Clinical feasibility of 3D-QALAS – Single breath-hold 3D myocardial T1- and T2-mapping

PurposeTo investigate the in-vivo precision and clinical feasibility of 3D-QALAS - a novel method for simultaneous three-dimensional myocardial T1- and T2-mapping.MethodsTen healthy subjects and 23 patients with different cardiac pathologies underwent cardiovascular 3 T MRI examinations including 3D-QALAS, MOLLI and T2-GraSE acquisitions. Precision was investigated in the healthy subjects between independent scans, between dependent scans and as standard deviation of consecutive scans. Clinical feasibility of 3D-QALAS was investigated for native and contrast enhanced myocardium in patients. Data were analyzed using mean value and 95% confidence interval, Pearson correlation, Paired t-tests, intraclass correlation and Bland-Altman analysis.ResultsAverage myocardial relaxation time values and SD from eight repeated acquisitions within the group of healthy subjects were 1178 ± 18.5 ms (1.6%) for T1 with 3D-QALAS, 52.7 ± 1.2 ms (2.3%) for T2 with 3D-QALAS, 1145 ± 10.0 ms (0.9%) for T1 with MOLLI and 49.2 ± 0.8 ms (1.6%) for T2 with GraSE.Myocardial T1 and T2 relaxation times obtained with 3D-QALAS correlated very well with reference methods; MOLLI for T1 (r = 0.994) and T2-GraSE for T2 (r = 0.818) in the 23 patients. Average native/post-contrast myocardial T1 values from the patients were 1166.2 ms/411.8 ms for 3D-QALAS and 1174.4 ms/438.9 ms for MOLLI. Average native myocardial T2 values from the patients were 53.2 ms for 3D-QALAS and 54.4 ms for T2-GraSE.ConclusionsRepeated independent and dependent scans together with the intra-scan repeatability, demonstrated all a very good precision for the 3D-QALAS method in healthy volunteers. This study shows that 3D T1 and T2 mapping in the left ventricle is feasible in one breath hold for patients with different cardiac pathologies using 3D-QALAS.     

The value of ESWAN in diagnosis and differential diagnosis of prostate cancer: Preliminary study

ObjectiveTo evaluate the value of enhanced T2 star-weighted angiography (ESWAN) in diagnosis and differential diagnosis of prostate cancer by comparing the multiple indices of ESWAN in benign prostatic hyperplasia (BPH), prostate cancer (PCa) and the normal peripheral zone (PZ).MethodsTraditional MRI and ESWAN were performed on forty-nine clinically-diagnosed PCa patients, sixty BPH patients, and forty-six normal adult males. The ESWAN indices (magnitude value, phase value, R2* value and T2* value) measured on different regions of interest (ROIs) were analyzed. Additionally, receiver operating characteristic (ROC) analysis was performed to obtain the area under the curve (AUC), sensitivity, specificity, and optimal cut-off points of PCa and BPH, PCa and PZ respectively.ResultsThe magnitude value, phase value, R2* value and T2* value of PZ were 1529.43 ± 254.43, 0.0689 ± 0.1619, 16.57 ± 8.11, 82.75 ± 53.87, respectively; the magnitude value, phase value, R2* value, and T2* value of PCa were 1540.18 ± 338.62, − 0.0176 ± 0.0919, 26.93 ± 11.31, and 45.99 ± 17.43, respectively; the magnitude value, phase value, R2* value, and T2* value of BPH were 1579.49 ± 285.28, 0.0209 ± 0.0839, 20.69 ± 3.95, and 51.56 ± 8.90, respectively. Compared with normal PZ, phase value of PCa was lower (t = − 3.302, P = 0.001), R2* value higher (t = 5.326, P = 0.000), and T2* value lower (t = − 4.570, P = 0.000); compared with BPH, phase value of PCa was lower (t = − 2.261, P = 0.026), R2* value higher (t = 3.988, P = 0.000), and T2* value lower (t = − 2.155, P = 0.033). When PCa and PZ were distinguished, the AUC of magnitude value, phase value, R2* value, and T2* value were respectively 0.539 (P = 0.510), 0.679 (P = 0.0007), 0.811 (P < 0.0001), and 0.762 (P < 0.0001); the diagnosis efficiency of R2* value was higher than that of T2* value (P = 0.037), while the diagnosis efficiency of T2* value was equivalent to phase value (P = 0.256). When PCa was differentiated from BPH, the AUC of magnitude value, phase value, R2* value, and T2* value were 0.518 (P = 0.752), 0.612 (P = 0.039), 0.705 (P = 0.0001), and 0.685 (P = 0.0006), respectively; there was no statistical difference in the diagnostic efficiency of phase value, R2* value, and T2* value.ConclusionsThe phase value, R2* value and T2* value can distinguish PCa and normal PZ, PCa and BPH, so they are valuable for the diagnosis and differential diagnosis of PCa, moreover, the diagnostic efficiency of R2* value is better than other indices.     

