Single-shot Fast Spin-echo Imaging Research Articles

High-resolution anatomical imaging of the fetal brain with a reduced field of view using outer volume suppression.

To achieve high-resolution fetal brain anatomical imaging without introducing image artifacts by reducing the FOV, and to demonstrate improved image quality compared to conventional full-FOV fetal brain imaging. Reduced FOV was achieved by applying outer volume suppression (OVS) pulses immediately prior to standard single-shot fast spin echo (SSFSE) imaging. In the OVS preparation, a saturation RF pulse followed by a gradient spoiler was repeated three times with optimized flip-angle weightings and a variable spoiler scheme to enhance signal suppression. Simulations and phantom and in-vivo experiments were performed to evaluate OVS performance. In-vivo high-resolution SSFSE images acquired using the proposed approach were compared with conventional and high-resolution SSFSE images with a full FOV, using image quality scores assessed by neuroradiologists and calculated image metrics. Excellent signal suppression in the saturation bands was confirmed in phantom and in-vivo experiments. High-resolution SSFSE images with a reduced FOV acquired using OVS demonstrated the improved depiction of brain structures without significant motion and blurring artifacts. The proposed method showed the highest image quality scores in the criteria of sharpness, contrast, and artifact and was selected as the best method based on overall image quality. The calculated image sharpness and tissue contrast ratio were also the highest with the proposed method. High-resolution fetal brain anatomical images acquired using a reduced FOV with OVS demonstrated improved image quality both qualitatively and quantitatively, suggesting the potential for enhanced diagnostic accuracy in detecting fetal brain abnormalities in utero.

MRI AND BLOOD-BASED BIOMARKERS ASSOCIATED WITH SURGICAL MANAGEMENT IN CHILDREN AND ADULTS WITH SMALL BOWEL CROHN'S DISEASE

Abstract BACKGROUND Despite advances in medical therapy, many children and adults with ileal Crohn’s Disease (CD) progress to fibrostenosis requiring surgery. Prior studies have identified circulating and imaging biomarkers associated with strictures, although their associations with need for surgery are not well-established. PURPOSE We aimed to identify MRI and circulating biomarkers associated with the need for surgical management in chidlren and adults with ileal CD. METHODS This prospective, multi-center study included pediatric and adult CD cases undergoing ileal resection (n=50), and CD controls receiving medical therapy (n=83). Noncontrast research MRI examinations measured bowel wall three-dimensional magnetization transfer ratio normalized to skeletal muscle (normalized 3D MTR), modified Look-Locker inversion recovery (MOLLI) T1 relaxation, intravoxel incoherent motion (IVIM) diffusion-weighted imaging metrics, and the simplified magnetic resonance index of activity (sMaRIA) (Figure 1). Circulating biomarkers included CD64, ECM1, and GM-CSF autoantibodies (Ab). Clinical variables, including demographics, anthropometrics, and routine clinical laboratory data (e.g., CRP, fecal calprotectin), also were obtained at the research visit. Associations between MRI and circulating biomarkers and need for ileal resection were tested using univariate and multivariable LASSO regression. RESULTS Mean participant age was 23.9±13.1 years. Disease duration and treatment exposures did not vary between the groups. Univariate biomarker associations with ileal resection included log GM-CSF Ab (odds ratio [OR]=2.87; p=0.0009), normalized 3D MTR (OR=1.05; p=0.002), log MOLLI T1 (OR=0.01; p=0.02), log IVIM perfusion fraction (f) (OR=0.38; p=0.04), and IVIM apparent diffusion coefficient (ADC) (OR=0.3; p=0.001). MRI and circulating biomarker Tukey box plots are presented in Figure 2. The multivariable model for surgery based upon AICc criteria included age (OR=1.03; p=0.29), BMI (OR=0.91; p=0.09), log GM-CSF Ab (OR=3.37; p=0.01), normalized 3D MTR (OR=1.07; p=0.007), sMaRIA (OR=1.14; p=0.61), luminal narrowing (OR=10.19; p=0.003), log CRP (normalized) (OR=2.75; p=0.10), and hematocrit (OR=0.90; p=0.13). CONCLUSION After accounting for clinical and MRI measures of severity, normalized 3D MTR and GM-CSF Ab are associated with need for surgery in ileal CD. GM-CSF autoantibodies and MRI biomarker sequences may be useful for guiding management decisions in CD patients. Figure 1 Research MRI images from a surgical Crohn’s disease patient with stricturing behavior involving the terminal ileum. A and B. Coronal and axial fat-saturated T2-weighted single-shot fast spin-echo (SSFSE) images show wall thickening and luminal narrowing of the terminal ileum (arrows) with more proximal bowel dilation measuring greater than 3 cm. C. Axial 3D magnetization transfer images – MT pulse on (bottom image, arrow), MT pulse off (top image, arrow). D. Axial modified Look-Locker inversion recovery (MOLLI) T1 relaxation image (arrow). E. Representative axial intravoxel incoherent motion diffusion-weighted images with increasing b-values (left to right, arrows). Figure 2 Variation in circulating and imaging biomarkers in Crohn’s disease patients with medical and surgical management. Ctrl: non-IBD healthy controls; Med: CD patients with nonsurgical medical management; Surg: CD patients with surgical management.

