Multi-echo Magnetic Resonance Research Articles

Quantification of volumetric thigh and paravertebral muscle fat content: comparison of quantitative Dixon (Q-Dixon) magnetic resonance imaging (MRI) with high-speed T2-corrected multiecho MR spectroscopy.

Muscle fat infiltration (MFI) is increasingly recognized as a critical factor influencing muscle function and metabolic health. Accurate quantification of MFI is essential for diagnosing and monitoring various muscular and metabolic disorders. Quantitative Dixon (Q-Dixon) magnetic resonance imaging (MRI) and high-speed T2-corrected multi-echo (HISTO) magnetic resonance spectroscopy (MRS) are both advanced imaging techniques that offer potential for detailed assessment of MFI. However, the validity and reliability of these methods in measuring volumetric changes in muscle composition, particularly in both thigh and paravertebral muscles, have not been thoroughly compared. This study aims to validate volumetric measurements using Q-Dixon MRI against HISTO MRS in thigh and paravertebral muscles, taking into account the heterogeneity of MFI. A retrospective study was conducted with 54 subjects [mean age, 60 years; 38 male (M)/16 female (F)] for thigh muscle and 56 subjects (mean age, 50 years; 22 M/34 F) for paravertebral muscle assessment using a 3-Tesla MRI. The proton density fat fraction (PDFF) was measured with Q-Dixon MRI and HISTO MRS within the upper-middle part of quadriceps femoris and paravertebral muscles at L4/5 level in volumes-of-interest (VOIs). The corresponding volumetric Q-Dixon freehand VOI PDFF was measured. Scatterplots, Bland-Altman plots, Spearman correlation coefficients, and Wilcoxon signed rank test with Bonferroni correction were employed. The Kruskal-Wallis H tests followed by Bonferroni-corrected post hoc tests were analyzed to compare parameter differences with visual MFI grades. Q-Dixon cubic VOI PDFF correlated positively with HISTO MRS PDFF in thigh (r=0.96, P<0.001) and paravertebral groups (r=0.98, P<0.001), with insignificant differences (P=0.29, 0.82, respectively). Both PDFF values from cubic VOIs in Q-Dixon and HISTO MRS differed from the freehand Q-Dixon PDFF (all P<0.001). Only for <5% HISTO MRS PDFF, there was a difference between HISTO MRS PDFF and Q-Dixon cubic VOI PDFF (P=0.002). Volumetric Q-Dixon cubic VOI PDFF exhibited good correlation and consistency with HISTO MRS PDFF for quantitative fat assessment in thigh and paravertebral muscles except for muscles with fat fraction <5%, and the Q-Dixon freehand VOI PDFF offers a more comprehensive assessment of the actual MFI compared to cubic VOI.

High-Speed T2 -Corrected Multiecho Magnetic Resonance Spectroscopy for Quantitatively Detecting Skeletal Muscle Fatty Infiltration and Predicting the Loss of Ambulation in Patients With Duchenne Muscular Dystrophy.

High-speed T2 -corrected multiecho MRS (HISTO-MRS) is emerging as a quantitative modality for detecting muscle fat infiltration (MFF). However, the predictive value of HISTO-MRS for the loss of ambulation (LoA) in Duchenne muscular dystrophy (DMD) is unknown. To determine the feasibility of HISTO-MRS for assessing MFF in DMD and further identify the predictive value of HISTO-MRS for the LoA. Prospective. A total of 134 DMD boys (9.20 ± 2.43 years old) and 21 healthy boys (9.25 ± 2.10 years old). A 3 T, fast spin echo T1 -weighted imaging (T1 WI), two-point-Dixon gradient echo sequence (2-pt-Dixon) and HISTO-MRS. Subjective T1 WI fat grades by three radiologists, ROI analysis for MFF on 2pt-Dixon (Dixon MFF) and MFF on HISTO-MRS (HISTO MFF) by two radiologists. Clinical motor function: North Star Ambulatory Assessment, 10-m run/walk time, Gowers maneuver, and time to four-stairs climb and descend. Spearman rank correlation was used to assess the relation of fat filtration assessments and motor ability. Bland-Altman plots was performed to determine the agreement of HISTO MFF and Dixon MFF. Receiver operating characteristic (ROC) curves were analyzed to determine the discriminating ability of above MRI modalities for ambulatory and nonambulatory DMD. Logistic regression was used to identify the predictor of LoA. Variables with P < 0.05 in univariate logistic regression analysis were entered into the multivariate logistic regression model. HISTO MFF was significantly correlated with Dixon MFF. Bland-Altman plots show good agreement of HISTO MFF and Dixon MFF. ROC curves indicated that HISTO MFF show similar discrimination of LoA for DMD with Dixon MFF but better value than T1WI fat grades. Logistic regression showed that HISTO MFF was an independent predictor for LoA. HISTO-MRS is a potential quantitative method for assessing fat infiltration and shows predictive value for LoA in DMD patients. Stage 5.