Bi-phase age-related brain gray matter magnetic resonance T1ρ relaxation time change in adults

ObjectivesTo investigate normative value and age-related change of brain magnetic resonance T1ρ relaxation at 1.5 T.MethodsThis study was approved by the local ethical committee with participants' written consent obtained. There were 42 adults healthy volunteers, including 20 males (age: 41 ± 16 (mean ± standard deviation) years, range: 22–68 years,) and 22 females (age: 39 ± 15 years, range: 21–62 years). MRI was performed at 1.5 T using 3D fluid suppressed turbo spin echo sequence. Regions-of-interests (ROIs) were obtained by atlas-based tissue segmentation and T1ρ was calculated by fitting the mean value to mono-exponential model. Correlation between T1ρ relaxation of brain gray matter regions and age was investigated.ResultsA regional difference among individual gray matter areas was noted; the highest values were observed in the hippocampus (98.37 ± 5.37 ms, median: 97.88 ms) and amygdala (94.95 ± 4.34 ms, median: 94.73 ms), while the lowest values were observed in the pallidum (83.81 ± 5.49 ms, median: 83.77 ms) and putamen (83.93 ± 4.76 ms, median: 83.99 ms). Gray matter T1ρ values decreased slowly (mean slope: − 0.256) and significantly (p < 0.05) with age in gray matter for subjects younger than 40 years old, while for subjects older than 40 years old there was no apparent correlation between T1ρ relaxation and age. Global white matter measured T1ρ value of 88.65 ± 3.47 ms (median: 87.86 ms), and the correlation with age was not significant (p = 0.18).ConclusionGray matter T1ρ relaxation demonstrates a bi-phase change with age in adults of 22–68 years.     

Colorectal carcinoma: Ex vivo evaluation using 3-T high-spatial-resolution quantitative T2 mapping and its correlation with histopathologic findings

PurposeIn this study, we aimed to evaluate the feasibility of determining the mural invasion depths of colorectal carcinomas using high-spatial-resolution (HSR) quantitative T2 mapping on a 3-T magnetic resonance (MR) scanner.Materials and methodsTwenty colorectal specimens containing adenocarcinomas were imaged on a 3-T MR system equipped with a 4-channel phased-array surface coil. HSR quantitative T2 maps were acquired using a spin-echo sequence with a repetition time/echo time of 7650/22.6–361.6 ms (16 echoes), 87 × 43.5-mm field of view, 2-mm section thickness, 448 × 224 matrix, and average of 1. HSR fast-spin-echo T2-weighted images were also acquired. Differences between the T2 values (ms) of the tumor tissue, colorectal wall layers, and fibrosis were measured, and the MR images and histopathologic findings were compared.ResultsIn all specimens (20/20, 100%), the HSR quantitative T2 maps clearly depicted an 8-layer normal colorectal wall in which the T2 values of each layer differed from those of the adjacent layer(s) (P < 0.001). Using this technique, fibrosis (73.6 ± 9.4 ms) and tumor tissue (104.2 ± 6.4 ms) could also be clearly differentiated (P < 0.001). In 19 samples (95%), the HSR quantitative T2 maps and histopathologic data yielded the same findings regarding the tumor invasion depth.ConclusionsOur results indicate that 3-T HSR quantitative T2 mapping is useful for distinguishing colorectal wall layers and differentiating tumor and fibrotic tissues. Accordingly, this technique could be used to determine mural invasion by colorectal carcinomas with a high level of accuracy.     