Impact of deep learning-based reconstruction and anti-peristaltic agent on the image quality and diagnostic performance of magnetic resonance enterography comparing single breath-hold single-shot fast spin echo with and without anti-peristaltic agent.

While anti-peristaltic agents are beneficial for high quality magnetic resonance enterography (MRE), their use is constrained by potential side effects and increased examination complexity. We explored the potential of deep learning-based reconstruction (DLR) to compensate for the absence of anti-peristaltic agent, improve image quality and reduce artifact. This study aimed to evaluate the need for an anti-peristaltic agent in single breath-hold single-shot fast spin-echo (SSFSE) MRE and compare the image quality and artifacts between conventional reconstruction (CR) and DLR. We included 45 patients who underwent MRE for Crohn's disease between October 2021 and September 2022. Coronal SSFSE images without fat saturation were acquired before and after anti-peristaltic agent administration. Four sets of data were generated: SSFSE CR with and without an anti-peristaltic agent (CR-A and CR-NA, respectively) and SSFSE DLR with and without an anti-peristaltic agent (DLR-A and DLR-NA, respectively). Two radiologists independently reviewed the images for overall quality and artifacts, and compared the three images with DLR-A. The degree of distension and inflammatory parameters were scored on a 5-point scale in the jejunum and ileum, respectively. Signal-to-noise ratio (SNR) levels were calculated in superior mesenteric artery (SMA) and iliac bifurcation level. In terms of overall quality, DLR-NA demonstrated no significant difference compared to DLR-A, whereas CR-NA and CR-A demonstrated significant differences (P<0.05, both readers). Regarding overall artifacts, reader 1 rated DLR-A slightly better than DLR-NA in four cases and rated them as identical in 41 cases (P=0.046), whereas reader 2 demonstrated no difference. Bowel distension was significantly different in the jejunum (Reader 1: P=0.046; Reader 2: P=0.008) but not in the ileum. Agreements between the images (Reader 1: ĸ=0.73-1.00; Reader 2: ĸ=1.00) and readers (ĸ=0.66 for all comparisons) on inflammation were considered good to excellent. The sensitivity, specificity, and accuracy in diagnosing inflammation in the terminal ileum were the same among DLR-NA, DLR-A, CR-NA and CR-A (94.42%, 81.83%, and 89.69 %; and 83.33%, 90.91%, and 86.21% for Readers 1 and 2, respectively). In both SMA and iliac bifurcation levels, SNR of DLR images exhibited no significant differences. CR images showed significantly lower SNR compared with DLR images (P<0.001). SSFSE without anti-peristaltic agents demonstrated nearly equivalent quality to that with anti-peristaltic agents. Omitting anti-peristaltic agents before SSFSE and adding DLR could improve the scanning outcomes and reduce time.

Estimate of fetal brain temperature using proton resonance frequency thermometry during 3 Tesla fetal magnetic resonance imaging.

T2-weighted Single Shot Fast Spin Echo (SSFSE) scans at 3 Tesla (3T) are increasingly used to image fetal pathology due to their excellent tissue contrast resolution and signal-to-noise ratio (SNR). Temperature changes that may occur in response to radio frequency (RF) pulses used for these sequences at 3T have not been studied in human fetal brains. To evaluate the safety of T2-weighted SSFSE for fetal brains at 3T, magnetic resonance (MR) thermometry was used to measure relative temperature changes in a typical clinical fetal brain MR exam. Relative temperature was estimated using sets of gradient recalled echo (GRE) images acquired before and after T2-weighted SSFSE images which lasted 27.47±8.19 minutes. Thirty-one fetuses with cardiac abnormalities, and 20 healthy controls were included in this study. Fetal brain temperature was estimated by proton resonance frequency (PRF) thermometry and compared to the estimated temperature in the gluteal muscle of the mother. Seven scans with excessive motion were excluded. Local outlier factor (LOF) was performed to remove 12 additional scans with spurious phase measurements due to motion degradation and potential field drift. Linear regression was performed to determine if temperature changes are dependent on the rate of energy deposition during the scan. For the 32 participants used in the analysis, 17 with cardiac abnormalities and 15 healthy controls, the average relative fetal temperate change was 0.19±0.73 ℃ higher than the mother, with no correlation between relative temperature change and the rate of images acquired during the scans (regression coefficient =-0.05, R-squared =0.05, P=0.22, F-statistic =1.60). The difference in the relative temperature changes between the fetal brain and mother's gluteal tissue in the healthy controls was on average 0.08 ℃ lower and found not to be statistically different (P=0.76) to the group with cardiac abnormalities. Our results indicate that the estimated relative temperature changes of the fetal brain compared to the mother's gluteal tissue from RF pulses during the course of the T2-weighted SSFSE fetal MR exam are minimal. The differences in acquired phase between these regions through the exam were found not to be statistically different. These findings support that fetal brain imaging at 3T is within FDA limits and safe.

