Magnetization-prepared Rapid Acquisition With Gradient Echo Research Articles

Voxel-based Morphometry of Alzheimer's Disease Using a Localizer Image: A Comparative Study with Magnetization Prepared Rapid Acquisition with Gradient Echo.

Magnetization prepared rapid acquisition with gradient echo (MPRAGE) sequence is a gold-standard technique for voxel-based morphometry (VBM) because of high spatial resolution and excellent tissue contrast, especially between gray matter (GM) and white matter (WM). Despite its benefits, MPRAGE exhibits distinct challenge for VBM in some patients with neurological disease because of long scan time and motion artifacts. Speedily acquired localizer images may alleviate this problem. This study aimed to evaluate the feasibility of VBM using 3D Fast Low Angle Shot image captured for localizer (L3DFLASH). Consecutive 13 patients with pathologically confirmed Alzheimer's disease (AD) (82 ± 9 years) and 21 healthy controls (HC) (79 ± 4 years) were included in this study. Whole-brain L3DFLASH and MPRAGE were captured and preprocessed using the Computational Anatomy Toolbox 12 (CAT12). Agreement with MPRAGE was evaluated for L3DFLASH using regional normalized volume for segmented brain areas. In addition to brain volume difference on VBM and Bland-Altman analysis, atrophic pattern of AD on VBM was evaluated using L3DFLASH and MPRAGE. Acquisition time was 18s for L3DFLASH and 288s for MPRAGE. There was a slight systematic difference in all regional normalized volumes from L3DFLASH and MPRAGE. For the whole cohort, GM volume measured from MPRAGE was greater than that from L3DFLASH in most of the region on VBM. When AD and HC were compared, AD-related atrophic pattern was demonstrated in both L3DFLASH and MPRAGE on VBM, although the difference was noted in significant clusters between them. Although systematic difference was noted in regional brain volume measured from L3DFLASH and MPRAGE, AD-related atrophic pattern was preserved in L3DFLASH on VBM. VBM, using speedily acquired localizer image, may provide limited but useful information for evaluating brain atrophy.

Abstract 19141: Carotid Artery Plaque Rim Sign on Computed Tomography Angiography is Associated With Intraplaque Hemorrhage and Inflammatory Microenvironment

Introduction: The carotid artery rim sign on CTA is characterized by soft-plaque components surrounded by a rind of thin, adventitial calcification and its role in plaque instability is not established yet. Intraplaque hemorrhage (IPH) and the inflammatory microenvironment in carotid atheroma are considered features of atherosclerotic plaque vulnerability leading to cerebrovascular events. Hypothesis: The association between rim sign on CTA and carotid IPH and inflammation remains scantly investigated. In this study, we aimed to determine whether rim sign is associated with IPH on MRA and with the extent of IPH and inflammation on histology. We hypothesized that rim sign may be a radiological predictor of carotid IPH and inflammation. Methods: We retrospectively enrolled 100 consecutive patients who underwent carotid endarterectomy (CEA) and neck CTA before CEA. On CTA, the ipsilateral rim sign was defined as the presence of adventitial calcifications with internal soft-tissue plaque of ≥2 mm in maximum thickness. Of the included patients, 25 had MRA with 3D magnetization-prepared rapid acquisition with gradient echo (MPRAGE) sequence. Carotid plaque specimens were collected and stained with H&E to quantify IPH (%). Histologically, we defined IPH as an area of carotid plaque with blood elements, and inflammatory microenvironment as the presence of lymphocytes and plasma cells (chronic inflammation) and foam cells. Results: The rim sign on CTA was present in 56 (56%) of patients. IPH on MRA was present in 11 (44%) patients. The rim sign was significantly associated with the presence of IPH on MRA [9 (81.8%) vs 2 (14.3%); p=0.003]. On histology, the rim sign was associated with a higher extent of IPH [5.0 % (IQR 2.0-25.0) vs 5.0% (IQR 0.0-10.0); p=0.017], with chronic inflammation [44 (78.6%) vs 12 (21.4%); p=0.003], and foam cells [51 (91.1%) vs 5 (8.9%); p<0.001]. Conclusions: These findings suggest that rim sign on CTA may be proposed as a potential imaging marker of IPH as well as a histologic predictor of IPH extent and carotid plaque inflammatory microenvironment.

The development of ultra-high field MRI guidance technology for neuronavigation.

