Magnetization-prepared Rapid Gradient-echo Sequence Research Articles

NIMG-40. RADIOMICS-BASED DIFFERENTIATION OF GLIOBLASTOMA AND METASTATIC DISEASE: DOES DIFFERENCE IN TYPE OF T1-CONTRAST ENHANCED SEQUENCE MATTER?

Abstract BACKGROUND To evaluate the radiomics-based model performance for differentiation between glioblastoma (GB) and intracranial metastatic disease (IMD) using magnetization prepared rapid gradient echo (MPRAGE) and volumetric interpolated breath-hold examination (VIBE) T1-contrast enhanced sequences. MATERIALS AND METHODS T1-CE MPRAGE and VIBE sequences acquired in 108 patients (31 GBs and 77 IMD) during the same MRI session were retrospectively evaluated. Post standardized image pre-processing and segmentation, radiomics features were extracted from necrotic and enhancing tumor components. A total of 90 machine learning (ML) pipelines were evaluated using a five-fold cross-validation. Performance was measured by mean AUC, Log-loss, and Brier scores. Pearson correlation analysis of radiomics features from tumor subcomponents was also performed. RESULTS The mean AUC across the top-ten pipelines varied between 0.890-0.851 with T1-CE MPRAGE and 0.907-0.869 with T1-CE VIBE sequence. Top performing models for the MPRAGE sequence commonly used support vector machines, while those for VIBE sequence used either support vector machines or random forest. Common feature reduction methods for top-performing models included linear combination filter and least absolute shrinkage and selection operator (LASSO) for both sequences. Only three of the top ten models used the same combination of feature reduction-ML algorithm pipeline. A feature-wise comparison showed that the radiomic features between sequences were strongly correlated, with the highest correlation for shape-based features. CONCLUSION Radiomics features derived from T1-CE MPRAGE and VIBE sequences may have similar overall classification performance for differentiating GB from IMD, albeit often using different feature selection-ML algorithm pipelines.

Oxygen extraction fraction mapping based combining quantitative susceptibility mapping and quantitative blood oxygenation level-dependent imaging model using multi-delay PCASL

Background and purposeThe oxygen extraction fraction is an essential biomarker for the assessment of brain metabolism. A recently proposed method combined with quantitative susceptibility mapping and quantitative blood oxygen level-dependent magnitude enables noninvasive mapping of the oxygen extraction fraction. Our study investigated the oxygen extraction fraction mapping variations of single-delay and multi-delay arterial spin-labeling. Materials and methodsA total of twenty healthy participants were enrolled. The multi-echo spoiled gradient-echo, multi-delay arterial spin-labeling, and magnetization-prepared rapid gradient echo sequences were acquired at 3.0 T. The mean oxygen extraction fraction was generated under a single delay time of 1780 ms, multi-delay arterial spin-labeling of transit-corrected cerebral blood flow, and multi-delay arterial spin-labeling of arterial cerebral blood volume. The results were compared via paired t tests and the Wilcoxon test. Linear regression analyses were used to investigate the relationships among the oxygen extraction fraction, cerebral blood flow, and venous cerebral blood volume. ResultsThe oxygen extraction fraction estimate with multi-delay arterial spin-labeling yielded a significantly lower value than that with single-delay arterial spin-labeling. The average values for the whole brain under single-delay arterial spin-labeling, multi-delay arterial spin-labeling of transit-corrected cerebral blood flow, and multi-delay arterial spin-labeling of arterial cerebral blood volume were 41.5 ± 1.7 % (P < 0.05), 41.3 ± 1.9 % (P < 0.001), and 40.9 ± 1.9 % (N = 20), respectively. The oxygen extraction fraction also showed a significant inverse correlation with the venous cerebral blood volume under steady-state conditions when multi-delay arterial spin-labeling was used (r = 0.5834, p = 0.0069). ConclusionThese findings suggest that the oxygen extraction fraction is significantly impacted by the arterial spin-labeling methods used in the quantitative susceptibility mapping plus the quantitative blood oxygen level-dependent model, indicating that the differences should be accounted for when employing oxygen extraction fraction mapping based on this model in diseases.

Radiomics Based Differentiation of Glioblastoma and Metastatic Disease: Impact of Different T1-Contrast Enhanced Sequences on Radiomic Features and Model Performance.