Clinical Quality Control of MRI Total Kidney Volume Measurements in Autosomal Dominant Polycystic Kidney Disease.

Total kidney volume measured on MRI is an important biomarker for assessing the progression of autosomal dominant polycystic kidney disease and response to treatment. However, we have noticed that there can be substantial differences in the kidney volume measurements obtained from the various pulse sequences commonly included in an MRI exam. Here we examine kidney volume measurement variability among five commonly acquired MRI pulse sequences in abdominal MRI exams in 105 patients with ADPKD. Right and left kidney volumes were independently measured by three expert observers using model-assisted segmentation for axial T2, coronal T2, axial single-shot fast spin echo (SSFP), coronal SSFP, and axial 3D T1 images obtained on a single MRI from ADPKD patients. Outlier measurements were analyzed for data acquisition errors. Most of the outlier values (88%) were due to breathing during scanning causing slice misregistration with gaps or duplication of imaging slices (n = 35), slice misregistration from using multiple breath holds during acquisition (n = 25), composing of two overlapping acquisitions (n = 17), or kidneys not entirely within the field of view (n = 4). After excluding outlier measurements, the coefficient of variation among the five measurements decreased from 4.6% pre to 3.2%. Compared to the average of all sequences without errors, TKV measured on axial and coronal T2 weighted imaging were 1.2% and 1.8% greater, axial SSFP was 0.4% greater, coronal SSFP was 1.7% lower and axial T1 was 1.5% lower than the mean, indicating intrinsic measurement biases related to the different MRI contrast mechanisms. In conclusion, MRI data acquisition errors are common but can be identified using outlier analysis and excluded to improve organ volume measurement consistency. Bias toward larger volume measurements on T2 sequences and smaller volumes on axial T1 sequences can also be mitigated by averaging data from all error-free sequences acquired.

High-Resolution Single-Shot Fast Spin-Echo MR Imaging with Deep Learning Reconstruction Algorithm Can Improve Repeatability and Reproducibility of Follicle Counting.

To investigate the diagnostic performance of high-resolution single-shot fast spin-echo (SSFSE) imaging with deep learning (DL) reconstruction algorithm on follicle counting and compare it with original SSFSE images and conventional fast spin-echo (FSE) images. This study included 20 participants (40 ovaries) with clinically confirmed polycystic ovary syndrome (PCOS) who underwent high-resolution ovary MRI, including three-plane T2-weighted FSE sequences and slice-matched T2-weighted SSFSE sequences. A DL reconstruction algorithm was applied to the SSFSE sequences to generate SSFSE-DL images, and the original SSFSE images were also saved. Subjective evaluations such as the blurring artifacts, subjective noise, and clarity of the follicles on the SSFSE-DL, SSFSE, and conventional FSE images were independently conducted by two observers. Intra-class correlation coefficients and Bland-Altman plots were used to present the repeatability and reproducibility of the follicle number per ovary (FNPO) based on the three types of images. SSFSE-DL images showed less blurring artifact, subjective noise, and better clarity of the follicles than SSFSE and FSE (p < 0.05). For the repeatability of the FNPO, SSFSE-DL showed the highest intra-observer (ICC = 0.930; 95% CI: 0.878-0.962) and inter-observer (ICC = 0.914; 95% CI: 0.843-0.953) agreements. The inter-observer 95% limits of agreement (LOA) for SSFSE-DL, SSFSE, and FSE ranged from -3.7 to 4.5, -4.4 to 7.0, and -7.1 to 7.6, respectively. The intra-observer 95% LOA for SSFSE-DL, SSFSE, and FSE ranged from -3.5 to 4.0, -5.1 to 6.1, and -5.7 to 4.2, respectively. The absolute values of intra-observer and inter-observer differences for SSFSE-DL were significantly lower than those for SSFSE and FSE (p < 0.05). Compared with the original SSFSE images and the conventional FSE images, high-resolution SSFSE images with DL reconstruction algorithm can better display follicles, thus improving FNPO assessment.

Semi-automatic segmentation of the fetal brain from magnetic resonance imaging.