Magnetic resonance imaging at 7T offers improved image spatial and contrast resolution for visualization of small brain nuclei targeted in neuromodulation. However, greater image geometric distortion and a lack of compatible instrumentation preclude implementation. In this report, the authors detail the development of a stereotactic image localizer and accompanying imaging sequences designed to mitigate geometric distortion, enabling accurate image registration and surgical planning of basal ganglia nuclei. Magnetization-prepared rapid acquisition with gradient echo (MPRAGE), fast gray matter acquisition T1 inversion recovery (FGATIR), T2-weighted, and T2*-weighted sequences were optimized for 7T in 9 human subjects to visualize basal ganglia nuclei, minimize image distortion, and maximize target contrast-to-noise and signal-to-noise ratios. Extracranial spatial distortions were mapped to develop a skull-contoured image localizer embedded with spherical silicone fiducials for improved MR image registration and target guidance. Surgical plan accuracy testing was initially performed in a custom-developed MRI phantom (n = 5 phantom studies) and finally in a human trial. MPRAGE and T2*-weighted sequences had the best measures among global measures of image quality (3.8/4, p < 0.0001; and 3.7/4, p = 0.0002, respectively). Among basal ganglia nuclei, FGATIR outperformed MPRAGE for globus pallidus externus (GPe) visualization (2.67/4 vs 1.78/4, p = 0.008), and FGATIR, T2-weighted imaging, and T2*-weighted imaging outperformed MPRAGE for substantia nigra visualization (1.44/4 vs 2.56/4, p = 0.04; vs 2.56/4, p = 0.04; vs 2.67/4, p = 0.003). Extracranial distortion was lower in the head's midregion compared with the base and apex ( 1.17-1.33 mm; MPRAGE and FGATIR, p < 0.0001; T2-weighted imaging, p > 0.05; and T2*-weighted imaging, p = 0.013). Fiducial placement on the localizer in low distortion areas improved image registration (fiducial registration error, 0.79-1.19 mm; p < 0.0001) and targeting accuracy (target registration error, 0.60-1.09 mm; p = 0.04). Custom surgical software and the refined image localizer enabled successful surgical planning in a human trial (fiducial registration error = 1.0 mm). A skull-contoured image localizer that accounts for image distortion is necessary to enable high-accuracy 7T imaging-guided targeting for surgical neuromodulation. These results may enable improved clinical efficacy for the treatment of neurological disease.

Dedicated Isotropic 3-D T1 SPACE Sequence Imaging for Radiosurgery Planning Improves Brain Metastases Detection and Reduces the Risk of Intracranial Relapse

<h3>Purpose/Objective(s)</h3> Stereotactic radiosurgery (SRS) is increasingly used for patients with brain metastasis, yet the risk of distant intracranial failure (DIF) continues to be the principal disadvantage of this focal approach. The objective of this study was to determine if advanced dedicated treatment planning images at SRS would improve lesion detection and consequentially reduce DIF. <h3>Materials/Methods</h3> Patients treated with SRS at a single tertiary care institution underwent dedicated treatment planning MRIs including a standard three-dimensional (3D) magnetization-prepared rapid acquisition with gradient echo (MPRAGE) sequence as well as an optimized 3D sampling perfection with application-optimized contrasts using different flip angle evolutions (SPACE) sequence from 02/2020-01/2021. DIF was calculated using the Kaplan-Meier method and comparisons were made to a historical consecutive cohort of patients treated using MPRAGE alone (02/2019-01/2020). <h3>Results</h3> 134 patients underwent 170 SRS courses for 821 brain metastases imaged with both MPRAGE and SPACE (primary cohort). MPRAGE sequence evaluation alone detected 679 (82.7%) lesions. With neuroradiologists evaluating SPACE and MPRAGE, an additional 108 lesions were identified (p<0.001). Upon multidisciplinary review, 34 (4.1%) additional lesions were identified. Compared to the historical cohort (103 patients, 133 SRS courses, 479 brain metastases) treated using MPRAGE alone, patients treated using MPRAGE and SPACE had improved median time to DIF (13.5 vs. 5.1 months, <i>p</i>=0.004). The benefit was even more pronounced for patients treated for their first SRS course (18.4 vs. 6.3 months, <i>p</i>=0.001). On multivariate analysis, factors associated with improved DIF included stable extracranial disease, better performance status, using MPRAGE and SPACE images, and being treated for first course SRS (all <i>p</i><0.05). SRS using MPRAGE and SPACE was associated with a 60% reduction in risk of DIF compared with a historical cohort using MPRAGE alone (HR: 0.40; 95%CI: 0.28, 0.57, <i>p</i><0.001). <h3>Conclusion</h3> Among patients with brain metastasis treated with SRS, the addition of a dedicated treatment planning SPACE sequence to MPRAGE substantially improved detection of brain metastasis compared to MPRAGE alone. This approach was associated with a statistically significant and clinically meaningful prolongation in time to DIF, especially for patients undergoing their first course of SRS.

Prospective comparison of volumetric post-contrast T1-Sampling Perfection with Application optimized Contrasts by using different flip angle Evolutions and Magnetization-Prepared Rapid Acquisition with Gradient Echo in patients with metastatic melanoma.

