RF-related heating assessment of extracranial neurosurgical implants at 7 T

Purpose

The purpose was to evaluate radiofrequency (RF)-related heating of commonly used extracranial neurosurgical implants in 7-T magnetic resonance imaging (MRI).

Materials and methods

Experiments were performed using a 7-T MR system equipped with a transmit/receive RF head coil. Four commonly used titanium neurosurgical implants were studied using a test procedure adapted from the American Society for Testing and Materials Standard F2182-11a. Implants (n = 4) were tested with an MRI turbo spin echo pulse sequence designed to achieve maximum RF exposure [specific absorption rate (SAR) level = 9.9 W/kg], which was further validated by performing calorimetry. Maximum temperature increases near each implant's surface were measured using fiberoptic temperature probes in a gelled-saline-filled phantom that mimicked the conductive properties of soft tissue. Measurement results were compared to literature data for patient safety.

Results

The highest achievable phantom averaged SAR was determined by calorimetry to be 2.0 ± 0.1 W/kg due to the highly conservative SAR estimation model used by this 7-T MR system. The maximum temperature increase at this SAR level was below 1.0 °C for all extracranial neurosurgical implants that underwent testing.

Conclusion

The findings indicated that RF-related heating under the conditions used in this investigation is not a significant safety concern for patients with the particular extracranial neurosurgical implants evaluated in this study.     

In vitro assessment of 3-T MRI issues for a bioabsorbable,coronary artery scaffold with metallic markers

Objective

Coronary artery stents are made from metallic mesh and, therefore, to ensure patient safety, these implants must be evaluated to determine risks associated with MRI. Recently, bioabsorbable scaffolds, which have metallic markers, have been developed for use in the coronary arteries. Because of the metallic materials, these implants may present issues for patients undergoing MRI. Therefore, the objective of this investigation was to assess MRI issues (i.e., magnetic field interactions, MRI-related heating, and artifacts at 3 T) for a new bioabsorbable, coronary artery scaffold with metallic markers.

Methods

A bioabsorbable, coronary artery scaffold (Mirage Microfiber Scaffold) underwent assessments for magnetic field interactions, MRI-related heating, and artifacts at 3-Tesla using standard techniques. MRI-related heating was evaluated with the scaffold placed in a gelled-saline-filled phantom and MRI was performed at an MR system reported, whole body averaged SAR of 2.9 W/kg for 15 minutes. Artifacts were characterized using T1-weighted spin echo and gradient echo, pulse sequences.

Results

There were no magnetic field interactions. The highest temperature rise was 1.6 °C (highest background temperature rise, 1.6 °C). Artifacts were relatively small in relation to the size and shape of this coronary artery scaffold. Notably, the lumen of the scaffold could be visualized on the GRE pulse sequence.

Conclusion

The results demonstrated that the coronary artery scaffold is acceptable (or “MR conditional,” using current MRI labeling terminology) for a patient undergoing an MRI procedure at 3 T or less. To our knowledge, this is the first bioabsorbable, coronary artery scaffold that has been evaluated for MRI issues.     

A next-generation,flow-diverting implant used to treat brain aneurysms: in vitro evaluation of magnetic field interactions,heating and artifacts at 3-T

Background and Purpose

Fine-mesh braided, stent-like structures (flow diverters) have been proposed for treatment of brain aneurysms. To date, the safety of performing magnetic resonance imaging (MRI) in patients with these implants is unknown. Therefore, the purpose of this study was to evaluate MRI issues at 3-T for a new flow-diverting implant used to treat brain aneurysms.

Methods

The Surpass NeuroEndoGraft (Surpass Medical, Ltd., Tel Aviv, Israel) underwent evaluation for magnetic field interactions, MRI-related heating and artifacts using standardized techniques. Magnetic field interactions were assessed for this implant with regard to translational attraction (i.e., using the deflection angle technique) and torque (qualitative assessment method). MRI-related heating was evaluated by placing the implant in a gelled-saline-filled, head/torso phantom and performing MRI using a transmit/receive radiofrequency body coil at a whole-body-averaged specific absorption rate of 2.9 W/kg for 15 min. Artifacts were characterized using T1-weighted, spin echo (SE) and gradient echo (GRE) pulse sequences.