Abstract 5269: Imaging the tumor microenvironment in rectal cancer: Decline in tumor blood flow (BF) during neoadjuvant treatment predicts excellent outcome

Abstract Introduction: A watch-and-wait strategy for rectal cancer patients may possibly omit surgery after neoadjuvant treatment. To optimally stratify patients for such strategy, reliable and preferably non-invasive biomarkers that repeatedly can assess neoadjuvant therapy response are needed. Recognizing the importance of the tumor microenvironment, we investigated a less explored imaging marker assessing tumor BF for its potential to predict overall survival (OS). Methods: 24 rectal cancer patients given curative-intent neoadjuvant radiotherapy (RT) underwent a multi-echo dynamic magnetic resonance imaging (MRI) sequence with gadolinium contrast for estimation of tumor BF before either 25x2 Gy (n=18) with concomitant chemotherapy or 5x5 Gy (n=6). 4-7 weeks post-RT the MRI was repeated. Baseline blood samples were analyzed for lactate dehydrogenase (LDH) and angiopoietin-2 (ANGPT-2). Tumor volumes were measured before and after RT. After the subsequent surgery, ypT scoring assessed tumor RT response. Cox regression for OS analysis and t-test for group comparisons were performed. Results: 7 patients were non-survivors and the median follow-up for survivors was 55 months (range, 44-60). The change in tumor BF (ΔBF) during neoadjuvant RT was identified as a significant marker of OS (Table). Tumor stage and volume were not significant. All patients with more than 20% decline in BF were survivors. Separating cases in two groups based on ΔBF revealed that patients with increase or a low decrease had higher baseline levels of LDH (p = 0.032) and ANGPT-2 (p = 0.028). Discussion: MRI-assessed tumor ΔBF during neoadjuvant treatment is a significant predictor of OS in rectal cancer patients, making ΔBF a potential biomarker for treatment stratification in a watch-and-wait strategy. Blood LDH and ANGPT-2 indicate that non-responding tumors may have a hypoxic microenvironment insusceptible to RT. Parameter Hazard ratio for impaired OS p-value Tumor stage 1.08 [0.40-2.95] 0.88 ypT score of the surgical specimen 1.54 [0.76-3.12] 0.23 RT fractionation (25x2 Gy versus 5x5 Gy) 2.24 [0.50-9.90] 0.29 Baseline BF 0.96 [0.92-1.00] 0.05 Post-RT BF 1.02 [1.00-1.04] 0.11 ΔBF 1.03 [1.01-1.05] 0.01 Baseline tumor volume 1.01 [0.99-1.04] 0.43 Post-RT tumor volume 1.01 [0.98-1.05] 0.42 Δtumor volume 1.03 [0.99-1.07] 0.15 Citation Format: Kine M. Bakke, Sebastian Meltzer, Endre Grøvik, Anne Negård, Stein H. Holmedal, Lars G. Lyckander, Arne E. Færden, Atle Bjørnerud, Kjell-Inge Gjesdal, Anne H. Ree, Kathrine R. Redalen. Imaging the tumor microenvironment in rectal cancer: Decline in tumor blood flow (BF) during neoadjuvant treatment predicts excellent outcome [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5269.

MRI-based synthetic CT shows equivalence to conventional CT for the morphological assessment of the hip joint.