Intravoxel incoherent motion diffusion-weighted imaging as an adjunct to dynamic contrast-enhanced MRI to improve accuracy of the differential diagnosis of benign and malignant breast lesions

PurposeTo investigate the value of use of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) as an adjunct to dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to distinguish benign from malignant breast lesions.Materials and methodsRetrospective analysis of data pertaining to 117 patients with breast lesions who underwent DCE-MRI and IVIM-DWI examination with 3.0 T MRI was conducted. A total of 128 lesions were pathologically confirmed (47 benign and 81 malignant). Between-group differences in DCE-MRI parameters (Morphology, enhancement pattern, maximum slope of increase (MSI) and time–signal curve (TIC) type) and IVIM-DWI parameters (f value, D value and D* value) were assessed. Multivariate logistic regression was performed to identify variables that distinguished benign from malignant breast lesions. The diagnostic performance of DCE-MRI and DCE-MRI plus IVIM-DWI, to distinguish benign from malignant breast lesions, was evaluated using pathology results as the gold standard.ResultsLesion morphology, MSI, and TIC type (P < 0.05), but not the enhancement pattern (P > 0.05), were significantly different between the benign and malignant groups. The f (8.53 ± 2.14) and D* (7.64 ± 2.07) values in the malignant group were significantly higher than those in the benign group (7.68 ± 1.97 and 6.83 ± 2.13, respectively), while the D value (0.99 ± 0.22) was significantly lower than that (1.34 ± 0.17) in the benign group (P < 0.05 for all). On logistic regression analysis, the sensitivity, specificity and accuracy of DCE-MRI were 90.1%, 70.2% and 82.8% respectively; the corresponding figures for the combination of IVIM-DWI and DCE-MRI were 88.8%, 85.1%, and 87.5%respectively.ConclusionIVIM-DWI method as an adjunct to DCE-MRI can improve the specificity and accuracy in differential diagnosis of benign and malignant lesions of breast.     

Towards intrinsic R2* imaging in the prostate at 3 and 7 tesla

PurposeHypoxia is an important marker for resistance to therapy. In this study, we quantify the macroscopic effects of R2* mapping in prostate cancer patients incorporating susceptibility matching and field strengths effects.Materials and methods91 patients were scanned without endorectal coil (ERC) at 3 T. Only when rectal gas was absent, data was included for analysis. Another group of 10 patients was scanned using a susceptibility matched ERC. To assess the residual contamination of R2 and macroscopic field non-uniformities, a group of 10 patients underwent ultra-high resolution 7 T MRI.ResultsOf the patients scanned at 3 T 60% presented rectal gas and were excluded, due to susceptibility artifacts. At 3 T the tumor was significantly different (P < 0.01) from the healthy surrounding tissue in R2* values at intrapatient level. Using the measured median R2* value of 24.9 s^− 1 at 3 T and 43.2 s^− 1 at 7 T of the peripheral zone, the minimum contribution of macroscopic susceptibility effects is 15% at 3 T.ConclusionR2* imaging might be a promising tool for hypoxia imaging, particularly when minimizing macroscopic susceptibility effects contaminating intrinsic R2* of tissue, such as rectal gas. At 3 T macroscopic effects still contribute 15% in the R2* value, compared to ultra-high resolution R2* mapping at 7 T.     

Quantifying global-brain metabolite level changes with whole-head proton MR spectroscopy at 3 T

Background and purposeTo assess the sensitivity of non-localized, whole-head ¹H-MRS to an individual's serial changes in total-brain NAA, Glx, Cr and Cho concentrations — metabolite metrics often used as surrogate markers in neurological pathologies.Materials and methodsIn this prospective study, four back-to-back (single imaging session) and three serial (successive sessions) non-localizing, ~3 min ¹H-MRS (TE/TR/TI = 5/10⁴/940 ms) scans were performed on 18 healthy young volunteers: 9 women, 9 men: 29.9 ± 7.6 [mean ± standard deviation (SD)] years old. These were analyzed by calculating a within-subject coefficient of variation (CV = SD/mean) to assess intra- and inter-scan repeatability and prediction intervals. This study was Health Insurance Portability and Accountability Act compliant. All subjects gave institutional review board-approved written, informed consent.ResultsThe intra-scan CVs for the NAA, Glx, Cr and Cho were: 3.9 ± 1.8%, 7.3 ± 4.6%, 4.0 ± 3.4% and 2.5 ± 1.6%, and the corresponding inter-scan (longitudinal) values were: 7.0 ± 3.1%, 10.6 ± 5.6%, 7.6 ± 3.5% and 7.0 ± 3.9%. This method is shown to have 80% power to detect changes of 14%, 27%, 26% and 19% between two serial measurements in a given individual.ConclusionsSubject to the assumption that in neurological disorders NAA, Glx, Cr and Cho changes represent brain-only pathology and not muscles, bone marrow, adipose tissue or epithelial cells, this approach enables us to quantify them, thereby adding specificity to the assessment of the total disease load. This will facilitate monitoring diffuse pathologies with faster measurement, more extensive (~90% of the brain) spatial coverage and sensitivity than localized ¹H-MRS.     

