Dual-source parallel radiofrequency transmission for magnetic resonance breast imaging at 3 T: Any added clinical value?

Purpose

To investigate the influence of dual-source parallel radiofrequency (RF) excitation on clinical breast MR images.

Methods

A 3 T MR system with both dual-source and conventional single-source RF excitations was used to examine 22 patients. Axial TSE-T₂WI with fat suppression, TSE-T₁WI without fat suppression, THRIVE (3D field echo) and DWI (SE-EPI) were obtained by using both excitation techniques. Image homogeneity, image contrast and lesion conspicuity were measured or independently scored by two radiologists and were compared by paired-sample t test or Wilcoxon test.

Results

Both excitations revealed 24 lesions. For SE sequences using dual-source mode, image homogeneity was improved (P = 0.00), scan time was reduced, and ghost artifacts on DWI were significantly reduced (P = 0.00). However, image contrast was not increased and lesion conspicuity had no significant difference between two modes, except DWI on which lesion conspicuity was significantly improved (P = 0.00), due to less ghost artifacts. For field-echo sequence, image homogeneity, acquisition time, image contrast and lesion conspicuity had no significant difference between the two modes.

Conclusions

Dual-source parallel RF transmission has some added value for improving breast image quality. However, its value is limited in terms of improving lesion detection and characterization.     

Automated measurement of fat infiltration in the hip abductors from Dixon magnetic resonance imaging

PurposeIntramuscular fat infiltration is a dynamic process, in response to exercise and muscle health, which can be quantified by estimating fat fraction (FF) from Dixon MRI. Healthy hip abductor muscles are a good indicator of a healthy hip and an active lifestyle as they have a fundamental role in walking. The automated measurement of the abductors' FF requires the challenging task of segmenting them. We aimed to design, develop and evaluate a multi-atlas based method for automated measurement of fat fraction in the main hip abductor muscles: gluteus maximus (GMAX), gluteus medius (GMED), gluteus minimus (GMIN) and tensor fasciae latae (TFL).MethodWe collected and manually segmented Dixon MR images of 10 healthy individuals and 7 patients who underwent MRI for hip problems. Twelve of them were selected to build an atlas library used to implement the automated multi-atlas segmentation method. We compared the FF in the hip abductor muscles for the automated and manual segmentations for both healthy and patients groups. Measures of average and spread were reported for FF for both methods. We used the root mean square error (RMSE) to quantify the method accuracy. A linear regression model was used to explain the relationship between FF for automated and manual segmentations.ResultsThe automated median (IQR) FF was 20.0(16.0–26.4) %, 14.3(10.9–16.5) %, 15.5(13.9–18.6) % and 16.2(13.5–25.6) % for GMAX, GMED, GMIN and TFL respectively, with a FF RMSE of 1.6%, 0.8%, 2.1%, 2.7%. A strong linear correlation (R² = 0.93, p < .001, m = 0.99) was found between the FF from automated and manual segmentations. The mean FF was higher in patients than in healthy subjects.ConclusionThe automated measurement of FF of hip abductor muscles from Dixon MRI had good agreement with FF measurements from manually segmented images. The method was accurate for both healthy and patients groups.     

Improved visualization of diffusion-prepared MR neurography (SHINKEI) in the lumbosacral plexus combining high-intensity reduction (HIRE) technique

PurposeThis study attempted to improve visualization of the pelvic nervous system using the high-intensity reduction (HIRE)-nerve-SHeath signal increased with INKed rest-tissue RARE Imaging (SHINKEI) technique that involves subtracting signals of 3D heavily T2W images from SHINKEI images. We identified the optimum TE value for 3D heavily T2W images and assessed the usefulness of the HIRE-SHINKEI technique.Materials and methodsCoronal lumbosacral plexus images were acquired from six healthy volunteers at 3 T. We optimized the TE of the 3D heavily T2-weighted (T2W) images in HIRE-SHINKEI and compared HIRE-SHINKEI images with conventional SHINKEI images with respect to nerve depiction, and vein, bladder, and cerebrospinal fluid (CSF) signal suppression using a 5-point scale.ResultsIn 3D heavily T2W images optimized by HIRE-SHINKEI technique, the signal corresponding to nerves became significantly lower at TE = 400 ms (p < 0.0005), while that of veins occurred at TE = 400 ms and 600 ms (p < 0.05). The suppression of bladder signals was significant at TE = 400, 600, and 800 ms (p < 0.05); however, there was no difference in signal inhibition from CSF at all TEs tested. Based on these results, an optimal TE of 600 ms was identified for 3D heavily T2W images; these images corresponded to the minimal loss of nerve signal and simultaneous maximum subtraction of signals from the bladder, vein, and CSF with dissimilar T2 values. Compared with SHINKEI images, the optimized HIRE-SHINKEI images selectively delineated nerves in greater detail, and along with significant signal suppression of the bladder (p < 0.0001) and veins (p < 0.05).ConclusionHIRE-SHINKEI can be used to better visualize the lumbosacral plexus with higher signal suppression of other pelvic structures. Such detailed Magnetic resonance neurography and selective depiction of nerves are useful for the diagnosis of peripheral nerve disorders.     