Volumetric turbo spin echo (3D-TSE) T1-weighted imaging techniques such as T1-SPACE (Sampling Perfection with Application optimized Contrasts by using different flip angle Evolutions) improve detection of intracranial metastases (IM) compared to volumetric magnetisation-prepared gradient recalled echo techniques such as MPRAGE (Magnetization-Prepared Rapid Acquisition with Gradient Echo). However, incomplete vascular suppression can produce false positives when using 3D-TSE. Research into 3D-TSE has generally targeted patients with known or suspected IM, but the clinical implications of false positives are greater in patients with lower likelihood of IM. This study examined additional findings identified by T1-SPACE in patients with metastatic melanoma, targeting patients with a lower incidence of IM. Patients with metastatic melanoma and an upcoming brain MRI booking were identified prospectively. Consent for adding post-contrast T1-SPACE to the MRI protocol (which included MPRAGE) was obtained. Imaging was initially assessed without T1-SPACE. Subsequently, T1-SPACE images were examined and additional findings identified were recorded, including their correlation with MPRAGE. One hundred examinations were performed, 24 having evidence of active IM. T1-SPACE allowed identification of additional lesions in five patients, including two with small solitary IM not identified when first assessing MPRAGE. In 18 examinations, T1-SPACE identified additional equivocal findings, confidently attributed to artefact (most commonly normal vessels) following correlation with MPRAGE. T1-SPACE improves detection of small lesions in patients without known IM, changing patient management. False positives are common but can be clarified with MPRAGE. Combining T1-SPACE and MPRAGE allows both sensitivity and specificity to be optimised.

Comparison of contrast-enhanced T1-weighted imaging using DANTE-SPACE, PETRA, and MPRAGE: a clinical evaluation of brain tumors at 3 Tesla.

We aimed to compare the performance of three contrast-enhanced T1-weighted three-dimensional (3D) magnetic resonance (MR) sequences to detect brain tumors at 3 Tesla. The three sequences were: (I) delay alternating with nutation for tailored excitation sampling perfection with application-optimized contrasts using different flip angle evolution (DANTE-SPACE), (II) pointwise encoding time reduction with radial acquisition (PETRA), and (III) magnetization-prepared rapid acquisition with gradient echo (MPRAGE). This study involved 77 consecutive patients, including 34 patients with known primary brain tumors and 43 patients suspected of intracranial metastases. All patients underwent each of the three sequences with comparable spatial resolution and acquisition time post-injection. Signal-to-noise ratios (SNRs) for gray matter (GM) and white matter (WM), contrast-to-noise ratios (CNRs) for lesion/GM, lesion/WM, and GM/WM were quantitatively compared. Two radiologists determined the total number of enhancing lesions by consensus. Intraclass correlation coefficients (ICCs) between the two radiologists for metastases presence, qualitative ratings for image quality, and acoustic noise level of each sequence were assessed. Among the three sequences, SNRs and CNRs between lesions and surrounding parenchyma were highest using DANTE-SPACE, but CNRWM/GM was the lowest with DANTE-SPACE. SNRs for PETRA images were significantly higher than those for MPRAGE (P<0.001). CNRs between lesions and surrounding parenchyma were similar for PETRA and MPRAGE (P>0.05). Significantly more brain metastases were detected with DANTE-SPACE (n=94) compared with MPRAGE (n=71) and PETRA (n=72). The ICCs were 0.964 for MPRAGE, 0.975 for PETRA, and 0.973 for DANTE-SPACE. Qualitative scores for lesion imaging using DANTE-SPACE were significantly higher than those obtained with PETRA and MPRAGE (P=0.002 and P=0.004, respectively). The acoustic noise level for PETRA (64.45 dB) was significantly lower than that for MPRAGE (78.27 dB, P<0.01) and DANTE-SPACE (80.18 dB, P<0.01). PETRA achieves comparable detection of brain tumors with MPRAGE and is preferred for depicting osseous metastases and meningeal enhancement. DANTE-SPACE with blood vessel suppression showed improved detection of cerebral metastases compared with MPRAGE and PETRA, which could be helpful for the differential diagnosis of tumors.

Deep Learning-Based Classification and Voxel-Based Visualization of Frontotemporal Dementia and Alzheimer's Disease.

Frontotemporal dementia (FTD) and Alzheimer’s disease (AD) have overlapping symptoms, and accurate differential diagnosis is important for targeted intervention and treatment. Previous studies suggest that the deep learning (DL) techniques have the potential to solve the differential diagnosis problem of FTD, AD and normal controls (NCs), but its performance is still unclear. In addition, existing DL-assisted diagnostic studies still rely on hypothesis-based expert-level preprocessing. On the one hand, it imposes high requirements on clinicians and data themselves; On the other hand, it hinders the backtracking of classification results to the original image data, resulting in the classification results cannot be interpreted intuitively. In the current study, a large cohort of 3D T1-weighted structural magnetic resonance imaging (MRI) volumes (n = 4,099) was collected from two publicly available databases, i.e., the ADNI and the NIFD. We trained a DL-based network directly based on raw T1 images to classify FTD, AD and corresponding NCs. And we evaluated the convergence speed, differential diagnosis ability, robustness and generalizability under nine scenarios. The proposed network yielded an accuracy of 91.83% based on the most common T1-weighted sequence [magnetization-prepared rapid acquisition with gradient echo (MPRAGE)]. The knowledge learned by the DL network through multiple classification tasks can also be used to solve subproblems, and the knowledge is generalizable and not limited to a specified dataset. Furthermore, we applied a gradient visualization algorithm based on guided backpropagation to calculate the contribution graph, which tells us intuitively why the DL-based networks make each decision. The regions making valuable contributions to FTD were more widespread in the right frontal white matter regions, while the left temporal, bilateral inferior frontal and parahippocampal regions were contributors to the classification of AD. Our results demonstrated that DL-based networks have the ability to solve the enigma of differential diagnosis of diseases without any hypothesis-based preprocessing. Moreover, they may mine the potential patterns that may be different from human clinicians, which may provide new insight into the understanding of FTD and AD.

