Intracranial vascular feature changes in time of flight MR angiography in patients undergoing carotid revascularization surgery

PurposeTo characterize the intracranial vascular features extracted from time of flight (TOF) images and their changes from baseline to follow-up in patients undergoing carotid revascularization, using arterial spin labeling (ASL) cerebral blood flow (CBF) measurement as a reference.MethodsIn this retrospective study, brain TOF and ASL images of 99 subjects, acquired before, within 48 h, and/or 6 months after, carotid revascularization surgery were analyzed. TOF images were analyzed using a custom software (iCafe) to quantify intracranial vascular features, including total vessel length, total vessel volume, and number of branches. Mean whole-brain CBF was calculated from ASL images. ASL scans showing low ASL signal in the entire flow territory of an internal carotid artery (ICA), which may be caused by labeling failure, were excluded. Changes and correlations between time points were analyzed separately for TOF intracranial vascular features and ASL CBF.ResultsSimilar to ASL CBF, TOF vascular features (i.e. total vessel length, total vessel volume and number of branches) increased dramatically from baseline to post-surgery, then returned to a level slightly higher than the baseline in long-term follow-up (All P < 0.05). Correlation between time points was observed for all three TOF vascular features but not for ASL CBF.ConclusionIntracranial vascular features, including total vessel length, total vessel volume and number of branches, extracted from TOF images are useful in detecting brain blood flow changes induced by carotid revascularization surgery.     

Angiographic contrast mechanism comparison between Simultaneous Non-contrast Angiography and intraPlaque hemorrhage (SNAP) sequence and Time of Flight (TOF) sequence for intracranial artery

PurposeTo theoretically compare the MR angiography (MRA) contrast mechanism of Time of Flight (TOF) and Simultaneous Non-contrast Angiography and intraPlaque hemorrhage (SNAP) for intracranial artery imaging with in-vivo validation.MethodsThe contrast ratio (CR) of SNAP and TOF was simulated under different blood velocities and travel distance that the blood had flown through. The CR and the slope of CR with respect to blood velocity of SNAP and TOF were compared in theoretical simulation. Two healthy subjects (a 60 years old female and a 29 years old male) were imaged on a 3 T MR scanner with SNAP, TOF and phase contrast (PC) images as the validation set. The measured CR from the images in validation set was compared with the theoretically simulated CR by Person's correlation coefficient. The ratio of CR difference to velocity difference in the validation set was compared between TOF and SNAP with Student's t-test. Thirty patients (21 males, age: 48 ± 13.8 years) with carotid artery atherosclerotic plaque were imaged with both TOF and SNAP as the comparison test. Between TOF and SNAP, the CR and total artery length were compared with Student's t-test, and the prevalence of stenosis was compared with Cohen's kappa in comparison test.ResultsThe theoretically simulated CR was significantly correlated with in-vivo measured CR from the validation set for TOF (p < 0.001) and SNAP (p < 0.001). The simulation revealed that the CR of SNAP was higher than that of TOF when the blood velocity and travel distance were within the range to have effective MRA contrast. Similarly, the in-vivo comparison test showed that SNAP had higher CR (p < 0.001 for all tested intracranial arteries) and longer total artery length (1.4 ± 0.4 m vs 1.2 ± 0.2 m, p < 0.001) than TOF. The stenosis detection performance was similar between TOF and SNAP (Cohen's kappa 0.72; 95% confidence interval: 0.51–0.93). Moreover, compared with TOF, SNAP showed higher slope of CR with respect to velocity in simulation (0.06 ± 0.02 s/cm vs 0.02 ± 0.05 s/cm, p < 0.001), and higher ratio of CR difference to velocity difference in validation test (0.47 ± 0.38 s/cm vs 0.19 ± 0.38 s/cm, p = 0.001).ConclusionsCompared with TOF, the SNAP shows better performance to visualize distal intracranial artery and worse performance to visualize ICA, and is more sensitive to blood velocity.     