Preliminary quantitative analysis of vertebral microenvironment changes in type 2 diabetes mellitus using FOCUS IVIM-DWI and IDEAL-IQ sequences

PurposeTo explore the application of intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI) on account of field-of-view optimized and constrained undistorted single shot (FOCUS) and iteraterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation(IDEAL-IQ) sequences in evaluating the vertebral microenvironment changes of type 2 diabetes mellitus(T2DM) patients and the correlation with bone mineral density(BMD).Method128 T2DM patients (mean age 63.4 ± 5.28 years) underwent both dual-energy X-ray absorptiometry (DEXA) and spine MRI. The FOCUS IVIM-DWI and IDEAL-IQ derived parameters of the vertebral body(L1, L2, L3, L4)were measured on corresponding maps of the lumbar spine. The subjects were divided into 3 groups according to T-scores as follows: normal (n = 37), osteopenia (n = 43), and osteoporosis(n = 48) group.One-way analysis of variance (ANOVA) were used to compare the vertebral parameters(ADC_slow, ADC_fast, f, FF, R2*) among three BMD cohorts.Receiver operating characteristic (ROC) analyses and Spearman's rank correlation were performed to test the diagnostic performance and the correlation between them respectively.ResultsThere were significant differences in vertebral ADC_slow, ADC_fast, FF and R2* between the three groups (P < 0.05).Statistically, BMD was moderately negatively correlated with FF (r = −0.584, P < 0.001) and weakly positively with ADC_slow (r = 0.334, P < 0.001), meanwhile moderately positively correlated with R2*(r = 0.509, P < 0.001) and ADC_fast(0.545, P < 0.001).ADC_fast was moderately negatively correlated with FF (r = −0.417, P < 0.001), weakly positively correlated with R2*(0.359, P < 0.001).Compared with the area under the curve (AUC) of ADC_slow, ADC_fast, FF and R2*, the AUC of ADC_fast was higher in identifying between normal and abnormal(osteopenia and osteoporosis), normal from osteopenia, while the AUC of FF was higher in identifying osteopenia from osteoporosis.ConclusionsFOCUS IVIM-DWI and IDEAL-IQ of lumbar spine might be useful to evaluate the vertebral microenvironment changes of T2DM patients.     

Diffusion weighted imaging for evaluation of breast lesions: Comparison between high b-value single-shot and routine readout-segmented sequences at 3 T

PurposeIn this study, we compare readout-segmented echo-planar imaging (rs-EPI) Diffusion Weighted Imaging (DWI) to a work-in-progress single-shot EPI with modified Inversion Recovery Background Suppression (ss-EPI-mIRBS) sequence at 3 T using a b-value of 2000 s/mm² on image quality, lesion visibility and evaluation time.MethodFrom September 2017 to December 2018, 23 women (one case used for training) with known breast cancer were included in this study, after providing signed informed consent. Women were scanned with the conventional rs-EPI sequence and the work-in-progress ss-EPI-mIRBS during the same examination. Four breast radiologists (4–13 years of experience) independently scored both series for overall image quality (1: extremely poor to 9: excellent). All lesions (47 in total, 36 malignant, and 11 benign and high-risk) were evaluated for visibility (1: not visible, 2: visible if location is given, 3: visible) and probability of malignancy (BI-RADS 1 to 5). ADC values were determined by measuring signal intensity in the lesions using dynamic contrast-enhanced (DCE) images for reference. Evaluation times for all assessments were automatically recorded. Results were analyzed using the visual grading characteristics (VGC) and the resulting area under the curve (AUC_VGC) method. Statistical analysis was performed in SPSS, with McNemar tests, and paired t-tests used for comparison.ResultsNo significant differences were detected between the two sequences in image quality (AUC_VGC: 0.398, p = 0.087) and lesion visibility (AUC_VGC: 0.534, p = 0.336) scores. Lesion characteristics (e.g benign and high-risk, versus malignant; small (≤10 mm) vs. larger (>10 mm)) did not result in different image quality or lesion visibility between sequences. Sensitivity (rs-EPI: 72.2% vs. ss-EPImIRBS: 78.5%, p = 0.108) and specificity (70.5% vs. 56.8%, p = 0.210, respectively) were comparable. In both sequences the mean ADC value was higher for benign and high-risk lesions than for malignant lesions (ss-EPI-mIRBS: p = 0.022 and rs-EPI: p = 0.055). On average, ss-EPI-mIRBS resulted in decreased overall reading time by 7.7 s/case (p = 0.067); a reduction of 17%. For malignant lesions, average reading time was significantly shorter using ss-EPI-mIRBS compared to rs-EPI (64.0 s/lesion vs. 75.9 s/lesion, respectively, p = 0.039).ConclusionBased on this study, the ss-EPI sequence using a b-value of 2000 s/mm² enables for a mIRBS acquisition with quality and lesion conspicuity that is comparable to conventional rs-EPI, but with a decreased reading time.     

