B0 Images Research Articles

Quantitative analysis of hypertrophic myocardium using diffusion tensor magnetic resonance imaging.

Systemic hypertension is a causative factor in left ventricular hypertrophy (LVH). This study is motivated by the potential to reverse or manage the dysfunction associated with structural remodeling of the myocardium in this pathology. Using diffusion tensor magnetic resonance imaging, we present an analysis of myocardial fiber and laminar sheet orientation in ex vivo hypertrophic (6 SHR) and normal (5 WKY) rat hearts using the covariance of the diffusion tensor. First, an atlas of normal cardiac microstructure was formed using the WKY b0 images. Then, the SHR and WKY b0 hearts were registered to the atlas. The acquired deformation fields were applied to the SHR and WKY heart tensor fields followed by the preservation of principal direction (PPD) reorientation strategy. A mean tensor field was then formed from the registered WKY tensor images. Calculating the covariance of the registered tensor images about this mean for each heart, the hypertrophic myocardium exhibited significantly increased myocardial fiber derangement ([Formula: see text]) with a mean dispersion of 38.7deg, and an increased dispersion of the laminar sheet normal ([Formula: see text]) of 54.8deg compared with 34.8deg and 51.8deg, respectively, in the normal hearts. Results demonstrate significantly altered myocardial fiber and laminar sheet structure in rats with hypertensive LVH.

Impact of region-of-interest method on quantitative analysis of DTI data in the optic tracts.

BackgroundTo extract DTI parameters from a specific structure, a region of interest (ROI) must be defined. ROI selection in small structures is challenging; the final measurement results could be affected due to the significant impact of small geometrical errors. In this study the optic tracts were analyzed with the aim to assess differences in DTI parameters due to ROI method and to identify the most reliable method.MethodsImages of 20 healthy subjects were acquired. Fractional anisotropy (FA) was extracted from the optic tracts by four different ROI methods. Manual tracing was performed in 1) the b0 image and 2) a T1-weighted image registered to the FA image. Semi-automatic segmentation was performed based on 3) tractography and 4) the FA-skeleton algorithm in the tract-based spatial statistics (TBSS) framework. Results were analyzed with regard to ROI method as well as to inter-scan, intra-rater and inter-rater reliability.ResultsThe resulting FA values divided the ROI methods into two groups that differed significantly: 1) the FA-skeleton and the b0 methods showed higher FA values compared to 2) the tractography and the T1-weighted methods. The intra- and inter-rater variabilities were similar for all methods, except for the tractography method where the inter-rater variability was higher. The FA-skeleton method had a better reproducibility than the other methods.ConclusionChoice of ROI method was found to be highly influential on FA values when the optic tracts were analyzed. The FA-skeleton method performed the best, yielding low variability and high repeatability.

자기공명 확산강조영상검사 시 영상왜곡 감소에 관한 연구

본 연구는 DWI 검사 시 자화율 차이로 인해 뇌줄기에 발생하는 영상의 왜곡을 새로운 SS-TSE를 적용하여 감소시키고자 하였다. 연구방법은 2015년 7월부터 동년 9월까지 DWI 검사를 검사한 30명을 대상으로, 기존의 SS-EPI 기법과 새로운 SS-TSE를 적용하여 기법에 따른 뇌줄기의 왜곡과 오차율을 비교평가 하였다. 연구결과, 새로운 SS-TSE 적용 시 왜곡이 감소된 것을 볼 수 있으며, 오차율 또한 b0 영상은 2.4%(11.1%에서 8.7%), b1000 영상은 1.2%(11.4%에서 10.1%) 감소하는 것을 볼 수 있었다. 결론적으로, 뇌줄기의 DWI 검사 시 본 연구의 SS-TSE를 이용하면 기존 기법 사용 시 발생하는 영상의 왜곡을 감소시킬 수 있어 진단적 가치가 높은 영상을 획득할 수 있다. Single-shot echo planar imaging(SS-EPI) is well established as high sensitivity for ischemic stroke. However, it is prone to susceptibility artifact in brain stem that diminish the image quality. single-shot turbo spin echo(SS-TSE) is a new DWI technique that can reduce susceptibility artifact. Thus, this research was conducted so as to reduce geometric distortion in brain stem by using single-shot turbo spin echo technique. Thirty patients without brain disease underwent diffusion MR on a 3T scanner with SS-EPI and SS-TSE. Obtained images with both sequences were analyzed for geometric distortion and error percentage as well. Image quality in terms of geometric distortion of SS-TSE were found to be significantly better than those for SS-EPI. And error percentage was considerably reduced for 2.4% of b0 image(from 11.1% to 8.7%), 1.2% of b1000 image(from 11.4% to 10.1%), respectively. In summary, diffusion MR using SS-TSE significantly reduce geometric distortion compared to SS-EPI in brain stem and may provide improved diagnostic performance.

