Fast Imaging With Steady-state Precession Research Articles

Trimodal Therapy Using an MR–guided Radiation Therapy Partial Bladder Tumor Boost in Muscle Invasive Bladder Cancer

Bladder preservation with trimodal therapy (TMT; maximal tumor resection followed by chemoradiation) is an effective paradigm for select patients with muscle invasive bladder cancer. We report our institutional experience of a TMT protocol using nonadaptive magnetic resonance imaging-guided radiation therapy (MRgRT) for partial bladder boost (PBB). A retrospective analysis was performed on consecutive patients with nonmetastatic muscle invasive bladder cancer who were treated with TMT using MRgRT between 2019 and 2022. Patients underwent intensity modulated RT-based nonadaptive MRgRT PBB contoured on True fast imaging with steady state precession (FISP) images (full bladder) followed sequentially by computed tomography-based RT to the whole empty bladder and pelvic lymph nodes with concurrent chemotherapy. MRgRT treatment time, table shifts, and dosimetric parameters of target coverage and normal tissue exposure were described. Prospectively assessed acute and late genitourinary and gastrointestinal (GI) toxicity were reported. Two-year local control was assessed with Kaplan-Meier methods. Seventeen patients were identified for analysis. PBB planning target volume margins were ≤8 mm in 94% (n=16) of cases. Dosimetric target coverage parameters were favorable and all normal tissue dose constraints were met. For MRgRT PBB fractions, median table shifts were 0.4 cm (range, 0-3.15), 0.45 cm (0-2.65), and 0.75 cm (0-4.8) in the X, Y, and Z planes, respectively. Median treatment time for MRgRT PBB fractions was 9 minutes (range, 6.9-17.4). We identified 32 out of 100 total MRgRT fractions that may have benefitted from online adaptation based on changes in organ position relative to planning target volume, predominantly because of small bowel (13/32, 41%) or rectum (8/32, 25%). Two patients discontinued RT prematurely. The incidence of highest-grade acute genitourinary toxicity was 1 to 2 (69%) and 3 (6%), whereas the incidence of acute GI toxicity was 1 to 2 (81%) and 3 (6%). There were no late grade 3 events; 17.6% had late grade 2 cystitis and none had late GI toxicity. With median follow-up of 18.2 months (95% CI, 12.4-22.5), the local control rate was 92%, and no patient has required salvage cystectomy. Nonadaptive MRgRT PBB is feasible with favorable dosimetry and low resource utilization. Larger studies are needed to evaluate for potential benefits in toxicity and local control associated with this approach in comparison to standard treatment techniques.

SPIO-enhanced 0.35T MRI-guided radiotherapy for liver malignancies: usefulness in tumor visualization.

The purpose of this study was to investigate the changes of tumor-to-liver signal ratio in a 0.35T MRI-guided radiotherapy system and to evaluate the usefulness and pitfalls of superparamagnetic iron oxide (SPIO) administration for visualization of liver tumors. Forty-two patients treated with MRI-guided stereotactic ablative radiotherapy (SABR) for liver tumors were included in this study. The tumor-to-liver signal ratios before and after SPIO administration were retrospectively assessed and compared on true fast imaging with steady-state precession (FISP). Before SPIO administration, liver tumors were either invisible or barely visible in 15 cases (36%), but all tumors became visible after SPIO administration. The mean values of tumor-to-liver signal ratio before and after SPIO administration were 0.939 ± 0.201 and 1.336 ± 0.300, respectively (mean ± standard deviation, p < 0.001). In six (14%) patients, liver tumors were visible on true FISP imaging before SPIO administration, but became invisible after administration. This study showed that liver tumors that are invisible on true FISP imaging can be made visible by administration of SPIO, and that MRI-guided SABR can be performed accurately. This is the first report to examine the usefulness of liver-specific contrast agent superparamagnetic iron oxides in 0.35T MRI-guided radiation therapy. Liver tumors that are invisible on true fast imaging with steady-state precession can be made visible by administration of superparamagnetic iron oxides.