To evaluate the radiomics-based model performance for differentiation between glioblastoma (GB) and brain metastases (BM) using magnetization prepared rapid gradient echo (MPRAGE) and volumetric interpolated breath-hold examination (VIBE) T1-contrast enhanced sequences. T1-CE MPRAGE and VIBE sequences acquired in 108 patients (31 GBs and 77 BM) during the same MRI session were retrospectively evaluated. Post standardized image pre-processing and segmentation, radiomics features were extracted from necrotic and enhancing tumor components. Pearson correlation analysis of radiomics features from tumor subcomponents was also performed. A total of 90 machine learning (ML) pipelines were evaluated using a five-fold cross validation. Performance was measured by mean AUC-ROC, Log-loss and Brier scores. A feature-wise comparison showed that the radiomic features between sequences were strongly correlated, with the highest correlation for shape-based features. The mean AUC across the top-ten pipelines ranged between 0.851-0.890 with T1-CE MPRAGE and between 0.869-0.907 with T1-CE VIBE sequence. Top performing models for the MPRAGE sequence commonly used support vector machines, while those for VIBE sequence used either support vector machines or random forest. Common feature reduction methods for top-performing models included linear combination filter and least absolute shrinkage and selection operator (LASSO) for both sequences. For the same ML-feature reduction pipeline, model performances were comparable (AUC-ROC difference range: [-0.078, 0.046]). Radiomic features derived from T1-CE MPRAGE and VIBE sequences are strongly correlated and may have similar overall classification performance for differentiating GB from BM. BM: Brain metastases, GB: glioblastoma, T1-CE: T1 contrast enhanced sequence, MPRAGE: magnetization prepared rapid gradient echo, ML: machine learning, RF: random forest, VIBE: volumetric interpolated breath-hold examination.

Modern Magnetic Resonance Imaging Modalities to Advance Neuroimaging in Astronauts.

INTRODUCTION: The rapid development of the space industry requires a deeper understanding of spaceflight's impact on the brain. MRI research reports brain volume changes following spaceflight in astronauts, potentially affecting cognition. Recently, we have demonstrated that this evidence of volumetric changes, as measured by typical T1-weighted sequences (e.g., magnetization-prepared rapid gradient echo sequence; MPRAGE), is error-prone due to the microgravity-related redistribution of cerebrospinal fluid in the brain. More modern neuroimaging methods, particularly dual-echo MPRAGE (DEMPRAGE) and magnetization-prepared rapid gradient echo sequence utilizing two inversion pulses (MP2RAGE), have been suggested to be resilient to this error. Here, we tested if these imaging modalities offered consistent segmentation performance improvements in some commonly employed neuroimaging software packages.METHODS: We conducted manual gray matter tissue segmentation in traditional T1w MRI images to utilize for comparison. Automated tissue segmentation was performed for traditional T1w imaging, as well as on DEMPRAGE and MP2RAGE images from the same subjects. Statistical analysis involved a comparison of total gray matter volumes for each modality, and the extent of tissue segmentation agreement was assessed using a test of similarity (Dice coefficient).RESULTS: Neither DEMPRAGE nor MP2RAGE exhibited consistent segmentation performance across all toolboxes tested.DISCUSSION: This research indicates that customized data collection and processing methods are necessary for reliable and valid structural MRI segmentation in astronauts, as current methods provide erroneous classification and hence inaccurate claims of neuroplastic brain changes in the astronaut population.Berger L, Burles F, Jaswal T, Williams R, Iaria G. Modern magnetic resonance imaging modalities to advance neuroimaging in astronauts. Aerosp Med Hum Perform. 2024; 95(5):245-253.

Specific Alterations in Brain White Matter Networks and Their Impact on Clinical Function in Pediatric Patients With Thoracolumbar Spinal Cord Injury.

The alternation of brain white matter (WM) network has been studied in adult spinal cord injury (SCI) patients. However, the WM network alterations in pediatric SCI patients remain unclear. To evaluate WM network changes and their functional impact in children with thoracolumbar SCI (TSCI). Prospective. Thirty-five pediatric patients with TSCI (8.94 ± 1.86 years, 8/27 males/females) and 34 age- and gender-matched healthy controls (HCs) participated in this study. 3.0 T/DTI imaging using spin-echo echo-planar and T1-weighted imaging using 3D T1-weighted magnetization-prepared rapid gradient-echo sequence. Pediatric SCI patients were evaluated for motor and sensory scores, injury level, time since injury, and age at injury. The WM network was constructed using a continuous tracing method, resulting in a 90 × 90 matrix. The global and regional metrics were obtained to investigate the alterations of the WM structural network. topology. Two-sample independent t-tests, chi-squared test, Mann-Whitney U-test, and Spearman correlation. Statistical significance was set at P < 0.05. Compared with HCs, pediatric TSCI patients displayed decreased shortest path length (Lp = 1.080 ± 0.130) and normalized Lp (λ = 5.020 ± 0.363), and increased global efficiency (Eg = 0.200 ± 0.015). Notably, these patients also demonstrated heightened regional properties in the orbitofrontal cortex, limbic system, default mode network, and several audio-visual-related regions. Moreover, the λ and Lp values negatively correlated with sensory scores. Conversely, nodal efficiency values in the right calcarine fissure and surrounding cortex positively correlated with sensory scores. The age at injury positively correlated with node degree in the left parahippocampal gyrus and nodal efficiency in the right posterior cingulate gyrus. Reorganization of the WM networks in pediatric SCI patients is indicated by increased global and nodal efficiency, which may provide promising neuroimaging biomarkers for functional assessment of pediatric SCI. 2 TECHNICAL EFFICACY: Stage 5.

