A semiautomatic postprocessing of liver R2* measurement for assessment of liver iron overload

Purpose

The purpose was to propose and evaluate a semiautomatic postprocessing method to measure liver R2^? values in patients with a broad range of liver iron content.

Materials and Methods

Multiecho gradient echo magnetic resonance images were acquired in patients diagnosed with thalassemia or other types of congenital anemias. Liver R2^? values were measured using a routine manually defined region-of-interest (mROI) method and a semiautomatic (SA) method. In the semiautomatic method, pixelwise (pSA) and averaged (aSA) signal fitting was performed on the segmented liver tissues after hepatic vessel extraction. The pixelwise fitting approach resulted in a liver R2^? map with an overlay of nonfitted pixels associated with noise performance. The following aSA approach derived overall R2^? by fitting the averaged signal intensities of all pixels within the liver ROI excluding vessels and nonfitted pixels. The measurement accuracy and interobserver agreement using mROI and the two semiautomatic approaches (pSA and aSA) were evaluated.

Results

In a total of 45 exams with R2^? ranging from 30 to 1500 s⁻¹, the R2^? measurements using all three methods were overall highly correlated and concordant with each other. R2^? values measured by aSA were consistently higher than those measured by mROI. At lower R2^? (<1000 s⁻¹), R2^? values measured by pSA were consistent with aSA but higher than mROI; with increasing R2^?, the pSA method became less stable and underestimated R2^? due to increased noise level. The interobserver agreement was higher for the aSA method compared to pSA and mROI.

Conclusion

The semiautomatic postprocessing method provides a promising tool for reliable liver R2^? measurement with additional information for overall evaluation of iron distribution and measurement confidence. This method may offer the potential of reducing interoperator variability and improving diagnostic confidence in patients with liver iron overload.     

GESFIDE-PROPELLER Approach for Simultaneous R2 and R2* Measurements in the Abdomen

Purpose

To investigate the feasibility of combining GESFIDE with PROPELLER sampling approaches for simultaneous abdominal R2 and R2* mapping.

Materials and Methods

R2 and R2* measurements were performed in 9 healthy volunteers and phantoms using the GESFIDE-PROPELLER and the conventional Cartesian-sampling GESFIDE approaches.

Results

Images acquired with the GESFIDE-PROPELLER sequence effectively mitigated the respiratory motion artifacts, which were clearly evident in the images acquired using the conventional GESFIDE approach. There was no significant difference between GESFIDE-PROPELLER and reference MGRE R2* measurements (p = 0.162) whereas the Cartesian-sampling based GESFIDE methods significantly overestimated R2* values compared to MGRE measurements (p < 0.001).

Conclusion

The GESFIDE-PROPELLER sequence provided high quality images and accurate abdominal R2 and R2* maps while avoiding the motion artifacts common to the conventional Cartesian-sampling GESFIDE approaches.     

Assessment of cardiac iron by MRI susceptometry and R2* in patients with thalassemia

A magnetic resonance imaging cardiac magnetic susceptometry (MRI-CS) technique for assessing cardiac tissue iron concentration based on phase mapping was developed. Normal control subjects (n=9) and thalassemia patients (n=13) receiving long-term blood transfusion therapy underwent MRI-CS and MRI measurements of the cardiac relaxation rate R2*. Using MRI-CS, subepicardium and subendocardium iron concentrations were quantified exploiting the hemosiderin/ferritin iron specific magnetic susceptibility. The average of subepicardium and subendocardium iron concentrations and R2* of the septum were found to be strongly correlated (r=0.96, P<.0001), and linear regression analysis yielded CIC (μg Fe/g_{wet tissue})=(6.4±0.4)·R2* _septum (s⁻¹) − (120±40). The results demonstrated that septal R2* indeed measures cardiac iron level.     