Low-dose dobutamine cardiovascular magnetic resonance segmental strain study of early phase of intramyocardial hemorrhage rats

BackgroundThis study investigates the segmental myocardial strain of the early phase of intramyocardial hemorrhage (IMH) caused by reperfused myocardial infarction (MI) in rats by low-dose dobutamine (LDD) cardiovascular magnetic resonance (CMR) feature-tracking.MethodsNine sham rats and nine rats with 60-min myocardial ischemia followed by 48-h reperfusion were investigated using CMR, including T2*-mapping sequence and fast imaging with steady-state precession (FISP)–cine sequence. Another FISP–cine sequence was acquired after 2 min of dobutamine injection; the MI, IMH, and Non-MI (NMI) areas were identified. The values of peak radial strains (PRS) and peak circumferential strains (PCS) of the MI, IMH and NMI segments were acquired. The efficiency of PRS and PCS (EPRS and EPCS, respectively) were calculated on the basis of the time of every single heartbeat.ResultsThe PRS, PCS, EPRS, and EPCS of the sham group increased after LDD injection. However, the PRS, PCS, EPRS, and EPCS of the IMH segment did not increase. Moreover, the PRS and PCS of the MI and NMI segments did not increase, but the EPRS and EPCS of these segments increased. The PRS, PCS, EPRS, and EPCS of the IMH segment were lower than those of the MI and NMI segments before and after LDD injection, but without a significant difference between MI segment and NMI segment before and after LDD injection.ConclusionsLDD could help assess dysfunctions in segments with IMH, especially using the efficiency of strain. IMH was a crucial factor that decreased segmental movement and reserved function.

3D magnetic resonance fingerprinting with quadratic RF phase.

To implement 3D magnetic resonance fingerprinting (MRF) with quadratic RF phase (qRF-MRF) for simultaneous quantification of T1 , T2 , ΔB0 , and . 3D MRF data with effective undersampling factor of 3 in the slice direction were acquired with quadratic RF phase patterns for T1 , T2 , and sensitivity. Quadratic RF phase encodes the off-resonance by modulating the on-resonance frequency linearly in time. Transition to 3D brings practical limitations for reconstruction and dictionary matching because of increased data and dictionary sizes. Randomized singular value decomposition (rSVD)-based compression in time and reduction in dictionary size with a quadratic interpolation method are combined to be able to process prohibitively large data sets in feasible reconstruction and matching times. Accuracy of 3D qRF-MRF maps in various resolutions and orientations are compared to 3D fast imaging with steady-state precession (FISP) for T1 and T2 contrast and to 2D qRF-MRF for contrast and ΔB0 . The precision of 3D qRF-MRF was 1.5-2 times higher than routine clinical scans. 3D qRF-MRF ΔB0 maps were further processed to highlight the susceptibility contrast. Natively co-registered 3D whole brain T1 , T2 , , ΔB0 , and QSM maps can be acquired in as short as 5 min with 3D qRF-MRF.

HYDRA: Hybrid deep magnetic resonance fingerprinting.

Magnetic resonance fingerprinting (MRF) methods typically rely on dictionary matching to map the temporal MRF signals to quantitative tissue parameters. Such approaches suffer from inherent discretization errors, as well as high computational complexity as the dictionary size grows. To alleviate these issues, we propose a HYbrid Deep magnetic ResonAnce fingerprinting (HYDRA) approach, referred to as HYDRA. HYDRA involves two stages: a model-based signature restoration phase and a learning-based parameter restoration phase. Signal restoration is implemented using low-rank based de-aliasing techniques while parameter restoration is performed using a deep nonlocal residual convolutional neural network. The designed network is trained on synthesized MRF data simulated with the Bloch equations and fast imaging with steady-state precession (FISP) sequences. In test mode, it takes a temporal MRF signal as input and produces the corresponding tissue parameters. We validated our approach on both synthetic data and anatomical data generated from a healthy subject. The results demonstrate that, in contrast to conventional dictionary matching-based MRF techniques, our approach significantly improves inference speed by eliminating the time-consuming dictionary matching operation, and alleviates discretization errors by outputting continuous-valued parameters. We further avoid the need to store a large dictionary, thus reducing memory requirements. Our approach demonstrates advantages in terms of inference speed, accuracy, and storage requirements over competing MRF methods.

