25.7±3.6 kg/m2; 18 male), using a 3.0-Tesla-MRI scanner. Whole-brain CBF maps were calculated, normalized to a common space, smoothed, and compared between groups using ANCOVA (covariates; age, gender, and gray matter volume). Reduced CBF appeared in multiple sites in HF over controls, with principally-lateralized lower flow in temporal, parietal, and occipital regions. Areas with decreased CBF included the bilateral pre-frontal, frontal, temporal and occipital cortex, thalamus, cerebellum, corona radiate, corpus callosum, hippocampus, and amygdala. Conclusion HF subjects showed lower, and largely lateralized, CBF in multiple autonomic, mood, and cognitive regulatory sites. The reduced CBF likely contributes to the lateralized brain injury, leading to autonomic and neuropsychological deficits found in the condition.

Background and Purpose Accurate grading of cerebral glioma using conventional structural imaging techniques remains challenging due to the relatively poor sensitivity and specificity of these methods. The purpose of this study was to evaluate the relative sensitivity and specificity of structural MRI and MR measurements of perfusion, diffusion, and spectroscopic parameters for glioma grading. A secondary objective was to evaluate a whole-brain MR spectroscopic imaging method for evaluation of brain tumors. Materials and Methods Fifty six patients with radiologically suspected untreated glioma were studied with T1- and T2-weighted MR imaging, DCE-MR imaging, DTI, and volumetric whole-brain MR spectroscopic imaging. ROC analysis was performed using the relative CBV, ADC, FA, and multiple spectroscopic parameters to determine optimum thresholds for tumor grading and to obtain the sensitivity, specificity, PPV, and NPV for identifying high-grade gliomas. Logistic regression was performed to analyze all the parameters together. Results The relative CBV individually classified glioma as low and high grade with a sensitivity and specificity of 100% and 88% respectively based on a threshold value of 3.34. On combining all parameters under consideration, the classification was achieved with 2% error and sensitivity and specificity of 100% and 96% respectively. Conclusion Individually, CBV measurement provides the greatest diagnostic performance for predicting glioma grade; however, the most accurate classification can be achieved by combining all of the imaging parameters. The whole-brain MR spectroscopic imaging method provided data from of a large fraction of the tumor volumes.

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Patients with Type 2 diabetes mellitus (T2DM) show cognitive and mood impairment, indicating potential for brain injury in regions that control these functions. However, brain tissue integrity in cognition, anxiety, and depression regulatory sites, and their associations with these functional deficits in T2DM subjects remain unclear. We examined gray matter (GM) changes in 34 T2DM and 88 control subjects using high-resolution T1-weighted images, collected from a 3.0-Tesla magnetic resonance imaging scanner, and assessed anxiety [Beck Anxiety Inventory], depressive symptoms [Beck Depression Inventory-II], and cognition [Montreal Cognitive Assessment]. We also investigated relationships between GM status of cognitive and mood control sites and these scores in T2DM. Significantly increased anxiety (p = 0.003) and depression (p = 0.001), and reduced cognition (p = 0.002) appeared in T2DM over controls. Decreased GM volumes appeared in several regions in T2DM patients, including the prefrontal, hippocampus, amygdala, insular, cingulate, cerebellum, caudate, basal-forebrain, and thalamus areas (p < 0.01). GM volumes were significantly associated with anxiety (r = −0.456,p = 0.009), depression (r = −0.465,p = 0.01), and cognition (r = 0.455,p = 0.009) scores in regions associated with those regulations (prefrontal cortices, hippocampus, para hippocampus, amygdala, insula, cingulate, caudate, thalamus, and cerebellum) in T2DM patients. Patients with T2DM show brain damage in regions that are involved in cognition, anxiety, and depression control, and these tissue alterations are associated with functional deficits. The findings indicate that mood and cognitive deficits in T2DM patients has brain structural basis in the condition.

Purpose Magnetic resonance (MR) imaging and computed tomography (CT) are used almost exclusively in radiation therapy planning of glioblastoma multiforme (GBM), despite their well-recognized limitations. MR spectroscopic imaging (MRSI) can identify biochemical patterns associated with normal brain and tumor, predominantly by observation of choline (Cho) and N-acetylaspartate (NAA) distributions. In this study, volumetric 3-dimensional MRSI was used to map these compounds over a wide region of the brain and to evaluate metabolite-defined treatment targets (metabolic tumor volumes [MTV]). Methods and Materials Volumetric MRSI with effective voxel size of ~1.0 mL and standard clinical MR images were obtained from 19 GBM patients. Gross tumor volumes and edema were manually outlined, and clinical target volumes (CTVs) receiving 46 and 60 Gy were defined (CTV46 and CTV60, respectively). MTVCho and MTVNAA were constructed based on volumes with high Cho and low NAA relative to values estimated from normal-appearing tissue. Results The MRSI coverage of the brain was between 70% and 76%. The MTVNAA were almost entirely contained within the edema, and the correlation between the 2 volumes was significant (r=0.68, P=.001). In contrast, a considerable fraction of MTVCho was outside of the edema (median, 33%) and for some patients it was also outside of the CTV46 and CTV60. These untreated volumes were greater than 10% for 7 patients (37%) in the study, and on average more than one-third (34.3%) of the MTVCho for these patients were outside of CTV60. Conclusions This study demonstrates the potential usefulness of whole-brain MRSI for radiation therapy planning of GBM and revealed that areas of metabolically active tumor are not covered by standard RT volumes. The described integration of MTV into the RT system will pave the way to future clinical trials investigating outcomes in pa tients treated based on metabolic information.