Results

The Surpass NeuroEndoGraft exhibited minor magnetic field interactions (21° deflection angle and no torque), which were acceptable from a safety consideration. Heating was not substantial, with the highest temperature change being 2.3°C (background temperature rise without the implant was 1.5°C). Artifacts may create issues if the area of interest is in the same area or close to this implant.

Conclusions

The findings demonstrated that it would be acceptable for patients with this next-generation, flow-diverting implant to undergo MRI at 3-T or less.     

Evaluation of MRI issues for a new neurological implant,the Sensor Reservoir

Background and Purpose

A new neurological implant, the Sensor-Reservoir, was developed to provide a relative measurement of ICP, which permits a noninvasive technique to detect and localize occlusions in ventricular drainage systems and, thus, to identify mechanical damage to shunt valves. The “reservoir” of this device can be used to administer medication or a contrast agent, to extract cerebral spinal fluid (CSF), and with the possibility of directly measuring ICP. The Sensor-Reservoir was evaluated to identify possible MRI-related issues at 1.5-T/64-MHz and 3-T/128-MHz.

Materials and Methods

Standard testing techniques were utilized to evaluate magnetic field interactions (i.e., translational attraction and torque), MRI-related heating, and artifacts at 3-T for the Sensor-Reservoir. In addition, 12 samples of the Sensor-Reservoir underwent testing to determine if the function of these devices was affected by exposures to various MRI conditions at 1.5-T/64-MHz and 3-T/128-MHz.

Results

Magnetic field interactions for the Sensor-Reservoir were not substantial. The heating results indicated a highest temperature rise of 1.8 °C, which poses no patient risks. Artifacts were relatively small in relation to the size and shape of the Sensor-Reservoir, but may interfere diagnostically if the area of interest is near the device. All devices were unaffected by exposures to MRI conditions at 1.5-T/64-MHz and 3-T/128-MHz.

Conclusion

When specific guidelines are followed, the Sensor-Reservoir is “MR conditional” for patients undergoing MRI examinations at 3-T or less.     

In vitro assessment of MRI issues at 3-Tesla for a breast tissue expander with a remote port

Objectives

A patient with a breast tissue expander may require a diagnostic assessment using magnetic resonance imaging (MRI). To ensure patient safety, this type of implant must undergo in vitro MRI testing using proper techniques. Therefore, this investigation evaluated MRI issues (i.e., magnetic field interactions, heating, and artifacts) at 3-Tesla for a breast tissue expander with a remote port.

Methods

A breast tissue expander with a remote port (Integra Breast Tissue Expander, Model 3612-06 with Standard Remote Port, PMT Corporation, Chanhassen, MN) underwent evaluation for magnetic field interactions (translational attraction and torque), MRI-related heating, and artifacts using standardized techniques. Heating was evaluated by placing the implant in a gelled-saline-filled phantom and MRI was performed using a transmit/receive RF body coil at an MR system reported, whole body averaged specific absorption rate of 2.9-W/kg. Artifacts were characterized using T1-weighted and GRE pulse sequences.

Results

Magnetic field interactions were not substantial and, thus, will not pose a hazard to a patient in a 3-Tesla or less MRI environment. The highest temperature rise was 1.7 °C, which is physiologically inconsequential. Artifacts were large in relation to the remote port and metal connector of the implant but will only present problems if the MR imaging area of interest is where these components are located.

Conclusions

A patient with this breast tissue expander with a remote port may safely undergo MRI at 3-Tesla or less under the conditions used for this investigation. These findings are the first reported at 3-Tesla for a tissue expander.     

A new vascular coupling device: Assessment of MRI issues at 3-tesla

Objective

Vascular grafting frequently involves a time-consuming operation. A new vascular coupling device (VCD) made from metallic material was recently developed that may be advantageous because of the reduced operative time and decreased patient risks. Because of the metal, there are safety concerns related to MRI. Therefore, the purpose of this investigation was to use standardized testing techniques to evaluate MRI issues for this VCD in association with a 3-Tesla MR system.