True FISP Cardiac Gated CSF Flow Dynamic Imaging of Chiari Malformation

Abstract INTRODUCTION Brain pulsation and related CSF dynamics is a well-known intraoperative characteristic, but methods for its visualization on magnetic resonance imaging (MRI) have until now been very limited. Best characterized techniques including phase-contrast MRI and cine echo-planar imaging, although of significant value, lack a detailed spatial and temporal resolution needed to investigate CSF and structural dynamics in an adequate manner to address preoperative decision making. Electrocardiographic (ECG)-gated true fast imaging with steady-state precession (FISP) sequences has been widely used to investigate cardiac motion and is capable of demonstrating brain pulsations and movements of intracranial structures surrounded by CSF with high temporal and spatial precision. We feature here the application of true FISP cardiac-gated imaging to the management of 2 patients with Chiari Malformation Type 1 and associated syringohydromyelia. METHODS Two children with Chiari Malformation Type 1 and concurrent syringohydromyelia underwent true FISP cardiac-gated imaging at our institution. RESULTS While conventional imaging studies such as T1 and phase-contrast cine MRI appeared to demonstrate obstruction of CSF flow secondary to tonsillar herniation, true FISP showed patent peritonsillar CSF flow and the presence of a pulsatile arachnoid veil. Subsequently, open surgery confirmed the presence of an arachnoid veil, and postoperative true FISP imaging revealed restoration of CSF flow following arachnoid veil fenestration. CONCLUSION We demonstrated 2 patients who presented with Chiari 1 malformation, where true FISP cardiac imaging was very instructive in visualizing dynamic images of an arachnoid veil and its possible role in the development of syringomyelia without a significant obstruction of outflow by cerebellar tonsils at the foramen of Magendie. We advocate use of this technology will aid in pre and post-surgical decision making, providing a more representative image of posterior fossa pathology in patients with Chiari 1 malformation.

A systematic optimization of 19F MR image acquisition to detect macrophage invasion into an ECM hydrogel implanted in the stroke-damaged brain

19F-MR imaging of perfluorocarbon (PFC)-labeled macrophages can provide a unique insight into their participation and spatio-temporal dynamics of inflammatory events, such as the biodegradation of an extracellular matrix (ECM) hydrogel implanted into a stroke cavity. To determine the most efficient acquisition strategy for 19F-MR imaging, five commonly used sequences were optimized using a design of experiment (DoE) approach and compared based on their signal-to-noise ratio (SNR). The fast imaging with steady-state precession (FISP) sequence produced the most efficient detection of a 19F signal followed by the rapid acquisition with relaxation enhancement (RARE) sequence. The multi-slice multi-echo (MSME), fast low angle shot (FLASH), and zero echo time (ZTE) sequences were significantly less efficient. Imaging parameters (matrix/voxel size; slice thickness, number of averages) determined the accuracy (i.e. trueness and precision) of object identification by reducing partial volume effects, as determined by analysis of the point spread function (PSF). A 96 × 96 matrix size (0.35 mm3) produced the lowest limit of detection (LOD) for RARE (2.85 mM PFPE; 119 mM 19F) and FISP (0.43 mM PFPE; 18.1 mM 19F), with an SNR of 2 as the detection threshold. Imaging of a brain phantom with PFC-labeled macrophages invading an ECM hydrogel further illustrated the impact of these parameter changes. The systematic optimization of sequence and imaging parameters provides the framework for an accurate visualization of 19F-labeled macrophage distribution and density in the brain. This will enhance our understanding of the contribution of periphery-derived macrophages in bioscaffold degradation and its role in brain tissue regeneration.

Simultaneous estimation of PD, T1 , T2 , T2* , and ∆B0 using magnetic resonance fingerprinting with background gradient compensation.