Monitoring of extra-axial brain tumor response to radiotherapy using pseudo-continuous arterial spin labeling images: Preliminary results

IntroductionTechnological developments have increased the ease of performing perfusion MRI by arterial spin labeling (ASL) in clinical settings. The objective of this study was to evaluate the effects of radiotherapy on extra-axial brain tumors by using MR perfusion images obtained using the pseudo-continuous arterial spin labeling (pcASL) method.Materials and MethodsSix consecutive patients (nine lesions) with extra-axial brain tumors treated only with radiotherapy were enrolled in this study. MR examinations, including pcASL imaging, were performed before and after radiotherapy. Cerebral blood flow, maximum tumor blood flow (mTBF), tumor volume and the ratio of signal enhancement by contrast material (enhancement ratio) were evaluated in serial examinations during the course of radiotherapy. Both the percentage change in mTBF (mTBF ratio) and the percentage change in volume (volume ratio) were calculated using values obtained before and after radiotherapy. The correlation between the volume ratio and the mTBF ratio was assessed using linear regression analysis and Spearman’s rank correlation coefficient (r_s).ResultsA strong correlation was demonstrated between the tumor volume ratio and the mTBF ratio before and after radiotherapy (r_s= 0.93, P< .01). However, no significant correlation was identified between changes in enhancement and volume ratio (r_s= 0.20) or between changes in enhancement and mTBF ratio (r_s= 0.30) before and after radiotherapy.ConclusionThe mTBF measured using pcASL may serve as an additive index for tumor volume when determining tumor response to radiotherapy even in the absence of contrast material.     

Renal plasma flow (RPF) measured with multiple-inversion-time arterial spin labeling (ASL) and tracer kinetic analysis: Validation against a dynamic contrast-enhancement method

PurposeTo propose and validate a method for accurately quantifying renal plasma flow (RPF) with arterial spin labeling (ASL).Materials and methodsThe proposed method employs a tracer-kinetic approach and derives perfusion from the slope of the ASL difference signal sampled at multiple inversion-times (TIs). To validate the method's accuracy, we performed a HIPAA-compliant and IRB-approved study with 15 subjects (9 male, 6 female; age range 24–73) to compare RPF estimates obtained from ASL to those from a more established dynamic contrast-enhanced (DCE) MRI method. We also investigated the impact of TI-sampling density on the accuracy of estimated RPF.ResultsGood agreement was found between ASL- and DCE-measured RPF, with a mean difference of 9 ± 30 ml/min and a correlation coefficient R = 0.92 when ASL signals were acquired at 16 TIs and a mean difference of 9 ± 57 ml/min and R = 0.81 when ASL signals were acquired at 5 TIs. RPF estimated from ASL signals acquired at only 2 TIs (400 and 1200 ms) showed a low correlation with DCE-measured values (R = 0.30).ConclusionThe proposed ASL method is capable of measuring RPF with an accuracy that is comparable to DCE MRI. At least 5 TIs are recommended for the ASL acquisition to ensure reliability of RPF measurements.     

Fast carotid artery MR angiography with compressed sensing based three-dimensional time-of-flight sequence

ObjectiveIn this study, we sought to investigate the feasibility of fast carotid artery MR angiography (MRA) by combining three-dimensional time-of-flight (3D TOF) with compressed sensing method (CS-3D TOF).Materials and methodsA pseudo-sequential phase encoding order was developed for CS-3D TOF to generate hyper-intense vessel and suppress background tissues in under-sampled 3D k-space. Seven healthy volunteers and one patient with carotid artery stenosis were recruited for this study. Five sequential CS-3D TOF scans were implemented at 1, 2, 3, 4 and 5-fold acceleration factors for carotid artery MRA. Blood signal-to-tissue ratio (BTR) values for fully-sampled and under-sampled acquisitions were calculated and compared in seven subjects. Blood area (BA) was measured and compared between fully sampled acquisition and each under-sampled one.ResultsThere were no significant differences between the fully-sampled dataset and each under-sampled in BTR comparisons (P > 0.05 for all comparisons). The carotid vessel BAs measured from the images of CS-3D TOF sequences with 2, 3, 4 and 5-fold acceleration scans were all highly correlated with that of the fully-sampled acquisition. The contrast between blood vessels and background tissues of the images at 2 to 5-fold acceleration is comparable to that of fully sampled images. The images at 2 × to 5 × exhibit the comparable lumen definition to the corresponding images at 1 ×.ConclusionBy combining the pseudo-sequential phase encoding order, CS reconstruction, and 3D TOF sequence, this technique provides excellent visualizations for carotid vessel and calcifications in a short scan time. It has the potential to be integrated into current multiple blood contrast imaging protocol.     