부분용적효과를 고려한 확산텐서영상에 대한 관심영역 분석 연구

In this study, we proposed ameliorated method for region of interest (ROI) study to improve its accuracy using partial volume effect (PVE). PVE which arose in volumetric images when more than one tissue type occur in a voxel, could be used to reduce an amount of gray matter and cerebrospinal fluid within ROI of diffusion tensor image (DTI). In order to define ROIs, individual b0 image was spatially aligned to the JHU DTI-based atlas using linear and non-linear registration (http://cmrm.med.jhmi.edu/). Fractional anisotropy (FA) and mean diffusivity (MD) maps were estimated by fitting diffusion tensor model to each image voxel, and their mean values were computed within each ROI with PVE threshold. Participants of this study consisted of 20 healthy controls, 27 Alzheimer's disease and 27 normal-pressure hydrocephalus patients. The result showed that the mean FA and MD of each ROI were increased and decreased respectively, but standard deviation was significantly decreased when PVE was applied. In conclusion, the proposed method suggested that PVE was indispensable to improve an accuracy of DTI ROI study.

Does b1000-b0 Mismatch Challenge Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery Mismatch in Stroke?

Our aim was to explore whether the mismatch in lesion visibility between b1000 and b0 images is an alternative to mismatch between diffusion-weighted imaging and fluid-attenuated inversion recovery imaging as a surrogate marker of stroke age. We analyzed patients from the European multicenter I-KNOW database. Independent readers assessed the visibility of ischemic lesions of the anterior circulation on b0 and fluid-attenuated inversion recovery imaging images. The signal-intensity ratio for b0 and fluid-attenuated inversion recovery imaging images was also measured from the segmented stroke lesion volume on b1000 images. This study included 112 patients (68 men; mean age, 67.4 years) with stroke onset within (n=85) or longer than (n=27) 4.5 hours. b1000-b0 mismatch identified patients within 4.5 hours of stroke onset with moderate sensitivity (72.9%; 95% confidence interval [CI], 63.5-82.4) and specificity (70.4%; 95% CI, 53.2-87.6), high positive predictive value (88.6%; 95% CI, 81.1-96.0), and low negative predictive value (45.2%; 95% CI, 30.2-60.3). Global comparison of b1000-b0 mismatch with diffusion-weighted imaging-fluid-attenuated inversion recovery imaging mismatch (considered the imaging gold standard) indicated high sensitivity (85.9%; 95% CI, 78.2-93.6), specificity (91.2%; 95% CI, 76.3-98.1), and positive predictive value (96.7%; 95% CI, 88.0-99.1) and moderate negative predictive value (73.8%; 95% CI, 60.5-87.1) of this new approach. b0 signal-intensity ratio (r=0.251; 95% CI, 0.069-0.417; P=0.008) was significantly although weakly correlated with delay between stroke onset and magnetic resonance imaging. b1000-b0 mismatch may identify patients with ischemic stroke of the within 4.5 hours of onset with high positive predictive value, perhaps constituting an alternative imaging tissue clock.

Combined evaluation of conventional MRI, dynamic contrast-enhanced MRI and diffusion weighted imaging for response evaluation of patients with multiple myeloma