This study aims to estimate PD, T1 , T2 , T2* , and B0 simultaneously using magnetic resonance fingerprinting (MRF) with compensation of the linearly varying background field. MRF based on fast imaging with steady-state precession (FISP) and multi-echo spoiled gradient (SPGR) schemes are alternatively used, which encode T2 and T2* , respectively. Simulations are performed to determine the appropriate ratio of the FISP and SPGR sections with respect to the T2 and T2* accuracy. Additionally, background field inhomogeneity (Gz ) compensation using z-shim gradients are incorporated into the SPGR section and the dictionary. The background field compensation is tested in the phantom experiment under well-shimmed and poor-shimmed conditions. An in vivo experiment is performed and the estimated parameters are compared before and after Gz compensation. The T1 , T2 , and T2* values from the phantom results are in good agreement with the reference methods under well-shimmed condition. The underestimated T2 and T2* values under poor-shimmed condition are recovered by Gz compensation and the parameters are also in good agreement with the reference methods. In the human brain, T2 and T2* values are restored by Gz compensation in regions where the magnetic field is particularly inhomogeneous, such as near the sinus and ear canals. The proposed FISP and SPGR combined MRF provides a simultaneous estimation of PD, T1 , T2 , T2* , and B0 . By incorporating field inhomogeneity as a gradient term into both the sequence and dictionary, T2 and T2* values can be restored where field inhomogeneity exists.

Magnetic resonance field fingerprinting.

To develop and evaluate the magnetic resonance field fingerprinting method that simultaneously generates T1 , T2 , B0 , and maps from a single continuous measurement. An encoding pattern was designed to integrate true fast imaging with steady-state precession (TrueFISP), fast imaging with steady-state precession (FISP), and fast low-angle shot (FLASH) sequence segments with varying flip angles, radio frequency (RF) phases, TEs, and gradient moments in a continuous acquisition. A multistep matching process was introduced that includes steps for integrated spiral deblurring and the correction of intravoxel phase dispersion. The method was evaluated in phantoms as well as in vivo studies in brain and lower abdomen. Simultaneous measurement of T1 , T2 , B0 , and is achieved with T1 and T2 subsequently being less afflicted by B0 and variations. Phantom results demonstrate the stability of generated parameter maps. Higher undersampling factors and spatial resolution can be achieved with the proposed method as compared with solely FISP-based magnetic resonance fingerprinting. High-resolution B0 maps can potentially be further used as diagnostic information. The proposed magnetic resonance field fingerprinting method can estimate T1 , T2 , B0 , and maps accurately in phantoms, in the brain, and in the lower abdomen.

MR fingerprinting Deep RecOnstruction NEtwork (DRONE).

PurposeDemonstrate a novel fast method for reconstruction of multi‐dimensional MR fingerprinting (MRF) data using deep learning methods.MethodsA neural network (NN) is defined using the TensorFlow framework and trained on simulated MRF data computed with the extended phase graph formalism. The NN reconstruction accuracy for noiseless and noisy data is compared to conventional MRF template matching as a function of training data size and is quantified in simulated numerical brain phantom data and International Society for Magnetic Resonance in Medicine/National Institute of Standards and Technology phantom data measured on 1.5T and 3T scanners with an optimized MRF EPI and MRF fast imaging with steady state precession (FISP) sequences with spiral readout. The utility of the method is demonstrated in a healthy subject in vivo at 1.5T.ResultsNetwork training required 10 to 74 minutes; once trained, data reconstruction required approximately 10 ms for the MRF EPI and 76 ms for the MRF FISP sequence. Reconstruction of simulated, noiseless brain data using the NN resulted in a RMS error (RMSE) of 2.6 ms for T1 and 1.9 ms for T2. The reconstruction error in the presence of noise was less than 10% for both T1 and T2 for SNR greater than 25 dB. Phantom measurements yielded good agreement (R2 = 0.99/0.99 for MRF EPI T1/T2 and 0.94/0.98 for MRF FISP T1/T2) between the T1 and T2 estimated by the NN and reference values from the International Society for Magnetic Resonance in Medicine/National Institute of Standards and Technology phantom.ConclusionReconstruction of MRF data with a NN is accurate, 300‐ to 5000‐fold faster, and more robust to noise and dictionary undersampling than conventional MRF dictionary‐matching.