Cardiac T2 measurements in patients with iron overload: a comparison of imaging parameters and analysis techniques

Measurement of cardiac T2 has emerged as an important tool to noninvasively quantify cardiac iron concentration in order to detect preclinical evidence of toxic levels and titrate chelation therapy. However, there exists variation among practitioners in cardiac T2 measurement methods. This study examines the impact of different imaging parameters and data analysis techniques on the calculated cardiac R2 (1/T2) in patients at risk for cardiac siderosis. The study group consisted of 36 patients with thalassemia syndromes who had undergone clinical magnetic resonance imaging assessment of cardiac siderosis using a standardized protocol and who were selected to yield a broad range of cardiac R2 values. Cardiac R2 measurements were performed on a 1.5-T scanner using an electrocardiogram-gated, segmented, multiecho gradient echo sequence obtained in a single breath-hold. R2 was calculated from the signal intensity versus echo time data in the ventricular septum on a single midventricular short-axis slice. There was good agreement between R2 measured with a blood suppression prepulse (black blood technique) and without (mean difference 6.0 ± 10.7 Hz). The black blood technique had superior within-study reproducibility (R2 mean difference 1.6 ± 8.6 Hz versus 2.7 ± 14.6 Hz) and better interobserver agreement (R2 mean difference 3.4 ± 8.2 Hz versus 8.3 ± 16.5 Hz). With the same minimum echo time, the use of small (1.0 ms) versus large (2.2 ms) echo spacing had minimal impact on cardiac R2 (mean difference 0.3 ± 8.7 Hz). The application of a region-of-interest-based versus a pixel-based data analysis also had little effect on cardiac R2 calculation (mean difference 8.4 ± 6.9 Hz). With black blood images, fitting the signal curve to a monoexponential decay or to a monoexponential decay with a constant offset yielded similar R2 values (mean difference 3.4 ± 8.1 Hz). In conclusion, the addition of a blood suppression prepulse for cardiac R2 measurement yields similar R2 values and improves reproducibility and interobserver agreement. The findings regarding other variations may be helpful in establishing a broadly accepted imaging and analysis technique for cardiac R2 calculation.     

Comparison between multi-echo T2* with and without fat saturation pulse for quantification of liver iron overload

Purpose

To test a magnetic resonance image (MRI) technique that uses an additional pulse in multi-echo T2* sequence that works to suppress the fat signal, in subjects with liver iron overload and concomitant presence of fat in the liver, which have been revealed as a major drawback that compromises the correct iron quantification by MRI.

Materials and Methods

Fifty magnetic resonance images of the liver (1.5 T scanner) of individuals with blood ferritin increases were retrospectively reviewed for the presence of steatosis, using the sequence in and out of phase, and iron overloading, using two sequences T2 * multi-echo: one standard and other with additional fat suppression pulse. T2 * values and their standard deviations were analyzed statistically.

Results

Our results showed that a significantly lower standard deviation of T2* values is obtained when the fat saturation pulse is applied in patients with steatosis. We found that modulation of fat signal on liver iron overload resulted in a different categorization of some patients. In one case, the patient was re-classified within normal levels of liver iron.

Conclusion

Our findings may contribute to a better measure of liver iron overload with relevant implications for patient treatment and care.     

Development of T2-relaxation values in regional brain sites during adolescence

Brain tissue changes accompany multiple neurodegenerative and developmental conditions in adolescents. Complex processes that occur in the developing brain with disease can be evaluated accurately only against normal aging processes. Normal developmental changes in different brain areas alter tissue water content, which can be assessed by magnetic resonance (MR) T2 relaxometry. We acquired proton-density (PD) and T2-weighted images from 31 subjects (mean age±S.D., 17.4±4.9 years; 18 male), using a 3.0-T MR imaging scanner. Voxel-by-voxel T2-relaxation values were calculated, and whole-brain T2-relaxation maps constructed and normalized to a common space template. We created a set of regions of interest (ROIs) over cortical gray and white matter, basal ganglia, amygdala, thalamic, hypothalamic, pontine and cerebellar sites, with sizes of ROIs varying from 12 to 243 mm³; regional T2-relaxation values were determined from these ROIs and normalized T2-relaxation maps. Correlations between R2 (1/T2) values in these sites and age were assessed with Pearson's correlation procedures, and gender differences in regional T2-relaxation values were evaluated with independent-samples t tests. Several brain regions, but not all, showed principally positive correlations between R2 values and age; negative correlations emerged in the cerebellar peduncles. No significant differences in T2-relaxation values emerged between males and females for those areas, except for the mid pons and left occipital white matter; males showed higher T2-relaxation values over females. The findings indicate that T2-relaxation values vary with development between brain structures, and emphasize the need to correct for such age-related effects during any determination of potential changes from control values.     