Arterial spin labelling as a gadolinium-free alternative in the detection of prostate cancer

PurposeTo determine the capability of Gadolinium-free arterial spin labelling (ASL) sequences as novel, contrast-free, non-invasive alternative perfusion imaging method to differentiate prostate cancer (PCA) from benign prostate tissue compared to conventional DCE MRI.MethodsThirty men with histologically confirmed PCA were included in this prospectively enrolled single center cohort study. All patients received multiparametric MRI (T2, DWI, DCE) at 3 T with additional ASL of the PCA lesion. Primary endpoint was differentiability of PCA versus benign prostate tissue by signal intensities (SI) and contrast ratios (CR) in ASL in comparison to DCE. For DCE also Signal-Enhancement-Ratio (SER) of native and early contrast enhancement SI was assessed. Secondary objectives were differences regarding PCA localisation in peripheral (PZ) or transition zone (TZ) and PCA detection.ResultsIn both, ASL and DCE, average SI of PCA differed significantly from SI in benign tissue in the TZ and PZ (p < 0,01, respectively). ASL had significantly higher CR discerning PCA and benign tissue in PZ and TZ (PZ = 5.19; TZ = 6.45) compared to DCE SI (PZ = 1.61; TZ = 1.43) and DCE SER (PZ = 1.59; TZ = 1.43) (p < 0.01, respectively). In subjective evaluation, PCA could be detected in ASL in 28 patients, compared to 29 in DCE.ConclusionASL had significantly higher CR differentiating PCA from benign tissue in PZ and TZ compared to DCE. Visual detection of PCA does not differ significantly between the two sequences. As perfusion gadolinium-based contrast media is seen more critical in the last few years, ASL seems to be a promising alternative to DCE in PCA detection.     

Influence of cholecystectomy on the flow dynamic pattern of bile in the extrahepatic bile duct: Assessment by cine-dynamic MRCP with spatially-selective IR pulse

PurposeTo evaluate the influence of cholecystectomy on the flow dynamic pattern of bile in the extrahepatic bile duct by using cine-dynamic MRCP with spatially-selective inversion-recovery (IR) pulse non-invasively.Materials and methods56 patients with cholecystectomy and 48 control subjects without cholecystectomy who underwent cine-dynamic MRCP with spatially-selective IR pulse at 1.5 T or 3 T (TR/TE, 4000 msec/500 msec; echo train spacing, 6.5 msec; echo train length, 172; section thickness, 50 mm; matrix, 320 × 320; field of view, 320 × 320 mm; bandwidth, 488 Hz; and inversion time, 2200 msec). In cine-dynamic MRCP, IR pulse with 20 mm width was placed on the common bile duct (CBD) to evaluate the movement of bile (antegrade and reversed bile flow). Cine-dynamic MRCP imaging was scanned every 15 s (imaging, 4 s; rest, 11 s) during 5 min to acquire a series of single-shot images (a total of 20 images). The frequency that antegrade or reversed bile flow was observed in the extrahepatic bile duct, and 5-point grading score based on the moving distance of antegrade or reversed bile flow were compared between the groups. Both groups were compared using the χ² and Mann-Whitney U tests (P < 0.05 considered significant).ResultsAntegrade bile flow was observed more frequently in the cholecystectomy group than in the non-cholecystectomy group (5.1 times vs. 2.8 times, P = 0.008). Mean grading score of antegrade bile flow was significantly greater in the cholecystectomy group than in the non-cholecystectomy group (mean grade, 0.33 vs 0.21; P = 0.014). Regarding reversed bile flow, there were no significant differences in the frequency and grading score between cholecystectomy group and non-cholecystectomy group.ConclusionAntegrade bile flow was observed more frequently and predominantly in patients after cholecystectomy in cine-dynamic MRCP with spatially-selective IR pulse while reversed bile flow was observed equivalently.     