PurposeTo evaluate the value of the combined evaluation of SE MRI, dynamic contrast enhanced MRI (DCE-MRI) and diffusion weighted imaging (DWI) in multiple myeloma (MM) patients after treatment compared to the international myeloma working group (IMWG) response criteria. Materials and methodsThe retrospective study includes 27 newly diagnosed patients, providing 99 MRI-investigations. Patients were categorized according to the IMWG response criteria. Quantitative assessment was based on signal intensities (SI) of T1-weighted, fat-saturated T2-weighted and b1000 images, apparent diffusion coefficients (ADC) and parameters from time-intensity-curves (TIC) derived from L3. Qualitative visual analysis of conventional MRI-images, b1000-images and TICs, providing a “combined skeletal score”, was used to create MRI response criteria. ResultsThe combined skeletal score could significantly differentiate between subgroups based on IMWG response criteria (p=0.016). The gold standard plasmacytosis could significantly differentiate between subgroups based on MRI response criteria (p<0.001), as well as slope (p<0.001) and ADC (p=0.006). There is a good agreement between IMWG and MRI response criteria (Kendall’s coefficient=0.761). ConclusionResponse evaluation of MM-patients based on the combination of anatomical information from conventional MRI with functional information from DCE-MRI and DWI, is useful for monitoring therapy.

Retrospective head motion correction approaches for diffusion tensor imaging: Effects of preprocessing choices on biases and reproducibility of scalar diffusion metrics.

To evaluate how retrospective head motion correction strategies affect the estimation of scalar metrics commonly used in clinical diffusion tensor imaging (DTI) studies along with their across-session reproducibility errors. Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD) and their respective across-session reproducibility errors were measured on a 4T test-retest dataset of healthy participants using five processing pipelines. These differed in: 1) the number of b0 volumes used for motion correction reference (one or five); 2) the estimations of the gradient matrix rotation (based on 6 or 12 degrees of freedom derived from coregistration); and 3) the software packages used (FSL or DTIPrep). Biases and reproducibility were evaluated in three regions of interest (ROIs) (bilateral arcuate fasciculi, cingula, and the corpus callosum) and also at the full brain level with tract based skeleton images. Preprocessing choices affected DTI measures and their reproducibility. The DTIPrep pipeline exhibited higher DTI metrics: FA/MD and AD (P < 0.05) relative to FSL pipelines both at the ROI and full brain level, and lower RD estimates (P < 0.05) at the ROI level. Within FSL pipelines no such effects were found (P-values ranging between 0.25 and 0.97). The DTIPrep pipeline showed the highest number of white matter skeleton voxels, with significantly higher reproducibility (P < 0.001) relative to the other pipelines (tested on P < 0.01 uncorrected maps). The use of an iteratively averaged b0 image as motion correction reference (as performed by DTIPrep) affects both scalar values and improves test-retest reliability relative to the other tested pipelines. These considerations are potentially relevant for data analysis in longitudinal DTI studies.

Improvement of renal diffusion-weighted magnetic resonance imaging with readout-segmented echo-planar imaging at 3 T

PurposeTo assess the feasibility of a respiratory-gated implementation of readout-segmented SE-EPI (RESOLVE) for renal diffusion-weighted imaging (DWI) by comparison with single-shot SE-EPI (ss-EPI) in a phantom, healthy volunteers and chronic kidney disease (CKD) patients. Materials and MethodsA fluid-filled phantom, 20 healthy volunteers and 10 CKD patients were scanned with the same parameters and coils on a 3T MR system with 3 DW sequences (b-values=0, 300, 500, 900s/mm2): a standard ss-EPI (Reference EPI), a ss-EPI with higher resolution, bandwidth and acceleration factor (HR-EPI) and RESOLVE with the same spatial resolution as HR-EPI but a segmentation of the readout into 5 shots. Geometric distortions, image blurring using a ‘Canny’ edge detection based measure, cortico-medullary differentiation measured on b0 images and ADC quantification were compared between the 3 sequences using one-way analysis of variance (ANOVA) with post-hoc Bonferroni (p<0.05 was taken as statistically significant). ResultsRESOLVE reduced significantly geometric distortions and blurring and improved, in the volunteers and patients, the sharpness score by 56% on average in comparison to ss-EPI (p=0.02). In healthy volunteers, the cortico-medullary differentiation with RESOLVE was also possible on a wider range of b-values (p<0.02) with ADC values (in 10−6mm2/s) of 1994±246 in the cortex and 1762±238 in the medulla (p<0.001). In CKD patients, ADC values (in 10−6mm2/s) from the RESOLVE sequence were not different between the cortex (1755±145) and the medulla (1799±163, p=0.49). ConclusionDespite a longer scan time, RESOLVE enhanced significantly the quality of renal diffusion-weighted images by improving the difference in SI and ADC between the renal cortex and medulla in healthy volunteers. In CKD patients, RESOLVE showed a disappearance of this cortico-medullary ADC difference. These improvements justify further clinical studies.

