Steady-state Precession Sequence Research Articles

Evaluating T1-weighted MRI techniques for fetal gastrointestinal diagnostics: A comparative study

PurposeIn clinical practice, fetal gastrointestinal magnetic resonance imaging (MRI) encounters significant challenges. T1-weighted images are particularly susceptible to the effects of fetal and maternal movements compared to other weighted images, complicating the acquisition of satisfactory results. This study aimed to compare three fast 3D-T1 weighted gradient echo (GRE) sequences—free-breathing stack-of-stars VIBE (STAR-VIBE), breath-hold VIBE (BH-VIBE), and free-breathing multi-average VIBE (MA-VIBE)—for fetal gastrointestinal MRI in fetuses with both normal and abnormal gastrointestinal tracts between 21 and 36 weeks of gestation. MethodsThis study enrolled 67 pregnant women who underwent fetal abdominal MRI at our hospital between October 2022 and October 2023, during their gestational period of 21–36 weeks. Among these participants, 22 were suspected of having fetal gastrointestinal anomalies based on ultrasound findings, while the remaining 45 were considered to have normal fetal gastrointestinal development. All subjects underwent True fast imaging with steady-state precession sequence scanning along with three T1-weighted imaging techniques on a Siemens 1.5-T Aera scanner: STAR-VIBE, BH-VIBE, and MA-VIBE. Two radiologists evaluated image quality, intestinal clarity, and lesion conspicuity using a five-point scale where higher scores indicated superior performance for each technique; they were blinded to the acquisition schemes used. Interobserver variability assessments were also conducted. ResultsThe free-breathing MA-VIBE sequence demonstrated significantly better performance than both STAR-VIBE and BH-VIBE in terms of fetal gastrointestinal MRI quality (3.81 ± 0.40 vs. 3.35 ± 0.70 vs. 2.90 ± 0.64; p < .05). The STAR-VIBE and BH-VIBE sequences exhibited moderate consistency (kappa = 0.586 and kappa = 0.527 respectively; P < .05), whereas the MA-VIBE sequence showed higher consistency (kappa = 0.712; P < .05). ConclusionThe free-breathing MA-VIBE sequence provided superior visualization for assessing fetal intestinal conditions compared to other methods employed in this study. On a 1.5 T MRI device, T1-weighted images based on the free-breathing MA-VIBE sequence can effectively overcome motion artifacts and compensate for the reduced signal-to-noise ratio caused by the application of acceleration techniques, thus significantly improving the quality of T1-weighted images.

Synthetic computed tomography for low-field magnetic resonance-only radiotherapy in head-and-neck cancer using residual vision transformers.

Synthetic computed tomography (sCT) scans are necessary for dose calculation in magnetic resonance (MR)-only radiotherapy. While deep learning (DL) has shown remarkable performance in generating sCT scans from MR images, research has predominantly focused on high-field MR images. This study presents the first implementation of a DL model for sCT generation in head-and-neck (HN) cancer using low-field MR images. Specifically, the use of vision transformers (ViTs) was explored. The dataset consisted of 31 patients, resulting in 196 pairs of deformably-registered computed tomography (dCT) and MR scans. The latter were obtained using a balanced steady-state precession sequence on a 0.35T scanner. Residual ViTs were trained on 2D axial, sagittal, and coronal slices, respectively, and the final sCTs were generated by averaging the models' outputs. Different image similarity metrics, dose volume histogram (DVH) deviations, and gamma analyses were computed on the test set (n=6). The overlap between auto-contours on sCT scans and manual contours on MR images was evaluated for different organs-at-risk using the Dice score. The median [range] value of the test mean absolute error was 57 [37-74] HU. DVH deviations were below 1% for all structures. The median gamma passing rates exceeded 94% in the 2%/2mm analysis (threshold=90%). The median Dice scores were above 0.7 for all organs-at-risk. The clinical applicability of DL-based sCT generation from low-field MR images in HN cancer was proved. High sCT-dCT similarity and dose metric accuracy were achieved, and sCT suitability for organs-at-risk auto-delineation was shown.