Quantification of low fat contents: a comparison of MR imaging and spectroscopy methods at 1.5 and 3 T

Magnetic resonance spectroscopy (MRS) has long been considered the golden standard for non-invasive measurement of tissue fat content. With improved techniques for fat/water separation, imaging has become an alternative to MRS for fat quantification. Several imaging models have been proposed, but their performance relative to MRS at very low fat contents is yet not fully established. In this work, imaging and spectroscopy were compared at 1.5 T and 3 T in phantoms with 0-3% fat fraction (FF). We propose a multispectral model with individual a priori R₂ relaxation rates for water and fat, and a common unknown R₂′ relaxation. Magnitude and complex image reconstructions were also compared. Best accuracy was obtained with the imaging method at 1.5 T. At 3 T, the FFs were underestimated due to larger fat-water phase shifts. Agreement between measured and true FF was excellent for the imaging method at 1.5 T (imaging: FF_meas= 0.98 FF_true− 0.01%, spectroscopy: FF_meas= 0.77 FF_true+ 0.08%), and fair at 3 T (imaging: FF_meas= 0.91 FF_true− 0.19%, spectroscopy: FF_meas= 0.79 FF_true+ 0.02%). The imaging method was able to quantify FFs down to approx. 0.5%. We conclude that the suggested imaging model is capable of fat quantification with accuracy and precision similar to or better than spectroscopy and offers an improvement vs. a model with a common R₂* relaxation only.     

Clinical comparison of single-shot EPI,readout-segmented EPI and TGSE-BLADE for diffusion-weighted imaging of cerebellopontine angle tumors on 3 tesla

ObjectiveThe complex anatomical structures of cerebellopontine angle (CPA) pose a unique challenge to diffusion weighted imaging (DWI). This study aimed to compare the clinical utility of the prototypic 2D turbo gradient- and spin echo-BLADE-DWI (TGSE-BLADE-DWI) with that of readout-segmented echo-planar DWI (RESOLVE-DWI) and single-shot echo-planar DWI (SS-EPI-DWI) to visualize CPA anatomic structures and identify CPA tumors.MethodsA total of 8 volunteers and 36 patients with pathological CPA tumors were enrolled to perform the three DWI sequences at 3 T. Scan time of TGSE-BLADE-DWI, RESOLVE-DWI and SS-EPI-DWI was 5 min 51 s, 5 min 15 s and 1 min 22 s, respectively. Subjective analysis, including visualization of anatomical structures, geometric distortion, ghosting artifacts, lesion conspicuity, diagnostic confidence, and overall image quality of the three DWI sequences were scored and assessed. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and apparent diffusion coefficient (ADC) of CPA tumors were measured and compared.ResultsA total of 39 lesions were identified, TGSE-BLADE-DWI detected all of them, RESOLVE-DWI 36 and SS-EPI-DWI 27. Significant differences were found in all the subjective parameters among the three DWI sequences (all p < 0.001). TGSE-BLADE-DWI was significantly better than RESOLVE-DWI in visualization of CPA anatomical structures, geometric distortion, ghosting artifacts, lesion conspicuity, diagnostic confidence, and overall image quality (all p < 0.01), and RESOLVE-DWI showed significantly superior performance than SS-EPI-DWI in all parameters (all p < 0.001). CNRs and ADCs were not significantly different among the three DWI sequences (p = 0.355, p = 0.590, respectively). No significant differences were detected between TGSE-BLADE-DWI SNR and RESOLVE-DWI SNR (p = 0.058), or TGSE-BLADE-DWI SNR and SS-EPI-DWI SNR (p = 0.155).ConclusionCompared with RESOLVE-DWI and SS-EPI-DWI, TGSE-BLADE-DWI minimized geometric distortions and ghosting artifacts and demonstrated an improved ability for depicting CPA tumors with better lesion conspicuity.SummaryGeometric distortions and ghosting artifacts are found at bone-air interfaces using conventional diffusion-weighted imaging (DWI), which is a challenge for imaging cerebellopontine angle (CPA) tumors. Our study validated that geometric distortions and ghosting artifacts were not present on 2D turbo gradient- and spin-echo-BLADE-DWI scans, making this technique useful for visualizing CPA anatomic structures and diagnosing CPA tumors.     