Volumetric measurements of fetal brain maturation in the third trimester of pregnancy are key predictors of developmental outcomes. Improved understanding of fetal brain development trajectories may aid in identifying and clinically managing at-risk fetuses. Currently, fetal brain structures in magnetic resonance images (MRI) are often manually segmented, which requires both time and expertise. To facilitate the targeting and measurement of brain structures in the fetus, we compared the results of five segmentation methods applied to fetal brain MRI data to gold-standard manual tracings. Adult women with singleton pregnancies (n = 21), of whom five were scanned twice, approximately 3 weeks apart, were recruited [26 total datasets, median gestational age (GA) = 34.8, IQR = 30.9-36.6]. T2-weighted single-shot fast spin echo images of the fetal brain were acquired on 1.5T and 3T MRI scanners. Images were first combined into a single 3D anatomical volume. Next, a trained tracer manually segmented the thalamus, cerebellum, and total cerebral volumes. The manual segmentations were compared with five automatic methods of segmentation available within Advanced Normalization Tools (ANTs) and FMRIB's Linear Image Registration Tool (FLIRT) toolboxes. The manual and automatic labels were compared using Dice similarity coefficients (DSCs). The DSC values were compared using Friedman's test for repeated measures. Comparing cerebellum and thalamus masks against the manually segmented masks, the median DSC values for ANTs and FLIRT were 0.72 [interquartile range (IQR) = 0.6-0.8] and 0.54 (IQR = 0.4-0.6), respectively. A Friedman's test indicated that the ANTs registration methods, primarily nonlinear methods, performed better than FLIRT (p < 0.001). Deformable registration methods provided the most accurate results relative to manual segmentation. Overall, this semi-automatic subcortical segmentation method provides reliable performance to segment subcortical volumes in fetal MR images. This method reduces the costs of manual segmentation, facilitating the measurement of typical and atypical fetal brain development.

Impact of adaptive image receive coil technology for liver MR imaging at 3.0 Tesla: Intraindividual comparison with use of conventional coil

PurposeA newly developed Adaptive Image Receive (AIR) coil is designed to be more flexible to conform to the human body habitus, and may improve image quality by reducing the distance between the coil element and the imaging subject. This study evaluated the AIR coil's usefulness for liver MR imaging at 3.0 T in comparison with that of a conventional coil retrospectively. MethodThe study population comprised 50 consecutive patients, who underwent follow-up liver MR examinations with a 3.0-T MR system using both an AIR coil and a conventional coil to evaluate hepatocellular carcinoma. Three-dimensional fat-suppressed T1-weighted gradient-echo images before and after injection of an MRI contrast agent, T2-weighted single-shot fast spin-echo (SSFSE) images, and diffusion-weighted (DW) images obtained with the AIR coil were compared with corresponding images obtained with the conventional coil. One radiologist measured signal-to-noise ratios (SNRs), while two other radiologists used a 3-point scale to independently assess subjective image noise, artifacts, signal uniformity, and overall image quality. ResultsSNRs for the AIR coil were significantly higher than those for the conventional coil (P <.05). Subjective image noise for the AIR coil on pre- and postcontrast T1-weighted and DW images was lower than for the conventional coil for both readers (P <.05). Overall image quality on pre- and postcontrast T1-weighted and DW images for the AIR coil was better than that for the conventional coil for at least one reader (P <.05). ConclusionsIn comparison with the conventional coil, AIR coil improved SNR and image quality of liver MR imaging.

Impact of Deep Learning Reconstruction Combined With a Sharpening Filter on Single-Shot Fast Spin-Echo T2-Weighted Magnetic Resonance Imaging of the Uterus.

This study aimed to evaluate the effects of deep learning (DL) reconstruction and a postprocessing sharpening filter on the image quality of single-shot fast spin-echo (SSFSE) T2-weighted imaging (T2WI) of the uterus. Fifty consecutive patients who underwent pelvic magnetic resonance imaging were included. Parasagittal T2WI with a slice thickness of 4 mm was obtained with the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) and SSFSE sequences (mean scan time, 204 and 22 seconds, respectively). The following 3 types of SSFSE images were reconstructed, and the signal-to-noise ratio (SNR) and tissue contrast were assessed: conventional reconstruction (SSFSE-C), DL reconstruction (SSFSE-DL), and DL with a sharpening filter (SSFSE-DLF). Three radiologists independently assessed image quality, and area under the visual grading characteristics curve (AUCVGC) analysis was performed to compare the SSFSE and PROPELLER images. Compared with that of the PROPELLER images, the SNR of the SSFSE-C, SSFSE-DL, and SSFSE-DLF images was significantly lower (P < 0.05), significantly higher (P < 0.05), and equivalent, respectively. The SSFSE-DL images exhibited significantly lower contrast between the junctional zone and myometrium than those obtained with the other sequences (P < 0.05). In qualitative comparisons with the PROPELLER images, all 3 SSFSE sequences, SSFSE-DL, and SSFSE-DLF demonstrated significantly higher scores for artifacts, noise, and sharpness, respectively (P < 0.01). The overall image quality of SSFSE-C (mean AUCVGC, 0.03; P < 0.01) and SSFSE-DL (mean AUCVGC, 0.23; P < 0.01) was rated as significantly inferior, whereas that of SSFSE-DLF (mean AUCVGC, 0.69) was equivalent or significantly higher (P < 0.01). Using a combination of DL and a sharpening filter markedly increases the image quality of SSFSE of the uterus to the level of the PROPELLER sequence.