Methods

The VCD (corlife oHG, Hannover, Germany) was evaluated for magnetic field interactions (translational attraction and torque), MRI-related heating, and artifacts at 3-Tesla. MRI-related heating was assessed with the VCD in a gelled-saline-filled phantom with MRI performed at a whole body averaged SAR of 2.9-W/kg for 15-min. Artifacts were assessed using T1-weighted, spin echo, and gradient echo pulse sequences.

Results

The VCD exhibited minor magnetic field interactions and minimal heating (maximum temperature elevation, 1.8 °C). Artifacts were relatively small in relation to the size and shape of this implant. The lumen of the VCD could not be visualized using the gradient echo pulse sequence.

Conclusions

The metallic VCD that underwent evaluation is MR conditional for a patient undergoing an MRI procedure at 3-Tesla or less.     

Wireless MR tracking of interventional devices using phase-field dithering and projection reconstruction

Purpose

Device tracking is crucial for interventional MRI (iMRI) because conventional device materials do not contribute to the MR signal, may cause susceptibility artifacts and are generally invisible if moved out of the scan plane. A robust method for wireless tracking and dynamic guidance of interventional devices equipped with wirelessly connected resonant circuits (wRC) is presented.

Methods

The proposed method uses weak spatially-selective excitation pulses with very low flip angle (0.3°), a Hadamard multiplexed tracking scheme and employs phase-field dithering to obtain the 3D position of a wRC. RF induced heating experiments (ASTM protocol) and balloon angioplasties of the iliac artery were conducted in a perfused vascular phantom and three Thiel soft-embalmed human cadavers.

Results

Device tip tracking was interleaved with various user-selectable fast pulse sequences receiving a geometry update from the tracking kernel in less than 30 ms. Integrating phase-field dithering significantly improved our tracking robustness for catheters with small diameters (4–6 French). The volume root mean square distance error was 2.81 mm (standard deviation: 1.31 mm). No significant RF induced heating (< 0.6 °C) was detected during heating experiments.

Conclusion

This tip tracking approach provides flexible, fast and robust feedback loop, intuitive iMRI scanner interaction, does not constrain the physician and delivers very low specific absorption rates. Devices with wRC can be exchanged during a procedure without modifications to the iMRI setup or the pulse sequence. A drawback of our current implementation is that position information is available for a single tracking coil only. This was satisfactory for balloon angioplasties of the iliac artery, but further studies are required for complex navigation and catheter shapes before animal trials and clinical application.     

Delayed gadolinium-enhanced MRI of the fibrocartilage disc of the temporomandibular joint – a feasibility study

Objective

To 1) test the feasibility of delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC) at 3 T in the temporomandibular joint (TMJ) and 2) to determine the optimal delay for measurements of the TMJ disc after i.v. contrast agent (CA) administration.

Design

MRI of the right and left TMJ of six asymptomatic volunteers was performed at 3 T using a dedicated coil. 2D inversion recovery (2D-IR) sequences were performed at 4 time points covering 120 minutes and 3D gradient-echo (3D GRE) dual flip-angle sequences were performed at 14 time points covering 130 minutes after the administration of 0.2 mmol/kg of Gd-diethylenetriamine pentaacetic acid ion (Gd-DTPA)^2-, i.e., 0.4 mL of Magnevist™ per kg body weight. Pair-wise tests were used to assess differences between pre-and post-contrast T1 values.

Results

2D-IR sequences showed a statistically significant drop (p < 0.001) in T1 values after i.v. CA administration. The T1 drop of 50% was reached 60 minutes after bolus injection in the TMJ disc. The 3D GRE dual flip-angle sequences confirmed these results and show plateau of T1 after 60 minutes.

Conclusions

T1(Gd) maps calculated from dGEMRIC data allow in vivo assessment of the fibrocartilage disc of the TMJ. The recommended measurement time for dGEMRIC in the TMJ after i.v. CA administration is from 60 to 120 minutes.     

Hepatocellular lesions with increased iron uptake on superparamagnetic iron oxide-enhanced magnetic resonance imaging in cirrhosis or chronic hepatitis: comparison of four magnetic resonance sequences for lesion conspicuity

Purpose

The aim of this study was to determine the adequate MR sequence for the lesion conspicuity of hepatocellular lesions with increased iron uptake on superparamagnetic iron oxide (SPIO)-enhanced MRI.