Self-navigated 3D whole-heart MRA for non-enhanced surveillance of thoracic aortic dilation: A comparison to CTA

PurposeTo prospectively compare image quality and reliability of a non-contrast, self-navigated 3D whole-heart magnetic resonance angiography (MRA) sequence with contrast-enhanced computed tomography angiography (CTA) for sizing of thoracic aortic aneurysm (TAA).MethodsSelf-navigated 3D whole-heart 1.5 T MRA was performed in 20 patients (aged 67 ± 9 years, 75% male) for sizing of TAA; a subgroup of 18 (90%) patients underwent additional contrast-enhanced CTA on the same day. Subjective image quality was scored according to a 4-point Likert scale and ratings between observers were compared by Cohen's Kappa statistics. For MRA, subjective motion blurring and signal inhomogeneity was rated according to a 3-point scale, respectively. Objective signal inhomogeneity of MRA was quantified as standard deviation of the voxel intensities in a circular region of interest (ROI) placed in the ascending aorta divided by their mean value. Continuous MRA and CTA measurements were analyzed with regression and Bland-Altman analysis.ResultsOverall subjective image quality as rated by two observers was 1 [interquartile range (IQR) 1–2] for self-navigated MRA and 1.5 [IQR 1–2] for CTA (p = 0.717). For MRA, perfect inter-observer agreement was found regarding presence of artefacts and subjective image sharpness (κ = 1). Subjective signal inhomogeneity agreed moderately between the observers (κ = 0.58, p = 0.007), however, it correlated strongly with objectively quantified inhomogeneity of the blood pool signal (r = 0.78, p < 0.0001). Maximum diameters of TAA as measured by self-navigated MRA and CTA showed very strong correlation (r = 0.99, p < 0.0001) without significant inter-method bias (bias −0.03 mm, lower and upper limit of agreement −0.74 and 0.68 mm, p = 0.749). Inter-observer correlation of aortic aneurysm as measured by MRA was very strong (r = 0.96) without significant bias (p = 0.695).ConclusionSelf-navigated 3D whole-heart MRA enables reliable contrast- and radiation free aortic dilation surveillance without significant difference to standardized CTA while providing predictable acquisition time and offering excellent image quality.     

Improving dynamic contrast-enhanced MRI of the lung using motion-weighted sparse reconstruction: Initial experiences in patients

PurposeThe purpose of this study was to evaluate the performance of motion-weighted Golden-angle RAdial Sparse Parallel MRI (motion-weighted GRASP) for free-breathing dynamic contrast-enhanced MRI (DCE-MRI) of the lung.MethodsMotion-weighted GRASP incorporates a soft-gating motion compensation algorithm into standard GRASP reconstruction, so that motion-corrupted motion k-space (e.g., k-space acquired in inspiratory phases) contributes less to the final reconstructed images. Lung MR data from 20 patients (mean age = 57.9 ± 13.5) with known pulmonary lesions were retrospectively collected for this study. Each subject underwent a free-breathing DCE-MR scan using a fat-statured T₁-weighted stack-of-stars golden-angle radial sequence and a post-contrast breath-hold MR scan using a Cartesian volumetric-interpolated imaging sequence (BH-VIBE). Each radial dataset was reconstructed using GRASP without motion compensation and motion-weighted GRASP. All MR images were visually evaluated by two experienced radiologists blinded to reconstruction and acquisition schemes independently. In addition, the influence of motion-weighted reconstruction on dynamic contrast-enhancement patterns was also investigated.ResultsFor image quality assessment, motion-weighted GRASP received significantly higher visual scores than GRASP (P < 0.05) for overall image quality (3.68 vs. 3.39), lesion conspicuity (3.54 vs. 3.18) and overall artifact level (3.53 vs. 3.15). There was no significant difference (P > 0.05) between the breath-hold BH-VIBE and motion-weighted GRASP images. For assessment of temporal fidelity, motion-weighted GRASP maintained a good agreement with respect to GRASP.ConclusionMotion-weighted GRASP achieved better reconstruction performance in free-breathing DCE-MRI of the lung compared to standard GRASP, and it may enable improved assessment of pulmonary lesions.     

A fast method for the quantification of fat fraction and relaxation times: Comparison of five sites of bone marrow

PurposeBone marrow is found either as red bone marrow, which mainly contains haematopoietic cells, or yellow bone marrow, which mainly contains adipocytes. In adults, red bone marrow is principally located in the axial skeleton. A recent study has introduced a method to simultaneously estimate the fat fraction (FF), the T1 and T2* relaxation times of water (T1w, T2*w) and fat (T1f and T2*f) in the vertebral bone marrow. The aim of the current study was to measure FF, T1w, T1f, T2*w and T2*f in five sites of bone marrow, and to assess the presence of regional variations.MethodsMRI experiments were performed at 1.5 T on five healthy volunteers (31.6 ± 15.6 years) using a prototype chemical-shift-encoded 3D multi-gradient-echo sequence (VIBE) acquired with two flip angles. Acquisitions were performed in the shoulders, lumbar spine and pelvis, with acquisition times of < 25 seconds per sequence. Signal intensities of magnitude images of the individual echoes were used to fit the signal and compute FF, T1w, T1f, T2*w and T2*f in the humerus, sternum, vertebra, ilium and femur.ResultsRegional variations of fat fraction and relaxation times were observed in these sites, with higher fat fraction and longer T1w in the epiphyses of long bones. A high correlation between FF and T1w was measured in these bones (R = 0.84 in the humerus and R = 0.84 in the femur). In most sites, there was a significant difference between water and fat relaxation times, attesting the relevance of measuring these parameters separately.ConclusionThe method proposed in the current study allowed for measurements of FF, T1w, T1f, T2*w and T2*f in five sites of bone marrow. Regional variations of these parameters were observed and a strong negative correlation between the T1 of water and the fat fraction in bones with high fat fractions was found.     