3D reconstruction of ablation lesions from in-vitro preparations using MRI

Abstract Radiofrequency ablation is the gold standard for treating cardiac arrhythmias. However, the success rate of this procedure depends on numerous parameters. Wet lab experiments provide the opportunity to investigate cardiac electrophysiology under reproducible conditions. To evaluate the electrophysiological changes of ablated myocardium in these studies it is necessary to consider the three-dimensional (3D) geometry of the lesions. For this purpose, we investigated the usage of different magnetic resonance imaging (MRI) sequences as well as an image processing procedure to analyze in-vitro preparations. To differentiate signal intensities between nonablated and ablated tissue we evaluated FISP (fast imaging with steady-state precession; delivering dominantly T1 -weighted images) and RARE (rapid acquisition with relaxation enhancement; delivering dominantly T2 -weighted images). After image processing, the ablated tissue was segmented in each image slice forming a 3D volume. The geometry of the lesion was modeled by the boundary of this volume. It was generally feasible to distinguish between healthy myocardium and ablated tissue as well as to determine lesion transmurality. The analysis of the reconstructed lesion geometries from FISP and RARE MRI showed a high agreement, however T2 -weighted sequences showed larger lesion volumes as well as higher variations in segmentation compared to T1 - mapping. FISP with higher quality may be used to reconstruct the 3D geometry of the ablation lesions.

MR fingerprinting using fast imaging with steady state precession (FISP) with spiral readout

MR fingerprinting using fast imaging with steady state precession (FISP) with spiral readout

Bone marrow lesions are associated with altered trabecular morphometry

Bone marrow lesions (BMLs) are a common magnetic resonance (MR) feature in patients with osteoarthritis, however their pathological basis remains poorly understood and has not been evaluated invivo. Our aim was to evaluate the trabecular structure associated with the presence and size of BMLs present in the same regions of interest (ROI) using quantitative MR-based trabecular morphometry. 158 participants in the Osteoarthritis Initiative (OAI) were imaged with a coronal 3D fast imaging with steady state precession (FISP) sequence for trabecular morphometry in the same session as the OAI 3T MR knee evaluation. The proximal medial tibial subchondral bone in the central weight-bearing ROI on these knee 3D FISP images were quantitatively evaluated for apparent bone volume fraction, trabecular number, spacing, and thickness. BMLs were also evaluated in the subchondral bone immediately adjacent to the articular cartilage. BML volume was also evaluated within the same trabecular morphometry ROI and semi-quantitatively classified as none, small, or large. Kruskal-Wallis test was used to determine if mean apparent bone volume fraction, trabecular number, spacing, or thickness differed by BML score. Compared to knees with ROIs containing no BMLs, knees with small or large BMLs had statistically higher apparent bone volume fraction (P<0.01), trabecular number (P<0.01), and thickness (P=0.02), and lower trabecular spacing (P<0.01). Compared to knees with ROIs containing no BMLs, knees with ROIs containing small or large BMLs had higher apparent bone volume fraction, trabecular number and thickness, but lower trabecular spacing. These findings may represent areas of locally increased bone remodeling or compression.

Intraobserver and Interobserver Variability of Renal Volume Measurements in Polycystic Kidney Disease Using a Semiautomated MR Segmentation Algorithm

Total renal volume and changes in kidney volume are markers of disease progression in autosomal-dominant polycystic kidney disease (ADPKD) but are not used in clinical practice in part because of the complexity of manual measurements. This study aims to assess the intra- and interobserver reproducibility of a semiautomated renal volumetric algorithm using fluid-sensitive MRI pulse sequences. Renal volumes of 17 patients with ADPKD were segmented from high-resolution coronal HASTE and true fast imaging with steady-state precession (FISP) MR acquisitions. Measurements performed independently by four readers were repeated, typically after 7 days. Intraobserver agreement indexes were calculated for total kidney volume for each patient. Interobserver agreement indexes were obtained for the six paired combinations of readers as well as for two readers after rigorous formalized training. Pearson and concordance correlation coefficients, coefficients of variation (CVs), and 95% limits of agreement were determined. The HASTE and true FISP sequences performed similarly with a median intraobserver agreement of greater than 98.1% and a CV of less than 2.4% across all readers. The median interobserver agreement was greater than 95.2% and the CV was less than 7.1%, across all reader pairs. Reader training further lowered interobserver CV. The mean total kidney volume was 1420 mL (range, 331-3782 mL) for HASTE imaging and 1445 mL (range, 301-3714 mL) for true FISP imaging, with mean image processing times per patient of 43 and 28 minutes, respectively. This semiautomated MR volumetric algorithm provided excellent intraobserver and very good interobserver reproducibility using fluid-sensitive pulse sequences that emphasize cyst conspicuity.