Materials and Methods

SPIO-enhanced MRI was performed using a 1.5-T system. Among 25 patients with hypovascular hepatocellular nodules on contrast-enhanced dynamic CT (no early enhancement at arterial phase and hypoattenuation at equilibrium phase), 39 lesions with increased iron uptake on SPIO-enhanced MRI were evaluated. SPIO-enhanced MRI included (1) T1-weighted in-phase gradient recalled echo (GRE) images, (2) T2-weighted fast spin echo (FSE) images, (3) T2*-weighted GRE with moderate TE (7 ms) and (4) long TE (12 ms). The lesion-to-liver contrast-to-noise ratios of the hepatocellular nodule and the signal-to-noise ratio (SNR) of the hepatic parenchyma were calculated by one radiologist for a quantitative assessment. MR images were reviewed retrospectively by two independent radiologists to compare the subjective lesion conspicuity in each image set based on a four-point rating scale.

Result

The mean lesion-to-liver contrast-to-noise ratios with T2*-weighted GRE with moderate TE (7 ms) was highest (5.79±3.71) and was significantly higher than those with T1-weighted, in-phase images (3.79±3.23, P<.01), T2-weighted images (2.72±1.52, P<.001) and T2*-weighted GRE with long TE (12 ms) (3.93±2.69, P<.05). The subjective rating of lesion conspicuity was best on the T2*-weighted GRE with moderate TE (7 ms), followed by that on the T2*-weighted GRE with moderate TE (7 ms; P<.05).

Conclusion

T2*-weighted GRE sequence with moderate TE (7 ms) showed high lesion-to-liver contrast-to-noise ratios in hepatocellular lesions with increased iron uptake on SPIO-enhanced MRI, indicating better lesion conspicuity of hypointense hepatocellular nodules in cirrhosis or chronic hepatitis.     

Noncontrast MRI with diffusion-weighted imaging as the sole imaging modality for detecting liver malignancy in patients with high risk for hepatocellular carcinoma

Purpose

To compare the diagnostic performance of the noncontrast MRI including DWI to the standard MRI for detecting hepatic malignancies in patients with chronic liver disease.

Materials and methods

We included 135 patients with 136 histologically-confirmed hepatocellular carcinomas (HCCs), 12 cholangiocarcinomas, and 34 benign lesions (≤ 2.0 cm), and 22 patients with cirrhosis but no focal liver lesion who underwent 3.0 T liver MRI. Noncontrast MRI set (T1- and T2-weighted images and DWI) and standard MRI set (gadoxetic acid-enhanced and noncontrast MRI) were analyzed independently by three observers to detect liver malignancies using receiver operating characteristic analysis.

Results

The Az value of the noncontrast MRI (mean, 0.906) was not inferior to that of the combined MRI (mean, 0.924) for detecting malignancies by all observers (P > 0.05). For each observer, no significant difference was found in the sensitivity and specificity between the two MRI sets for detecting liver malignancies and distinguishing them from benign lesions (P > 0.05), whereas negative predictive value was higher with the combined MRI than with the noncontrast MRI (P = 0.0001). When using pooled data, the sensitivity of the combined MRI (mean 94.8%) was higher than that of the noncontrast MRI (mean, 91.7%) (P = 0.001), whereas specificity was equivalent (78.6% vs 77.5%).

Conclusion

Noncontrast MRI including DWI showed reasonable performance compared to the combined gadoxetic acid-enhanced and noncontrast MRI set for detecting HCC and cholangiocarcinoma and differentiating them from benign lesions in patients with chronic liver disease.     

Validation of optimal DCE-MRI perfusion threshold to classify at-risk tumor imaging voxels in heterogeneous cervical cancer for outcome prediction

Purpose

To classify tumor imaging voxels at-risk for treatment failure within the heterogeneous cervical cancer using DCE MRI and determine optimal voxel's DCE threshold values at different treatment time points for early prediction of treatment failure.

Material and Method

DCE-MRI from 102 patients with stage IB2–IVB cervical cancer was obtained at 3 different treatment time points: before (MRI 1) and during treatment (MRI 2 at 2–2.5 weeks and MRI 3 at 4–5 weeks). For each tumor voxel, the plateau signal intensity (SI) was derived from its time-SI curve from the DCE MRI. The optimal SI thresholds to classify the at-risk tumor voxels was determined by the maximal area under the curve using ROC analysis when varies SI value from 1.0 to 3.0 and correlates with treatment outcome.