Use of cine phase-contrast MRI in the assessment of distal splenorenal shunt function

Magnetic resonance imaging (MRI) features of a surgical splenorenal shunt in a 28-year-old girl are described. The woman underwent color doppler ultrasonography during follow up for the shunt, which was inconclusive. MR was used to investigate the function of the shunt. Velocity and flow direction in splanchnic vessels and in the shunt were evaluated using cine fast phase-contrast sequences. MR findings could be of help in the evaluation of patients undergoing surgical shunts during follow up.     

Quantitative liver iron measurement by magnetic resonance imaging: in vitro and in vivo assessment of the liver to muscle signal intensity and the R2* methods

Purpose

To evaluate the liver-to-muscle signal intensity and R2* methods to gain a transferable, clinical application for liver iron measurement.

Materials and Methods

Sixteen liver phantoms and 33 human subjects were examined using three 1.5-T MRI scanners from two different vendors. Phantom-to-muscle and liver-to-muscle signal intensity ratios were analyzed to determine MRI estimated phantom and hepatic iron concentration (M-PIC and M-HIC, respectively). R2* was calculated for the phantoms and the liver of human subjects. Seven patients' biochemical hepatic iron concentration was obtained.

Results

M-PIC and R2* results of three scanners correlated linearly to phantom iron concentrations (r=0.984 to 0.989 and r=0.972 to 0.981, respectively), and no significant difference between the scanners was found (P=.482 and P=.846, respectively) in vitro. The patients' R2* correlated linearly to M-HIC of the standard scanner (r=0.981). M-HIC values did not differ from those obtained from the biopsy specimens (P=.230). The difference in M-HIC was significant, but the difference in R2* was not significant between the scanners (P<.0001 and P=.505, respectively) in vivo.

Conclusion

Both methods, M-HIC and R2*, are reliable iron concentration indicators with linear dependence on iron concentration in vivo and in vitro. The R2* method was found to be comparable among different scanners. Transferability testing is needed for the use of the methods at various scanners.     

Diffusion-weighted imaging versus superparamagnetic iron oxide (SPIO)-enhanced MRI: exclusive and combined values in the assessment of hepatic metastases

Purpose

The purpose was to validate diffusion-weighted imaging (DWI) in the assessment of hepatic metastases compared with superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging.

Materials and Methods

For 21 consecutive patients with 160 metastases from extrahepatic malignancy and 25 benign focal lesions, two radiologists evaluated four separate review sessions (I, SPIO-enhanced T2?-weighted images; II, precontrast DWI; III, SPIO-enhanced T2?-weighted images and precontrast DWI; IV, SPIO-enhanced T2?-weighted images plus precontrast and SPIO-enhanced DWI) and assigned confidence levels using a five-grade scale for each hepatic lesion.

Results

The A_z values after receiver operating characteristic curve analysis for Reader 1 and Reader 2 were 0.80 and 0.75 on session I, 0.91 and 0.91 on session II, 0.97 and 0.96 on session III and 0.96 and 0.96 on session IV, respectively. The A_z value of session II was significantly higher than that of session I (Reader 1, P=.004; Reader 2, P<.001), and that of session III was significantly higher than that of session I (P<.001 for each reader) or session II (Reader 1, P=.004; Reader 2, P=.003). Although there was no significant difference of A_z value between session III and session IV (Reader 1, P=.231; Reader 2, P=.878), the sensitivity improved for session IV compared with that for session III (Reader 1, P=.031; Reader 2, P=.039).

Conclusion

In the assessment of hepatic metastases, DWI can provide more accurate information than can SPIO-enhanced images. Diagnostic accuracy can be increased even more through the combination of both techniques.     

Blood oxygen level-dependent MRI for the monitoring of neoadjuvant chemotherapy in breast carcinoma: initial experience

Purpose

To determine the feasibility of using R2? map MRI for pretreatment diagnosis and monitoring of tumor response to neoadjuvant chemotherapy (NAC) in patients with breast cancer.

Material and Methods

Twenty-eight women with breast cancer, as evidenced by pathology, underwent MR imaging prior to and after chemotherapy. All patients were examined by conventional MRI and R2? map imaging. Subjects were divided into major histological response (MHR) and non-major histological response (NMHR) groups. Mean R2? values of cancerous and normal glandular tissues were measured before and following NAC. Differences in R2? and ΔR2?% values between these two groups were compared with paired or independent t tests. The relationship between ΔR2?% and histological response was examined using Spearman's correlation test.