Importance of Veins for Neurosurgery as Landmarks Against Brain Shifting Phenomenon: An Anatomical and 3D-MPRAGE MR Reconstruction of Superficial Cortical Veins.

Modern neurosurgery uses preoperative imaging daily. Three-dimensional reconstruction of the cortical anatomy and of the superficial veins helps the surgeons plan and perform neurosurgical procedures much more safely. The target is always to give the patient maximum benefit in terms of outcome and minimize intraoperative and postoperative complications. This study aims to develop a method for the combined representation of the cerebral cortex anatomy and the superficial cerebral veins, whose integration is beneficial in daily practice. Only those patients who underwent surgical procedures with craniotomy and a large opening of the dura mater were included in this study, for a total of 23 patients, 13 females (56.5%) and 10 males (43.5%). The average age was 50.1 years. We used a magnetic resonance tomograph Magnetom Vision® 1.5T (Siemens AG). Two sequences were applied: a strongly T1-weighted magnetization-prepared rapid acquisition with gradient echo (MPRAGE) sequence to visualize cerebral anatomical structures, and a FLASH-2D-TOF angiography sequence to visualize the venous vessels on the cortical surface after the administration of a paramagnetic contrast agent. The two data sets were superimposed manually, co-registered in an interactive process, and merged to create a combined data set, segmented and visualized as a three-dimensional reconstruction. Furthermore, we present our method for visualizing superficial veins, which helps manage brain shift (BS). We also performed anatomical observations on the reconstructions. The reconstructions of the cortical and venous anatomy proved to be a valuable tool in surgical planning and positively influenced the surgical procedure. Due to the good correlation with the existing surgical site, this method should be validated on a larger cohort or in a multicentric study.

Detecting Task Functional MRI Activation Using the Multiband Multiecho (MBME) Echo-Planar Imaging (EPI) Sequence.

Blood oxygen level-dependent (BOLD) functional MRI (fMRI) has been widely applied to detect brain activations. Recent advances in multiband (MB) and multiecho (ME) techniques have greatly improved fMRI methods. MB imaging improves temporal and/or spatial resolution, while ME imaging has been shown to improve BOLD sensitivity. This study aimed to evaluate the novel MBME echo planar imaging (EPI) sequence utilizing MB and ME simultaneously to determine if the MBME outperform the MB single echo (MBSE) sequence for task fMRI. To compare the performance of MBME with MBSE in a task fMRI study. Prospective. A total of 29 healthy volunteers aged 20-46 years (9 male, 20 female). MBSE and MBME gradient-echo EPI sequences were applied at 3T. Additional T1 -weighted magnetization-prepared rapid acquisition with gradient echo (MPRAGE) was collected. A checkerboard visual task was presented during the functional MBSE and MBME scans. The MBME or MBSE signal was evaluated using the temporal signal-to-noise ratio (tSNR). Task activation was evaluated using the z-score, volume, sensitivity, and specificity. Test-retest metrics of task activation were examined with the Dice coefficient (DC) and intraclass correlation coefficient (ICC) on subjects with repeated scans. A linear mixed-effects model was used to compared MBME and MBSE activation at the voxel base. The paired t-test was used to compare tSNR, activation z-score, and volume, along with sensitivity, specificity, and DC between MBSE and MBME. While similar task activation was detected in the visual cortex, MBME showed higher activation volume and higher sensitivity compared with MBSE (P < 0.05). ICC was higher for MBME than MBSE, while there was a trend of differences in DC (P = 0.08). MBME resulted in higher task fMRI activation volume and sensitivity without losing specificity. Reliability was also higher for MBME scans compared with MBSE. 1 TECHNICAL EFFICACY STAGE: 1.

Attenuation correction using deep Learning and integrated UTE/multi-echo Dixon sequence: evaluation in amyloid and tau PET imaging.

