CAMRD Project 268

Collaboration with Duke Silvio O. Conte Center Project 1

 Location of White Matter Hyperintensities and Alterations in White Matter Tracts in Late Onset Depression

K.R.R. Krishnan, M.D., J.R. MacFall, Ph.D.

 

Summary

This project is a collaboration between the Duke Department of Radiology (JR MacFall) and the Duke Department of Psychiatry (KRR Krishnan).  It is a continuation of work initially done at 1.5T in CAMRD under a NIMH funded Clinical Research Center for the Study of Late Life Depression (P30-MH40159, R01-MH54846).  Currently it is investigating the improvements in image segmentation achieved at 3T.   The present work is under an NIMH funded Silvio O.Conte Center for the Neuroscience of Depression (P50-MH60451). The Conte Center requires good resolution, multi-spectral MR images to allow segmentation of brain grey, white matter, csf and vascular lesions that can occur in the brain grey and white matter. It is hypothesized that these lesions, which are thought to be related to hypertension and cardiovascular disease can complicate the course and outcome of major depression. The 3 Tesla magnetic field strength of the CAMRD MRI coupled with the use of parallel imaging methods (SENSE and SMASH) allow the achievement of short imaging times with adequate signal-to-noise ratios for image segmentation:

 

Four contrast 3 T data acquired at 3 T.  Proton Density (upper left), T2-weighted (upper right), T1-weighted (lower left), FLAIR (lower right). Objects outside the head are tubes of water for reference materials.

 

Segmented image resulting from an automated image segmentation algorithm showing grey, white matter, csf, lesions (red) and other (skin, skull related) tissues.

 

 

Protocol Considerations

 

Previous 1.5T imaging protocol:

  1. Proton Density and T2-Weighted: Tr=4sec, Te=30msec, 135msec, 2D dual echo fast-spin-echo, echo-train length=16 (8 for each echo), 256x256 matrix, 20cm field-of-view, 3mm slice thickness, 53 slices. Scan time=12minutes
  2. T1-Weighted: Tr=12msec, Te=5msec, 3D Inversion-prepared spoiled gradient echo, Ti=300msec, 256x256 matrix, 24cm field-of-view, 1.5mm slice thickness, 124 slices. Scan time 10 minutes.

These scans took about 25 minutes, total, giving high resolution in-plane (0.78x0.78mm) and lower slice resolution (3mm).  Improving slice resolution requires more slices to continue to cover the volume needed (about 15 cm from brain base to crown). Going to 1.5mm thickness would double the PD, T2-W scan time causing too much motion sensitivity.  Using the features of the 3 T Siemens scanner we developed the following protocol:

 

Present 3.0 T imaging protocol:

  1. T1-Weighted: Tr=22msec, Te=7msec, flip angle=25 degrees, 3D spoiled turbo-FLASH, 256x192 matrix, 24cm field-of-view, phase field-of-view=82%, 1.0mm slice thickness, 160 slices. SMASH factor of 2 giving a scan time of 7 minutes.
  2. Proton Density Weighted: Tr=6.55 sec, Te=18msec, 2D  turbo-spin-echo, echo-train length=7, 256x256 matrix, 24cm field-of-view, phase field-of-view=82%, 1.5mm slice thickness, 100 slices. SMASH factor of 2 giving scan time=5minutes
  3. T2-Weighted: Tr=7sec, Te=105msec, 2D  turbo-spin-echo, echo-train length=5, 256x192 matrix, 24cm field-of-view, phase field-of-view=82%, 1.5mm slice thickness, 100 slices. SMASH factor of 2 giving scan time=5minutes
  4. FLAIR Weighted: Tr=9sec, Te=105msec, Ti=2400msec, echo-train-length=15, 256x256 matrix. 24cm field-of-view, phase field-of-view=82%, 2 mm slice thickness, 75 slices. SMASH factor of 2 giving scan time=10 minutes

 

 

This protocol gives shorter individual scan times and adds in the FLAIR contrast for improved lesion detection.

 

Segmentation Algorithm Considerations

 

The algorithm used,  illustrated below, is a mixture model developed by Koen Van Leemput at the Katholieke Universiteit Leuven with modifications for processing considerations developed in a collaboration between Duke University (Neuropsychiatric Imaging Research Laboratory) and Dr. Guido Gerig at University of North Carolina at Chapel Hill.

 

Publications from CAMRD Project 268 Collaboration

1.         Krishnan, K.R., W.D. Taylor, D.R. McQuoid, J.R. MacFall, M.E. Payne, J.M. Provenzale, and D.C. Steffens, Clinical characteristics of magnetic resonance imaging-defined subcortical ischemic depression. Biol Psychiatry, 2004. 55(4): p. 390-7.

2.         Beyer, J.L., M. Kuchibhatla, M. Payne, M. Moo-Young, F. Cassidy, J. MacFall, and K.R. Krishnan, Caudate volume measurement in older adults with bipolar disorder. Int J Geriatr Psychiatry, 2004. 19(2): p. 109-14.