Group delay method for MRI aortic pulse wave velocity measurements in clinical protocols with low temporal resolution: Validation in a heterogeneous cohort

BackgroundMRI assessment of aortic pulse wave velocity (PWV) helps predict the risk of vascular events, but the recommended phase contrast sampling rate is faster than what is utilized in most clinical sequences. There are many existing MRI databases obtained for assessment of cardiac output using lower temporal frequency sampling where information might be obtained about aortic stiffness (PWV). In this work, we sought to evaluate whether the Group Delay (GD) method can generate a reproducible measure of stiffness and describe expected age-related stiffening of the aortic arch using lower sampling rates in standard clinical sequences.MethodsPhase contrast (PC) MRI was obtained on the ascending and descending aortic arch in a heterogeneous adult cohort (n = 23; 9 women) spanning over a wide range of ages (ages 24–89, mean 49.4 ± 18.4). Data was collected with standard cardiac MRI protocols for cardiac output evaluation (repetition time = 7.8 ms, views-per-segment = 4, encoding velocity = 200 cm/s). Pulse wave transit times (TT) were computed using the GD method, two other validated automated approaches (cross correlation TT Algorithm by Gaddum and Segment by Medviso), and the manual tangent method. Pressure waveforms from tonometry and flow waveforms from PC MRI were used to assess wave reflections.ResultsGroup Delay and TT-Algorithm showed significant and high retest reproducibility (r = 0.86 for both) as well as high PWV correlation with age (r = 0.93, P-value < 0.00005 and r = 0.96, P-value < 0.00005 respectively) and with each other (r = 0.94, P-value < 0.00001, RMSE = 0.94 m/s). Arbitrary altering of the image acquisition trigger in the GD method introduced error of 10%–13%, but the TT-algorithm error range was 11%–25%.ConclusionGroup Delay enables reproducible assessment of transit time to derive PWV from low temporal resolution clinical cardiac MRI sequences that can also identify age-related stiffening.     

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.     

Quantitative diffusion-weighted imaging and dynamic contrast-enhanced MR imaging for assessment of tumor aggressiveness in prostate cancer at 3T

PurposeTo compare diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MR imaging (DCE-MRI) for characterization of prostate cancer (PC).Methods104 PC patients who underwent prostate multiparametric MRI at 3T including DWI and DCE-MRI before MRI-guided biopsy or radical prostatectomy. Apparent diffusion coefficient (ADC) with histogram analysis (mean, 0–25th percentile, skewness, and kurtosis), intravoxel incoherent motion model including D and f; stretched exponential model including distributed diffusion coefficient (DDC) and a; and permeability parameters including K^trans, K_ep, and V_e were obtained from a region of interest placed on the dominant tumor of each patient.ResultsADC_mean, ADC_0–25, D, DDC, and V_e were significantly lower and K_ep was significantly higher in GS ≥ 3 + 4 tumors (n = 89) than in GS = 3 + 3 tumors (n = 15), and also in GS ≥ 4 + 3 tumors (n = 57) than in GS ≤ 3 + 4 tumors (n = 47) (P < 0.001 to P = 0.040). f was significantly lower in GS ≥ 4 + 3 tumors than in GS ≤ 3 + 4 tumors (P = 0.022), but there was no significant difference between GS = 3 + 3 tumors and GS ≥ 3 + 4 tumors, or between the remaining metrics in both comparisons. In metrics with area under the curve (AUC) >0.80, there was a significant difference in AUC between ADC_0–25 and D, and DDC for separating GS ≤ 3 + 4 tumors from GS ≥ 4 + 3 tumors (P = 0.040 and P = 0.022, respectively). There were no significant differences between metrics with AUC > 0.80 for separating GS = 3 + 3 tumors from GS ≥ 3 + 4 tumors. ADC_0–25 had the highest correlation with Gleason grade (ρ = −0.625, P < 0.001).ConclusionsDWI and DCE-MRI showed no apparent clinical superiority of non-Gaussian models or permeability MRI over the mono-exponential model for assessment of tumor aggressiveness in PC.     