This study evaluated the accuracy of synthetic computed tomography (sCT), as compared to CT, for the 3D assessment of the hip morphology. Thirty male patients with asymptomatic hips, referred for magnetic resonance (MR) imaging and CT, were included in this retrospective study. sCT images were generated from three‐dimensional radiofrequency‐spoiled T1‐weighted multi‐echo gradient‐echo MR images using a commercially available deep learning‐enabled software and were compared with CT images through mean error and surface distance computation and by means of eight clinical morphometric parameters relevant for hip care. Parameters included center‐edge angle (CEA), sharp angle, acetabular index, extrusion index, femoral head center‐to‐midline distance, acetabular version (AV), and anterior and posterior acetabular sector angles. They were measured by two senior orthopedic surgeons and a radiologist in‐training on CT and sCT images. The reliability and agreement of CT‐ and sCT‐based measurements were assessed using intraclass correlation coefficients (ICCs) for absolute agreement, Bland–Altman plots, and two one‐sided tests for equivalence. The surface distance between CT‐ and sCT‐based bone models were on average submillimeter. CT‐ and sCT‐based measurements showed moderate to excellent interobserver and intraobserver correlation (0.56 < ICC < 0.99). In particular, the inter/intraobserver agreements were good for AV (ICC > 0.75). For CEA, the intraobserver agreement was good (ICC > 0.75) and the interobserver agreement was moderate (ICC > 0.69). Limits of agreements were similar between intraobserver CT and intermodal measurements. All measurements were found statistically equivalent, with average intermodal differences within the intraobserver limits of agreement. In conclusion, sCT and CT were equivalent for the assessment of the hip joint bone morphology.

Liver fat accumulation measured by high-speed T2-corrected multi-echo magnetic resonance spectroscopy can predict risk of cholelithiasis.

BACKGROUNDLiver fat accumulation is associated with increased cholesterol synthesis and hypersecretion of biliary cholesterol, which may be related to the development of cholelithiasis.AIMTo investigate whether liver fat accumulation measured by high-speed T2-corrected multi-echo magnetic resonance spectroscopy (MRS) is a risk factor for cholelithiasis.METHODSForty patients with cholelithiasis and thirty-one healthy controls were retrospectively enrolled. The participants underwent high-speed T2-corrected multi-echo single-voxel MRS of the liver at a 3T MR scanner. The proton density fat fraction (PDFF) and R2 value were calculated. Serum parameters and waist circumference (WC) were recorded. Spearman’s correlation analysis was used to analyze the relationship between PDFF, R2, and WC values. Multivariate logistic regression analysis was carried out to determine the significant predictors of the risk of cholelithiasis. Receiver operating characteristic curve (ROC) analysis was used to evaluate the discriminative performance of significant predictors.RESULTSPatients with cholelithiasis had higher PDFF, R2, and WC values compared with healthy controls (5.8% ± 4.2% vs 3.3% ± 2.4%, P = 0.001; 50.4 ± 24.8/s vs 38.3 ± 8.8/s, P = 0.034; 85.3 ± 9.0 cm vs 81.0 ± 6.9 cm, P = 0.030; respectively). Liver iron concentration extrapolated from R2 values was significantly higher in the cholelithiasis group (2.21 ± 2.17 mg/g dry tissue vs 1.22 ± 0.49 mg/g dry tissue, P = 0.034) than in the healthy group. PDFF was positively correlated with WC (r = 0.502, P < 0.001) and R2 (r = 0.425, P < 0.001). Multivariate logistic regression analysis showed that only PDFF was an independent risk factor for cholelithiasis (odds ratio = 1.79, 95%CI: 1.22-2.62, P = 0.003). ROC analysis showed that the area under the curve of PDFF was 0.723 for discriminating cholelithiasis from healthy controls, with a sensitivity of 55.0% and specificity of 83.9% when the cut-off value of PDFF was 4.4%.CONCLUSIONPDFF derived from high speed T2-corrected multi-echo MRS can predict the risk of cholelithiasis.

MR-based PET attenuation correction using a combined ultrashort echo time/multi-echo Dixon acquisition.

To develop a magnetic resonance (MR)-based method for estimation of continuous linear attenuation coefficients (LACs) in positron emission tomography (PET) using a physical compartmental model and ultrashort echo time (UTE)/multi-echo Dixon (mUTE) acquisitions. We propose a three-dimensional (3D) mUTE sequence to acquire signals from water, fat, and short T2 components (e.g., bones) simultaneously in a single acquisition. The proposed mUTE sequence integrates 3D UTE with multi-echo Dixon acquisitions and uses sparse radial trajectories to accelerate imaging speed. Errors in the radial k-space trajectories are measured using a special k-space trajectory mapping sequence and corrected for image reconstruction. A physical compartmental model is used to fit the measured multi-echo MR signals to obtain fractions of water, fat, and bone components for each voxel, which are then used to estimate the continuous LAC map for PET attenuation correction. The performance of the proposed method was evaluated via phantom and in vivo human studies, using LACs from computed tomography (CT) as reference. Compared to Dixon- and atlas-based MRAC methods, the proposed method yielded PET images with higher correlation and similarity in relation to the reference. The relative absolute errors of PET activity values reconstructed by the proposed method were below 5% in all of the four lobes (frontal, temporal, parietal, and occipital), cerebellum, whole white matter, and gray matter regions across all subjects (n=6). The proposed mUTE method can generate subject-specific, continuous LAC map for PET attenuation correction in PET/MR.