Improved gray-white matter contrast using magnetization prepared fast imaging with steady-state free precession (MP-FISP) brain imaging at 0.55 T.

To improve the gray/white matter contrast of magnetization prepared rapid gradient echo (MP-RAGE) MRI at 0.55 T by optimizing the acquisition and sequence kernel parameters. A segmented magnetization prepared rapid gradient echo prototype sequence was implemented with (MP-RAGE*) and without (MP-FISP*) radiofrequency spoiling. Optimized parameters were derived with the assistance of an extended phase graph signal simulation as a function of the relaxation times, the flip angle, the delay times, and the effective inversion time using segmentation. The resulting protocols were compared to the MP-RAGE product sequence offered by the vendor in terms of signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). A tissue segmentation reproducibility study was performed on three volunteers for the product MP-RAGE and the MP-FISP*. The MP-RAGE simulation reproduced the parameters already used in the product MP-RAGE on the scanner. An average CNR improvement of 15% for the custom MP-RAGE* over the product MP-RAGE and additional 22% for the MP-FISP* over the MP-RAGE* were observed, which is in accordance with the simulation results. The total improvement, averaged over all volunteers and regions, was 41%. The reproducibility study did not yield a significant difference between MP-RAGE and MP-FISP*. We presented some easy-to-implement adjustments to the MP-RAGE sequence at 0.55 T, which can lead to an overall average improvement of 41% in CNR.

Optimized flow compensation for contrast-enhanced T1-weighted Wave-CAIPI 3D MPRAGE imaging of the brain

Flow-related artifacts have been observed in highly accelerated T1-weighted contrast-enhanced wave-controlled aliasing in parallel imaging (CAIPI) magnetization-prepared rapid gradient-echo (MPRAGE) imaging and can lead to diagnostic uncertainty. We developed an optimized flow-mitigated Wave-CAIPI MPRAGE acquisition protocol to reduce these artifacts through testing in a custom-built flow phantom. In the phantom experiment, maximal flow artifact reduction was achieved with the combination of flow compensation gradients and radial reordered k-space acquisition and was included in the optimized sequence. Clinical evaluation of the optimized MPRAGE sequence was performed in 64 adult patients, who all underwent contrast-enhanced Wave-CAIPI MPRAGE imaging without flow-compensation and with optimized flow-compensation parameters. All images were evaluated for the presence of flow-related artifacts, signal-to-noise ratio (SNR), gray-white matter contrast, enhancing lesion contrast, and image sharpness on a 3-point Likert scale. In the 64 cases, the optimized flow mitigation protocol reduced flow-related artifacts in 89% and 94% of the cases for raters 1 and 2, respectively. SNR, gray-white matter contrast, enhancing lesion contrast, and image sharpness were rated as equivalent for standard and flow-mitigated Wave-CAIPI MPRAGE in all subjects. The optimized flow mitigation protocol successfully reduced the presence of flow-related artifacts in the majority of cases.Relevance statementAs accelerated MRI using novel encoding schemes become increasingly adopted in clinical practice, our work highlights the need to recognize and develop strategies to minimize the presence of unexpected artifacts and reduction in image quality as potential compromises to achieving short scan times.Key points• Flow-mitigation technique led to an 89–94% decrease in flow-related artifacts.• Image quality, signal-to-noise ratio, enhancing lesion conspicuity, and image sharpness were preserved with the flow mitigation technique.• Flow mitigation reduced diagnostic uncertainty in cases where flow-related artifacts mimicked enhancing lesions.Graphical

Brain alterations in sensorimotor and emotional regions associated with temporomandibular disorders.

Temporomandibular disorders (TMD) are characterized by sensorimotor and psychological dysfunction, with evidence revealing the implication of a dysfunctional central nervous system. Previous magnetic resonance imaging (MRI) studies have reported brain alterations in TMD, but most studies focused on either structure or function by a single modality of MRI and investigated static functional connectivity (FC) in TMD. By combining structural and functional MRI data, the present study aimed to identify brain regions with structural abnormalities in TMD patients and examine static and dynamic FC seeded by these regions to investigate structural brain alterations and related disrupted FC underlying the pathophysiology of TMD. We recruited 30 TMD patients and 20 healthy controls who underwent 3.0T MRI scanning with T1-weighted images using a three-dimensional magnetization-prepared rapid gradient-echo sequence and resting state functional images using a gradient-echo echo-planar imaging sequence. Cortical thickness, volume, surface area, and subcortical volume were calculated, where brain areas with significant structural between-group differences were treated as seeds for static and dynamic FC analyses. In this preliminary study, we found between-group alterations in sensorimotor regions including decreased cortical thickness in the right sensorimotor cortex as well as decreased volume in the left putamen and associated reduced dynamic FC with the anterior midcingulate cortex; and alterations in emotion processing and regulation regions including decreased volume/surface area in the left posterior superior temporal gyrus and associated increased dynamic FC with the precuneus in TMD patients than controls, having all p < 0.05 with corrections for multiple comparisons. Our findings of structural and functional abnormalities in brain regions implicated in sensorimotor and emotional functions provided evidence for the biopsychosocial model of TMD and facilitated our understanding of the pathophysiological mechanism underlying TMD. The associations between neuroimaging results and clinical measurements of TMD warrant further exploration.