3.         Taylor, W.D., E. Hsu, K.R. Krishnan, and J.R. MacFall, Diffusion tensor imaging: background, potential, and utility in psychiatric research. Biol Psychiatry, 2004. 55(3): p. 201-7.

4.         Taylor, W.D., D.C. Steffens, J.R. MacFall, D.R. McQuoid, M.E. Payne, J.M. Provenzale, and K.R. Krishnan, White matter hyperintensity progression and late-life depression outcomes. Arch Gen Psychiatry, 2003. 60(11): p. 1090-6.

5.         Levy, R.M., D.C. Steffens, D.R. McQuoid, J.M. Provenzale, J.R. MacFall, and K.R. Krishnan, MRI lesion severity and mortality in geriatric depression. Am J Geriatr Psychiatry, 2003. 11(6): p. 678-82.

6.         Taylor, W.D., J.R. MacFall, J.M. Provenzale, M.E. Payne, D.R. McQuoid, D.C. Steffens, and K.R. Krishnan, Serial MR imaging of volumes of hyperintense white matter lesions in elderly patients: correlation with vascular risk factors. AJR Am J Roentgenol, 2003. 181(2): p. 571-6.

7.         Taylor, W.D., J.R. MacFall, D.C. Steffens, M.E. Payne, J.M. Provenzale, and K.R. Krishnan, Localization of age-associated white matter hyperintensities in late-life depression. Prog Neuropsychopharmacol Biol Psychiatry, 2003. 27(3): p. 539-44.

8.         Payne, M.E., D.L. Fetzer, J.R. MacFall, J.M. Provenzale, C.E. Byrum, and K.R. Krishnan, Development of a semi-automated method for quantification of MRI gray and white matter lesions in geriatric subjects. Psychiatry Res, 2002. 115(1-2): p. 63-77.

9.         Kim, D.M., S.A. Xanthakos, L.A. Tupler, D.P. Barboriak, H.C. Charles, J.R. MacFall, and K.R. Krishnan, MR signal intensity of gray matter/white matter contrast and intracranial fat: effects of age and sex. Psychiatry Res, 2002. 114(3): p. 149-61.

10.       Taylor, W.D., M.E. Payne, K.R. Krishnan, H.R. Wagner, J.M. Provenzale, D.C. Steffens, and J.R. MacFall, Evidence of white matter tract disruption in MRI hyperintensities. Biol Psychiatry, 2001. 50(3): p. 179-83.

11.       MacFall, J.R., M.E. Payne, J.E. Provenzale, and K.R. Krishnan, Medial orbital frontal lesions in late-onset depression. Biol Psychiatry, 2001. 49(9): p. 803-6.

12.       Steffens, D.C., J.R. MacFall, M.E. Payne, K.A. Welsh-Bohmer, and K.R. Krishnan, Grey-matter lesions and dementia. Lancet, 2000. 356(9242): p. 1686-7.

13.       Steffens, D.C., C.E. Byrum, D.R. McQuoid, D.L. Greenberg, M.E. Payne, T.F. Blitchington, J.R. MacFall, and K.R. Krishnan, Hippocampal volume in geriatric depression. Biol Psychiatry, 2000. 48(4): p. 301-9.

14.       Doraiswamy, P.M., J. MacFall, K.R. Krishnan, C. O'Connor, X. Wan, M. Benaur, M. Lewandowski, and M. Fortner, Magnetic resonance assessment of cerebral perfusion in depressed cardiac patients: preliminary findings. Am J Psychiatry, 1999. 156(10): p. 1641-3.

15.       Passe, T.J., P. Rajagopalan, L.A. Tupler, C.E. Byrum, J.R. MacFall, and K.R. Krishnan, Age and sex effects on brain morphology. Prog Neuropsychopharmacol Biol Psychiatry, 1997. 21(8): p. 1231-7.

16.       Byrum, C.E., J.R. MacFall, H.C. Charles, V.R. Chitilla, O.B. Boyko, L. Upchurch, J.S. Smith, P. Rajagopalan, T. Passe, D. Kim, S. Xanthakos, K. Ranga, and R. Krishnan, Accuracy and reproducibility of brain and tissue volumes using a magnetic resonance segmentation method. Psychiatry Res, 1996. 67(3): p. 215-34.

17.       Rajagopalan, P., K.R. Krishnan, T.J. Passe, and J.R. Macfall, Magnetic resonance imaging using deoxyhemoglobin contrast versus positron emission tomography in the assessment of brain function. Prog Neuropsychopharmacol Biol Psychiatry, 1995. 19(3): p. 351-66.

18.       MacFall, J.R., C.E. Byrum, I. Parashos, B. Early, H.C. Charles, V. Chittilla, O.B. Boyko, L. Upchurch, and K.R. Krishnan, Relative accuracy and reproducibility of regional MRI brain volumes for point-counting methods. Psychiatry Res, 1994. 55(3): p. 167-77.