Results

Before NAC, the average R2? values in carcinoma were lower than in normal glandular tissue (P<.05). After two to four cycles of NAC, the R2? values in carcinoma were increased (P<.05 ), but this change was not significant in normal glandular tissue. After NAC, ΔR2?% was significantly higher in MHR as compared to NMHR (P<.05). The ΔR2?% correlated with the histological response (r=0.581, P<.01).

Conclusion

In women undergoing NAC for breast cancer treatment, R2? and ΔR2?% appear to provide predictive information of tumor response which is probably associated with changes in tumor angiogenesis and tissue oxygenation. R2? map imaging of breasts may therefore be useful in monitoring tumor response to NAC.     

MRI allows for longitudinal quantitative analysis of body fat composition in rats: An analysis of sibutramine-associated changes at the group level

Purpose

Body fat distribution changes are associated with multiple alterations in metabolism. Therefore, the assessment of body fat compartments by MRI in animal models is a promising approach to obesity research. Standard T1-weighted (T1w) whole body MRI was used here to quantify different effects in the subcutaneous and visceral fat compartments in rats under treatment with an anorexiant.

Materials and methods

Twenty rats on a high caloric diet were investigated by the identical MRI protocol at baseline and after seven weeks. Ten rats received a treatment with sibutramine, 10 rats served as vehicle control group. To longitudinally assess body fat components, MRI analysis was used with two approaches: 2D slicewise graphic analysis (SGA) was compared with an automated 3D analysis algorithm (3DA).

Results

At the group level, fat volume differences showed a longitudinal increase of subcutaneous and visceral fat volumes for the control group, whereas the sibutramine group showed stable subcutaneous fat volumes and decrease in visceral fat volumes. SGA and 3DA volume determination showed significant correlations for subcutaneous fat volume (C = 0.85, p < 0.001), visceral fat volume (C = 0.87, p < 0.001), and total fat volume (C = 0.90, p < 0.001).

Conclusion

It could be demonstrated that computer-based analysis of T1w MRI could be used to longitudinally assess changes in body fat compartments in rats at the group level. In detail, it was possible to investigate the effect of sibutramine separate on the fat compartments in rats.     

Role of apparent diffusion coefficient values for the differentiation of viable and necrotic areas of breast cancer and its potential utility to guide voxel positioning for MRS in the absence of dynamic contrast-enhanced MRI data

We carried out retrospective analysis of apparent diffusion coefficient (ADC) values in 48 infiltrating ductal breast cancer patients who had dynamic contrast-enhanced magnetic resonance imaging (DCEMRI; Group I) and in 53 patients (Group II) for whom DCEMRI data were not available. Twenty-three patients of Group I showed no necrosis (Group Ia), while in 25 patients, both viable (nonnecrotic) and necrotic tumor areas (Group Ib) were observed on DCEMRI. T1-weighted, fat-suppressed and short inversion recovery images were used to identify the viable and necrotic tumor areas in Group II patients, and necrosis was not seen in 11 patients (Group IIa), while 42 (Group IIb) showed both viable and necrotic tumor areas. The ADCs of the necrotic area of Group Ib (1.79±0.30 ×10(-3) mm(2)/s) and Group IIb (1.83±0.40 ×10(-3) mm(2)/s) patients were similar and significantly higher (P<.01) compared to the ADCs of the viable tumor area of Group Ia (0.96±0.21 ×10(-3) mm(2)/s) and Group IIa (0.90±0.17 ×10(-3) mm(2)/s) patients. Proton MR spectroscopy (MRS) data were also available in these patients, and the ADC values were retrospectively determined from the voxel from which MR spectrum was obtained. These values were compared with the ADC obtained for the viable and necrotic areas of the tumor. ADC of the MRS voxel was similar to that obtained for the viable tumor area in patients of both groups. This interesting observation reveals the potential utility of using ADC values to identify viable tumor area for positioning of voxel for MRS in the absence of DCEMRI data.     

A comparative study at 3 T of sequence dependence of T2 quantitation in the knee

Objective

T₂ mapping has been used widely in detecting cartilage degeneration in osteoarthritis. Several scanning sequences have been developed in the determination of T₂ relaxation times of tissues. However, the derivation of these times may vary from sequence to sequence. This study seeks to evaluate the sequence-dependent differences in T₂ quantitation of cartilage, muscle, fat and bone marrow in the knee joint at 3 T.