Results

The optimal SI thresholds for MRI 1, 2 and 3 were 2.2, 2.2 and 2.1 for significant differentiation between local recurrence/control, respectively, and 1.8, 2.1 and 2.2 for death/survival, respectively.

Conclusion

Optimal SI thresholds are clinically validated to quantify at-risk tumor voxels which vary with time. A single universal threshold (SI = 1.9) was identified for all 3 treatment time points and remained significant for the early prediction of treatment failure.     

MRI detection of brown adipose tissue with low fat content in newborns with hypothermia

Purpose

To report the observation of brown adipose tissue (BAT) with low fat content in neonates with hypoxic–ischemic encephalopathy (HIE) after they have undergone hypothermia therapy.

Materials and Methods

The local ethics committee approved the imaging study. Ten HIE neonates (3 males, 7 females, age range: 2–3 days) were studied on a 3-T MRI system using a low-flip-angle (3°) six-echo proton-density-weighted chemical-shift-encoded water-fat pulse sequence. Fat-signal fraction (FF) measurements of supraclavicular and interscapular (nape) BAT and adjacent subcutaneous white adipose tissues (WAT) were compared to those from five non-HIE neonates, two recruited for the present investigation and three from a previous study.

Results

In HIE neonates, the FF range for the supraclavicular, interscapular, and subcutaneous regions was 10.3%–29.9%, 28.0%–57.9%, and 62.6%–88.0%, respectively. In non-HIE neonates, the values were 23.7%–42.2% (p = 0.01), 45.4%–59.5% (p = 0.06), and 67.8%–86.3% (p = 0.38), respectively. On an individual basis, supraclavicular BAT FF was consistently the lowest, interscapular BAT values were higher, and subcutaneous WAT values were the highest (p < 0.01).

Conclusion

We speculate that hypothermia therapy in HIE neonates likely promotes BAT-mediated non-shivering thermogenesis, which subsequently leads to a depletion of the tissue's intracellular fat stores. We believe that this is consequently reflected in lower FF values, particularly in the supraclavicular BAT depot, in contrast to non-HIE neonates.     

Optimization of MR diffusion-weighted imaging acquisitions for pancreatic cancer at 3.0 T

Objectives

To investigate and optimize diffusion-weighted imaging (DWI) acquisitions for pancreatic cancer at 3.0 T.

Methods

Forty-five patients with pancreatic cancer were examined by four DWI acquisitions with b values = 0 and 600 s/mm² at 3.0 T, including breath-holding DWI (BH-DWI), respiratory-triggered DWI (TRIG-DWI), respiratory-triggered DWI with inversion–recovery technique (TRIGIR-DWI), and free-breathing DWI with inversion–recovery technique (FBIR-DWI). Artifacts, contrast ratio (CR), contrast-to-noise ratio (CNR) and apparent diffusion coefficient (ADC) of pancreatic cancer were statistically compared among DWI acquisitions.

Results

TRIGIR-DWI displayed the lowest artifacts and highest CR compared to other DWI acquisitions. CNRs of pancreatic cancer in TRIG-DWI and TRIGIR-DWI were statistically higher than that in FBIR-DWI and BH-DWI. Different ADCs between pancreatic cancer and noncancerous pancreatic tissues were noticed by a paired-samples T test in TRIG-DWI (p = 0.017), TRIGIR-DWI (p = 0.00001) and FBIR-DWI (p = 0.000041).

Conclusions

TRIGIR-DWI may be the optimal acquisition of DWI for pancreatic cancer at 3.0 T.     

Enhancement of abdominal organs on hepatic arterial phase: quantitative comparison between 1.5- and 3.0-T magnetic resonance imaging

Purpose

To compare the extent of enhancement of abdominal organs as shown on subphases of hepatic arterial phase quantitatively between 1.5- and 3.0-T MRI among patients with various abdominal conditions.