Reconstructing multi-echo magnetic resonance images via structured deep dictionary learning

Multi-echo magnetic resonance (MR) images are acquired by changing the echo times (for T2 weighted) or relaxation times (for T1 weighted) of scans. The resulting (multi-echo) images are usually used for quantitative MR imaging. Acquiring MR images is a slow process and acquiring multi scans of the same cross section for multi-echo imaging is even slower. In order to accelerate the scan, compressed sensing (CS) based techniques have been advocating partial K-space (Fourier domain) scans; the resulting images are reconstructed via structured CS algorithms. In recent times, it has been shown that instead of using off-the-shelf CS, better results can be obtained by adaptive reconstruction algorithms based on structured dictionary learning. In this work, we show that the reconstruction results can be further improved by using structured deep dictionaries. Experimental results on real datasets show that by using our proposed technique the scan-time can be cut by half compared to the state-of-the-art.

Accuracy of Automated Liver Contouring, Fat Fraction, and R2* Measurement on Gradient Multiecho Magnetic Resonance Images.

This study aimed to evaluate the performance of an automated workflow of volumetric liver proton density fat fraction (PDFFvol) and R2* quantification with automated inline liver volume (LV) segmentation. Dual-echo and multiecho Dixon magnetic resonance images were evaluated in 74 consecutive patients (group A, PDFF < 10%; B, PDFF ≥ 10%; C, R2* ≥ 100 s; D, post-hemihepatectomy). The values of PDFFvol and R2*vol measurements across the LV were generated on multiecho images in an automated fashion based on inline liver segmentation on dual-echo images. Similar measurements were performed manually. Using the inline algorithm, the mis-segmented LV was highest in group D (80%). There were no significant differences between automated and manual measurements of PDFFvol. Automated R2*vol was significantly lower than manual R2*vol in group A (P = 0.004). Inline LV segmentation performed well in patients without and with hepatic steatosis. In cases with iron overload and post-hemihepatectomy, extrahepatic areas were erroneously included to a greater extent, with a tendency toward overestimation of PDFFvol.

T1 Shortening in the Globus Pallidus after Multiple Administrations of Gadobutrol: Assessment with a Multidynamic Multiecho Sequence.

Purpose To determine the association between the administration of the macrocyclic contrast medium gadobutrol and T1 relaxation time in the brains of patients with normal renal function by using multidynamic multiecho (MDME) magnetic resonance (MR) imaging sequences. Materials and Methods The institutional review board approved this retrospective study, and the need to obtain written informed consent was waived. This study included 46 patients (revealed by an electronic medical record search) who had received one or more gadobutrol injections and a maximum of one MR imaging contrast medium injection other than gadobutrol before MDME sequence acquisition. One radiologist performed quantitative analyses of regions of interest on quantitative T1 maps twice to cover the normal-appearing globus pallidus (GP), frontal white matter, frontal cortex, and thalamus. The number of administrations and the cumulative dose of gadobutrol, age, intervals between administrations, sex, and treatment were investigated. Univariable and multivariable linear regression analyses of the T1 values in four brain regions and the GP-to-thalamus signal intensity (SI) ratio were performed. P values of less than the Bonferroni-corrected value of .01 were considered to indicate significant differences. Results Intraobserver reproducibility was good to excellent (intraclass correlation coefficients, 0.62-0.81). Because of high multicollinearity between the number of gadobutrol administrations and accumulated dose (r = 0.96, P < .001), the number of gadobutrol administrations was considered in the regression analyses. T1 shortening in the GP was independently associated with the number of gadobutrol administrations (P = .002). T1 in the other brain regions and the GP-to-thalamus SI ratio were not significantly associated with the number of gadobutrol administrations (P > .01). Conclusion Multiple exposures to gadobutrol are associated with T1 shortening in the GP. © RSNA, 2017 Online supplemental material is available for this article.

Luminal Water Imaging: A New MR Imaging T2 Mapping Technique for Prostate Cancer Diagnosis.