MR Imaging of Pulmonary Embolism: Diagnostic Accuracy of Contrast-enhanced 3D MR Pulmonary Angiography, Contrast-enhanced Low–Flip Angle 3D GRE, and Nonenhanced Free-Induction FISP Sequences

To evaluate relative detection of pulmonary embolism (PE) with standard bolus-triggered contrast-enhanced breath-hold magnetic resonance (MR) pulmonary angiography, contrast-enhanced recirculation-phase breath-hold low-flip angle three-dimensional (3D) gradient-echo (GRE), and nonenhanced free-induction cardiac- and respiratory-triggered true fast imaging with steady-state precession (FISP) MR sequences. The study was HIPAA compliant and institutional review board approved. Twenty-two patients with a computed tomographic (CT) angiography diagnosis of PE underwent MR imaging within 48 hours of CT. MR included three complementary techniques: MR pulmonary angiography, 3D GRE, and triggered true FISP. Each sequence was analyzed separately by two independent reviewers who recorded presence of emboli in categorized pulmonary artery anatomic territories. CT angiography results were analyzed by a third independent reviewer, who retrospectively recorded presence of emboli using the same format; these results served as the reference standard. Sensitivity, specificity, and positive and negative predictive values for PE detection were calculated for each MR technique on a per-embolus basis, and 95% confidence intervals were calculated according to the efficient-score method. A two-sample t test was used to compare values among MR techniques. Sensitivities for PE detection were 55% for MR pulmonary angiography, 67% for triggered true FISP, and 73% for 3D GRE MR imaging. Combining all three MR sequences improved overall sensitivity to 84%. Specificity was 100% for all detection methods except for MR pulmonary angiography (one false-positive). Agreement between readers was high (κ = 0.87). Embolus detection rates were lowest in the lingula branch for all MR sequences compared with remainder of the vascular territories (P = .07). There are complementary benefits to combining standard MR pulmonary angiography, 3D GRE, and triggered true FISP MR examinations for evaluation of PE.

Dynamic Magnetic Resonance Imaging of the Cervical Spine with High-Resolution 3-Dimensional T2-Imaging

Imaging of the cervical spine in functional positions has so far been limited to conventional X-ray examinations or the scarcely available open magnetic resonance imaging (MRI). An MRI compatible positioning device allows MRI examinations in various positions and even in motion. In combination with high-resolution T2-weighted MRI it allows detailed functional imaging of the cervical spine and nerve roots. To evaluate the utility of this method a population of patients from a clinical study was examined 5 years after anterior cervical discectomy and fusion (ACDF). A total of 32 patients (median age 51.5 years, 15 female, 17 male) were examined after a median interval of 64.3 months from ACDF including 16 patients with a titanium cage and 16 with autologous bone graft. The prototype of an MR compatible positioning device (NeuroSwing) was used for MRI of the cervical spine in functional positions on a 1.5 T MRI unit (Siemens Avanto). A real-time true fast imaging with steady-state precession (FISP) sequence [6 mm, TR 704, TE 1.3 ms, matrix 256 x 207, field of view (FoV) 22 cm] was used for monitoring of flexion up to 45° and extension up to 40° or until patient discomfort. A sagittal T2 sampling perfection with application optimized contrast using different flip angle evolution sequence (SPACE sequence, 0.9 mm isotropic voxels, TR 1770, TE 186 ms, matrix 320 x 318, FoV 28 cm) and an axial true FISP sequence (3 mm slices, TR 194, TE 1.9 ms, matrix 256 x 256, FoV 22 cm) were used for imaging in the end positions. Using the motorized positioning device and a real-time true FISP sequence, imaging of the cervical spine in flexion and extension motion was possible in a quality suitable to observe changes in the alignment of vertebral bodies, the width of the spinal canal and the spinal cord itself. The 3D T2-weighted SPACE sequence yielded high quality and resolution images in the maximum flexion and extension positions. Compared to primary axial T2 true FISP slices, axial reconstructions of the T2 SPACE sequence were found to be clearly less affected by metal artifacts with the additional benefit of multiplanar and transforaminal reconstructions. The combination of a mechanical positioning device and a high-resolution 3D T2-weighted sequence (SPACE) on a conventional 1.5 T MRI allows kinematic imaging of the cervical spine as well as high-resolution imaging in the end positions, even in the presence of metal implants. In this proof of concept study a good visualization of narrowing of the spinal canal in functional positions could be achieved, showing the potential of MRI in functional positions for clinical and research applications.