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

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

Three-dimensional black-blood T2 mapping with compressed sensing and data-driven parallel imaging in the carotid artery

PurposeTo develop a 3D black-blood T₂ mapping sequence with a combination of compressed sensing (CS) and parallel imaging (PI) for carotid wall imaging.Materials and methodsA 3D black-blood fast-spin-echo (FSE) sequence for T₂ mapping with CS and PI was developed and validated. Phantom experiments were performed to assess T₂ accuracy using a Eurospin Test Object, with different combination of CS and PI acceleration factors. A 2D multi-echo FSE sequence was used as a reference to evaluate the accuracy. The concordance correlation coefficient and Bland-Altman statistics were calculated. Twelve volunteers were scanned twice to determine the repeatability of the sequence and the intraclass correlation coefficient (ICC) was reported. Wall-lumen sharpness was calculated for different CS and PI combinations. Six patients with carotid stenosis > 50% were scanned with optimised sequence. The T₂ maps were compared with multi-contrast images.ResultsPhantom scans showed good correlation in T₂ measurement between current and reference sequence (r = 0.991). No significant difference was found between different combination of CS and PI accelerations (p = 0.999). Volunteer scans showed good repeatability of T₂ measurement (ICC: 0.93, 95% CI 0.84–0.97). The mean T₂ of the healthy wall was 48.0 ± 9.5 ms. Overall plaque T₂ values from patients were 54.9 ± 12.2 ms. Recent intraplaque haemorrhage and fibrous tissue have higher T₂ values than the mean plaque T₂ values (88.1 ± 6.8 ms and 62.7 ± 9.3 ms, respectively).ConclusionThis study demonstrates the feasibility of combining CS and PI for accelerating 3D T₂ mapping in the carotid artery, with accurate T₂ measurements and good repeatability.     

Quantitative Dixon MRI sequences to relate muscle atrophy and fatty degeneration with range of motion and muscle force in brachial plexus injury

BackgroundAssessment of muscle atrophy and fatty degeneration in brachial plexus injury (BPI) could yield valuable insight into pathophysiology and could be used to predict clinical outcome. The objective of this study was to quantify and relate fat percentage and cross-sectional area (CSA) of the biceps to range of motion and muscle force of traumatic brachial plexus injury (BPI) patients.MethodsT1-weighted TSE sequence and three-point Dixon images of the affected and non-affected biceps brachii were acquired on a 3 Tesla magnetic resonance scanner to determine the fat percentage, total and contractile CSA of 20 adult BPI patients. Regions of interest were drawn by two independent investigators to determine the inter-observer reliability. Paired Students' t-test and multivariate analysis were used to relate fat percentage, total and contractile CSA to active flexion and biceps muscle force.ResultsThe mean fat percentage 12 ± 5.1% of affected biceps was higher than 6 ± 1.0% of the non-affected biceps (p < 0.001). The mean contractile CSA 8.1 ± 5.1 cm² of the affected biceps was lower than 19.4 ± 4.9 cm² of the non-affected biceps (p < 0.001). The inter-observer reliability was excellent (ICC 0.82 to 0.96). The contractile CSA contributed most to the reduction in active flexion and muscle force.ConclusionQuantitative measurement of fat percentage, total and contractile CSA using three-point Dixon sequences provides an excellent reliability and relates with active flexion and muscle force in BPI.     

Abnormal lipid metabolism in skeletal muscle tissue of patients with muscular dystrophy: In vitro,high-resolution NMR spectroscopy based observation in early phase of the disease