An MRI Study Combining Virtual Brain Grafting and Surface-Based Morphometry Analysis to Investigate Contralateral Alterations in Cortical Morphology in Patients With Diffuse Low-Grade Glioma.

The human brain has ability to reorganize itself in response to glioma. However, the mechanism of cortical reorganization remains unclear. To investigate alterations in cortical thickness and local gyration index (LGI) in patients with unilateral frontal lobe diffuse low-grade glioma (DLGG). Retrospective. Ninety-nine patients with histopathologically proven DLGG invading the left frontal lobe (LF; N=56) or the right frontal lobe (RF; N=43), and healthy controls (HC; N=53). 3.0 T, 3D T1-weighted images and gadolinium enhanced T1-weighted images using magnetization-prepared rapid gradient echo sequence, T2-weighted images, and fluid-attenuated inversion recovery using turbo spin echo sequence. In patients with DLGG, virtual brain grafting combined with Freesurfer was utilized to enable automated cortical thickness and LGI calculation. In HC, standard FreeSurfer pipeline was applied to calculate these measures. Radiomic features were extracted from glioma using Pyradiomic software. General linear model and Pearson's correlation analysis. A P value <0.05 was considered statistically significant. For LF patients, there was significantly increased cortical thickness in the rostral middle frontal gyrus, significantly reduced cortical thickness in the precentral gyrus and hypogyrification in the lingual and medial orbitofrontal (MOF) gyrus in contralateral hemisphere. For RF patients, there was significantly increased cortical thickness in the middle temporal, lateral occipital extending to isthmus cingulate gyrus, significantly reduced cortical thickness in the precentral gyrus and hypogyrification in the lingual gyrus in the contralateral hemisphere. A negative association between four textural features of DLGG and LGI in the right MOF gyrus of LF group was found (r=-0.609, -0.442, -0.545, and -0.417, respectively). Cortical thickness compensation was shown in contralateral homotopic location and some distant contralateral regions. Additionally, there was decreased cortical thickness in the contralateral precentral gyrus and hypogyrification in contralateral lingual gyrus. 4 TECHNICAL EFFICACY: Stage 2.

T1 Mapping From MPRAGE Acquisitions: Application to the Measurement of the Concentration of Nanoparticles in Tumors for Theranostic Use.

The measurement of the concentration of theranostic agents in vivo is essential for the assessment of their therapeutic efficacy and their safety regarding healthy tissue. To this end, there is a need for quantitative T1 measurements that can be obtained as part of a standard clinical imaging protocol applied to tumor patients. To generate T1 maps from MR images obtained with the magnetization-prepared rapid gradient echo (MPRAGE) sequence. To evaluate the feasibility of the proposed approach on phantoms, animal and patients with brain metastases. Pilot. Solutions containing contrast agents (chelated Gd3+ and iron nanoparticles), male rat of Wistar strain, three patients with brain metastases. A 3-T and 7-T, saturation recovery (SR), and MPRAGE sequences. The MPRAGE T1 measurement was compared to the reference SR method on phantoms and rat brain at 7-T. The robustness of the in vivo method was evaluated by studying the impact of misestimates of tissue proton density. Concentrations of Gd-based theranostic agents were measured at 3-T in gray matter and metastases in patients recruited in NanoRad clinical trial. A linear model was used to characterize the relation between T1 measurements from the MPRAGE and the SR acquisitions obtained in vitro at 7-T. The slope of the linear model was 0.966 (R2 =0.9934). MPRAGE-based T1 values measured in the rat brain were 1723 msec in the thalamus. MPRAGE-based T1 values measured in patients in white matter and gray matter amounted to 747 msec and 1690 msec. Mean concentration values of Gd3+ in metastases were 61.47 μmol. The T1 values obtained in vitro and in vivo support the validity of the proposed approach. The concentrations of Gd-based theranostic agents may be assessed in patients with metastases within a standard clinical imaging protocol using the MPRAGE sequence. 2. Stage 1.

Histogram Analysis Based on Neurite Orientation Dispersion and Density MR Imaging for Differentiation Between Glioblastoma Multiforme and Solitary Brain Metastasis and Comparison of the Diagnostic Performance of Two ROI Placements.