Histological correlation of 7 T multi-parametric MRI performed in ex-vivo Achilles tendon

IntroductionThe goal of this in vitro validation study was to investigate the feasibility of biochemical MRI techniques, such as sodium imaging, T2 mapping, fast imaging with steady state precession (FISP), and reversed FISP (PSIF), as potential markers for collagen, glycosaminoglycan and water content in the Achilles tendon. Materials and methodsFive fresh cadaver ankles acquired from a local anatomy department were used in the study. To acquire a sodium signal from the Achilles tendon, a 3D-gradient-echo sequence, optimized for sodium imaging, was used with TE=7.71ms and TR=17ms. The T2 relaxation times were obtained using a multi-echo, spin-echo technique with a repetition time (TR) of 1200ms and six echo times. A 3D, partially balanced, steady-state gradient echo pulse sequence was used to acquire FISP and PSIF images, with TR/TE=6.96/2.46ms. MRI parameters were correlated with each other, as well as with histologically assessed glycosaminoglycan and water content in cadaver Achilles tendons. ResultsThe highest relevant Pearson correlation coefficient was found between sodium SNR and glycosaminoglycan content (r=0.71, p=0.007). Relatively high correlation was found between the PSIF signal and T2 values (r=0.51, p=0.036), and between the FISP signal and T2 values (r=0.56, p=0.047). Other correlations were found to be below the moderate level. ConclusionThis study demonstrated the feasibility of progressive biochemical MRI methods for the imaging of the AT. A GAG-specific, contrast-free method (sodium imaging), as well as collagen- and water-sensitive methods (T2 mapping, FISP, PSIF), may be used in fast-relaxing tissues, such as tendons, in reasonable scan times.

371 MRI-BASED CARTILAGE THICKNESS LOSS AND JOINT SPACE NARROWING IN AN OAI CORE PROGRESSION SAMPLE, AND THEIR RELATIONSHIP WITH AGE, SEX, AND BMI

Purpose: Recent evidence suggests that peri-articular bone changes are integral to knee osteoarthritis (OA) pathophysiology. Peri-articular trabecular morphology changes have been associated with radiographic knee OA severity and may identify individuals at risk for knee OA progression. However, it is unclear how patient characteristics are associated with peri-articular trabecular morphology in knees with OA. The purpose of this study was to evaluate the association between patient characteristics and trabecular morphology in knees with OA. Methods: The sample comprised a convenience sample of 337 participants in the Osteoarthritis Initiative (OAI) progression cohort who at the 30or 36-month OAI visit had 3-tesla magnetic resonance imaging that included coronal 3D Fast Imaging with Steady State Precession (FISP) trabecular morphometry sequences. We used a trabecular morphometry program with a modified algorithm (calcDCN, University of CaliforniaSan Francisco) to evaluate 4 peri-articular trabecular morphology measures: bone volume fraction (BVF), trabecular number (tb.n), spacing (tb.sp), and thickness (tb.th). The four measures were calculated for 20 consecutive central slices within a 15mm x 3.75mm region of interest placed in the peri-articular medial tibia and then averaged. Intratester reproducibility was high (ICC = 0.99). The association between demographic data or knee-specific data (from the 24-month OAI visit) and trabecular morphometry were evaluated with independent sample t-tests or Wilcoxon rank-sum tests (when applicable) and Spearman correlations. Among a subset of 285 patients with 24-month joint space narrowing (JSN) scores, four forward-selection multiple linear regression models were used to further evaluate the associations between patient characteristics and each trabecular morphometry measure. Results: Participants were 66±9 years of age, body mass index 29.6±4.8 kg/m, and 50% female. Peri-articular trabecular morphometry was averaged (± standard deviation) for the cohort: BVF = 0.12±0.08, tb.sp = 1.53±1.25mm, tb.n = 0.86±0.39mm−1, and tb.th = 0.13±0.03mm. Peri-articular trabecular morphometry was not significantly different (p > 0.05) between participants with or without college degrees (n = 208, n = 127; respectively), with or without history of smoking (n =147, n = 188; respectively), and with or without knee symptoms at the 24month OAI visit (n = 191, n = 145; respectively). Many variables were associated with trabecular morphometry (see table). Age correlated with BVF (r = −0.16), tb.n (r = −0.18), and tb.sp (r = 0.17), but not tb.th (r = −0.08). Body mass index also correlated with BVF (r = 0.12), tb.n (r = 0.14), and tb.sp (r = −0.14), but not tb.th (r = 0.07). The 400-meter walk time (24-month visit) was related to tb.sp (r = 0.12). In multiple linear regression models, the presence of medial JSN and female gender were associated with all 4 trabecular morphometry measures. Three patient characteristics were associated with select measures: age (associated with tb.sp, tb.n), history of knee injury/surgery (associated with BVF, tb.th), and race (associated with tb.th).