Purpose:PET measures of amyloid and tau pathologies are powerful biomarkers for the diagnosis and monitoring of Alzheimer’s disease (AD). Because cortical regions are close to bone, quantitation accuracy of amyloid and tau PET imaging can be significantly influenced by errors of attenuation correction (AC). This work presents an MR-based AC method that combines deep learning with a novel ultrashort time-to-echo (UTE)/Multi-Echo Dixon (mUTE) sequence for amyloid and tau imaging.Methods:Thirty-five subjects that underwent both 11C-PiB and 18F-MK6240 scans were included in this study. The proposed method was compared with Dixon-based atlas method as well as other magnetization-prepared rapid acquisition with gradient echo (MPRAGE)- or Dixon- based deep learning methods. The Dice coefficient and validation loss of the generated pseudo-CT images were used for comparison. PET error images regarding standardized uptake value ratio (SUVR) were quantified through regional and surface analysis to evaluate the final AC accuracy.Results:The Dice coefficients of the deep learning methods based on MPRAGE, Dixon and mUTE images were 0.84 (0.91), 0.84 (0.92), and 0.87 (0.94) for the whole-brain (above-eye) bone regions, respectively, higher than the atlas method of 0.52 (0.64). The regional SUVR error for the atlas method was around 6%, higher than the regional SUV error. The regional SUV and SUVR errors for all deep learning methods were below 2%, with mUTE-based deep learning method performing the best. As for the surface analysis, the atlas method showed the largest error (> 10%) near vertices inside superior frontal, lateral occipital, superior parietal and inferior temporal cortices. The mUTE-based deep learning method resulted in the least number of regions with error higher than 1%, with the largest error (> 5%) showing up near the inferior temporal and medial orbitofrontal cortices.Conclusion:Deep learning with mUTE can generate accurate AC for amyloid and tau imaging in PET/MR.

Detection of Coalescent Acute Mastoiditis on MRI in Comparison with CT

PurposeCurrent imaging standard for acute mastoiditis (AM) is contrast-enhanced computed tomography (CT), revealing inflammation-induced bone destruction, whereas magnetic resonance imaging (MRI) outperforms CT in detecting intracranial infection. Our aim was to compare the diagnostic performance of MRI with CT in detecting coalescent AM and see to which extent MRI alone would suffice to diagnose or rule out this condition.MethodsThe MR images of 32 patients with AM were retrospectively analyzed. Bone destruction was evaluated from T2 turbo spin echo (TSE) and T1 Gd magnetization-prepared rapid acquisition with gradient echo (MPRAGE) images. Intramastoid enhancement and diffusion restriction were evaluated subjectively and intramastoid apparent diffusion coefficient (ADC) values were measured. The MRI findings were compared with contrast-enhanced CT findings of the same patients within 48 h of the MR scan.ResultsDepending on the anatomical subsite, MRI detected definite bone defects with a sensitivity of 100% and a specificity of 54–82%. Exception was the inner cortical table where sensitivity was only 14% and specificity was 76%. Sensitivity for general coalescent mastoiditis remained 100% due to multiple coexisting lesions. The absence of intense enhancement and non-restricted diffusion had a high negative predictive value for coalescent mastoiditis: an intramastoid ADC above 1.2 × 10−3 mm2/s excluded coalescent mastoiditis with a negative predictive value of 92%.ConclusionThe MRI did not miss coalescent mastoiditis but was inferior to CT in direct estimation of bone defects. When enhancement and diffusion characteristics are also considered, MRI enables dividing patients into low, intermediate and high-risk categories with respect to coalescent mastoiditis, where only the intermediate risk group is likely to benefit from additional CT.

On the value of QSM from MPRAGE for segmenting and quantifying iron-rich deep gray matter.

Quantitative susceptibility mapping (QSM) has been employed for both iron evaluation and segmentation of deep gray matter (DGM), but QSM sequences are not typically used in standard brain volumetric studies, which use T1-weighted magnetization-prepared rapid acquisition with gradient echo (MPRAGE) with short TE. Here, QSM produced directly from standard MPRAGE phase ( ) is evaluated for segmentation and quantification of highly iron-rich DGM regions. Simulations were used to explore quality and possible limitations. In addition, QSM from a standard multi-echo gradient-echo ( ) was compared to in 40 healthy adults at 3T. DGM structures with weak contrast on MPRAGE magnitude were evaluated for improving segmentation with , with focus on the iron-rich globus pallidus (GP). Furthermore, susceptibility quantification was assessed on six DGM nuclei and compared to standard . Limited by TE and signal-to-noise ratio, only iron-rich regions like GP and dentate nucleus produced adequate contrast on , confining applications to such regions. improved GP segmentation with mean Dice scores raised by 9.0%, and mean volumetric differences reduced by 9.7%. Simulations suggested that phase contrast-to-noise ratio (CNR) should be above 3.0 to attain segmentation improvement. For quantification purposes, higher CNR is required, and typical provided comparable estimates to in large iron-rich DGM nuclei. Despite the short TE of standard MPRAGE, can improve GP segmentation over the use of MPRAGE magnitude alone and roughly quantify high-iron regions in DGM. Thus, reconstructing can be a useful addition to volumetric studies that rarely include standard .

Quantitative Susceptibility Mapping for Characterization of Intraplaque Hemorrhage and Calcification in Carotid Atherosclerotic Disease.