3D Isotropic Super-resolution Prostate MRI Using Generative Adversarial Networks and Unpaired Multiplane Slices.

We developed a deep learning-based super-resolution model for prostate MRI. 2D T2-weighted turbo spin echo (T2w-TSE) images are the core anatomical sequences in a multiparametric MRI (mpMRI) protocol. These images have coarse through-plane resolution, are non-isotropic, and have long acquisition times (approximately 10-15min). The model we developed aims to preserve high-frequency details that are normally lost after 3D reconstruction. We propose a novel framework for generating isotropic volumes using generative adversarial networks (GAN) from anisotropic 2D T2w-TSE and single-shot fast spin echo (ssFSE) images. The CycleGAN model used in this study allows the unpaired dataset mapping to reconstruct super-resolution (SR) volumes. Fivefold cross-validation was performed. The improvements from patch-to-volume reconstruction (PVR) to SR are 80.17%, 63.77%, and 186% for perceptual index (PI), RMSE, and SSIM, respectively; the improvements from slice-to-volume reconstruction (SVR) to SR are 72.41%, 17.44%, and 7.5% for PI, RMSE, and SSIM, respectively. Five ssFSE cases were used to test for generalizability; the perceptual quality of SR images surpasses the in-plane ssFSE images by 37.5%, with 3.26% improvement in SSIM and a higher RMSE by 7.92%. SR images were quantitatively assessed with radiologist Likert scores. Our isotropic SR volumes are able to reproduce high-frequency detail, maintaining comparable image quality to in-plane TSE images in all planes without sacrificing perceptual accuracy. The SR reconstruction networks were also successfully applied to the ssFSE images, demonstrating that high-quality isotropic volume achieved from ultra-fast acquisition is feasible.

Fetal growth, fetal development, and placental features in women with polycystic ovary syndrome: analysis based on fetal and placental magnetic resonance imaging.

Polycystic ovary syndrome (PCOS), a common endocrine-metabolic dysfunction in reproductive-aged women, may be involved in compromised pregnancy and offspring outcomes. This study aimed to investigate whether maternal PCOS affects fetal growth, fetal development, and placental features. This retrospective case-control study included 60 pregnant women with PCOS (PCOS group) and 120 healthy pregnant women without PCOS (control group). Fetal magnetic resonance imaging (MRI) was performed followed by an ultrasound examination and indications for imaging, including known or suspected fetal pathology, history of fetal abnormality in previous pregnancy or in a family member, and concern for placenta accreta. Fetal MRI images were analyzed for head circumference (HC), abdomen circumference (AC), lung-to-liver signal intensity ratio (LLSIR, a prenatal marker of fetal lung maturity), lengths of liver and kidney diameters in fetuses, and placental relative signal intensity on T2-weighted single-shot fast spin echo (SSFSE) imaging (rSISSFSE), and placental relative apparent diffusion coefficient value (rADC). Data on height and weight of offspring were collected through telephone follow-up. Compared to the control group, the PCOS group showed the following characteristics: (1) smaller biparietal diameter and femur length in fetuses (P=0.026 and P=0.005, respectively), (2) smaller HC in fetuses (evident after 32 weeks; P=0.044), (3) lower LLSIR and smaller dorsoventral length of liver in fetuses (evident before 32 weeks; P=0.005 and P=0.019, respectively), and (4) smaller placental thickness (evident before 32 weeks; P=0.017). No significant differences in placental rSISSFSE or rADC were observed between the groups (all P>0.05). No significant differences in height and weight of offspring during childhood existed between the groups (all P>0.05). There exist alterations of fetal growth, fetal development, and placental features from women with PCOS.