Purpose To assess the feasibility of luminal water imaging, a quantitative T2-based magnetic resonance (MR) imaging technique, for the detection and grading of prostate cancer (PCa). Materials and Methods Eighteen patients with biopsy-proven PCa provided informed consent to be included in this institutional human ethics board-approved prospective study between January 2015 and January 2016. Patients underwent 3.0-T MR imaging shortly before radical prostatectomy. T2 distributions were generated with a regularized non-negative least squares algorithm from multiecho spin-echo MR imaging data. From T2 distributions, maps of seven MR parameters, Ncomp, T2short, T2long, geometric mean T2 (gmT2), luminal water fraction (LWF), Ashort, and Along, were generated and compared with digitized images of hematoxylin-eosin-stained whole-mount histologic slices. A paired t test was used to determine significant differences between MR parameters in malignant and nonmalignant tissue. Correlation with Gleason score (GS) was evaluated with the Spearman rank correlation test. Diagnostic accuracy was evaluated by using logistic generalized linear mixed-effect models and receiver operating characteristic (ROC) analysis. Results The average values of four MR parameters (gmT2, Ashort, Along, and LWF) were significantly different between malignant and nonmalignant tissue. All MR parameters except for T2long showed significant correlation (P < .05) with GS in the peripheral zone. The highest correlation with GS was obtained for LWF (-0.78 ± 0.11, P < .001). ROC analysis demonstrated high accuracy for tumor detection, with the highest area under the ROC curve obtained for LWF (0.97 in the peripheral zone and 0.98 in the transition zone). Conclusion Results of this pilot study demonstrated the feasibility of luminal water imaging in the detection and grading of PCa. A study with a larger cohort of patients and a broader range of GS is required to further evaluate this new technique in clinical settings. © RSNA, 2017.

High-SNR multiple T2 (*)-contrast magnetic resonance imaging using a robust denoising method based on tissue characteristics.

To develop an effective method that can suppress noise in successive multiecho T2 (*)-weighted magnetic resonance (MR) brain images while preventing filtering artifacts. For the simulation experiments, we used multiple T2 -weighted images of an anatomical brain phantom. For in vivo experiments, successive multiecho MR brain images were acquired from five healthy subjects using a multiecho gradient-recalled-echo (MGRE) sequence with a 3T MRI system. Our denoising method is a nonlinear filter whose filtering weights are determined by tissue characteristics among pixels. The similarity of the tissue characteristics is measured based on the l2 -difference between two temporal decay signals. Both numerical and subjective evaluations were performed in order to compare the effectiveness of our denoising method with those of conventional filters, including Gaussian low-pass filter (LPF), anisotropic diffusion filter (ADF), and bilateral filter. Root-mean-square error (RMSE), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were used in the numerical evaluation. Five observers, including one radiologist, assessed the image quality and rated subjective scores in the subjective evaluation. Our denoising method significantly improves RMSE, SNR, and CNR of numerical phantom images, and CNR of in vivo brain images in comparison with conventional filters (P < 0.005). It also receives the highest scores for structure conspicuity (8.2 to 9.4 out of 10) and naturalness (9.2 to 9.8 out of 10) among the conventional filters in the subjective evaluation. This study demonstrates that high-SNR multiple T2 (*)-contrast MR images can be obtained using our denoising method based on tissue characteristics without noticeable artifacts. Evidence level: 2 J. MAGN. RESON. IMAGING 2017;45:1835-1845.

Sub-millimeter resolution electrical conductivity images of brain tissues using magnetic resonance-based electrical impedance tomography

Recent magnetic resonance (MR)-based electrical impedance tomography (MREIT) of in vivo animal and human subjects enabled the imaging of electromagnetic properties, such as conductivity and permittivity, on tissue structure and function with a few millimeter pixel size. At those resolutions, the conductivity contrast might be sufficient to distinguish different tissue type for certain applications. Since the precise measurement of electrical conductivity under the tissue levels can provide alternative information in a wide range of biomedical applications, it is necessary to develop high-resolution MREIT technique to enhance its availability. In this study, we provide the experimental evaluation of sub-millimeter resolution conductivity imaging method using a 3T MR scanner combined with a multi-echo MR pulse sequence, multi-channel RF coil, and phase optimization method. From the phantom and animal imaging results, sub-millimeter resolution exhibited similar signal-to-noise ratio of MR magnitude and noise levels in magnetic flux density comparing to the existing millimeter resolution. The reconstructed conductivity images at sub-millimeter resolution can distinguish different brain tissues with a pixel size as small as 350 μm.