Carotid artery intraplaque hemorrhage (IPH), an unstable component of atherosclerosis, is associated with an increased risk of stroke. To investigate quantitative susceptibility mapping (QSM) as a tool for the evaluation of IPH and calcification in vivo. Prospective. Ten healthy volunteers and 15 patients. 3.0T Susceptibility-weighted imaging (SWI), magnetization-prepared rapid acquisition with gradient echo (MP-RAGE), T1 -weighted sampling perfection with application of optimized contrasts using different flip angle evolution (T1 -SPACE), T2 -weighted turbo spin-echo (T2 WI), and time-of-flight (TOF) sequences. The vessel wall area of the carotid artery was measured with QSM and compared with T1 -SPACE on healthy volunteers. Four radiologists, blinded to clinical history and patient identity, determined the presence and area of IPH on MP-RAGE and QSM, as well as the area of calcification on T1 -SPACE and QSM. Bland-Altman analysis, Pearson correlation coefficients, linear regression analyses were performed to evaluate the concordance of area measurements. Cohen's kappa (κ) was analyzed to determine the agreement between IPH detections. The paired t-test was used to compare the group differences. In 423 matched slices, 20.1% (85/423) and 19.6% (83/423) were detected to have IPH on MP-RAGE and QSM, respectively. IPH detection by QSM and MP-RAGE showed good agreement (κ = 0.822, P < 0.001) between the two methods. There was no significant difference in IPH area measurements between QSM and MP-RAGE (7.28 mm2 ± 6.41 vs. 7.16 mm2 ± 5.99, P = 0.575). There was no significant difference in calcification area measurement between QSM and T1 -SPACE (3.51 mm2 ± 1.78 vs. 3.41 mm2 ± 2.02, P = 0.783). QSM is a novel imaging tool for the identification of IPH in patients with carotid atherosclerosis and enables differentiation of IPH and calcification. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 1 J. Magn. Reson. Imaging 2020;52:534-541.

Quantification of Carotid Intraplaque Hemorrhage: Comparison between Manual Segmentation and Semi-Automatic Segmentation on Magnetization-Prepared Rapid Acquisition with Gradient-Echo Sequences.

Purpose: Carotid intraplaque hemorrhage (IPH) increases risk of territorial cerebral ischemic events, but different sequences or criteria have been used to diagnose or quantify carotid IPH. The purpose of this study was to compare manual segmentation and semi-automatic segmentation for quantification of carotid IPH on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) sequences. Methods: Forty patients with 16–79% carotid stenosis and IPH on MPRAGE sequences were reviewed by two trained radiologists with more than five years of specialized experience in carotid plaque characterization with carotid plaque MRI. Initially, the radiologists manually viewed the IPH based on the MPRAGE sequence. IPH volume was then measured by three different semi-automatic methods, with high signal intensity 150%, 175%, and 200%, respectively, above that of adjacent muscle on the MPRAGE sequence. Agreement on measurements between manual segmentation and semi-automatic segmentation was assessed using the intraclass correlation coefficient (ICC). Results: There was near-perfect agreement between manual segmentation and the 150% and 175% criteria for semi-automatic segmentation in quantification of IPH volume. The ICC of each semi-automatic segmentation were as follows: 150% criteria: 0.861, 175% criteria: 0.809, 200% criteria: 0.491. The ICC value of manual vs. 150% criteria and manual vs. 175% criteria were significantly better than the manual vs. 200% criteria (p < 0.001). Conclusions: The ICC of 150% and 175% criteria for semi-automatic segmentation are more reliable for quantification of IPH volume. Semi-automatic classification tools may be beneficial in large-scale multicenter studies by reducing image analysis time and avoiding bias between human reviewers.

Improving acute demyelinating lesion detection: which T1-weighted magnetic resonance acquisition is more sensitive to gadolinium enhancement?

Because of the need for a standardized and accurate method for detecting multiple sclerosis (MS) inflammatory activity, different magnetic resonance (MR) acquisitions should be compared in order to choose the most sensitive sequence for clinical routine. To compare the sensitivity of a T1-weighted image to a single dose of gadolinium (Gd) administration both with and without magnetization transfer to detect contrast enhancement in active demyelinating focal lesions. A sample of relapsing-remitting MS patients were prospectively examined separately by two neuroradiologists using a 1.5 Tesla scanner. The outcome parameters were focused on Gd-enhancement detection attributed to acute demyelination. All MR examinations with at least one Gd-enhancing lesion were considered positive (MR+) and each lesion was analyzed according to its size and contrast ratio. Thirty-six MR examinations were analyzed with a high inter-observer agreement for MR+ detection (k coefficient > 0.8), which was excellent for the number of Gd-enhancing lesions (0.91 T1 spin-echo (SE), 0.88 T1 magnetization transfer contrast (MTC) sequence and 0.99 magnetization-prepared rapid acquisition with gradient-echo (MPRAGE). Significantly more MR+ were reported on the T1 MTC scans, followed by the T1 SE, and MPRAGE scans. Confidently, the T1 MTC sequence demonstrated higher accuracy in the detection of Gd-enhancing lesions, followed by the T1 SE and MPRAGE sequences. Further comparisons showed that there was a statistically significant increase in the contrast ratio and area of Gd-enhancement on the T1 MTC images when compared with both the SE and MPRAGE images. Single-dose Gd T1 MTC sequence was confirmed to be the most sensitive acquisition for predicting inflammatory active lesions using a 1.5 T magnet in this sample of MS patients.