Integrated RF/shim coil array for parallel reception and localized B0 shimming in the human brain

The purpose of this work was to develop a novel integrated radiofrequency and shim (RF/shim) coil array that can perform parallel reception and localized B0 shimming in the human brain with the same coils, thereby maximizing both the signal-to-noise ratio and shimming efficiency. A 32-channel receive-only head coil array was modified to enable both RF currents (for signal reception) and direct currents (for B0 shimming) to flow in individual coil elements. Its in vivo performance was assessed in the frontal brain region, which is affected by large susceptibility-induced B0 inhomogeneities. The coil modifications did not reduce their quality factor or signal-to-noise ratio. Axial B0 maps and echo-planar images acquired in vivo with direct currents optimized to shim specific slices showed substantially reduced B0 inhomogeneities and image distortions in the frontal brain region. The B0 root-mean-square error in the anterior half of the brain was reduced by 60.3% as compared to that obtained with second-order spherical harmonic shimming. These results demonstrate that the integrated RF/shim coil array can perform parallel reception and localized B0 shimming in the human brain and provide a much more effective shimming than conventional spherical harmonic shimming alone, without taking up additional space in the magnet bore and without compromising the signal-to-noise ratio or shimming performance.

Geometric distortions of diffusion weighted imaging of the head/neck in combined PET/MR: optimization of image acquisition and post-processing correction for oncology applications.

The combination of PET with Diffusion Weighted Imaging (DWI) is a promising application of PET/MR. DWI geometric accuracy can be compromised in body regions with complex anatomy. Here, we assess DWI head/neck image quality following optimization of acquisition and post-processing. Preliminary data from 10 patients with cancer of the tonsil or base-of-tongue is presented. An integrated PET/MR system (Siemens Biograph mMR) with a 3 T magnet was used. PET was performed as a single-bed, 20 min acquisition, 120 min post injection of 4 MBq/kg [18F]-FDG. MRI included axial T2 weighted STIR, B0 mapping and 2 DWI single-shot EPI measurements (DWI1 and DWI2) with b values 0, 500 and 1000 mm2/s. DWI2 was measured as 3 stacks, each at isocenter to maximize field homogeneity. DWI1/DWI2 had an effective echo spacing 0.375/0.145 ms. For DWI2, distortions were corrected using FSL with FUGUE and Topup algorithms. DWI geometric quality was evaluated in 44×44 mm2 region centred on the tumor, with the STIR image as anatomical reference. Correlation and DICE coefficients between DWI b0 and STIR images were computed, for all DWI image sets. Geometric quality of DWI1 was poor, but improved both by optimization of acquisition (DWI2) and by post-processing. Visually, hyperintensities on the Topup corrected DWI2 images matched closely the STIR images. Also, regions with high FDG uptake and low diffusion had matching shapes. Correlation and DICE coefficients had a large variation for DWI1, and showed an overall increase to a high level >0.6 and 0.8, respectively, following optimization of image acquisition and post-processing correction. Diffusion weighted images of the head/neck with a quality suitable for dual-modality assessment of tumour characteristics on a voxel basis can be obtained following the optimization of acquisition and post-processing.

Multisite longitudinal reliability of tract-based spatial statistics in diffusion tensor imaging of healthy elderly subjects