Dynamic contrast-enhanced MRI with Gd-EOB-DTPA for the quantitative assessment of early-stage liver fibrosis induced by carbon tetrachloride in rabbits

PurposeTo explore quantitative parameters obtained by dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) with Gd-EOB-DTPA in discriminating early-stage liver fibrosis (LF) in a rabbit model.Materials and methodsLF was established in 60 rabbits by the injection of 50% CCl₄ oil solution, whereas 30 rabbits served as the control group. All rabbits underwent pathological examination to determine the LF stage using the METAVIR classification system. DCE MRI was performed, and quantitative parameters, including K^trans, K_ep, V_e, V_p and Re were measured and evaluated among the different LF stages using spearman correlation coefficients and receiver operating characteristic curve.ResultsIn all, 24, 25, and 22 rabbits had stage F0, stage F1, and stage F2 LF, respectively. K^trans (r = 0.803) increased, and K_ep (r = −0.495) and Re (r = −0.701) decreased with LF stage progression (P < 0.001), while no significant correlation was found for V_e or V_p. K^trans and Re were significantly different between all LF stage pairs compared (F0 vs. F1, F0 vs. F2, F1 vs. F2, F0 vs. F1-F2, P < 0.05). With the exception of F0 vs. F1, K_ep differed significantly between stages (P < 0.05). The AUC of K^trans was higher than that of other quantitative parameters, with an AUC of 0.92, 0.99, 0.94 and 0.92 for staging F0 vs. F1, F0 vs. F2, F1 vs. F2, and F0 vs. F1-F2, respectively.ConclusionAmong quantitative parameters of Gd-EOB-DTPA DCE MRI, K^trans was the best predictor for quantitatively differentiating early-stage LF.     

The effect of morphological and microstructural integrity of the corpus callosum on cognition,fatigue and depression in mildly disabled MS patients

AimTo assess the value of callosal morphological and microstructural integrity in assessing different cognitive domains, fatigue and depression in mildly disabled multiple sclerosis (MS) patients.Materials and methodsWe assessed 29 mildly disabled MS patients and 15 healthy controls using 3T magnetic resonance images (T1-weighted, FLAIR and DTI) and neuropsychological tests assessing different cognitive functions, depression and fatigue. We compared the added value of morphological measures (corpus callosum area corrected for total intracranial volume, index, circularity and the more detailed thickness profile) and diffusion features (fractional anisotropy and mean diffusivity) in multilinear models including standard clinical and whole-brain parameters in assessing neuropsychological scores.ResultsEven in mildly disabled MS patients, a significant reduction of the corpus callosum (p < 0.001) was observed in comparison to healthy controls. Callosal area, index and circularity were significantly (p < 0.002) related to whole-brain white matter volume, T2 lesion load and deep grey matter volume, but not with cortical grey matter.The combination of commonly used imaging and clinical parameters explained between 7% (Fatigue) and 50% (processing speed, verbal memory) of the adjusted variance. Inclusion of the mean diffusivity increased the adjusted R² significantly to 69% (p = 0.004) and 71% (p = 0.002) for visuospatial and verbal memory respectively.ConclusionOur results show that callosal features may be used as an alternative to measuring whole-brain volumes. Furthermore, the microstructural integrity of the corpus callosum can help to predict an MS patient's memory performance.     

Assessment of the link between quantitative biexponential diffusion-weighted imaging and contrast-enhanced MRI in the liver