Respiratory-Correlated 4-Dimensional Magnetic Resonance Fingerprinting for Liver Cancer Radiation Therapy Motion Management

The objective of this study was to develop a respiratory-correlated (RC) 4-dimensional (4D) imaging technique based on magnetic resonance fingerprinting (MRF) (RC-4DMRF) for liver tumor motion management in radiation therapy. Thirteen patients with liver cancer were prospectively enrolled in this study. k-space MRF signals of the liver were acquired during free-breathing using the fast acquisition with steady-state precession sequence on a 3T scanner. The signals were binned into 8 respiratory phases based on respiratory surrogates, and interphase displacement vector fields were estimated using a phase-specific low-rank optimization method. Hereafter, the tissue property maps, including T1 and T2 relaxation times, and proton density, were reconstructed using a pyramid motion-compensated method that alternatively optimized interphase displacement vector fields and subspace images. To evaluate the efficacy of RC-4DMRF, amplitude motion differences and Pearson correlation coefficients were determined to assess measurement agreement in tumor motion between RC-4DMRF and cine magnetic resonance imaging (MRI); mean absolute percentage errors of the RC-4DMRF-derived tissue maps were calculated to reveal tissue quantification accuracy using digital human phantom; and tumor-to-liver contrast-to-noise ratio of RC-4DMRF images was compared with that of planning CT and contrast-enhanced MRI (CE-MRI) images. A paired Student t test was used for statistical significance analysis with a P value threshold of .05. RC-4DMRF achieved excellent agreement in motion measurement with cine MRI, yielding the mean (± standard deviation) Pearson correlation coefficients of 0.95 ± 0.05 and 0.93 ± 0.09 and amplitude motion differences of 1.48 ± 1.06 mm and 0.81 ± 0.64 mm in the superior-inferior and anterior-posterior directions, respectively. Moreover, RC-4DMRF achieved high accuracy in tissue property quantification, with mean absolute percentage errors of 8.8%, 9.6%, and 5.0% for T1, T2, and proton density, respectively. Notably, the tumor contrast-to-noise ratio in RC-4DMRI-derived T1 maps (6.41 ± 3.37) was found to be the highest among all tissue property maps, approximately equal to that of CE-MRI (6.96 ± 1.01, P=.862), and substantially higher than that of planning CT (2.91 ± 1.97, P=.048). RC-4DMRF demonstrated high accuracy in respiratory motion measurement and tissue properties quantification, potentially facilitating tumor motion management in liver radiation therapy.

Utility of balanced steady-state field precession sequence in the evaluation of retinal and subdural hemorrhages in patients with abusive head trauma.

Abusive head trauma is the leading cause of physical child abuse deaths in children under 5years of age in the United States. To evaluate suspected child abuse, radiologic studies are typically the first to identify hallmark findings of abusive head trauma including intracranial hemorrhage, cerebral edema, and ischemic injury. Prompt evaluation and diagnosis are necessary as findings may change rapidly. Current imaging recommendations include brain magnetic resonance imaging with the addition of a susceptibility weighted imaging (SWI) sequence which can detect additional findings that suggest abusive head trauma including cortical venous injury and retinal hemorrhages. However, SWI is limited due to blooming artifacts and artifacts from the adjacent skull vault or retroorbital fat, which can affect the evaluation of retinal, subdural, and subarachnoid hemorrhages. This work explores the utility of the high-resolution, heavily T2 weighted balanced steady-state field precession (bSSFP) sequence to identify and characterize retinal hemorrhage and cerebral cortical venous injury in children with abusive head trauma. The bSSFP sequence provides distinct anatomical images to improve the identification of retinal hemorrhage and cortical venous injury.