Preoperative differentiation of glioblastoma multiforme (GBM) and solitary brain metastasis (SBM) contributes to guide neurosurgical decision-making. To explore the value of histogram analysis based on neurite orientation dispersion and density imaging (NODDI) in differentiating between GBM and SBM and comparison of the diagnostic performance of two region of interest (ROI) placements. Retrospective. In all, 109 patients with GBM (n=57) or SBM (n=52) were enrolled. A 3.0 T scanners. T2 -dark-fluid sequence, contrast-enhanced T1 magnetization-prepared rapid gradient echo sequence, and NODDI. ROIs were placed on the peritumoral edema area (ROI1) and whole tumor area (ROI2, included the cystic, necrotic, and hemorrhagic areas). Histogram parameters of each isotropic volume fraction (ISOVF), intracellular volume fraction (ICVF), and orientation dispersion index (ODI) from NODDI images for two ROIs were calculated, respectively. Mann-Whitney U test, independent t-test, chi-square test, multivariate logistic regression analysis, DeLong's test. For the ROI1 and ROI2, the ICVFmin and ODImean obtained the highest area under curve (AUC, AUC=0.741 and 0.750, respectively) compared to other single parameters, and the AUC of the multivariate logistic regression model was 0.851 and 0.942, respectively. DeLong's test revealed significant difference in diagnostic performance between optimal single parameter and multivariate logistic regression model within the same ROI, and the multivariate logistic regression models between two different ROIs. The performance of multivariate logistic regression model is superior to optimal single parameter in both ROIs based on NODDI histogram analysis to distinguish SBM from GBM, and the ROI placed on the whole tumor area exhibited better diagnostic performance. 4 TECHNICAL EFFICACY: Stage 2.

Neuroimaging Markers for Determining Former American Football Players at Risk for Alzheimer's Disease.

NFL players, by virtue of their exposure to traumatic brain injury (TBI), are at higher risk of developing dementia and Alzheimer's disease (AD) than the general population. Early recognition and intervention before the onset of clinical symptoms could potentially avert/delay the long-term consequences of these diseases. Given that AD is thought to have a long pre-clinical incubation period, the aim of the current research was to determine whether former NFL players show evidence of incipient dementia in their structural imaging before diagnosis of AD. To identify neuroimaging markers of AD, against which former NFL players would be compared, we conducted a whole-brain volumetric analysis using a cohort of AD patients (ADNI clinical database) to produce a set of brain regions demonstrating sensitivity to early AD pathology (i.e., the “AD fingerprint”). A group of 46 former NFL players' brain magnetic resonance images were then interrogated using the AD fingerprint, that is, the former NFL subjects were compared volumetrically to AD patients using a T1-weighted magnetization-prepared rapid gradient echo sequence. The FreeSurfer image analysis suite (version 6.0) was used to obtain volumetric and cortical thickness data. The Automated Neuropsychological Assessment Metric-Version 4 was used to assess current cognitive functioning. A total of 55 brain regions demonstrated significant atrophy or ex vacuo dilatation bilaterally in AD patients versus controls. Of the 46 former NFL players, 41% demonstrated a greater than expected number of atrophied/dilated AD regions compared with age-matched controls, presumably reflecting AD pathology.

Evaluating the Safety of Simultaneous Intracranial Electroencephalography and Functional Magnetic Resonance Imaging Acquisition Using a 3 Tesla Magnetic Resonance Imaging Scanner.

BackgroundThe unsurpassed sensitivity of intracranial electroencephalography (icEEG) and the growing interest in understanding human brain networks and ongoing activities in health and disease have make the simultaneous icEEG and functional magnetic resonance imaging acquisition (icEEG-fMRI) an attractive investigation tool. However, safety remains a crucial consideration, particularly due to the impact of the specific characteristics of icEEG and MRI technologies that were safe when used separately but may risk health when combined. Using a clinical 3-T scanner with body transmit and head-receive coils, we assessed the safety and feasibility of our icEEG-fMRI protocol.MethodsUsing platinum and platinum-iridium grid and depth electrodes implanted in a custom-made acrylic-gel phantom, we assessed safety by focusing on three factors. First, we measured radio frequency (RF)-induced heating of the electrodes during fast spin echo (FSE, as a control) and the three sequences in our icEEG-fMRI protocol. Heating was evaluated with electrodes placed orthogonal or parallel to the static magnetic field. Using the configuration with the greatest heating observed, we then measured the total heating induced in our protocol, which is a continuous 70-min icEEG-fMRI session comprising localizer, echo-planar imaging (EPI), and magnetization-prepared rapid gradient-echo sequences. Second, we measured the gradient switching-induced voltage using configurations mimicking electrode implantation in the frontal and temporal lobes. Third, we assessed the gradient switching-induced electrode movement by direct visual detection and image analyses.ResultsOn average, RF-induced local heating on the icEEG electrode contacts tested were greater in the orthogonal than parallel configuration, with a maximum increase of 0.2°C during EPI and 1.9°C during FSE. The total local heating was below the 1°C safety limit across all contacts tested during the 70-min icEEG-fMRI session. The induced voltage was within the 100-mV safety limit regardless of the configuration. No gradient switching-induced electrode displacement was observed.ConclusionWe provide evidence that the additional health risks associated with heating, neuronal stimulation, or device movement are low when acquiring fMRI at 3 T in the presence of clinical icEEG electrodes under the conditions reported in this study. High specific absorption ratio sequences such as FSE should be avoided to prevent potential inadvertent tissue heating.