Coordinated Human Brainstem and Spinal Cord Networks during the Expectation of Pain Have Elements Unique from Resting-State Effects

Functional magnetic resonance imaging (fMRI) research on the human brainstem (BS) and spinal cord (SC) has identified extensive BS/SC resting-state networks (RSNs) by showing spontaneous coordinated blood oxygenation-level dependent (BOLD) signal fluctuations in the absence of a stimulus. Studies have shown that these networks can be influenced by participants’ level of arousal or attention (e.g., watching a video), and linked network function to autonomic homeostatic regulation. Here we explore how the cognitive state of expecting pain can influence connectivity in these networks. Data from two studies (a predictable pain stimulus study, and a resting-state study) were compared to show the effects of expecting pain on BS/SC networks, and how networks differed from networks associated with the resting-state. In each study, BOLD fMRI data were obtained from the cervical SC and brainstem in healthy participants at 3 tesla using a T2-weighted single-shot fast spin-echo imaging method. Functional connectivity was investigated within the entire 3D volume by means of structural equation modeling (SEM) and analyses of covariance (ANCOVA). Results showed extensive connectivity within/across BS and SC regions during the expectation of pain, and ANCOVA analyses showed that connectivity in specific components of these networks varied with individual pain sensitivity. Comparing these results to RSN fluctuations revealed commonalities in coordination between BS and SC regions, and specific BS–BS connectivity fluctuations unique to the expectation of pain. Based on the regions involved, these results provide evidence of brainstem regulation specific to the expectation of pain.

Echo-planar FLAIR Sequence Improves Subplate Visualization in Fetal MRI of the Brain.

Background The cortical plate (future cortex) is readily identifiable in utero at MRI. However, MRI evaluation of the remaining brain layers is limited by the poor T2 contrast between the subplate and the underlying intermediate zone (IZ). Purpose To compare the delineation of fetal brain lamination between T2-weighted single-shot fast spin-echo (SSFSE) and echo-planar imaging (EPI) fluid-attenuated inversion recovery (FLAIR) images, and to quantify differences in the depiction of brain layering between the two sequences. Materials and Methods Consecutive fetal brain MRI examinations performed between January 2014 and March 2018 with T2-weighted SSFSE and EPI-FLAIR images were reviewed. Two neuroradiologists evaluated the visibility of brain layers by using a three-point grading system, and findings were compared by using the sign test. One rater performed region-of-interest analysis in the cortical plate (CP), subplate (gyral crest and sulcal bottom), and IZ. Signal intensity (SI) ratios between adjacent brain compartments were calculated and compared by using the paired t test. Reader agreement was assessed by using weighted κ values. Results A total of 259 MRI examinations (mean gestational age [GA], 26.9 weeks ± 5.6) were included in the qualitative analysis, and 72 MRI examinations (mean GA, 27.4 weeks ± 5.5) were included in the quantitative analysis. Subplate identification on EPI-FLAIR images was superior to that on T2-weighted SSFSE images (subplate visualization [complete + partial]: frontal lobe, n = 243 vs n = 117; temporal lobe, n = 244 vs n = 137; parietal lobe n = 240 vs n = 93; and occipital lobe, n = 241 vs n = 97, respectively; P < .001), with higher interrater reliability (κ = 0.91-0.95 for EPI-FLAIR images and 0.80-0.87 for T2-weighted SSFSE images). SI ratios between the IZ and subplate were significantly higher on EPI-FLAIR images in all lobes (EPI-FLAIR images: 1.6-2.1; T2-weighted SSFSE images:1.2-1.2; P < .001). Subplate-to-CP ratios were not statistically significant between the two sequences (EPI-FLAIR:1.8-2.4; T2-weighted SSFSE: 2.0-2.2; P < .001). Conclusion The echo-planar fluid-attenuated inversion recovery sequence improves visualization of fetal brain lamination compared with the T2-weighted single-shot fast spin-echo sequence, as established by quantitative and qualitative methods. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Rossi in this issue.

Comparing Coordinated Networks Across the Brainstem and Spinal Cord in the Resting State and Altered Cognitive State.

Resting-state (RS) functional magnetic resonance imaging (fMRI) has been used to investigate networks of activity within the brain, as well as the brainstem (BS) and spinal cord (SC). While previous research has shown coordinated resting state networks (RSNs) in the BS/SC, their function is still unclear. The aim of this study was to investigate the function of RSNs across these regions, by examining how these networks change when participants are experiencing different cognitive states (RS, listening to an audio presentation, or watching a video). RS blood oxygenation-level dependent fMRI data were obtained from the human cervical SC and BS in 20 healthy participants (14 women, 6 men), at 3 tesla, with T2-weighted single-shot fast spin-echo imaging. Functional connectivity was investigated within the entire three-dimensional region by means of temporal correlations between anatomical regions and by structural equation modeling (SEM). Both correlational analyses and SEM showed extensive connectivity within and across BS and SC regions, and 37% to 40% of significant connections were consistent across study conditions. However, significant differences in connectivity between specific regions of the BS and SC were also identified which depended on the study conditions. The results indicate that connectivity across the RS SC/BS is influenced by a person's cognitive/emotional state. The known anatomical functions of the regions involved support the conclusion that this RS network may play a role in the integration of homeostatic autonomic functions.