Simultaneous liver iron and fat measures by magnetic resonance imaging in patients with hyperferritinemia

Objective. Hyperferritinemia is frequent in chronic liver diseases of any cause, but the extent to which ferritin truly reflects iron stores is variable. In these patients, both liver iron and fat are found in variable amount and association. Liver biopsy is often required to quantify liver fat and iron, but sampling variability and invasiveness limit its use. We aimed to assess single breath-hold multiecho magnetic resonance imaging (MRI) for the simultaneous lipid and iron quantification in patients with hyperferritinemia. Material and methods. We compared MRI results for both iron and fat with their respective gold standards – liver iron concentration and computer-assisted image analysis for steatosis on biopsy. We prospectively studied 67 patients with hyperferritinemia and other 10 consecutive patients were used for validation. We estimated two linear calibration equations for the prediction of iron and fat based on MRI. The agreement between MRI and biopsy was evaluated. Results. MRI showed good performances in both the training and validation samples. MRI information was almost completely in line with that obtained from liver biopsy. Conclusion. Single breath-hold multiecho MRI is an accurate method to obtain a valuable measure of both liver iron and steatosis in patients with hyperferritinemia.

Diagnostic value of MRI proton density fat fraction for assessing liver steatosis in chronic viral C hepatitis.

Objective. To assess the diagnostic performance of a T1-independent, T2*-corrected multiecho magnetic resonance imaging (MRI) technique for the quantification of hepatic steatosis in a cohort of patients affected by chronic viral C hepatitis, using liver biopsy as gold standard. Methods. Eighty-one untreated patients with chronic viral C hepatitis were prospectively enrolled. All included patients underwent MRI, transient elastography, and liver biopsy within a time interval <10 days. Results. Our cohort of 77 patients included 43/77 (55.8%) males and 34/77 (44.2%) females with a mean age of 51.31 ± 11.27 (18–81) years. The median MRI PDFF showed a strong correlation with the histological fat fraction (FF) (r = 0.754, 95% CI 0.637 to 0.836, P < 0.0001), and the correlation was influenced by neither the liver stiffness nor the T2* decay. The median MRI PDFF result was significantly lower in the F4 subgroup (P < 0.05). The diagnostic accuracy of MRI PDFF evaluated by AUC-ROC analysis was 0.926 (95% CI 0.843 to 0.973) for S ≥ 1 and 0.929 (95% CI 0.847 to 0.975) for S = 2. Conclusions. Our MRI technique of PDFF estimation allowed discriminating with a good diagnostic accuracy between different grades of hepatic steatosis.

A new noninvasive technique for estimating hepatic triglyceride: will liver biopsy become redundant in diagnosing non-alcoholic fatty liver disease?

Obesity and metabolic syndrome are healthcare problems that continue to rise in frequency worldwide. Both phenotypes are a strong predictor for development of liver steatosis in the context of non-alcoholic fatty liver disease or non-alcoholic steatohepatitis. Ultrasound may detect steatosis, but its sensitivity is limited and liver biopsy is still considered to be the gold standard. Less invasive techniques that accurately quantify liver steatosis are warranted. Jiménez-Agüero and colleagues propose that multi-echo magnetic resonance imaging might be such a diagnostic tool. They validated multi-echo magnetic resonance imaging with measured hepatic triglyceride concentration. Their results show that this innovative technique measures the grade of steatosis in different clinical situations. Therefore, multi-echo magnetic resonance imaging might be considered for monitoring liver steatosis as an intermediate endpoint. Wide clinical applicability is limited though, as it does not allow differentiation between non-alcoholic fatty liver disease and non-alcoholic steatohepatitis.

31P magnetic resonance spectroscopy of the breast and the influence of the menstrual cycle

Phosphorus metabolite ratios are potential biomarkers in breast cancer diagnosis and treatment monitoring. Our purpose was to investigate the metabolite ratios phosphomonoester to phosphodiester, phosphoethanolamine (PE) to glycerophosphoethanolamine (GPE), and phosphocholine (PC) to glycerophosphocholine (GPC) in glandular breast tissue, and the potential effect of the menstrual cycle, using (31)P magnetic resonance spectroscopy (MRS) at 7T. Seven women with regular menstrual cycles each underwent four examinations using a 3D (31)P multi-echo magnetic resonance spectroscopic imaging sequence. Peak integrals were assessed using IDL and JMRUI software. First, T2 relaxation times were calculated using multi-echo data pooled across subjects and time points. Subsequent, metabolite ratios were calculated for each phase of the menstrual cycle using the calculated T2 values to account for when combining the free induction decay and all five echoes. The metabolite ratios were calculated both on group level and individually. T2 decay fits resulted in a T2 relaxation time for PE of 154 ms (95 % CI 144-164), for PC of 173 ms (95 % CI 148-205), for Pi of 188 ms (95 % CI 182-193), for GPE of 48 ms (95 % CI 44-53), and for GPC of 23 ms (95 % CI 21-26). The metabolite ratios analyzed on group level showed negligible variation throughout the menstrual cycle. Individual results did show an apparent intra-individual variation; however, not significant due to the measurements' uncertainty. To conclude, phospholipids in glandular tissue as measured with (31)P MRS at 7 T are not significantly affected by the menstrual cycle.