Preoperative Evaluation of Gd-EOB-DTPA-Enhanced MRI Radiomics-Based Nomogram in Small Solitary Hepatocellular Carcinoma (≤3cm) With Microvascular Invasion: A Two-Center Study.

Preoperative evaluation of microvascular invasion (MVI) in small solitary hepatocellular carcinoma (HCC; maximum lesion diameter ≤ 3 cm) is important for treatment decisions. To apply gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI to develop and validate a nomogram for preoperative evaluation of MVI in small solitary HCC and to compare the effectiveness of radiomics evaluation models based on different volumes of interest (VOIs). Retrospective. A total of 196 patients include 62 MVI-positive and 134 MVI-negative patients were enrolled (training cohort, n=105; testing cohort, n=45; external validation cohort, n=46). 3.0 T, fat suppressed fast-spin-echo T2-weighted and Gd-EOB-DTPA-enhanced T1-weighted magnetization-prepared rapid gradient-echo sequences. Radiomics features were extracted on T2-weighted, arterial phase (AP), and hepatobiliary phase (HBP) images from different VOIs (VOIintratumor and VOIintratumor+peritumor ) and filtered by the least absolute shrinkage selection operator (LASSO) regression. From VOIintratumor and VOIintratumor+peritumor , eight radiomics models were constructed based on three MRI sequences (T2-weighted, AP, and HBP) and fused sequences (combined of three sequences). Nomograms were constructed of a clinical-radiological (CR) model and a clinical-radiological-radiomics (CRR) model. One-way analysis of variance, independent t-test, Chi-square test or Fisher's exact test, Wilcoxon rank-sum test, LASSO, logistic regression analysis, area under the curve (AUC), nomograms, decision curve, net reclassification improvement (NRI), integrated discrimination improvement (IDI) analyses, and DeLong test. Among eight radiomics models, the fused sequences-based VOIintratumor+peritumor radiomics model showed the best performance. The CRR model containing the best performance radiomics model and CR model with the AUC values were 0.934, 0.889, and 0.875, respectively. NRI and IDI analyses showed that the CRR model improved evaluation efficacy over the CR model for all three cohorts (all P-value <0.05). The CRR model nomogram could preoperatively evaluate MVI in small solitary HCC. The radiomics model based on VOIintratumor+peritumor might achieve better evaluation results. 4 TECHNICAL EFFICACY STAGE: 2.

Functional Connectivity in Pediatric Sickle Cell Disease

Children with sickle cell disease (SCD) have a high risk of developing cerebrovascular complications, such as stroke and silent cerebral infarction (SCI). SCI is associated with increased risk of future infarction as well as neurocognitive deficits related to brain injury location and size; however, neurocognitive impairment may occur in the absence of neuroimaging abnormalities. Resting state functional magnetic resonance imaging (RS-fMRI) measures blood oxygen level dependent (BOLD) signal during rest to evaluate functional connectivity between brain regions. Functional connectivity is the temporal correlation between the BOLD signal in spatially distant brain regions, which reflects synchronous activity. For this study, we hypothesized that participants with SCI would have lower functional connectivity than participants without SCI and that specific resting state networks would be associated with specific cognitive tests in SCD and control participants.We recruited 26 participants from the local pediatric hematology and SCD clinics. Children with SCD were included in the study if they had a SCD diagnosis confirmed by laboratory studies and no known prior history of overt stroke or seizure. We obtained clinical history, laboratory tests, neuropsychological testing scores, and RS-fMRI scans in 21 participants with SCD and 5 control participants without SCD, 2 of who had sickle cell trait. Each participant received a resting state functional connectivity scan using a 3T MR scanner. Participants were asked to remain still, stay awake, and keep their eyes open during the resting state scan. The MRI study protocol included a BOLD scan and a T1-weighted magnetization-prepared rapid gradient-echo sequence (MPRAGE) with a scan duration of 8 minutes. We performed standard image pre-processing steps, including realignment, normalization to Montreal Neurologic Institute (MNI) standard brain space via MPRAGE image, spatial smoothing, and slice timing correction.Table 1 shows the characteristics of the study participants. Eight participants with SCD had SCI diagnosed as an incidental finding during the study. The average connectivity within 7 resting state networks (control, default mode, dorsal attention, limbic, salience ventral attention, somato-motor, and visual networks) was compared between all (both SCD and control) participants with SCI and without SCI (Table 2). Participants with SCI had significantly lower functional connectivity in the control network (p = 0.0231, 95% CI: 0.073- 0.144) in comparison to participants without SCI. We also analyzed the relationship between 4 clinical variables and functional connectivity within each resting state network for all of the participants, with and without SCD. After adjusting for age and sex, there was a significant association between 3 resting state networks (control, salience ventral attention, and visual networks) and both hemoglobin and hematocrit (Table 3). There was a significant association between functional connectivity in the visual network and hemoglobin when adjusting for age and sex among just the participants with SCD (p = 0.045, 95% CI: 0.001-0.082). We analyzed the relationship between functional connectivity within each resting state network and neuropsychological test scores and found multiple significant associations between control, default mode, dorsal attention, salience ventral attention, and visual networks and attention/executive functioning test scores for all participants as well as just participants with SCD.Our findings suggest that children with SCD and SCI have decreased functional connectivity in the control network in comparison to children with and without SCD without SCI, which may indicate abnormalities in brain regions underlying executive dysfunction. Our data also established a relationship between the degree of anemia and functional connectivity, showing increased functional connectivity in the control, salience ventral attention, and visual network in participants with higher hemoglobin and hematocrit levels. Neuropsychological data shows that select test scores are associated with changes in functional connectivity in resting state networks primarily involved with attention and executive functioning. This research supports the utility of RS-fMRI as an adjunct analysis for investigating neurocognitive abnormalities in pediatric SCD. [Display omitted] DisclosuresLanzkron: Novartis: Research Funding; Imara: Research Funding; CSL Behring: Research Funding; Bluebird Bio: Consultancy; Shire: Research Funding; Novo Nordisk: Consultancy; Pfizer: Current holder of individual stocks in a privately-held company; Teva: Current holder of individual stocks in a privately-held company; GBT: Research Funding. Mirro: NOUS Imaging: Current Employment, Current holder of stock options in a privately-held company. Fields: Global Blood Therapeutics: Consultancy; Proclara Biosciences: Current equity holder in publicly-traded company. Lance: Novartis: Other: participated in research advisory board in 2020.