PurposeTo investigate if intravoxel incoherent motion (IVIM) modeled diffusion-weighted imaging (DWI) can be linked to contrast-enhanced (CE-)MRI in liver parenchyma and liver lesions.MethodsTwenty-five patients underwent IVIM-DWI followed by multiphase CE-MRI using Gd-EOB-DTPA (n = 20) or Gd-DOTA (n = 5) concluded with IVIM-DWI. Diffusion (D_slow), microperfusion (D_fast), its fraction (f_fast), wash-in-rate (R_early) and late-enhancement-rate (R_late) of Gd-EOB-DTPA were calculated voxel-wise for the liver. Parenchyma and lesions were segmented. Pre-contrast IVIM was compared 1) between low, medium and high R_early for parenchyma 2) to post-contrast IVIM substantiated with simulations 3) between low and high R_late per lesion type.ResultsD_fast and f_fast increased (P < 0.001) with 25.6% and 33.8% between low and high R_early of Gd-EOB-DTPA. D_slow decreased (− 15.0%; P < 0.001) with increasing R_early. Gd-DOTA demonstrated similar observations. f_fast (+ 10%; P < 0.001) and D_fast (+ 6.6%; P < 0.001) increased after Gd-EOB-DTPA, while decreasing after Gd-DOTA (− 4.2% and − 5.7%, P < 0.001) and were confirmed by simulations. For focal nodular hyperplasia lesions (n = 5) D_fast and f_fast increased (P < 0.001) with increasing R_late, whereas for hepatocellular carcinoma (n = 4) and adenoma (n = 7) no differences were found.ConclusionMicroperfusion measured by IVIM reflects perfusion in a way resembling CE-MRI. Also IVIM separated intra- and extracellular MR contrast media. This underlines the potential of IVIM in quantitative liver imaging.     

Validation of non-contrast multiple overlapping thin-slab 4D-flow cardiac magnetic resonance imaging

BackgroundCardiac magnetic resonance (CMR) flow quantification is typically performed using 2D phase-contrast (PC) imaging of a plane perpendicular to flow. 3D-PC imaging (4D-flow) allows offline quantification anywhere in a thick slab, but is often limited by suboptimal signal, potentially alleviated by contrast enhancement. We developed a non-contrast 4D-flow sequence, which acquires multiple overlapping thin slabs (MOTS) to minimize signal loss, and hypothesized that it could improve image quality, diagnostic accuracy, and aortic flow measurements compared to non-contrast single-slab approach.MethodsWe prospectively studied 20 patients referred for transesophageal echocardiography (TEE), who underwent CMR (GE, 3 T). 2D-PC images of the aortic valve and three 4D-flow datasets covering the heart were acquired, including single-slab, pre- and post-contrast, and non-contrast MOTS. Each 4D-flow dataset was interpreted blindly for ≥moderate valve disease and compared to TEE. Flow visualization through each valve was scored (0 to 4), and aortic-valve flow measured on each 4D-flow dataset and compared to 2D-PC reference.ResultsDiagnostic quality visualization was achieved with the pre- and post-contrast 4D-flow acquisitions in 25% and 100% valves, respectively (scores 0.9 ± 1.1 and 3.8 ± 0.5), and in 58% with the non-contrast MOTS (1.6 ± 1.1). Accuracy of detection of valve disease was 75%, 92% and 82%, respectively. Aortic flow measurements were possible in 53%, 95% and in 89% patients, respectively. The correlation between pre-contrast single-slab measurements and 2D-PC reference was weak (r = 0.21), but improved with both contrast enhancement (r = 0.71) and with MOTS (r = 0.67).ConclusionsAlthough non-contrast MOTS 4D-flow improves valve function visualization and diagnostic accuracy, a significant proportion of valves cannot be accurately assessed. However, aortic flow measurements using non-contrast MOTS is feasible and reaches similar accuracy to that of contrast-enhanced 4D-flow.     

Optimized enhanced acceleration selective arterial spin labeling (eAccASL) for non-gated and non-enhanced MR angiography of the hands