Materials and Methods

A total of 126 patients, of whom 68 were women (age range, 3–82 years; mean age, 48 years) and 58 were men (age range, 6–73 years; mean age, 50 years), were included in the study. Of 126 patients, 98 were scanned at 1.5 T and 28 were scanned at 3.0 T. The presence of one of three predefined subphases of hepatic arterial phase was determined on early post-gadolinium sequence in each patient by two reviewers in consensus. Extent of enhancement of the kidney, pancreas, spleen and liver on these subphases was determined quantitatively by measuring the signal intensities. Mann Whitney–Wilcoxon test was used to compare the contrast enhancement of organs on each subphase between 1.5- and 3.0-T MRI.

Results

The kidney, spleen, pancreas and liver demonstrated 1.79- to 2.45-, 1.65- to 1.97-, 1.66- to 1.8- and 1.1- to 2.02-fold higher enhancement on the subphases of hepatic arterial phase at 3.0 T compared to 1.5 T, respectively. The differences in contrast enhancement were significant for the kidney, pancreas and spleen on all subphases between 1.5 and 3.0 T.

Conclusion

The relative enhancement of the kidney, spleen and pancreas is consistently and significantly higher at 3.0 T than at 1.5 T in matched subphases of hepatic arterial enhancement.     

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.     

MR evaluation of breast lesions obtained by diffusion-weighted imaging with background body signal suppression (DWIBS) and correlations with histological findings

Objectives

Diffusion imaging represents a new imaging tool for the diagnosis of breast cancer. This study aims to investigate the role of diffusion-weighted MRI with background body signal suppression (DWIBS) for evaluating breast lesions.

Methods

90 patients were prospectively evaluated by MRI with STIR, TSE-T2, contrast enhanced THRIVE-T1 and DWIBS sequences. DWIBS were analyzed searching for the presence of breast lesions and calculating the ADC value. ADC values of ≤ 1.44 × 10^- 3 mm²/s were considered suspicious for malignancy. This analysis was then compared with the histological findings. Sensitivity, specificity, diagnostic accuracy (DA), positive predictive value (PPV) and negative (NPV) were calculated.

Results

In 53/90 (59%) patients, DWIBS indicated the presence of breast lesions, 16 (30%) with ADC values of  > 1.44 and 37 (70%) with ADC ≤ 1.44. The comparison with histology showed 25 malignant and 28 benign lesions. DWIBS sequences obtained sensitivity, specificity, DA, PPV and NPV values of 100, 82, 87, 68 and 100%, respectively.

Conclusion

DWIBS can be proposed in the MRI breast protocol representing an accurate diagnostic complement.     

7 T versus 3 T contrast-enhanced breast Magnetic Resonance Imaging of invasive ductulolobular carcinoma: First clinical experience

Purpose

Here we describe our first experience with contrast-enhanced (CE) MRI of breast cancer at 7 tesla (T), compared to 3 T and histopathology.

Materials and Methods

A 52 year old female patient with a mammographically suspicious breast mass (BI-RADS V) underwent 7 T CE-MRI. Results were described according to the BI-RADS-MRI criteria and compared to 3 T and histopathology.

Results

After contrast administration, a homogeneously enhancing, irregular spiculated mass was depicted at both 3 T and 7 T; sizes were identical. The most malignant kinetic curve was characterized by a rapid initial rise followed by a wash-out pattern in the delayed phase, i.e. a type 3 curve, at both field strengths. Even though T1-effects of contrast agents are suggested to be reduced at higher fields, quantification of contrast enhancement-to-noise ratio showed a ratio of 4.6 at 7 T and 2.8 at 3 T when comparing contrast-to-noise of the mass before and after contrast administration. Both examinations, using a single dose of gadolinium-based contrast agent, achieved good image quality. Final histopathological evaluation showed an invasive ductulolobular carcinoma with an intraductal component.

Conclusion

This initial experience suggests that clinical contrast-enhanced 7 T MRI of the breast is technically feasible and may allow BI-RADS-conform analysis.     

Diagnosis of relevant prostate cancer using supplementary cores from magnetic resonance imaging-prompted areas following multiple failed biopsies

Objectives

To establish the value of MRI in targeting re-biopsy for undiagnosed prostate cancer despite multiple negative biopsies and determine clinical relevance of detected tumors.