Noninvasive diffusion MRI to determine the severity of peripheral nerve injury

ObjectivePrimary repair of peripheral nerves is recommended following transection; however, patient management following repair is challenged by a lack of biomarkers to nerve regeneration. Previous studies have demonstrated that diffusion magnetic resonance imaging (MRI) may provide viable biomarkers of nerve regeneration in injury models; though, these methods have not been systematically evaluated in graded partial transections and repairs.MethodsEx vivo diffusion MRI was performed in fixed rat sciatic nerve samples 4 or 12 weeks following partial nerve transection and repair (25% cut = 12, 50% cut = 12 and 75% cut = 11), crush injuries (n = 12), and sham surgeries (n = 9). Behavioral testing and histologic evaluation were performed in the same animals and nerve samples for comparison.ResultsDiffusion tractography provided visual characterizations of nerve damage and recovery consistent with the expected degree of injury within each cohort. In addition, quantitative indices from diffusion MRI correlated with both histological and behavioral evaluations, the latter of indicated full recovery for sham and crush nerves and limited recovery in all partially transected/repaired nerves. Nerve recovery between 4 and 12 weeks was statistically significant in partial transections 50% and 75% depth cuts (p = 0.043 and p = 0.022) but not for 25% transections.InterpretationOur findings suggest that DTI can i) distinguish different degrees of partial nerve transection following surgical repair and ii) map spatially heterogeneous nerve recovery (e.g., due to collateral sprouting) from 4 to 12 weeks in partially transected nerves.     

High-performance rapid MR parameter mapping using model-based deep adversarial learning

PurposeTo develop and evaluate a deep adversarial learning-based image reconstruction approach for rapid and efficient MR parameter mapping.MethodsThe proposed method provides an image reconstruction framework by combining the end-to-end convolutional neural network (CNN) mapping, adversarial learning, and MR physical models. The CNN performs direct image-to-parameter mapping by transforming a series of undersampled images directly into MR parameter maps. Adversarial learning is used to improve image sharpness and enable better texture restoration during the image-to-parameter conversion. An additional pathway concerning the MR signal model is added between the estimated parameter maps and undersampled k-space data to ensure the data consistency during network training. The proposed framework was evaluated on T₂ mapping of the brain and the knee at an acceleration rate R = 8 and was compared with other state-of-the-art reconstruction methods. Global and regional quantitative assessments were performed to demonstrate the reconstruction performance of the proposed method.ResultsThe proposed adversarial learning approach achieved accurate T₂ mapping up to R = 8 in brain and knee joint image datasets. Compared to conventional reconstruction approaches that exploit image sparsity and low-rankness, the proposed method yielded lower errors and higher similarity to the reference and better image sharpness in the T₂ estimation. The quantitative metrics were normalized root mean square error of 3.6% for brain and 7.3% for knee, structural similarity index of 85.1% for brain and 83.2% for knee, and tenengrad measures of 9.2% for brain and 10.1% for the knee. The adversarial approach also achieved better performance for maintaining greater image texture and sharpness in comparison to the CNN approach without adversarial learning.ConclusionThe proposed framework by incorporating the efficient end-to-end CNN mapping, adversarial learning, and physical model enforced data consistency is a promising approach for rapid and efficient reconstruction of quantitative MR parameters.     