Type 1 Perimedullary Arteriovenous Fistula with Subarachnoid Hemorrhage: Utility of Contrast-enhanced 3D Gradient-echo Technique

In patients with perimedullary arteriovenous fistula (AVF) with subarachnoid hemorrhage (SAH), knowledge of lesion location is necessary to select the appropriate approach for catheter spinal angiography. We evaluated the utility of 3-dimensional (3D) fast imaging with steady-state precession (FISP) sequence for detecting type 1 perimedullary AVF with SAH. We evaluated 4 patients (2 men, 2 women, aged 53 to 68 years, mean age, 59.25 years) with type 1 perimedullary AVF who presented with SAH and underwent conventional spin-echo MR and contrast-enhanced 3D FISP imaging. Two neuroradiologists assessed detection of vascular lesions and delineation of their relationships to the adjacent vessels. Catheter angiography was used as the reference standard and compared with the MR findings. Perimedullary AVF was located at the medullocervical junction in 2 patients, cervical spine in one, and thoracic spine in one. For all patients, use of contrast-enhanced 3D FISP in addition to conventional MR imaging improved lesion detection and delineation of the relationship between the lesion and surrounding vessels. Contrast-enhanced 3D FISP imaging was useful for detecting and delineating type 1 perimedullary AVF with SAH.

Detection of degenerative cartilage disease: comparison of high-resolution morphological MR and quantitative T2 mapping at 3.0 Tesla

The aim of the study was to investigate the association of T2 relaxation times of the knee with early degenerative cartilage changes. Furthermore the impact of unloading the knee on T2 values was evaluated. Forty-three patients with knee pain and an ICRS (International Cartilage Repair Society) cartilage defect grade <or=2 were examined with 3T magnetic resonance imaging (MRI). Morphological cartilage grading was based on high-resolution proton-density (PD), turbo-spin-echo (TSE) and three-dimensional (3D) isotropic True fast imaging with steady-state precession (FISP) images of slices covering the cartilage layer above the posterior horn of the meniscus. T2 maps were calculated from a multi-echo, spin-echo (MESE) sequence, performed at the beginning and at the end of the scan (time interval 40 min). Influence of cartilage defect grading on deep, superficial, and global T2 values as well as on T2 values for zonal variation was assessed using analysis of variance (ANOVA) and Spearman rank correlation test. Differences among both T2 measurements were compared using paired t-test. Global and superficial T2 values significantly increased with cartilage defect grade regardless of the time elapsed from unloading (global T2: ICRS grade 0, 38.9 and 40.1 ms; grade 1, 41.2 and 44.5 ms; grade 2, 47.7 and 53.4 ms; P=0.041 and 0.008) with stronger correlation for second T2 measurement. In contrast there were no significant differences among grades in the zonal variation at any time. Significant differences for T2 values between the two subsequent measurements were consistently found. T2 mapping might be a sensitive method for the detection of early cartilage degeneration. From our results we would recommend to measure T2 after unloading.