Materials and Methods

Thirty-eight patients who underwent MRI after 2 or more negative biopsies due to continued clinical suspicion and later underwent TRUS-guided biopsy supplemented by biopsy of suspicious areas depicted by MRI were identified. Diagnostic performance of endorectal 3T MRI in diagnosing missed cancer foci was assessed using biopsy results as the standard of reference. Ratio of positive biopsies using systematic versus MRI-prompted approaches was compared. Gleason scores of detected cancers were used as surrogate for clinical relevance.

Results

Thirty-four percent of patients who underwent MRI before re-biopsy had prostate cancer on subsequent biopsy. The positive biopsy yield with systematic sampling was 23% versus 92% with MRI-prompted biopsies(p < 0.0001). Seventy-seven percent of tumors were detected exclusively in the MRI-prompted zones. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MRI to provide a positive biopsy were 92%, 60%, 55%, 94% and 71%, respectively. The anterior gland and apical regions contained most tumors; 75% of cancers detected by MRI-prompted biopsy had Gleason score ≥ 7.

Conclusions

Clinically relevant tumors missed by multiple TRUS-guided biopsies can be detected by a MRI-prompted approach.     

Effects of blood ΔR2* non-linearity on absolute perfusion quantification using DSC-MRI: Comparison with Xe-133 SPECT

Purpose

To evaluate whether a non-linear blood ΔR₂*-versus-concentration relationship improves quantitative cerebral blood flow (CBF) estimates obtained by dynamic susceptibility contrast (DSC) MRI in a comparison with Xe-133 SPECT CBF in healthy volunteers.

Material and Methods

Linear as well as non-linear relationships between ΔR₂* and contrast agent concentration in blood were applied to the arterial input function (AIF) and the venous output function (VOF) from DSC-MRI. To reduce partial volume effects in the AIF, the arterial time integral was rescaled using a corrected VOF scheme.

Results

Under the assumption of proportionality between the two modalities, the relationship CBF(MRI) = 0.58CBF(SPECT) (r = 0.64) was observed using the linear relationship and CBF(MRI) = 0.51CBF(SPECT) (r = 0.71) using the non-linear relationship.

Discussion

A smaller ratio of the VOF time integral to the AIF time integral and a somewhat better correlation between global DSC-MRI and Xe-133 SPECT CBF estimates were observed using the non-linear relationship. The results did not, however, confirm the superiority of one model over the other, potentially because realistic AIF signal data may well originate from a combination of blood and surrounding tissue.     

Usefulness of slice encoding for metal artifact correction (SEMAC) for reducing metallic artifacts in 3-T MRI

Purpose

The purpose of the study was to assess the usefulness of slice encoding for metal artifact correction (SEMAC) in 3.0-T magnetic resonance (MR) in minimizing metallic artifacts in patients with spinal prostheses.

Materials and Methods

Institutional review board approval and informed consent were obtained for this study. Twenty-seven spine MR scans were performed with metal artifact reduction SEMAC between May 2011 and July 2012 in patients with metallic devices. The MR scans were performed on a 3-T MR system (Achieva; Philips Healthcare, Best, the Netherlands) including SEMAC-corrected T2-weighted axial/sagittal images and two-dimensional fast spin echo (FSE) axial/sagittal images. The SEMAC-corrected images were compared to conventional T2-weighted FSE images. Two musculoskeletal radiologists qualitatively analyzed the images in terms of visualization of the pedicle, vertebral body, dural sac, intervertebral disc, intervertebral neural foramina, screws and metallic artifacts. The paired images were rated using a 5-point scale. P values less than .05 were considered to indicate statistically significant differences.

Results

The SEMAC-corrected MR images significantly reduced the metal-related artifacts. The T2-weighted images with SEMAC sequences enabled significantly improved periprosthetic visualizations of the pedicle, vertebral body, dural sac and neural foramina, with the exception of the intervertebral disc (P < .05). In addition, there was significant improvement in prosthesis visualization (P < .05).

Conclusion

MR images with SEMAC can reduce metal-related artifacts, providing improved delineation of the prosthesis and periprosthetic region. However, for the evaluation of the intervertebral disc, the SEMAC-corrected MR images showed no significant benefits.