PurposeQualitative (assignment of lipid components) and quantitative (quantification of lipid components) analysis of lipid components were performed in skeletal muscle tissue of patients with muscular dystrophy in early phase of the disease as compared to control/normal subjects.MethodsProton nuclear magnetic resonance (NMR) spectroscopy based experiment was performed on the lipid extract of skeletal muscle tissue of patients with muscular dystrophy in early phase of the disease and normal individuals for the analysis of lipid components [triglycerides, phospholipids, total cholesterol and unsaturated fatty acids (arachidonic, linolenic and linoleic acid)]. Specimens of muscle tissue were obtained from patients with Duchenne muscular dystrophy (DMD) [n = 11; Age, Mean ± SD; 9.2 ± 1.4 years; all were males], Becker muscular dystrophy (BMD) [n = 12; Age, Mean ± SD; 21.4 ± 5.0 years; all were males], facioscapulohumeral muscular dystrophy (FSHD) [n = 11; Age, Mean ± SD; 23.7 ± 7.5 years; all were males] and limb girdle muscular dystrophy-2B (LGMD-2B) [n = 18; Age, Mean ± SD; 24.2 ± 4.1 years; all were males]. Muscle specimens were also obtained from [n = 30; Mean age ± SD 23.1 ± 6.0 years; all were males] normal/control subjects.ResultsAssigned lipid components in skeletal muscle tissue were triglycerides (TG), phospholipids (PL), total cholesterol (CHOL) and unsaturated fatty acids (arachidonic, linolenic and linoleic acid)]. Quantity of lipid components was observed in skeletal muscle tissue of DMD, BMD, FSHD and LGMD-2B patients as compared to control/normal subjects. TG was significantly elevated in muscle tissue of DMD, BMD and LGMD-2B patients. Increase level of CHOL was found only in muscle of DMD patients. Level of PL was found insignificant for DMD, BMD and LGMD-2B patients. Quantity of TG, PL and CHOL was unaltered in the muscle of patients with FSHD as compared to control/normal subjects. Linoleic acids were significantly reduced in muscle tissue of DMD, BMD, FSHD and LGMD-2B as compared to normal/control individuals.ConclusionsResults clearly indicate alteration of lipid metabolism in patients with muscular dystrophy in early phase of the disease. Moreover, further evaluation is required to understand whether these changes are primary or secondary to muscular dystrophy. In future, these findings may prove an additional and improved approach for the diagnosis of different forms of muscular dystrophy.     

Water and lipid diffusion MRI using chemical shift displacement-based separation of lipid tissue (SPLIT)

PurposeTo obtain water and lipid diffusion-weighted images (DWIs) simultaneously, we devised a novel method utilizing chemical shift displacement-based separation of lipid tissue (SPLIT) imaging.Materials and methodsSingle-shot diffusion echo-planar imaging without fat suppression was used and the imaging parameters were optimized to separate water and lipid DWIs by chemical shift displacement of the lipid signals along the phase-encoding direction. Using the optimized conditions, transverse DWIs at the maximum diameter of the right calf were scanned with multiple b-values in five healthy subjects. Then, apparent diffusion coefficients (ADCs) were calculated in the tibialis anterior muscle (TA), tibialis bone marrow (TB), and subcutaneous fat (SF), as well as restricted and perfusion-related diffusion coefficients (D and D*, respectively) and the fraction of the perfusion-related diffusion component (F) for TA.ResultsWater and lipid DWIs were separated adequately. The mean ADCs of the TA, TB, and SF were 1.56 ± 0.03 mm²/s, 0.01 ± 0.01 mm²/s, and 0.06 ± 0.02 mm²/s, respectively. The mean D*, D, and F of the TA were 13.7 ± 4.3 mm²/s, 1.48 ± 0.05 mm²/s, and 4.3 ± 1.6%, respectively.ConclusionSPLIT imaging makes it possible to simply and simultaneously obtain water and lipid DWIs without special pulse sequence and increases the amount of diffusion information of water and lipid tissue.     

Cardiac magnetic resonance tissue tracking in right ventricle: Feasibility and normal values

PurposeTo investigate right ventricular (RV) strain in patients without identified cardiac pathology using cardiac magnetic resonance tissue tracking (CMR TT).MethodsA total of 50 consecutive patients with no identified cardiac pathology were analyzed. RV longitudinal and circumferential strain was assessed by CMR TT. The age range was 4–81 years with a median of 32 years (interquartile range, 15 to 56 years).ResultsAnalysis time per patient was < 5 min. The peak longitudinal strain (E_ll) was − 22.11 ± 3.51%. The peak circumferential strains (E_cc) for global, basal, mid-cavity and apical segments were as follows: − 11.69 ± 2.25%, − 11.00 ± 2.45%, − 11.17 ± 3.36%, − 12.90 ± 3.34%. There were significant gender differences in peak E_cc at the base (P = 0.04) and the mid-cavity (P = 0.03) with greater deformation in females than in males. On Bland-Altman analysis, peak E_ll (mean bias, 0.22 ± 1.67; 95% CI − 3.05 to 3.49) and mid-cavity E_cc (mean bias, 0.036 ± 1.75; 95% CI, − 3.39 to 3.47) had the best intra-observer agreement and inter-observer agreement, respectively.ConclusionsRV longitudinal and circumferential strains can be quickly assessed with good intra-observer and inter-observer variability using TT.     