Large-scale longitudinal neuroimaging studies with diffusion imaging techniques are necessary to test and validate models of white matter neurophysiological processes that change in time, both in healthy and diseased brains. The predictive power of such longitudinal models will always be limited by the reproducibility of repeated measures acquired during different sessions. At present, there is limited quantitative knowledge about the across-session reproducibility of standard diffusion metrics in 3T multi-centric studies on subjects in stable conditions, in particular when using tract based spatial statistics and with elderly people. In this study we implemented a multi-site brain diffusion protocol in 10 clinical 3T MRI sites distributed across 4 countries in Europe (Italy, Germany, France and Greece) using vendor provided sequences from Siemens (Allegra, Trio Tim, Verio, Skyra, Biograph mMR), Philips (Achieva) and GE (HDxt) scanners. We acquired DTI data (2×2×2mm3, b=700s/mm2, 5 b0 and 30 diffusion weighted volumes) of a group of healthy stable elderly subjects (5 subjects per site) in two separate sessions at least a week apart. For each subject and session four scalar diffusion metrics were considered: fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial (AD) diffusivity. The diffusion metrics from multiple subjects and sessions at each site were aligned to their common white matter skeleton using tract-based spatial statistics. The reproducibility at each MRI site was examined by looking at group averages of absolute changes relative to the mean (%) on various parameters: i) reproducibility of the signal-to-noise ratio (SNR) of the b0 images in centrum semiovale, ii) full brain test–retest differences of the diffusion metric maps on the white matter skeleton, iii) reproducibility of the diffusion metrics on atlas-based white matter ROIs on the white matter skeleton. Despite the differences of MRI scanner configurations across sites (vendors, models, RF coils and acquisition sequences) we found good and consistent test–retest reproducibility. White matter b0 SNR reproducibility was on average 7±1% with no significant MRI site effects. Whole brain analysis resulted in no significant test–retest differences at any of the sites with any of the DTI metrics. The atlas-based ROI analysis showed that the mean reproducibility errors largely remained in the 2–4% range for FA and AD and 2–6% for MD and RD, averaged across ROIs. Our results show reproducibility values comparable to those reported in studies using a smaller number of MRI scanners, slightly different DTI protocols and mostly younger populations. We therefore show that the acquisition and analysis protocols used are appropriate for multi-site experimental scenarios.

Zoomed echo-planar imaging using parallel transmission: impact on image quality of diffusion-weighted imaging of the prostate at 3T.

To assess impact of two-channel parallel transmission (pTx) with focused excitation [zoomed echo-planar imaging (EPI)] on image quality of prostate diffusion-weighted imaging (DWI) at 3T. 27 male volunteers (27±8years) underwent 3T prostate MRI using 2-channel radiofrequency-transmit system and 18-channel torso receive coil. Scans included EPI-DWI sequence (b values 50, 500, 1000s/mm(2)) acquired both with standard sinc pulse and 2-channel pTX with focused excitation, each acquired at large-field-of-view (FOV) (20×20cm) and small-FOV (14×14cm). An abdominal radiologist scored b-1000 images and ADC maps for image quality measures. Sequences were compared using paired Wilcoxon tests. pTx with focused excitation showed significant improvements compared with standard DWI on b-1000 images at large-FOV for the absence of wrap and overall image quality (p≤0.049); on b-1000 images at small-FOV for reduced distortion of prostate, absence of ghosting, absence of wrap, clarity of prostate capsule, clarity of peripheral/transition zone boundary, clarity of peri-urethral region, and overall image quality (p≤0.004); and on ADC maps at small-FOV for reduced distortion of prostate, sharpness of prostate, clarity of prostatic capsule, clarity of peri-urethral region, and overall image quality (p=0.002-0.036). When compared with standard large-FOV images, small-FOV images obtained using pTx with focused excitation showed no significant difference on the b-1000 images for any feature (p≥0.175), while showing significant improvements on the ADC maps in terms of reduced distortion, absence of ghosting, and absence of wrap (p=0.010-0.030). Zoomed DWI using 2-channel pTx reduced artifacts and improved image quality for 3T prostate DWI; benefit was most apparent for small-FOV images.

WE‐G‐18C‐01: Novel Method for Geometrically Undistorted B0 Inhomogeneity Field Map Estimation and Image Correction

Purpose:To develop and evaluate a method to estimate undistorted B0 inhomogeneity field maps of MRI and to correct susceptibility‐induced geometrical and intensity distortions in clinical images in order to support precision RT planning.Methods:The proposed method consisted of two major steps. First, undistorted B0 inhomogeneity field maps and images were estimated from k‐space data of a 3D dual gradient‐echo (GRE) acquisition using a novel joint reconstruction algorithm. After linearizing the cost function that includes two spatial regularizations, the algorithm iteratively estimated the undistorted field maps and images. Second, clinical images acquired with a low readout‐bandwidth in the same imaging session, e.g., 180 Hz/pixel in clinical brain T1‐weighted images, were corrected for geometrical and intensity distortions by using the undistorted field map. The method was evaluated through simulation, and studies of a geometric phantom with air‐water interfaces and human brain on a 3T scanner.Results:Simulation showed that our method reduced field map errors (RMS and maximum error) in the undistorted field maps ten‐fold compared to the distorted ones, and geometric and intensity artifacts in the jointly reconstructed images. In the phantom study, the 2‐mm distortion near the air‐water interface was fully corrected using the undistorted field map, but only partially corrected using the distorted field map with approximately 1‐mm residual distortion. In the patient study, there was &gt;2 mm distortion near the sinus in the distorted field map. The geometrically accurate field map obtained by our method resulted in improved correction of geometry and intensity in both GRE and clinical T1‐weighted images at the air/tissue interface.Conclusion:Our method can correct geometrical distortion in clinical images, create a geometrical accurate image template, or provide a means for quality assurance of individual patient images, to enable MRI as a primary modality in precision RT planning.Work supported by: NIH R01 EB016079