Coordinated Networks in the Human Brainstem and Spinal Cord during the Expectation of Pain

POSTER ABSTRACTIntroduction/Aim: Spontaneous variations in activity of brainstem (BS) and spinal cord (SC) regions may arise from a number of functions such as autonomic regulation, sensory, and motor functions. Recent evidence suggests that changes in a person’s cognitive/emotional state are linked to changes in identified BS and SC resting-state networks, indicating that these networks likely play a role in the integration of homeostatic autonomic functions. The aim of this study was to investigate how these networks change when participants are specifically expecting pain.Methods: Previously, data were obtained from the cervical SC and brainstem in 17 healthy participants during a stimulation paradigm that involved a predictable noxious heat stimulus. Blood oxygenation-level dependent (BOLD) fMRI data were obtained at 3 Tesla, with T2-weighted single-shot fast spin-echo imaging. For the current study we investigated functional connectivity in the entire 3D region with structural equation modelling (SEM) during the first two minutes of each run (baseline period, and after participants were told whether to expect a painful stimulus).Results: SEM results showed extensive connectivity within and across BS and SC regions both when participants were expecting pain, and when they were expecting no pain. Furthermore, significant differences in connectivity between regions of the BS and SC were also identified across study conditions.Discussion/Conclusions: The results indicate that connectivity across BS/SC networks is influenced by the expectation of pain in specific ways. The known functions of the regions involved support the conclusion that these networks likely serve to integrate autonomic regulation functions with pain processing.

Investigation of Resting-State BOLD Networks in the Human Brainstem and Spinal Cord

Resting-state functional magnetic resonance imaging (rs-fMRI) has been used to investigate networks within the cortex and has also provided some insight into the networks present in the brainstem (BS) and spinal cord (SC). The purpose of this study was to investigate resting-state blood oxygenation-level dependent (BOLD) fluctuations in the BS/SC and to identify resting-state networks (RSNs) across these regions. Resting-state BOLD fMRI data were obtained from the entire BS and cervical SC in 16 healthy participants, at 3 T, with T2-weighted single-shot fast spin-echo imaging. Data were spatially normalized and processed to remove physiological noise. Cluster-cluster functional connectivity was investigated across the entire 3D region by means of temporal correlations, and structural equation modeling (SEM) was used to investigate RSNs. Extensive connectivity was observed within and across BS and SC regions, with connections spanning up to 120 mm, although shorter connections were more prevalent. SEM results revealed extensive brainstem-cord connectivity that included specific anatomical regions within the brainstem. The results indicate the presence of a complex resting-state network which is highly interconnected in the spinal cord. Known anatomical connections between cortical and BS regions support the conclusion that the observed resting-state BOLD fluctuations in the BS/SC may be related to autonomic regulation. Future studies are required to further investigate these resting-state BOLD networks.

Clinical impact and cost-effectiveness of noncontrast MRI in the evaluation of suspected appendiceal abscesses in children.

Noncontrast MRI has been shown to be feasible in children with postappendectomy abscesses and helps guide clinical management, but its role in preoperative appendiceal abscesses is unclear. To determine the cost-effectiveness and impact on clinical management of noncontrast MRI in pediatric patients with suspected appendiceal abscess, both pre- and postappendectomy. Retrospective cohort study. In all, 82 children under the age of 18 years with suspected appendiceal abscess on ultrasound. Diffusion-weighted imaging and T2 -weighted single-shot fast spin-echo imaging of the abdomen and pelvis at 1.5T and 3T. The presence, location, size, and apparent diffusion coefficient (ADC) of fluid collections and the presence of a drainage path was noted by three pediatric radiologists. Imaging time, completeness of the exam, and impact on clinical management was recorded. The incremental cost-effectiveness ratio was calculated for MRI relative to CT, taking into account hospital charges, radiation exposure, and risk of adverse reaction to iodinated contrast. Descriptive statistics were used. Intraclass correlation coefficient and Fleiss' kappa were used to assess interobserver variation. Proportions were compared using Fisher's exact test (statistical significance at P < 0.05). MRI confirmed the presence of collections in most cases, with alternative diagnosis established in 10 patients (Tubo-ovarian abscess n = 7, Crohn's disease, ileal anastomotic leak, and Birkitts lymphoma each n = 1). MRI showed the presence of a safe drainage pathway in 92-97% of pelvic abscesses and 86-98% of abdominal abscesses compared with 7-10% and 75-81%, respectively, for ultrasound. MR was cost-effective compared with CT, taking into account the direct charges, risk of radiation induced cancer, and adverse reaction to iodinated contrast. Noncontrast MR is cost-effective and affects clinical management in a significant proportion of children with suspected appendiceal abscesses. 5 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2019.