Magnetic resonance imaging of cortical bone with ultrashort TE pulse sequences

PurposeNormal adult cortical bone has a very short T₂ and characteristically produces no signal with pulse sequence echo times (TEs) routinely used in clinical practice. We wished to determine whether it was possible to use ultrashort TE (UTE) pulse sequences to detect signal from cortical bone in human subjects and use this signal to characterise this tissue.Subjects and MethodsSeven volunteers and 10 patients were examined using ultrashort TE pulse sequences (TE=0.07 or 0.08 ms). Short and long inversion as well as fat suppression pulses were used as preparation pulses. Later echo images were also obtained as well as difference images produced by subtracting a later echo image from a first echo image. Saturation pulses were used for T₁ measurement and sequences with progressively increasing TEs for T₂* measurement. Intravenous gadodiamide was administered to four subjects.ResultsSignal in cortical bone was detected with UTE sequences in children, normal adults and patients. This signal was usually made more obvious by subtracting a later echo image from the first provided that the signal-to-noise ratio was sufficiently high.Normal mean adult T₁s ranged from 140 to 260 ms, and mean T₂*s ranged from 0.42 to 0.50 ms. T₁ increased significantly with age (P<.01).Increased signal was observed after contrast enhancement in the normal volunteer and the three patients to whom it was administered.Reduction in signal from short T₂ components was seen in acute fractures, and increase in signal in these components was seen with new bone formation after fracture malunion. In a case of osteoporosis, bone cross-sectional area and signal level appeared reduced.ConclusionSignal can be detected from normal and abnormal cortical bone with UTE pulse sequences, and this can be used to measure its T₁ and T₂* as well as observe contrast enhancement. Difference images are of value in increasing the conspicuity of cortical bone and observing abnormalities in disease.     

Magnetic resonance neurography of the lumbosacral plexus at 3 Tesla – CSF-suppressed imaging with submillimeter resolution by a three-dimensional turbo spin echo sequence

PurposeTo investigate magnetic resonance neurography (MRN) of the lumbosacral plexus (LSP) with cerebrospinal fluid (CSF) suppression by using submillimeter resolution for three-dimensional (3D) turbo spin echo (TSE) imaging.Materials and methodsUsing extended phase graph (EPG) analysis, the signal response of CSF was simulated considering dephasing from coherent motion for frequency-encoding voxel sizes ranging from 0.3 to 1.3 mm and for CSF velocities ranging from 0 to 4 cm/s. In-vivo MRN included 3D TSE data with frequency encoding parallel to the feet/head axis from 15 healthy adults (mean age: 28.5 ± 3.8 years, 5 females; acquisition voxel size: 2 × 2 × 2 mm³) and 16 pediatric patients (mean age: 6.7 ± 4.1 years, 7 females; acquisition voxel size: 0.7 × 0.7 × 1.4 mm³) acquired at 3 Tesla. Five of the adults were scanned repetitively with changing acquisition voxel sizes (1 × 2 × 2 mm³, 0.7 × 2× 2 mm³, and 0.5 × 2 × 2 mm³). Measurements of the bilateral ganglion of the L5 nerve root, averaged between sides, as well as the CSF in the thecal sac were obtained for all included subjects and compared between adults and pediatric patients and between voxel sizes, using a CSF-to-nerve signal ratio (CSFNR).ResultsAccording to simulations, the CSF signal is reduced along the echo train for moving spins. Specifically, it can be reduced by over 90% compared to the maximum simulated signal for flow velocities above 2 cm/s, and could be most effectively suppressed by considering a frequency-encoding voxel size of 0.8 mm or less. For in-vivo measurements, mean CSFNR was 1.52 ± 0.22 for adults and 0.10 ± 0.03 for pediatric patients (p < .0001). Differences in CSFNR were significant between measurements using a voxel size of 2 × 2 × 2 mm³ and measurements in data with reduced voxel sizes (p ≤ .0012), with submillimeter resolution (particularly 0.5 × 2 × 2 mm³) providing highest CSF suppression.ConclusionsApplying frequency-encoding voxel sizes in submillimeter range for 3D TSE imaging with frequency encoding parallel to the feet/head axis may considerably improve MRN of LSP pathology in adults in the future because of favorable CSF suppression.     

Superficial fibromatosis: MRI radiomics and T2 mapping correlate with treatment response

BackgroundSuperficial fibromatosis exhibits variable MR signal intensity due to collagenous and fibroproliferative components. Quantifying this signal heterogeneity using image texture analysis and T2-mapping could have prognostic and therapeutic implications.MethodsThis IRB-approved retrospective study included 13 patients with superficial fibromatosis, managed by observation, electron beam radiotherapy (EBT), or pentoxifylline/vitamin E. Two-dimensional regions of interest (ROIs) were drawn on proton-density or T2-weighted MRI for radiomics feature analysis, and corresponding T2-maps. Comparisons were made between baseline and follow-up T2 relaxation times and radiomics features: Shannon's entropy, kurtosis, skewness, mean of positive pixels (MPP), and uniformity of distribution of positive gray-level pixel values (UPP).ResultsThere were 19 nodules in 13 subjects. Mean patient age was 60 years; 62% (8/13) were female; mean follow-up was 9.7 months. Nodule diameter at baseline averaged 18.2 mm (std dev 16.2 mm) and decreased almost 10% to 16.6 mm (p = 0.1, paired t-test). Normalized T2 signal intensity decreased 23% from 0.71 to 0.55 (p = 0.03, paired t-test). T2 relaxation time decreased 16% from 46.5 to 39.1 ms (p < 0.001, paired t-test). Among radiomics features, skewness increased to 0.71 from 0.41 (p = 0.03, paired t-test), and entropy decreased from 8.37 to 8.03 (p = 0.05, paired t-test); differences in other radiomics features were not significant.ConclusionsRadiomics analysis and T2-mapping of superficial fibromatosis is feasible; robust decreases in absolute T2 relaxation time, and changes in image textural features (increased skewness and decreased entropy) offer novel imaging biomarkers of nodule collagenization and maturation.     