Removal of partial volume averaging with free water in MR diffusion tensor imaging using inversion recovery for b0 image

PurposeTo remove the partial volume averaging effect of free water in MR diffusion imaging of neural tissues by use of the fluid attenuated inversion recovery (FLAIR) without the penalty of an extended scan time. Materials and methodsThe magnetic resonance images were obtained from a normal volunteer in a coronal slice orientation at 3T with the 20-channel rf coil. In diffusion imaging only the b0 images were obtained with the FLAIR contrast while the diffusion weighted images were obtained without the FLAIR contrast. A composition of FLAIR b0 and non-FLAIR diffusion weighted images was used in calculating the diffusion tensor and fractional anisotropy after compensating the reduced signal amplitude due to the inversion recovery in the FLAIR b0 images. The fractional anisotropy of the non-FLAIR, FLAIR, and the composite methods were analyzed for the mean and histogram in the corpus callosum, cervical spine, and the fornix tracts. ResultsThe partial volume averaging effect was observed in the corpus callosum, the cervical spine, and the fornix tracts in the non-FLAIR b0 and diffusion images. The partial volume averaging effect was removed in the FLAIR diffusion images which took more than twice the scan time than the non-FLAIR diffusion imaging. The proposed composite FLAIR diffusion imaging removed the partial volume averaging effect as in the FLAIR diffusion imaging. The distribution of the FA histogram was very different between the non-FLAIR and FLAIR diffusion images, while it was very similar between the FLAIR and the composite FLAIR after correcting the white matter signal in the FLAIR b0 images. ConclusionsThe proposed composite FLAIR diffusion imaging method was equally effective in removing the partial volume averaging effect as the FLAIR diffusion imaging at a limited increase of the scan time since only a small number of b0 images needed to be obtained with the FLAIR contrast.

Early Time Course of FLAIR Signal Intensity Differs between Acute Ischemic Stroke Patients with and without Hyperintense Acute Reperfusion Marker

Background: In animal models of stroke, the time course of blood-brain barrier (BBB) disruptions has been elaborately studied. In human patients, leakage of gadolinium into cerebrospinal fluid (CSF) space, visualized on MRI fluid attenuated inversion recovery (FLAIR) images, is considered a sign of BBB disruptions. It was termed ‘hyperintense acute reperfusion marker' (HARM) and was associated with hemorrhages. However, the time course of the leakage is unknown and difficult to study in human patients. Also, the association of HARM with signal intensities and enhancement in the parenchyma on FLAIR images has not been thoroughly researched. Methods: We analyzed imaging data of acute ischemic stroke patients who underwent repetitive MRI examinations within the first 36 h after the time of symptom onset. HARM was evaluated on FLAIR images. Regions of interest (ROI) of the hyperintensities on diffusion-weighted imaging (DWI) were determined for each time point and mirrored to the contralateral side. The ROI were furthermore corrected for CSF-filled space, using apparent diffusion coefficient (ADC) images. The corrected ROI were used to determine mean signal intensities of the lesions relative to the contralateral side on FLAIR, ADC and B₀ images for each time point. Results: The 18 included patients (5 females; median age: 69 years; median NIHSS score: 5) received 3-5 MRI examinations on the first day and 1-2 examinations on day 2 after stroke. Eight of the patients (44.4%) showed HARM on at least 1 examination. In 6 of these patients, HARM was already seen at the second examination, at the earliest 3.5 h after symptom onset. The HARM-positive patients had higher relative signal intensities (rSI) on FLAIR images in the parenchyma corresponding to the DWI-positive tissue compared with the HARM-negative patients. This difference between groups was statistically significant for the 2nd and 3rd examination (medians of 4.31 and 6.37 h from symptom onset, p < 0.001 and p = 0.005, respectively). No significant difference in rSI between groups was seen for ADC or B₀ images. Conclusion: HARM does not only represent a contrast medium leakage from the pial system into the CSF space. It is accompanied by a markedly increased rSI in the early ischemic lesion on FLAIR images, which is likely due to parenchymal enhancement. The lack of differences on B₀ images excludes a pure T2 effect.