3D late gadolinium enhanced cardiovascular MR with CENTRA-PLUS profile/view ordering: Feasibility of right ventricular myocardial damage assessment using a swine animal model

AimsTo develop a high-resolution, 3D late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (MRI) technique for improved assessment of myocardial scars, and evaluate its performance against 2D breath-held (BH) LGE MRI using a surgically implanted animal scar model in the right ventricle (RV).Methods and resultsA k-space segmented 3D LGE acquisition using CENTRA-PLUS (Contrast ENhanced Timing Robust Acquisition with Preparation of LongitUdinal Signal; or CP) ordering is proposed. 8 pigs were surgically prepared with cardiac patch implantation in the RV, followed in 60 days by 1.5 T MRI. LGE with Phase-Sensitive Inversion Recovery (PSIR) were performed as follows: 1) 2DBH using pneumatic control, and 2) navigator-gated, 3D free-breathing (3DFB)-CP-LGE with slice-tracking. The animal heart was excised immediately after cardiac MR for scar volume quantification. RV scar volumes were also delineated from the 2DBH and 3DFB-CP-LGE images for comparison against the surgical standard. Apparent scar/normal tissue signal-to-noise ratio (aSNR) and contrast-to-noise ratio (aCNR) were also calculated.3DFB-CP-LGE technique was successfully performed in all animals. No difference in aCNR was noted, but aSNR was significantly higher using the 3D technique (p < 0.05). Against the surgical reference volume, the 3DFB-CP-LGE-derived delineation yielded significantly less volume quantification error compared to 2DBH-derived volumes (15 ± 10% vs 55 ± 33%; p < 0.05).ConclusionCompared to conventional 2DBH-LGE, 3DFB-LGE acquisition using CENTRA-PLUS provided superior scar volume quantification and improved aSNR.     

MR elastography of hepatocellular carcinoma: Correlation of tumor stiffness with histopathology features—Preliminary findings

PurposeTo determine if tumor stiffness by MR Elastography (MRE) is associated with hepatocellular carcinoma (HCC) pathologic features.Material and methodsA retrospective review was undertaken of all patients with pathologically confirmed HCC who underwent MRE prior to loco-regional therapy, surgical resection or transplant between 1/1/2007 to 12/31/2015. An independent observer measured tumor stiffness (kilopascals, kPa) by drawing regions of interest (ROI) covering the HCC and in the case of HCCs with non-enhancing/necrotic components, only the solid portion was included in the ROI. HCC tumor grade (WHO criteria), vascular invasion and tumor encapsulation were assessed from retrievable pathology specimens by an expert hepatobiliary pathologist. Tumor stiffness was compared by tumor grade, size, presence of capsule and vascular invasion using Student's t-test (or Exact Mann-Whitney test).Results21 patients were identified who had pathologically confirmed HCCs and tumor MRE data. 17 patients (81.0%) had underlying chronic liver disease. The mean ± SD tumor size (cm) was 5.3 ± 3.9 cm. The mean ± SD tumor stiffness was 5.9 ± 1.4 kPa. Tumors were graded as well differentiated (N = 2), moderately differentiated (N = 11) and poorly differentiated (N = 8). There was a trend toward increased tumor stiffness in well/moderately differentiated HCCs (6.5 ± 1.2 kPa; N = 13) compared to poorly differentiated HCCs (4.9 ± 1.2 kPa; N = 8) (p < 0.01). There was no significant correlation between tumor stiffness and liver stiffness or tumor size. There was no significant difference in tumor stiffness by presence or etiology of chronic liver disease, vascular invasion or tumor encapsulation.ConclusionPreliminary data suggest that tumor stiffness by MRE may be able to differentiate HCC tumor grade.     