Clinical evaluation of subtracted pointwise encoding time reduction with radial acquisition-based magnetic resonance angiography compared to 3D time-of-flight magnetic resonance angiography for improved flow dephasing at 3 Tesla

ObjectiveFlow dephasing artifacts within intracranial internal carotid artery (ICA) have been problematic for 3D time-of-flight magnetic resonance angiography (3D-TOF-MRA). This study aimed to evaluate pointwise encoding time reduction with radial acquisition subtraction-based MR angiography (PETRA-MRA) for decreasing flow dephasing artifacts compared to 3D-TOF-MRA in intracranial segments of ICA at 3 T.MethodsSixty healthy participants and seven patients with intracranial ICA aneurysms were enrolled to undergo 3D-TOF-MRA and PETRA-MRA. Two radiologists each evaluated the image quality of healthy participants using a 4-point scale (1: the best and 4: the worst). Quantitative analysis of the extent of homogeneity in signal intensity within the ICA and intracranial aneurysms was conducted using a parameter d: the higher the d value, the greater the signal homogeneity. Wilcoxon signed rank test, Chi-square test and the weighted kappa (κ) statistic were used for statistical analyses.ResultsThe image quality of PETRA-MRA with an overall score of 1.35 ± 0.53 was significantly better than that obtained with 3D-TOF-MRA, with an overall score of 3.50 ± 0.62 (Z = -9.56, p < 0.001). The parameter d of PETRA-MRA was higher than that of 3D-TOF-MRA for both 60 healthy participants (0.97 ± 0.05, 0.87 ± 0.11; z = -13.21, p < 0.001) and 7 patients with intracranial aneurysms (0.81 ± 0.18, 0.74 ± 0.16; z = -2.37, p = 0.018).ConclusionCompared with conventional 3D-TOF-MRA, PETRA-MRA remarkably improved the image quality with reduced flow dephasing artifacts in segments of intracranial ICA.     

Single-breath-hold T2WI liver MRI with deep learning-based reconstruction: A clinical feasibility study in comparison to conventional multi-breath-hold T2WI liver MRI

ObjectiveTo investigate the clinical feasibility of single-breath-hold (SBH) T2-weighted (T2WI) liver MRI with deep learning-based reconstruction in the evaluation of image quality and lesion delineation, compared with conventional multi-breath-hold (MBH) T2WI.MethodsOne hundred and fifty-two adult patients with suspected liver disease were prospectively enrolled. Two independent readers reviewed images acquired with conventional MBH-T2WI and SBH-T2WI at 3.0 T MR scanner. For image quality analyses, motion artifacts scores and boundary sharpness scores were compared using nonparametric Wilcoxon matched pairs tests between MBH-T2WI and SBH-T2WI. With the reference standard, 89 patients with 376 index lesions were included for lesion analyses. The lesion detection rates were compared by chi-square test, the lesion conspicuity scores and lesion-liver contrast ratio (CR) were compared using nonparametric Wilcoxon matched pairs tests between the two sequences.ResultsFor both readers, motion artifacts scores of SBH-T2WI were significantly lower than MBH-T2WI (P < 0.001). Boundary sharpness scores of SBH-T2WI were significantly higher than MBH-T2WI (P < 0.001). The lesion detection rates for SBH-T2WI were significantly higher than MBH-T2WI (P < 0.001); the differences of lesion detection rates between the two sequences were statistically significant for small (≤ 10 mm) liver lesions (P < 0.001), while not significant for larger (> 10 mm) lesions (P > 0.05). Lesion conspicuity scores were significantly higher on SBH-T2WI than MBH-T2WI in the entire cohort as well as in both stratified subgroups of lesions ≤10 mm and > 10 mm (P < 0.001 for all). CRs for focal liver lesions were also significantly higher with SBH-T2WI (P < 0.001).ConclusionThe SBH-T2WI sequence with deep-learning based reconstruction showed promising performance as it provided significantly better image quality, lesion detectability, lesion conspicuity and contrast within a single breath-hold, compared with the conventional MBH-T2WI.     