Comparison of the Accuracy of PET/CT and PET/MRI Spatial Registration of Multiple Metastatic Lesions

The purpose of this study was to compare the accuracy of the spatial registration of conventional PET/CT with that of hybrid PET/MRI of patients with FDG-avid metastatic lesions. Thirteen patients with known metastatic lesions underwent FDG PET/CT followed by PET/MRI with a hybrid whole-body system. The inclusion criterion for tumor analysis was spherical or oval FDG-avid tumor clearly identified with both CT and MRI. The spatial coordinates (x, y, z) of the visually estimated centers of the lesions were determined for PET/CT (PET and CT independently) and PET/MRI (PET, T1-weighted gradient-echo sequence with radial stack-of-stars trajectory, T2-weighted sequence), and the b0 images of an echo-planar imaging (EPI) diffusion-weighted imaging (DWI) acquisition. All MRI sequences were performed in the axial plane with free breathing. The spatial coordinates of the estimated centers of the lesions were determined for PET and CT and PET and MRI sequences. Distance between the isocenter of the lesion on PET images and on the images obtained with the anatomic modalities was measured, and misregistration (in millimeters) was calculated. The degree of misregistration was compared between PET/CT and PET/MRI with a paired Student t test. Nineteen lesions were evaluated. On PET/CT images, the average of the total misregistration in all planes of CT compared with PET was 4.13 ± 4.24 mm. On PET/MR images, lesion misregistration between PET and T1-weighted gradient-echo images had a shift of 2.41 ± 1.38 mm and between PET and b0 DW images was 5.97 ± 2.83 mm. Similar results were calculated for 11 lesions on T2-weighted images. The shift on T2-weighted images compared with PET images was 2.24 ± 1.12 mm. Paired Student t test calculations for PET/CT compared with PET/MRI T1-weighted gradient-echo images with a radial stack-of-stars trajectory, b0 DW images, and T2-weighted images showed significant differences (p < 0.05). Similar results were seen in the analysis of six lung lesions. PET/MRI T1-weighted gradient-echo images with a radial stack-of-stars trajectory and T2-weighted images had more accurate spatial registration than PET/CT images. This may be because that the whole-body PET/MRI system used can perform simultaneous acquisition, whereas the PET/CT system acquires data sequentially. However, the EPI-based b0 DWI datasets were significantly misregistered compared with the PET/CT datasets, especially in the thorax. Radiologists reading PET/MR images should be aware of the potential for misregistration on images obtained with EPI-based DWI sequences because of inherent spatial distortion associated with this type of MRI acquisition.

Differentiation between low-grade and high-grade glioma using combined diffusion tensor imaging metrics

ObjectiveTo ascertain whether diffusion tensor imaging (DTI) metrics including tensor shape measures such as planar and spherical isotropy coefficients (CP and CS) can be used to distinguish high-grade from low-grade gliomas. MethodsTwenty-five patients with histologically proved brain gliomas (10 low-grade and 15 high-grade) were included in this study. Contrast-enhanced T1-weighted images, non-diffusion weighted b=0 (b0) images, fractional anisotropy (FA), apparent diffusion coefficient (ADC), CS and CP maps were co-registered and each lesion was divided into two regions of interest (ROI): enhancing and immediate peritumoral edema (edema adjacent to tumor). Univariate and multivariate logistic regression analyses were applied to determine the best classification model. ResultsThere was a statistically significant difference in the multivariate logistic regression analysis. The best logistic regression model for classification combined three parameters (CS, FA and CP) from the immediate peritumoral part (p=0.02), resulting in 86% sensitivity, 80% specificity and area under the curve of 0.81. ConclusionOur study revealed that combined DTI metrics can function in effect as a non-invasive measure to distinguish between low-grade and high-grade gliomas.