Support Vector Machine-based Spontaneous Intracranial Hypotension Detection on Brain MRI

Background and PurposeTo develop a fully automatic algorithm for the magnetic resonance imaging (MRI) identification of patients with spontaneous intracranial hypotension (SIH).Material and MethodsA support vector machine (SVM) was trained with structured reports of 140 patients with clinically suspected SIH. Venous sinuses and basal cisterns were segmented on contrast-enhanced T1-weighted MPRAGE (Magnetization Prepared-Rapid Gradient Echo) sequences using a convolutional neural network (CNN). For the segmented sinuses and cisterns, 56 radiomic features were extracted, which served as input data for the SVM. The algorithm was validated with an independent cohort of 34 patients with proven cerebrospinal fluid (CSF) leaks and 27 patients who had MPRAGE scans for unrelated reasons.ResultsThe venous sinuses and the suprasellar cistern had the best discriminative power to separate SIH and non-SIH patients. On a combined score with 2 points, mean SVM score was 1.41 (±0.60) for the SIH and 0.30 (±0.53) for the non-SIH patients (p < 0.001). Area under the curve (AUC) was 0.91.ConclusionA fully automatic algorithm analyzing a single MRI sequence separates SIH and non-SIH patients with a high diagnostic accuracy. It may help to consider the need of invasive diagnostics and transfer to a SIH center.

Normalized intraplaque hemorrhage signal on MP-RAGE as a marker for acute ischemic neurological events.

This study sought to validate whether the signal intensity ratio (SIR) of carotid intraplaque hemorrhage (IPH) was associated with acute ischemic neurologic events. A retrospective review was completed of consecutive patients that underwent neck magnetic resonance angiography using magnetization prepared-rapid gradient echo (MP-RAGE) and T1-CUBE sequences between 2017 and 2020. Patients with magnetic resonance evidence of IPH were included. SIRs were measured by comparing the maximum IPH signal with the mean intramuscular signal from the adjacent sternocleidomastoid. Patients were stratified into ischemic or non-ischemic groups based on the presence of acute ipsilateral ischemic events (stroke, retinal artery occlusion). Logistic regression analysis was performed to determine if increasing IPH SIR was associated with an increased risk of ipsilateral ischemic events. Of 85 included patients (85 arteries), 66 were male (77.6%). Mean age was 71.0 (SD ± 11.1). There were 70 arteries with IPH that were ipsilateral to an ischemic event, and 15 that belonged to patients without an ischemic event. No association was found between increasing IPH SIR seen on MP-RAGE (odds ratio (OR): 0.82; 95% confidence interval (CI): 0.58-1.4; P = 0.43) or T1-CUBE sequences (OR: 0.85; 95% CI: 0.53-1.5; P = 0.56). There was no association between the SIR of IPH and acute ischemia on either MP-RAGE or T1-CUBE sequences. Further investigation is required prior to widespread acceptance of SIR as a predictive imaging marker of symptomatic carotid plaque.

