The purpose was to improve sodium MRI of human skin using a surface coil and twisted projection imaging with smaller, reshaped voxels. Calf skin sodium images were acquired in 14 healthy adults using twisted projection imaging with short TE ˜ 0.1 ms, first with a volume coil and voxels (1.5 × 1.5 × 15 = 34 mm3) reflecting the widely adopted skin imaging protocol (VolPencil). A 5-cm-diameter surface coil then facilitated 5× smaller (0.8 × 0.8 × 10 = 6.4 mm3) voxels with similar signal to noise ratio (SNR) in the same 12-min scan time (SurfPencil). "Pencil-shaped" voxels were then replaced with "pancake-shaped" (0.4 × 4 × 4 = 6.4 mm3) voxels, matching the anatomy of pressed flat skin (SurfPancake). Surface coil B1 was investigated with the novel use of spin-3/2 simulation. Protocol modifications were tested for signal increase (reduced loss) and correlation with (bias by) skin thickness. Higher resolution SurfPencil yielded 44% ± 16% greater skin sodium image intensity than VolPencil, whereas SurfPancake yielded an additional 20% ± 9% (p < 1e-8), reflecting reduced signal loss. Over the 1.0 to 1.8 mm skin thickness across participants, sodium intensity significantly increased 56% ± 19% and 44% ± 12% for VolPencil and SurfPencil, respectively (p < 0.003), but not for SurfPancake, reflecting reduced bias. Imaging yielded skin sodium concentration of 34 ± 5 mM for SurfPancake. This is greater than the ˜20 mM measures from the widely adopted protocol, but simulation (matching experimental trends) identified a remaining 64% signal loss; compensation yields 95 ± 15 mM. Surface coil imaging and "pancake" voxel reshaping increased skin sodium intensity and reduced bias by skin thickness. Simulated loss compensation yields skin sodium concentration similar to that measured by atomic absorption spectroscopy.
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