Blood Oxygen Level–Dependent Magnetic Resonance Imaging of the Kidneys

The aim of this study was to quantify the influence of image resolution on the apparent transverse relaxivity (R2*) of the magnetic resonance (MR) signal in human renal tissue in vivo and in phantom measurements. This prospective study included 17 healthy volunteers (age, 32 ± 8 years, 6 women). Parametrical R2* maps were computed via monoexponential fitting of multiecho 2-dimensional fast-field echo data measured at 1.5 T (repetition time [TR], 150 milliseconds; flip angle [FA], 40°; minimum echo time [TE], 4.6 milliseconds; ΔTE, 5 milliseconds; 16 echoes) and at 3 T (TR, 140 milliseconds; FA, 70°; minimum TE, 2 milliseconds; ΔTE, 5 milliseconds; 16 echoes) with varying nominal volumes of the encoded voxels (from 5.76 to 36.0 mm). For each voxel size, mean R2* values were computed in regions of interest drawn in the left and right renal parenchyma. For data acquired using minimum voxel size, the mean R2* values were computed over the cortex and medulla separately. The squared 2-norm of the residuals was computed to evaluate the goodness of the pixel-wise exponential fits. Six multiecho MR images of a water phantom were acquired using a 2-dimensional fast-field echo sequence (FA, 50°; TR, 108 milliseconds; TE, 4 milliseconds; ΔTE, 20 milliseconds) at 3 T after shim adjustment and in the presence of a uniform background gradient of 40 μT/m. The nominal voxel size was varied in a range between 2 and 12.5 mm. Mean R2* values of 13.04 ± 0.71 s (right renal cortex) and 16.47 ± 1.92 s (right renal medulla) were computed at 1.5 T. At 3 T, the R2* of the right medulla was 28.27 ± 1.52 s and the cortical R2* was 19.22 ± 2.32 s. Comparable relaxivity values were found over the left kidney at both field strengths. Increasing R2* values were observed for increasing voxel volume in both the water phantom and renal tissue data. At a constant slice thickness of 4 mm, the decrease in the in-plane resolution from 1.2 × 1.2 mm to 3.0 × 3.0 mm led to a maximum increase of the renal R2* of 15% at 1.5 T and of 12% at 3 T. Increasing the slice thickness from 3 to 8 mm at a constant in-plane resolution of 1.5 × 1.5 mm resulted in a maximum increase of the renal R2* of 30% at 1.5 T and of 26% at 3 T. On the other hand, increasing the voxel size improved the goodness of the fit implied by the smaller residuals. The phantom experiments and in vivo acquisitions of healthy renal tissue documented a significant dependence of the apparent R2* relaxation rate on the spatial resolution of the MR imaging data. In clinical practice, the voxel volume for the quantification of renal R2* should be optimized in a compromise between minimizing the effects of macroscopic field inhomogeneity and maintaining a sufficiently high signal-to-noise ratio and goodness of fit. When comparing quantitative R2* among different publications, the influence of the spatial resolution should be taken into account.

Improvement of the SNR and resolution of susceptibility-weighted venography by model-based multi-echo denoising