Methods

Three commercial phantoms and 10 healthy volunteers were studied using 3 T MR. T₂ relaxation times of the phantoms, cartilage, muscle, subcutaneous fat and marrow were derived using spin echo (SE), multiecho SE (MESE), fast SE (FSE) with varying echo train length (ETL), spiral and spoiler gradient (SPGR) sequences. The differences between these times were then evaluated using Student's t test. In addition, the signal-to-noise ratio (SNR) efficiency and coefficient of variation of T₂ from each sequence were calculated.

Results

The average T₂ relaxation time was 36.38±5.76 ms in cartilage and 34.08±6.55 ms in muscle, ranging from 27 to 45 ms in both tissues. The times for subcutaneous fat and marrow were longer and more varying, ranging from 41 to 143 ms and from 42 to 160 ms, respectively. In FSE acquisition, relaxation time significantly increases as ETL increases (P<.05). In cartilage, the SE acquisition yields the lowest T₂ values (27.52±3.10 ms), which is significantly lower than those obtained from other sequences (P<.002). T₂ values obtained from spiral acquisition (38.27±6.45 ms) were higher than those obtained from MESE (34.35±5.62 ms) and SPGR acquisition (31.64±4.53 ms). These differences, however, were not significant (P>.05).

Conclusion

T₂ quantification can be a valuable tool for the diagnosis of degenerative disease. Several different sequences exist to quantify the relaxation times of tissues. Sequences range in scan time, SNR efficiency, reproducibility and two- or three-dimensional mapping. However, when choosing a sequence for quantitation, it is important to realize that several factors affect the measured T₂ relaxation time.     

MSE-MRI sequence optimisation for measurement of bi- and tri-exponential T2 relaxation in a phantom and fruit

The transverse relaxation signal from vegetal cells can be described by multi-exponential behaviour, reflecting different water compartments. This multi-exponential relaxation is rarely measured by conventional MRI imaging protocols; mono-exponential relaxation times are measured instead, thus limiting information about of the microstructure and water status in vegetal cells. In this study, an optimised multiple spin echo (MSE) MRI sequence was evaluated for assessment of multi-exponential transverse relaxation in fruit tissues. The sequence was designed for the acquisition of a maximum of 512 echoes. Non-selective refocusing RF pulses were used in combination with balanced crusher gradients for elimination of spurious echoes. The study was performed on a bi-compartmental phantom with known T₂ values and on apple and tomato fruit. T₂ decays measured in the phantom and fruit were analysed using bi- and tri-exponential fits, respectively. The MRI results were compared with low field non-spatially resolved NMR measurements performed on the same samples.     

Quantitative assessment of iron deposition in the midbrain using 3D-enhanced T2 star weighted angiography (ESWAN): A preliminary cross-sectional study of 20 Parkinson’s disease patients

Conventional magnetic resonance imaging (MRI) assesses neurodegenerative structural changes in the cerebral anatomy of Parkinson's disease (PD) patients but cannot detect non-structural abnormalities; however, enhanced T2 star weighted angiography (ESWAN) can precisely indicate PD-related substantia nigra (SN) iron deposition. The differences in ESWAN-based parameters between different PD stages were assessed using midbrain iron deposits of 20 PD patients aged 64.3 ± 12.7 (41–85) years grouped by Hoehn and Yahr staging into minimal (stages ≤ 2.5) or moderate to severe (stages ≥ 3.0) motor impairment groups and 14 healthy control subjects. Conventional MRI and ESWAN measurements of mean phase value (MPV) and midbrain dimensions (width and diameter) revealed similar anatomical characteristics; however, ESWAN revealed the presence of smaller MPVs and SN pars compacta (SNc) (P < 0.01) and a negative correlation between reduction extent and motor impairment (P < 0.01). SNc width to midbrain diameter was reduced in moderate to severe impairment patients versus control and minimal impairment patients (both P < 0.01). A positive correlation was found between MPV and width or SNc width to midbrain diameter ratio (P < 0.01 and P < 0.05, respectively). Minimal impairment group mean MPV and substantia nigra pars reticulata (SNr) width evidenced no significant reduction, unlike significant reductions in the moderate to severe impairment group (P < 0.01). No significant changes were observed in MPV or width in the RN region (P > 0.05). ESWAN allows for early and accurate iron deposition determination in PD patients, particularly useful as a supplement to conventional MRI in early-stage PD patients.