Q‐ball imaging with PROPELLER EPI acquisition

Q-ball imaging (QBI) is an imaging technique that is capable of resolving intravoxel fiber crossings; however, the signal readout based on echo-planar imaging (EPI) introduces geometric distortions in the presence of susceptibility gradients. This study proposes an imaging technique that reduces susceptibility distortions in QBI by short-axis PROPELLER EPI acquisition. Conventional QBI and PROPELLER QBI data were acquired from two 3T MR scans of the brains of five healthy subjects. Prior to the PROPELLER reconstruction, residual distortions in single-blade low-resolution b0 and diffusion-weighted images (DWIs) were minimized by linear affine and nonlinear diffeomorphic demon registrations. Subsequently, the PROPELLER keyhole reconstruction was applied to the corrected DWIs to obtain high-resolution PROPELLER DWIs. The generalized fractional anisotropy and orientation distribution function maps contained fewer distortions in PROPELLER QBI than in conventional QBI, and the fiber tracts more closely matched the brain anatomy depicted by turbo spin-echo (TSE) T2-weighted imaging (T2WI). Furthermore, for fixed T(E), PROPELLER QBI enabled a shorter scan time than conventional QBI. We conclude that PROPELLER QBI can reduce susceptibility distortions without lengthening the acquisition time and is suitable for tracing neuronal fiber tracts in the human brain.

Optimal setting of image bounding box can improve registration accuracy of diffusion tensor tractography.

When we register diffusion tensor tractography (DTT) to anatomical images such as fast imaging employing steady-state acquisition (FIESTA), we register the B0 image to FIESTA. Precise registration of the DTT B0 image to FIESTA is possible with non-rigid registration compared to rigid registration, although the non-rigid methods lack convenience. We report the effect of image data bounding box settings on registration accuracy using a normalized mutual information (NMI) method METHODS: MRI scans of 10 patients were used in this study. Registration was performed without modification of the bounding box in the control group, and the results were compared with groups re-registered using multiple bounding boxes limited to the region of interest (ROI). The distance of misalignment after registration at 3 anatomical characteristic points that are common to both FIESTA and B0 images was used as an index of accuracy. Mean ([Formula: see text]SD) misalignment at the 3 anatomical points decreased significantly from [Formula: see text] to [Formula: see text]mm, [Formula: see text]), [Formula: see text] to [Formula: see text]mm, ([Formula: see text], and [Formula: see text] to [Formula: see text]mm, ([Formula: see text], each showing improvement compared to the control group CONCLUSION: Narrowing the image data bounding box to the ROI improves the accuracy of registering B0 images to FIESTA by NMI method. With our proposed methodology, accuracy can be improved in extremely easy steps, and this methodology may prove useful for DTT registration to anatomical image.

Increasing the Accuracy of Volume and ADC Delineation for Heterogeneous Tumor on Diffusion-Weighted MRI: Correlation with PET/CT

To improve the accuracy of volume and apparent diffusion coefficient (ADC) measurements in diffusion-weighted magnetic resonance imaging (MRI), we proposed a method based on thresholding both the b0 images and the ADC maps. In 21 heterogeneous lesions from patients with metastatic gastrointestinal stromal tumors (GIST), gross lesion were manually contoured, and corresponding volumes and ADCs were denoted as gross tumor volume (GTV) and gross ADC (ADC(g)), respectively. Using a k-means clustering algorithm, the probable high-cellularity tumor tissues were selected based on b0 images and ADC maps. ADC and volume of the tissues selected using the proposed method were denoted as thresholded ADC (ADC(thr)) and high-cellularity tumor volume (HCTV), respectively. The metabolic tumor volume (MTV) in positron emission tomography (PET)/computed tomography (CT) was measured using 40% maximum standard uptake value (SUV(max)) as the lower threshold, and corresponding mean SUV (SUV(mean)) was also measured. HCTV had excellent concordance with MTV according to Pearson's correlation (r=0.984, P<.001) and linear regression (slope = 1.085, intercept = -4.731). In contrast, GTV overestimated the volume and differed significantly from MTV (P=.005). ADC(thr) correlated significantly and strongly with SUV(mean) (r=-0.807, P<.001) and SUV(max) (r=-0.843, P<.001); both were stronger than those of ADC(g). The proposed lesion-adaptive semiautomatic method can help segment high-cellularity tissues that match hypermetabolic tissues in PET/CT and enables more accurate volume and ADC delineation on diffusion-weighted MR images of GIST.