The vein structures of the brain are important for understanding brain function and structure, especially when functional magnetic resonance imaging (fMRI) is utilized, as fMRI is based on changes in the blood-oxygen-level-dependent (BOLD) signal, which is directly related to veins. The aim of the present study was to develop an effective method to produce high signal-to-noise-ratio (SNR) and high-resolution multi-contrast susceptibility-weighted (SW) images of vein structures from 3T magnetic resonance (MR) scanners using multi-gradient-echo MR acquisition and a successive denoising process for both magnitude and phase data. Successive multi-echo MR images were acquired at multiple time points using a multigradient-recalled echo sequence at 3T, and noise in the magnitude and phase data was effectively suppressed using model-based denoising methods. A T(2)* relaxation model was used to denoise the magnitude data and a linear phase model was used to denoise the phase data. SW venography images were obtained from the denoised MR data and compared with conventional SW venography. To evaluate the performance of our denoising methods, we conducted numerical simulation studies and compared the mean-squared-error (MSE), SNR, and contrast-to-noise ratio (CNR) that we obtained using our procedure with those obtained using conventional denoising methods. In addition, images were inspected visually. Numerical simulations showed that our proposed model-based denoising methods were the most effective at suppressing noise. In vivo experiments also showed a substantial increase in the SNR of the phase mask obtained using the proposed denoising process (twice that of the conventional GRE-based phase mask). The T(2)* relaxation model method improved the SNR of the magnitude image (1.17-1.35 times that of the GRE-based magnitude image). Noise suppression of both magnitude and phase data using our proposed method resulted in an overall increase in the SNR and CNR in the final SW venography (1.1-1.5-fold and 1.96-fold higher SNR and CNR, respectively, than that of the GRE-based SW venography). We demonstrated that high SNR and high-resolution SW venograms can be obtained using multi-echo gradient-recalled acquisition and successive model-based denoising of both magnitude and phase data.

Quantification of Muscle Fat in Patients with Low Back Pain: Comparison of Multi-Echo MR Imaging with Single-Voxel MR Spectroscopy

To compare lumbar muscle fat-signal fractions derived from three-dimensional dual gradient-echo magnetic resonance (MR) imaging and multiple gradient-echo MR imaging with fractions from single-voxel MR spectroscopy in patients with low back pain. This prospective study had institutional review board approval, and written informed consent was obtained from all study participants. Fifty-six patients (32 women; mean age, 52 years ± 15 [standard deviation]; age range, 20-79 years) with low back pain underwent standard 1.5-T MR imaging, which was supplemented by dual-echo MR imaging, multi-echo MR imaging, and MR spectroscopy to quantify fatty degeneration of bilateral lumbar multifidus muscles in a region of interest at the intervertebral level of L4 through L5. Fat-signal fractions were determined from signal intensities on fat- and water-only images from both imaging data sets (dual-echo and multi-echo fat-signal fractions without T2* correction) or directly obtained, with additional T2* correction, from multi-echo MR imaging. The results were compared with MR spectroscopic fractions. The Student t test and Bland-Altman plots were used to quantify agreement between fat-signal fractions derived from imaging and from spectroscopy. In total, 102 spectroscopic measurements were obtained bilaterally (46 of 56) or unilaterally (10 of 56). Mean spectroscopic fat-signal fraction was 19.6 ± 11.4 (range, 5.4-63.5). Correlation between spectroscopic and all imaging-based fat-signal fractions was statistically significant (R(2) = 0.87-0.92; all P < .001). Mean dual-echo fat-signal fractions not corrected for T2* and multi-echo fat-signal fractions corrected for T2* significantly differed from spectroscopic fractions (both P < .01), but mean multi-echo fractions not corrected for T2* did not (P = .11). There was a small measurement bias of 0.5% (95% limits of agreement: -6.0%, 7.2%) compared with spectroscopic fractions. Large-volume image-based (dual-echo and multi-echo MR imaging) and spectroscopic fat-signal fractions agree well, thus allowing fast and accurate quantification of muscle fat content in patients with low back pain.

Multicontrast multiecho FLASH MRI for targeting the subthalamic nucleus

The subthalamic nucleus (STN) is one of the most common stimulation targets for treating Parkinson's disease using deep brain stimulation (DBS). This procedure requires precise placement of the stimulating electrode. Common practice of DBS implantation utilizes microelectrode recording to locate the sites with the correct electrical response after an initial location estimate based on a universal human brain atlas that is linearly scaled to the patient's anatomy as seen on the preoperative images. However, this often results in prolonged surgical time and possible surgical complications since the small-sized STN is difficult to visualize on conventional magnetic resonance (MR) images and its intersubject variability is not sufficiently considered in the atlas customization. This paper proposes a multicontrast, multiecho MR imaging (MRI) method that directly delineates the STN and other basal ganglia structures through five co-registered image contrasts (T1-weighted navigation image, R2* map, susceptibility-weighted imaging (phase, magnitude and fusion image)) obtained within a clinically acceptable time. The image protocol was optimized through both simulation and in vivo experiments to obtain the best image quality. Taking advantage of the multiple echoes and high readout bandwidths, no interimage registration is required since all images are produced in one acquisition, and image distortion and chemical shift are reduced. This MRI protocol is expected to mitigate some of the shortcomings of the state-of-the-art DBS implantation methods.