Background and Purpose-The Alberta Stroke Program Early CT Score (ASPECTS), a 10-point scale, is a clinical tool for assessment of early ischemic changes after stroke based on the location and extent of a visible stroke lesion. It has been extended for use with MR diffusion-weighted imaging. The purpose of this work was to automate a MR topographical score (MR-TS) using a digital atlas to develop an objective tool for large-scale analyses and possibly reduce interrater variability and slice orientation differences. Methods-We assessed 30 patients with acute ischemic stroke with a diffusion lesion who provided informed consent.Patients were imaged by CT and MRI within 24 hours of symptom onset. An MR-TS digital atlas was generated using the ASPECTS scoring sheet and anatomic MR data sets. Automated MR topographical scores (auto-MR-TS) were obtained based on the overlap of lesions on apparent diffusion coefficient maps with MR-TS atlas regions. Auto-MR-TS scores were then compared with scores derived manually (man-MR-TS) and with conventional CT ASPECTS scores. Results-Of the 30 patients, 29 were assessed with auto-MR-TS. Auto-MR-TS was significantly lower than CT ASPECTS (PϽ0.001), but with a median difference of only 1 point. There was no significant difference between the auto-MR-TS and the man-MR-TS with a median difference of 0 points; 86% of patient scores differed by Յ1 point. Conclusion-Auto-MR-TS

Purpose Local specific absorption rate (SAR) limits many applications of parallel transmit (pTx) in ultra high-field imaging. In this Note, we introduce the use of an array element, which is intentionally inefficient at generating spin excitation (a “dark mode”) to attempt a partial cancellation of the electric field from those elements that do generate excitation. We show that adding dipole elements oriented orthogonal to their conventional orientation to a linear array of conventional loop elements can lower the local SAR hotspot in a C-spine array at 7 T. Methods We model electromagnetic fields in a head/torso model to calculate SAR and excitation B1+ patterns generated by conventional loop arrays and loop arrays with added electric dipole elements. We utilize the dark modes that are generated by the intentional and inefficient orientation of dipole elements in order to reduce peak 10g local SAR while maintaining excitation fidelity. Results For B1+ shimming in the spine, the addition of dipole elements did not significantly alter the B1+ spatial pattern but reduced local SAR by 36%. Conclusion The dipole elements provide a sufficiently complimentary B1+ and electric field pattern to the loop array that can be exploited by the radiofrequency shimming algorithm to reduce local SAR.

BACKGROUND Psychogenic non-epileptic seizures (PNES) may involve hypoactivity in the right temporoparietal junction (TPJ), suggesting a promising target for therapeutic neuromodulation. In this proof-of-concept case series, we aimed to investigate the tolerability and potential efficacy of high frequency repetitive Transcranial Magnetic Stimulation (rTMS) over the right TPJ to decrease non-epileptic seizure rates. METHODS Seven subjects with video-EEG documented PNES without comorbid epileptic seizures were recruited. The rTMS protocol involved thirty stimulation sessions administered twice per day over three weeks. Each session consisted of three thousand pulses of high frequency (10 Hz) rTMS applied over the right TPJ. Tolerability was monitored throughout treatment. Weekly PNES counts were recorded at baseline, during treatment, and at post treatment intervals as the primary outcome measure. Additional psychometric scales assessing dissociation and functional neurological symptoms were collected at baseline and within 1-week post treatment as secondary outcome measures. RESULTS Treatment with rTMS was well tolerated by all participants. Participants reported a decrease in weekly seizure rates post vs. pre-treatment, which was sustained at 3-month follow-up. Improvement was also reported on the Dissociative Experiences Scale and the Conversion Disorder Subscale of the Screening for Somatoform Symptoms-7 Scale. CONCLUSION High-frequency rTMS over the right TPJ represents a promising treatment for PNES that warrants additional research.