Associations of High Intensities on Magnetization-Prepared Rapid Acquisition with Gradient Echo with Aortic Complicated Lesions in Ischemic Stroke Patients

Background: Aortic complicated lesions (ACLs) are key parameters for evaluating aortic embolic sources in embolic stroke, and are usually diagnosed using transesophageal echocardiography (TEE). However, alternative methods for diagnosing ACLs have not been well established. We investigated associations between high-intensity areas on T1-weighted imaging (T1WI) with magnetization-prepared rapid acquisition with gradient echo (MPRAGE) and ACLs on TEE among ischemic stroke patients. Methods: Participants comprised 135 patients (mean age, 71 years; 35 women) with ischemic stroke or transient ischemic attack who underwent TEE for evaluation of embolic sources and plaque imaging using MPRAGE for evaluation of aortic or carotid plaques. Aortic plaque with signal intensity ≥200% of sternocleidomastoid intensity on MPRAGE was categorized as “high intensity”. ACLs on TEE were defined by focal increases in intima-media thickness (IMT) ≥4.0 mm or the presence of ulcerated or mobile plaques. Results: Fifty-six patients (42%) showed high-intensity areas on MPRAGE at the aortic arch. Aortic maximum IMT was significantly higher in patients with high intensities than in those without (p < 0.001). Incidences of ACLs (66 vs. 20%, p < 0.001) or ulcerated or mobile plaques (30 vs. 6%, p < 0.001) were significantly higher in patients with high intensities than in patients without. Multivariable logistic regression analysis showed that high intensities on MPRAGE were independently associated with the presence of ACLs (OR 5.72; 95% CI 2.38–13.70) and ulcerated or mobile plaques (OR 4.18; 95% CI 1.29–13.50). Conclusions: High intensities on T1WI with MPRAGE in the aortic arch were significantly associated with the presence of ACLs. An evaluation of the aortic arch using MPRAGE may be useful for predicting ACLs.

Quantitative MRI evaluation of glaucomatous changes in the visual pathway.

BackgroundThe aims of this study were to investigate glaucomatous morphological changes quantitatively in the visual cortex of the brain with voxel-based morphometry (VBM), a normalizing MRI technique, and to clarify the relationship between glaucomatous damage and regional changes in the visual cortex of patients with open-angle glaucoma (OAG).MethodsThirty-one patients with OAG (age: 55.9 ± 10.7, male: female = 9: 22) and 20 age-matched controls (age: 54.9 ± 9.8, male: female = 10: 10) were included in this study. The cross-sectional area (CSA) of the optic nerve was manually measured with T2-weighed MRI. Images of the visual cortex were acquired with T1-weighed 3D magnetization-prepared rapid acquisition with gradient echo (MPRAGE) sequencing, and the normalized regional visual cortex volume, i.e., gray matter density (GMD), in Brodmann areas (BA) 17, 18, and 19, was calculated with a normalizing technique based on statistic parametric mapping 8 (SPM8) analysis. We compared the regional GMD of the visual cortex in the control subjects and OAG patients. Spearman’s rank correlation analysis was used to determine the relationship between optic nerve CSA and GMD in BA 17, 18, and 19.ResultsWe found that the normal and OAG patients differed significantly in optic nerve CSA (p < 0.001) and visual cortex GMD in BA 17 (p = 0.030), BA 18 (p = 0.003), and BA 19 (p = 0.005). In addition, we found a significant correlation between optic nerve CSA and visual cortex GMD in BA 19 (r = 0.33, p = 0.023), but not in BA 17 (r = 0.17, p = 0.237) or BA 18 (r = 0.24, p = 0.099).ConclusionQuantitative MRI parametric evaluation of GMD can detect glaucoma-associated anatomical atrophy of the visual cortex in BA 17, 18, and 19. Furthermore, GMD in BA 19 was significantly correlated to the damage level of the optic nerve, as well as the retina, in patients with OAG. This is the first demonstration of an association between the cortex of the brain responsible for higher-order visual function and glaucoma severity. Evaluation of the visual cortex with MRI is thus a very promising potential method for objective examination in OAG.

Quantitative volume-based morphometry in focal cortical dysplasia: A pilot study for lesion localization at the individual level