High-resolution vessel wall magnetic resonance imaging for depicting imaging features of unruptured intracranial vertebrobasilar dissecting aneurysms.

ObjectiveTo demonstrate the application value of high-resolution vessel wall magnetic resonance imaging (HR-VW-MRI) for depicting the imaging features of unruptured intracranial vertebrobasilar dissecting aneurysms (VBDAs).MethodsHR-VW-MRI data of 49 patients with suspected unruptured VBDAs were retrospectively analyzed. The presence of intramural hematomas (IMH), double lumens, intimal flaps, and outer diameter enlargements were recorded. Specificity and sensitivity were calculated for both two-dimensional (2D) and three-dimensional (3D) sequences. Additionally, IMH volumes were measured and posterior inferior cerebellar artery (PICA) involvement was analyzed.ResultsThirty-five VBDAs were confirmed in 34 patients. The overall sensitivity and specificity were 0.889 (95% confidence interval [CI]: 0.730–0.964) and 0.769 (95% CI: 0.460–0.938) for 2D sequences, and 0.917 (95% CI: 0.764–0.978) and 0.846 (95% CI: 0.537–0.973) for 3D sequences, respectively. Intimal flaps were detected in 57.1%, 87.5%, and 71.4% of all cases on 2D pre-contrast T1-weighted, contrast-enhanced T1-weighted, and 3D T1-weighted black-blood (BB) images, respectively. There was no significant difference in IMH volume between 3D T1-weighted BB and magnetization-prepared rapid gradient-echo sequences. PICA involvement was best visualized using 3D T1 sequences.Conclusion3D T1-weighted BB MRI provided good visualization of VBDA features, with large coverage, and was useful for detecting dissection flaps.

Temporal and extratemporal atrophic manifestation of temporal lobe epilepsy using voxel-based morphometry and corticometry: clinical application in lateralization of epileptogenic zone.

Advances in MRI acquisition and data processing have become important for revealing brain structural changes. Previous studies have reported widespread structural brain abnormalities and cortical thinning in patients with temporal lobe epilepsy (TLE), as the most common form of focal epilepsy. In this research, healthy control cases (n = 20) and patients with left TLE (n = 19) and right TLE (n = 14) were recruited, all underwent 3.0T MRI with magnetization-prepared rapid gradient echo sequence to acquire T1-weighted images. Morphometric alterations in gray matter were identified using voxel-based morphometry (VBM). Volumetric alterations in subcortical structures and cortical thinning were also determined. Patients with left TLE demonstrated more prevailing and widespread changes in subcortical volumes and cortical thickness than right TLE, mainly in the left hemisphere, compared to the healthy group. Both VBM analysis and subcortical volumetry detected significant hippocampal atrophy in ipsilateral compared to contralateral side in TLE group. In addition to hippocampus, subcortical volumetry found the thalamus and pallidum bilaterally vulnerable to the TLE. Furthermore, the TLE patients underwent cortical thinning beyond the temporal lobe, affecting gray matter cortices in frontal, parietal, and occipital lobes in the majority of patients, more prevalently for left TLE cases. Exploiting volume changes in individual patients in the hippocampus alone led to 63.6% sensitivity and 100% specificity for lateralization of TLE. Alteration of gray matter volumes in subcortical regions and neocortical temporal structures and also cortical gray matter thickness were evidenced as common effects of epileptogenicity, as manifested by the majority of cases in this study.

Prospective Motion Correction for Brain MRI Using an External Tracking System.

A wide range of strategies have been developed to mitigate motion, as a major source of image quality degradation in clinical MRI. We aimed to assess the efficiency of a commercially available prospective motion correction (PMC) system in reducing motion in acquiring high-resolution 3D magnetization-prepared rapid gradient-echo (MPRAGE). A total of 100 patients who referred for brain MRI studies were prospectively imaged using a 3.0T scanner. 3D MPRAGE acquisition was obtained with and without application of PMC. The motion tracking system (KinetiCor Inc.) consisted of a quad camera apparatus, which tracks a specific marker on patient's head by evaluating the marker's optical pattern. The patient's head motion in 6 degrees of freedom throughout the acquisition was then incorporated into the MRI sequence, updating the image acquisition in real time based on the most recent head pose data. MPRAGE images with and without motion correction were assessed independently by two board-certified neuroradiologists using a 5-point Likert scale. Statistical analysis included kappa and Wilcoxon Rank-Sum tests. Observers 1 and 2 identified nondiagnostic studies in 17.2% and 20.7% of patients (K = .78, 95% CI .70-.86) without motion correction and in 5.7% and 8% of the studies with motion correction (K = .84, 95% CI .76-.92). The number of nondiagnostic studies was significantly (P = .001) reduced from 19.5% to 5.7% after motion correction in consensus read analysis. The described motion tracking system can be used effectively in clinical practice reducing motion artifact and improving image quality of 3D MPRAGE sequence.