PurposeEnhanced acceleration selective arterial spin labeling (eAccASL) was introduced as non-enhanced and non-gated magnetic resonance angiography (MRA). This technique has not been applied to hand MRA. The objective of this study was to optimize the eAccASL for MRA of the hands and to investigate the factors for MRA visibility of the hands.MethodsTwenty healthy volunteers were examined on a 1.5 T MR system. To evaluate arterial visualization, we compared four different acceleration-encoding (AENC) values (i.e., 0.12, 0.29, 0.58, and 0.87 m/s²). Image quality score regarding the MRA depiction of the proximal artery (range, 0–10), the distal artery (0–5), and venous contamination (0–5) was evaluated by three radiologists. We measured the peak to peak arterial blood flow velocity (Vpp) measured by phase contrast cine MRI and hand temperature as the factors for arterial visualization. Qualitative scores were compared with Friedman's tests. Spearman's correlation of qualitative scores with Vpp and hand temperature was performed to analyze influencing factors.ResultsFor the distal arterial depiction, scores at AENC 0.12 (median, 9.0) and AENC 0.29 (8.0) were significantly better (both P < 0.0001) than those at AENC 0.87 (5.5). For the proximal arterial depiction, scores at AENC 0.12 (2.25) and AENC 0.29 (2.0) were significantly better (P < 0.001 and P < 0.01, respectively) than those at AENC 0.87 (1.5). Conversely, venous contamination scores at AENC 0.12 (3.0) and AENC 0.29 (3.0) were significantly worse (both P < 0.0001) than those at AENC 0.87 (4.0). There were significantly negative correlations between venous contamination and Vpp at AENC 0.12 (ρ = −0.56, P = 0.01), and 0.29 (ρ = −0.68, P = 0.001), whereas hand temperatures were not significantly correlated with scores (all P > 0.05).ConclusioneAccASL MRA of the hands was optimized by using low AENC values (0.12–0.29 m/s²). Venous contamination may increase with elevation of arterial blood flow.     

Precision-optimized single protocol pre-/post-contrast modified-look locker inversion T1 mapping using composite inversion group fitting

BackgroundInvestigation of a simple, precision optimized, identical pre−/post-contrast modified look locker inversion recovery (MOLLI) protocol employing Composite inversion group (IG) fitting in a clinical cardiomyopathy population.MethodsCardiac magnetic resonance imaging (MRI) was performed at 3 Tesla in 36 patients (48.0 years [IQR: 35.7, 58.2 years]) with known/suspicion of hypertrophic cardiomyopathy. T1 mapping was performed pre−/post-contrast (0.15 mmol/kg Gadobutrol) using a standard 3-parameter fit (STANDARD) and an optimized (OPTIMAL) single-protocol Composite-IG fitting MOLLI approach. The OPTIMAL protocol was based on a simulation study (for 11hb acquisitions) with cost metric analysis across the range of expected T1 values (300-1400 ms) and heart rates (50-80 bpm).All maps were generated offline based on motion corrected source images. Based on region of interest analysis, the precision of both approaches was assessed using a previously validated propagation of errors technique for pre−/post-contrast T1 mapping as well as calculated ECV (based on point-of care hematocrit measurements. Furthermore, respective T1 and ECV values were calculated. Statistical methods included Wilcoxon Signed-Rank tests and Student's paired t-test.ResultsA total of ~9000 11hb inversion groupings were simulated with a 4(0)2(0)2(0)2(0)1 grouping providing the optimal precision across the specified T1/heart rate range. In comparison to standard pre-contrast 5(3)3 MOLLI, this OPTIMAL protocol demonstrated a significantly improved pre-contrast precision (9.1 [6.2, 9.9]ms vs. 9.4 [7.3, 10.8]ms; P < 0.001) while no significant differences were found for post-contrast T1 mapping (4.5 [2.6, 5.3]ms vs. 4.2 [2.8, 5.1]ms; P = 0.25) and EVC mapping (0.38 [0.28, 0.45]ms vs. 0.35 [0.25, 0.44]ms; P = 0.07) or reproducibility (0.16 [0.14, 0.19] vs. 0.19 [0.13, 0.23] P = 0.53).Direct comparison of resulting T1/ECV values demonstrated no significant differences between STANDARD and OPTIMAL techniques for pre-contrast T1 (1178 [1158, 1199]ms vs. 1173 [1143, 1195]ms; P = 0.46) and significant differences for post-contrast T1 (466 [446, 506]ms vs. 456 [433, 503]ms; P = 0.04) and ECV (23.1 [20.8, 25.1]% vs. 23.9 [22.3, 26.4]%; P = 0.001).ConclusionsA single optimized Composite-IG fitting protocol for pre−/post-contrast T1 mapping demonstrated improved precision over standard MOLLI techniques. It enables a simplified workflow with reduction of potential sources of error especially with respect to image data co-registration easing advanced post-processing for generation of patient specific ECV maps.     