R1ρ dispersion and sodium imaging in human calf muscle

PurposeTo evaluate the magnitude of chemical exchange effects and R_1ρ dispersion in muscle and their relationship to tissue sodium levels with aging.MethodsSeven healthy volunteers (aged 24 to 87 years, median age 47) underwent MRI to assess tissue sodium levels and water T_1ρ values at different spin-locking frequencies in calf muscles. T_1ρ values at each locking field were computed based on a three-parameter mono-exponential model to fit signals obtained at different locking times, and R_1ρ (= 1/T_1ρ) rates were compared at different locking fields. In particular, the dispersion of R_1ρ (ΔR_1ρ = R_1ρ(0 Hz) − R_1ρ(500 Hz)) was examined as a function of subject age. Muscle sodium content was calculated by comparing signal intensities between tissues and reference standards within the same image. The variations of ΔR_1ρ with age and sodium were analyzed by linear regression.ResultsT_1ρ values and sodium content both increased with age. R_1ρ dispersion also increased with age and showed a strong linear correlation (correlation coefficient r = 0.98, P = 0.000578) with sodium content.ConclusionΔR_1ρ reports on the contribution of labile protons such as hydroxyls which may be associated with macromolecule accumulation in the extracellular matrix (ECM). An increase of sodium signal suggests an enlarged ECM volume fraction and/or an increase in sodium concentration, which occurs during normal aging. The strong correlation between ΔR_1ρ and sodium is likely the consequence of increased ECM and density of total charged sites within the matrix from molecules such as collagens and proteoglycans. The results from this study show the potential use of R_1ρ dispersion and sodium imaging in the assessment of pathological changes in muscle such as fibrosis.     

Combined modified-Dixon and PROPELLER method with low refocusing flip angle for contrast-enhanced fat-suppressed T1-weighted MRI: A prospective cross-sectional study

PurposeTo propose the combined modified-Dixon and PROPELLER sequence with low refocusing flip angle (RFA) and investigate whether this sequence can acquire clinical contrast-enhanced (CE), fat-suppressed T1-weighted (T1W) images of the head and neck.MethodsThe optimal RFA for T1W imaging was investigated in the brain of a healthy volunteer. The motion artifacts, water–fat separation error, contrast ratio (CR), and comprehensive quality were evaluated through comparison with a standard Cartesian modified-Dixon sequence in 50 patients. Two radiologists independently scored motion artifacts and water–fat separation error using a 4-point scale (1, unacceptable; 4, excellent) and comprehensive quality using a 5-point scale (1, substantially inferior; 5, substantially superior). The CR between CE lesions and non-CE muscle was calculated.ResultsThe optimal RFA of 40° was determined. In the motion artifact assessment, ratings of 3 or 4 points were assigned to 83% (observer-1, 42/50; observer-2, 41/50) and 99% (50/50; 49/50) of cases for the standard and proposed sequences, respectively (p < 0.001; p < 0.001). For the water–fat separation error assessment, ratings of 3 or 4 points were assigned to 100% (50/50; 50/50) and 97% (48/50; 49/50) of cases, respectively (p < 0.001; p = 0.02). In comprehensive evaluation, the proposed sequence was equal, slightly superior, or substantially superior to the standard sequence in 85% (39/50; 46/50). The CR was significantly higher with the proposed sequence [2.27 (1.99–2.97) vs. 2.08 (1.88–2.42), p < 0.001].ConclusionThe proposed sequence acquired stable fat-suppressed CE T1W images without motion artifacts and yielded superior overall image quality compared with the standard sequence.     

The development and optimisation of 3D black-blood R2* mapping of the carotid artery wall

PurposeTo develop and optimise a 3D black-blood R₂* mapping sequence for imaging the carotid artery wall, using optimal blood suppression and k-space view ordering.MethodsTwo different blood suppression preparation methods were used; Delay Alternating with Nutation for Tailored Excitation (DANTE) and improved Motion Sensitive Driven Equilibrium (iMSDE) were each combined with a three-dimensional (3D) multi-echo Fast Spoiled GRadient echo (ME-FSPGR) readout. Three different k-space view-order designs: Radial Fan-beam Encoding Ordering (RFEO), Distance-Determined Encoding Ordering (DDEO) and Centric Phase Encoding Order (CPEO) were investigated. The sequences were evaluated through Bloch simulation and in a cohort of twenty volunteers. The vessel wall Signal-to-Noise Ratio (SNR), Contrast-to-Noise Ratio (CNR) and R₂*, and the sternocleidomastoid muscle R₂* were measured and compared. Different numbers of acquisitions-per-shot (APS) were evaluated to further optimise the effectiveness of blood suppression.ResultsAll sequences resulted in comparable R₂* measurements to a conventional, i.e. non-blood suppressed sequence in the sternocleidomastoid muscle of the volunteers. Both Bloch simulations and volunteer data showed that DANTE has a higher signal intensity and results in a higher image SNR than iMSDE. Blood suppression efficiency was not significantly different when using different k-space view orders. Smaller APS achieved better blood suppression.ConclusionThe use of blood-suppression preparation methods does not affect the measurement of R₂*. DANTE prepared ME-FSPGR sequence with a small number of acquisitions-per-shot can provide high quality black-blood R₂* measurements of the carotid vessel wall.