Differentiation of central gland prostate cancer from benign prostatic hyperplasia using monoexponential and biexponential diffusion-weighted imaging

PurposeTo investigate biexponential apparent diffusion parameters of prostate central gland (CG) cancer, stromal hyperplasia (SH), and glandular hyperplasia (GH) and compare with monoexponential apparent diffusion coefficient (ADC) value for discriminating prostate cancer from benign hyperplasia.Materials and MethodsTwenty-one CG cancer foci, 23 SH and 26 GH nodules in the CG were analyzed in 39 patients (19 with CG cancer, 20 with peripheral zone cancer but no CG cancer) who underwent preoperative conventional DWI (b-value 0, 1000 s/mm²) and a 10 b-value (range 0 to 3000 s/mm²) DWI. All of the cancer and hyperplastic foci on MR images were localized on the basis of histopathologic correlation. The ADC value of the monoexponential DWI, and the fast apparent diffusion coefficient (ADCf), slow apparent diffusion coefficient (ADCs) value and the fraction of ADCf (f) of the biexponential DWI were calculated for all of the lesions. Receiver operating characteristic (ROC) analysis was performed for the differentiation of CG cancer from SH and GH.ResultsThe ADC values (× 10^? 3 mm²/s) were 0.87 ± 0.11, 1.06 ± 0.15, and 1.61 ± 0.27 in CG cancer, SH and GH foci, respectively, and differed significantly, yielding areas under the ROC curve (AUCs) of 1.00 and 0.80 for the differentiation of carcinoma from GH and SH, respectively. The ADCf (× 10^? 3 mm²/s), ADCs (× 10^? 3 mm²/s) and f for cancer were 1.92 ± 0.38, 0.53 ± 0.17, and 47.7 ± 6.1%, respectively, which were lower than the same values for GH (3.43 ± 0.65, 1.12 ± 0.21, 61.1 ± 8.7%) (all p < 0.01). The ADCf and ADCs for cancer were also lower than those for SH (3.11 ± 0.30, 0.79 ± 0.21) (all p < 0.01). The ADCf yielded AUCs (1.00, p > 0.01) that were comparable to those from ADC for the differentiation of cancer from GH, while ADCf yielded higher AUCs (0.92) compared with ADC (p < 0.01) for the differentiation of cancer from SH. ADCs and f revealed AUCs of 0.97 and 0.90, respectively, for the differentiation of cancer from GH, and the ADCs offered relatively lower AUCs (0.68) for differentiating cancer from SH.ConclusionBiexponential DWI could potentially improve the differentiation of prostate cancer in CG, and the ADCf of the biexponential model offers better accuracy than ADC.     

Inversion recovery ultrashort echo time magnetic resonance imaging: A method for simultaneous direct detection of myelin and high signal demonstration of iron deposition in the brain – A feasibility study

Multiple sclerosis (MS) causes demyelinating lesions in the white matter and increased iron deposition in the subcortical gray matter. Myelin protons have an extremely short T2* (< 1 ms) and are not directly detected with conventional clinical magnetic resonance (MR) imaging sequences. Iron deposition also reduces T2*, leading to reduced signal on clinical sequences. In this study we tested the hypothesis that the inversion recovery ultrashort echo time (IR-UTE) pulse sequence can directly and simultaneously image myelin and iron deposition using a clinical 3 T scanner. The technique was first validated on a synthetic myelin phantom (myelin powder in D₂O) and a Feridex iron phantom. This was followed by studies of cadaveric MS specimens, healthy volunteers and MS patients. UTE imaging of the synthetic myelin phantom showed an excellent bi-component signal decay with two populations of protons, one with a T2* of 1.2 ms (residual water protons) and the other with a T2* of 290 μs (myelin protons). IR-UTE imaging shows sensitivity to a wide range of iron concentrations from 0.5 to ~ 30 mM. The IR-UTE signal from white matter of the brain of healthy volunteers shows a rapid signal decay with a short T2* of ~ 300 μs, consistent with the T2* values of myelin protons in the synthetic myelin phantom. IR-UTE imaging in MS brain specimens and patients showed multiple white matter lesions as well as areas of high signal in subcortical gray matter. This in specimens corresponded in position to Perl's diaminobenzide staining results, consistent with increased iron deposition. IR-UTE imaging simultaneously detects lesions with myelin loss in the white matter and iron deposition in the gray matter.     