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.     

Evaluating renal arterial wall by non-enhanced 2D and 3D free-breathing black-blood techniques: Initial experience

ObjectivesTo evaluate the feasibility and reproducibility of 2D and 3D black-blood sequences in measuring morphology of renal arterial wall.MethodsThe 2D and 3D imaging sequences used variable-refocusing-flip-angle and constant-low-refocusing-flip-angle turbo spin echo (TSE) readout respectively, with delicately selected black-blood scheme and respiratory motion trigger for free-breathing imaging. Fourteen healthy subjects and three patients with Takayasu arteritis underwent renal artery wall imaging with 3D double inversion recovery (DIR) TSE and 2D Variable Flip Angle-TSE (VFA-TSE) black-blood sequences at 3.0 T. Four healthy subjects were randomly selected for scan-rescan reproducibility experiments. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and morphology of arterial wall were measured and compared using paired-t-test or Wilcoxon signed-rank test between 2D and 3D sequences. The inter-observer, intra-observer and scan-rescan agreements of above measurements were determined using intraclass correlation coefficient (ICC).ResultsThe 2D and 3D imaging sequences showed similar morphological measurements (lumen area, wall area, mean wall thickness and maximum wall thickness) of renal arterial wall (all P > 0.05) and excellent agreement (ICC: 0.853–0.954). Compared to 2D imaging, 3D imaging exhibited significantly lower SNR_lumen (P < 0.01) and SNR_wall (P = 0.037), similar contrast-to-noise ratio (CNR) (P = 0.285), and higher CNR efficiency (CNR_eff) (P < 0.01). Both 2D and 3D imaging showed good to excellent inter-observer (ICC: 0.723–0.997), intra-observer (ICC: 0.749–0.996) and scan-rescan (ICC: 0.710–0.992) reproducibility in measuring renal arterial wall morphology, SNR and CNR, respectively.ConclusionsBoth high-resolution free-breathing 2D VFA-TSE and 3D DIR TSE black-blood sequences are feasible and reproducible in high-resolution renal arterial wall imaging. The 2D imaging has high SNR, whereas 3D imaging has high imaging efficiency.     

Rapid whole-brain quantitative magnetization transfer imaging using 3D selective inversion recovery sequences

Selective inversion recovery (SIR) is a quantitative magnetization transfer (qMT) method that provides estimates of parameters related to myelin content in white matter, namely the macromolecular pool-size-ratio (PSR) and the spin-lattice relaxation rate of the free pool (R_1f), without the need for independent estimates of ∆B₀, B₁⁺, and T₁. Although the feasibility of performing SIR in the human brain has been demonstrated, the scan times reported previously were too long for whole-brain applications. In this work, we combined optimized, short-TR acquisitions, SENSE/partial-Fourier accelerations, and efficient 3D readouts (turbo spin-echo, SIR-TSE; echo-planar imaging, SIR-EPI; and turbo field echo, SIR-TFE) to obtain whole-brain data in 18, 10, and 7 min for SIR-TSE, SIR-EPI, SIR-TFE, respectively. Based on numerical simulations, all schemes provided accurate parameter estimates in large, homogenous regions; however, the shorter SIR-TFE scans underestimated focal changes in smaller lesions due to blurring. Experimental studies in healthy subjects (n = 8) yielded parameters that were consistent with literature values and repeatable across scans (coefficient of variation: PSR = 2.2–6.4%, R_1f = 0.6–1.4%) for all readouts. Overall, SIR-TFE parameters exhibited the lowest variability, while SIR-EPI parameters were adversely affected by susceptibility-related image distortions. In patients with relapsing remitting multiple sclerosis (n = 2), focal changes in SIR parameters were observed in lesions using all three readouts; however, contrast was reduced in smaller lesions for SIR-TFE, which was consistent with the numerical simulations. Together, these findings demonstrate that efficient, accurate, and repeatable whole-brain SIR can be performed using 3D TFE, EPI, or TSE readouts; however, the appropriate readout should be tailored to the application.