Ten Key Insights into the Use of Spinal Cord fMRI.

A comprehensive review of the literature-to-date on functional magnetic resonance imaging (fMRI) of the spinal cord is presented. Spinal fMRI has been shown, over more than two decades of work, to be a reliable tool for detecting neural activity. We discuss 10 key points regarding the history, development, methods, and applications of spinal fMRI. Animal models have served a key purpose for the development of spinal fMRI protocols and for experimental spinal cord injury studies. Applications of spinal fMRI span from animal models across healthy and patient populations in humans using both task-based and resting-state paradigms. The literature also demonstrates clear trends in study design and acquisition methods, as the majority of studies follow a task-based, block design paradigm, and utilize variations of single-shot fast spin-echo imaging methods. We, therefore, discuss the similarities and differences of these to resting-state fMRI and gradient-echo EPI protocols. Although it is newly emerging, complex connectivity and network analysis is not only possible, but has also been shown to be reliable and reproducible in the spinal cord for both task-based and resting-state studies. Despite the technical challenges associated with spinal fMRI, this review identifies reliable solutions that have been developed to overcome these challenges.

Variable-Density Single-Shot Fast Spin-Echo MRI with Deep Learning Reconstruction by Using Variational Networks.

Purpose To develop a deep learning reconstruction approach to improve the reconstruction speed and quality of highly undersampled variable-density single-shot fast spin-echo imaging by using a variational network (VN), and to clinically evaluate the feasibility of this approach. Materials and Methods Imaging was performed with a 3.0-T imager with a coronal variable-density single-shot fast spin-echo sequence at 3.25 times acceleration in 157 patients referred for abdominal imaging (mean age, 11 years; range, 1-34 years; 72 males [mean age, 10 years; range, 1-26 years] and 85 females [mean age, 12 years; range, 1-34 years]) between March 2016 and April 2017. A VN was trained based on the parallel imaging and compressed sensing (PICS) reconstruction of 130 patients. The remaining 27 patients were used for evaluation. Image quality was evaluated in an independent blinded fashion by three radiologists in terms of overall image quality, perceived signal-to-noise ratio, image contrast, sharpness, and residual artifacts with scores ranging from 1 (nondiagnostic) to 5 (excellent). Wilcoxon tests were performed to test the hypothesis that there was no significant difference between VN and PICS. Results VN achieved improved perceived signal-to-noise ratio (P = .01) and improved sharpness (P < .001), with no difference in image contrast (P = .24) and residual artifacts (P = .07). In terms of overall image quality, VN performed better than did PICS (P = .02). Average reconstruction time ± standard deviation was 5.60 seconds ± 1.30 per section for PICS and 0.19 second ± 0.04 per section for VN. Conclusion Compared with the conventional parallel imaging and compressed sensing reconstruction (PICS), the variational network (VN) approach accelerates the reconstruction of variable-density single-shot fast spin-echo sequences and achieves improved overall image quality with higher perceived signal-to-noise ratio and sharpness. © RSNA, 2018 Online supplemental material is available for this article.

Diagnostic per-lesion performance of a simulated gadoxetate disodium-enhanced abbreviated MRI protocol for hepatocellular carcinoma screening

To evaluate the diagnostic per-lesion performance of a simulated gadoxetate disodium-enhanced abbreviated MRI (AMRI) in cirrhotic and chronic hepatitis B (CHB) patients for hepatocellular carcinoma (HCC) screening. Seventy-nine consecutive patients at risk for HCC due to cirrhosis and/or CHB were included in this retrospective study. For each patient, the first gadoxetate disodium-enhanced MRI between 2008 through 2014 was analysed. Two independent readers read an anonymised abbreviated image set comprising axial T1-weighted (W) images with fat saturation in the hepatobiliary phase, 20 minutes or more after gadoxetate injection, and axial T2W single-shot fast spin echo images. Each observation >10mm was scored as negative or suspicious for HCC. Inter-reader agreement was assessed. A composite reference standard was used to determine the per-lesion diagnostic performance for each reader. Inter-reader agreement was substantial (κ=0.75). The final reference standard showed 27 HCCs in 13 patients (median 21mm, range 11-100mm). The two readers each correctly scored 23 as suspicious for HCC (sensitivity=85.2%), scored a total of 27 and 32 observations as suspicious for HCC (positive predictive value [PPV]=85.2% and 71.9%), and scored 83 and 78 observations or complete examinations as negative for HCC (negative predictive value [NPV]=95.2% and 94.9%). The AMRI protocol provides higher per-lesion sensitivity and NPV than reported values for ultrasound, the current recommended technique for screening, and similar per-lesion sensitivity and PPV to reported values for complete dynamic contrast-enhanced MRI.