Real-time cardiac magnetic resonance cine imaging with sparse sampling and iterative reconstruction for left-ventricular measures: Comparison with gold-standard segmented steady-state free precession

BackgroundSegmented cine imaging with a steady-state free-precession sequence (Cine-SSFP) is currently the gold standard technique for measuring ventricular volumes and mass, but due to multi breath-hold (BH) requirements, it is prone to misalignment of consecutive slices, time consuming and dependent on respiratory capacity. Real-time cine avoids those limitations, but poor spatial and temporal resolution of conventional sequences has prevented its routine application. We sought to examine the accuracy and feasibility of a newly developed real-time sequence with aggressive under-sampling of k-space using sparse sampling and iterative reconstruction (Cine-RT).MethodsStacks of short-axis cines were acquired covering both ventricles in a 1.5 T system using gold standard Cine-SSFP and Cine-RT. Acquisition parameters for Cine-SSFP were: acquisition matrix of 224 × 196, temporal resolution of 39 ms, retrospective gating, with an average of 8 heartbeats per slice and 1–2 slices/BH. For Cine-RT: acquisition matrix of 224 × 196, sparse sampling net acceleration factor of 11.3, temporal resolution of 41 ms, prospective gating, real-time acquisition of 1 heart-beat/slice and all slices in one BH. LV contours were drawn at end diastole and systole to derive LV volumes and mass.ResultsForty-one consecutive patients (15 male; 41 ± 17 years) in sinus rhythm were successfully included. All images from Cine-SSFP and Cine-RT were considered to have excellent quality. Cine-RT-derived LV volumes and mass were slightly underestimated but strongly correlated with gold standard Cine-SSFP. Inter- and intra-observer analysis presented similar results between both sequences.ConclusionsCine-RT featuring sparse sampling and iterative reconstruction can achieve spatial and temporal resolution equivalent to Cine-SSFP, providing excellent image quality, with similar precision measurements and highly correlated and only slightly underestimated volume and mass values.     

Selective microvascular muscle perfusion imaging in the shoulder with intravoxel incoherent motion (IVIM)

The evaluation of local muscle recruitment during a specific movement can be done indirectly by measuring changes in local blood flow. Intravoxel incoherent motion perfusion imaging exploits some properties of the magnetic resonance to measure locally microvascular perfusion, and seems ideally suited for this task. We studied the selectivity of the increase in intravoxel incoherent motion blood flow related parameter fD* in the muscles of 24 shoulders after two physical exam maneuvers, Jobe and Lift-off test (test order reversed in half of the volunteers) each held 2 min against resistance. After a lift-off, IVIM blood flow-related fD* was increased in the subscapularis (in 10⁻³ mm² s⁻¹, 3.24 ± 0.86 vs. rest 1.37 ± 0.58, p < 0.001) and the posterior bundle of deltoid (2.62 ± 1.34 vs. rest 0.77 ± 0.32, p < 0.001). Those increases were selective when compared with other rotator cuff muscles and deltoid bundles respectively. After a Jobe test, increase in fD* was scattered within the rotator cuff muscles, but was selective for the lateral deltoid compared to the other deltoid bundles (anterior, p < 0.001; posterior, p < 0.05). Those results were similar when the testing order was reversed. In conclusion, this study demonstrated a selective increase in local microvascular perfusion after specific muscle testing of the shoulder muscles with IVIM. This technique has the potential to non-invasively characterize perfusion-related musculoskeletal physiological as well as pathological processes.     

Motion corrected DWI with integrated T2-mapping for simultaneous estimation of ADC,T2-relaxation and perfusion in prostate cancer

ObjectiveMultiparametric magnetic resonance imaging (MRI) and PI-RADS (Prostate Imaging – Reporting and Data System) has become the standard to determine a probability score for a lesion being a clinically significant prostate cancer. T2-weighted and diffusion-weighted imaging (DWI) are essential in PI-RADS, depending partly on visual assessment of signal intensity, while dynamic-contrast enhanced imaging is less important. To decrease inter-rater variability and further standardize image evaluation, complementary objective measures are in need.MethodsWe here demonstrate a sequence enabling simultaneous quantification of apparent diffusion coefficient (ADC) and T2-relaxation, as well as calculation of the perfusion fraction f from low b-value intravoxel incoherent motion data. Expandable wait pulses were added to a FOCUS DW SE-EPI sequence, allowing the effective echo time to change at run time. To calculate both ADC and f, b-values 200 s/mm² and 600 s/mm² were chosen, and for T2-estimation 6 echo times between 64.9 ms and 114.9 ms were used.ResultsThree patients with prostate cancer were examined and all had significantly decreased ADC and T2-values, while f was significantly increased in 2 of 3 tumors. T2 maps obtained in phantom measurements and in a healthy volunteer were compared to T2 maps from a SE sequence with consecutive scans, showing good agreement. In addition, a motion correction procedure was implemented to reduce the effects of prostate motion, which improved T2-estimation.ConclusionsThis sequence could potentially enable more objective tumor grading, and decrease the inter-rater variability in the PI-RADS classification.