PurposeSurgical resection is the most effective treatment for focal cortical dysplasia (FCD). However, many patients with FCD have unremarkable or even negative findings on conventional magnetic resonance imaging (MRI). In this study, we explored the brain volume abnormalities of FCD patients at the individual level using an experimental volume-based morphometry algorithm and further estimated whether the volume abnormalities can help in the detection of FCD lesions. Materials and methodsSixteen patients with histologically-proven FCD lesions were retrospectively studied. Among them, eight patients had no visible abnormalities on routine MRI, three had abnormalities which partly matched the location of the surgical resection regions, and two did not match. For each patient, cerebral high-resolution T1-weighted magnetization-prepared rapid acquisition with gradient echo (MPRAGE) images were segmented into 45 structures, according to a brain anatomy template, and the volume of each structure was compared with an age- and gender-matched normal population at the individual level, based on a MorphoBox prototype. A Receiver Operating Characteristics (ROC) curve was used to evaluate the performance of the prototype in patients. To find the most appropriate threshold value for localizing the epileptogenic zones, deviations from the normative ranges of each resulting volume estimate were assessed by z-scores. ResultsVolume abnormalities including atrophic and hypertrophic volumes could be found in all the patients. Epileptogenic zones were found in brain structures with an abnormal volume in 87.5% (14/16) of patients. In 71.4% of patients (10/14), these zones were fully located in regions with an atrophic volume. This suggests that FCD lesions are more likely to be in regions with an atrophic volume than in those with a hypertrophic volume. When the best cut-off z-score value was –3.0, the sensitivity, specificity, and ROC area under the curve of the volume estimates were 93.9%, 79.6%, and 0.89, respectively. ConclusionVolume abnormalities can assist in the diagnosis of epileptogenic zones at the individual level in FCD patients with negative or positive findings on conventional MR images. Atrophic regions are more likely than hypertrophic ones to represent epileptogenic zones. Volume-based morphometry based on a MorphoBox prototype has potential to assist a careful scrutiny by radiologists with target in atrophic regions in patients who are initially deemed to be MR-negative, further trying to increase the detection rate of FCD.

Dynamic change of carotid intraplaque hemorrhage volume in subjects with mild carotid stenosis

Background and PurposeEarly detection of intraplaque hemorrhage (IPH) in the carotid artery is important as it is correlated with an increased risk of cerebral ischemic events. We examined changes in IPH with magnetic resonance imaging (MRI) over an extended follow-up period in patients with mild carotid stenosis. Materials and MethodsFrom November 2013 to November 2015, we retrospectively reviewed cerebral MRI of 2036 patients, including magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) sequences obtained with a 3.0 T (T) MRI unit. An experienced neuroradiologist reviewed all studies and found 38 patients with carotid IPH and carotid stenosis that were categorized as mild (<30%), according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Twenty-five patients agreed to join this study and signed informed consent for (MPRAGE) sequence imaging. We used semi-automated software to measure IPH volume on both the initial and follow up scans. ResultsThe median follow-up time of patients with mild carotid stenosis and IPH was 33.3 months. IPH volume increased in 10 of 27 carotid arteries (37.0%), with a mean volume increase of 42.6 ± 44.0 mm3. IPH volume decreased in 17 of 27 carotid arteries (63%), with a mean volume decrease of 17.2 ± 22.8 mm3. Two patients without IPH at baseline showed IPH development on follow-up imaging. There were no significant differences in patient demographics between the two groups. ConclusionsCarotid IPH volume in subjects with mild carotid stenosis can change over time and may not be correlated with any typical patient demographics.

Abstract T MP29: Contrast-Enhanced Ultrasound is Useful for Detection of Vulnerable Plaques

Background and Purpose: Vulnerable plaques of carotid arteries are characterized as the presence of large necrotic core, intraplaque hemorrhage (IPH), intraplaque neovascularization (IPN), and active inflammation with thin fibrous cap. MRI is widely used for the qualitative evaluation of the plaques in vivo and the high-intensity plaques (HIP) on magnetization-prepared rapid acquisition with gradient echo (MPRAGE) images indicate containing necrotic cores with IPH, which indicates vulnerable plaques. However, we encounter the symptomatic cases without the presence of HIP on MPRAGE in clinical practice. Recent studies showed the efficacy for the evaluation of IPN using contrast-enhanced ultrasound (CEUS). We aimed to assess the vulnerability of the plaques without high intensity on MPRAGE images using CEUS. Methods: Between July 2010 and June 2014, we enrolled 69 patients with internal carotid artery stenosis who underwent carotid endarterectomy (CEA) and preoperatively examined CEUS and MRI (MPRAGE). All plaques were evaluated with CEUS and the contrast effects were classified semi-quantitatively (grade 0: absent, 1: small, 2: large, 3: extensive). We also divided the plaques into two groups (HIP group or non-HIP group) based on the signal intensity of the plaques on MPRAGE images. The results of MRI and CEUS were compared with histopathological findings of CEA specimens. Results: Fifty-eight plaques of all 69 patients showed HIP (41 were symptomatic), and eleven plaques were non-HIP (five were symptomatic: amaurosis fugax in three, cerebral infarction in two). In non-HIP group, symptomatic plaques were more enhanced (three in grade 2, two in grade 3) than asymptomatic plaques (one in grade 0, five in grade 1) using CEUS. Histopathological findings of all five CEA specimens from symptomatic patients showed that extensive IPN, large necrotic core, and active inflammation with thin fibrous cap which indicated vulnerable plaques, but small amount of IPH. These histological findings were compatible with the results of CEUS and MRI findings. Conclusion: CEUS may be useful for diagnosis of vulnerable plaques without high intensity on MPRAGE images.