Left ventricular strain in patients with Takayasu arteritis with preserved ejection fraction: an analysis using cardiac magnetic resonance imaging feature tracking

The alteration of myocardial strain in patients with Takayasu arteritis (TAK) remains unclear. This study aimed to evaluate left ventricular (LV) stain in patients with TAK and preserved left ventricular ejection fraction (pLVEF) using cardiac magnetic resonance imaging feature tracking (CMR-FT) to analyze risk factors for impaired LV strain and to compare the baseline difference of LV strain between patients with reduced and nonreduced LVEF at 6-month follow-up. In all, 51 patients with TAK and 30 healthy controls were prospectively enrolled. All participants underwent multiple short- and long-axis cine scans with true fast imaging with steady-state precession sequence. In this observational study, LV global and regional longitudinal, circumferential, and radial strain and their strain rates were analyzed with FT on cine images. The relationship between LV strain and clinical data was explored. The baseline LV strain between patients with TAK and reduced and nonreduced LVEF was compared using transthoracic echocardiography (TTE) at the 6-month follow-up. Patients with TAK with pLVEF showed a decline in baseline global longitudinal peak strain (GLS) [TAK (-13.35%±3.11%) vs. controls (-14.77%±1.74%), P=0.021] and circumferential peak strain (GCS) [TAK (-21.46%±2.66%) vs. controls (-22.75%±2.57%), P=0.027] in comparison with normal controls. The longitudinal peak strain (LPS) in the apical (P=0.003) and midventricular regions (P=0.027) and the circumferential peak strain (CPS) in the basal (P=0.021) and midventricular regions (P=0.008) also decreased in patients with TAK. Patients with pulmonary hypertension (PH) or myocardial late gadolinium enhancement (LGE) showed a greater reduction in strain compared with those without PH or LGE. GLS showed a negative association with erythrocyte sedimentation rate (ESR), while GCS showed a positive association with disease duration. In the 30 patients who were followed up, the baseline global and apical circumferential diastolic peak strain rates (DPSR) in patients with reduced LVEF were higher than those in patients without reduced LVEF. In patients with TAK and pLVEF, CMR-FT indicated that both global and segmental myocardial strain decreased. PH, male gender, long disease duration, elevated ESR, and myocardial LGE were associated with declined LV strain. Baseline increased circumferential DPSR may be associated with the decline in LVEF during follow-up.

Synthetic CT generation for MRI-guided adaptive radiotherapy in prostate cancer.

Current MRI-guided adaptive radiotherapy (MRgART) workflows require fraction-specific electron and/or mass density maps, which are created by deformable image registration (DIR) between the simulation CT images and daily MR images. Manual density overrides may also be needed where DIR-produced results are inaccurate. This approach slows the adaptive radiotherapy workflow and introduces additional dosimetric uncertainties, especially in the presence of the magnetic field. This study investigated a method based on a conditional generative adversarial network (cGAN) with a multi-planar method to generate synthetic CT images from low-field MR images to improve efficiency in MRgART workflows for prostate cancer. Fifty-seven male patients, who received MRI-guided radiation therapy to the pelvis using the ViewRay MRIdian Linac, were selected. Forty-five cases were randomly assigned to the training cohort with the remaining twelve cases assigned to the validation/testing cohort. All patient datasets had a semi-paired DIR-deformed CT-sim image and 0.35T MR image acquired using a true fast imaging with steady-state precession (TrueFISP) sequence. Synthetic CT images were compared with deformed CT images to evaluate image quality and dosimetric accuracy. To evaluate the dosimetric accuracy of this method, clinical plans were recalculated on synthetic CT images in the MRIdian treatment planning system. Dose volume histograms for planning target volumes (PTVs) and organs-at-risk (OARs) and dose distributions using gamma analyses were evaluated. The mean-absolute-errors (MAEs) in CT numbers were 30.1 ± 4.2 HU, 19.6 ± 2.3 HU and 158.5 ± 26.0 HU for the whole pelvis, soft tissue, and bone, respectively. The peak signal-to-noise ratio was 35.2 ± 1.7 and the structural index similarity measure was 0.9758 ± 0.0035. The dosimetric difference was on average less than 1% for all PTV and OAR metrics. Plans showed good agreement with gamma pass rates of 99% and 99.9% for 1%/1 mm and 2%/2 mm, respectively. Our study demonstrates the potential of using synthetic CT images created with a multi-planar cGAN method from 0.35T MRI TrueFISP images for the MRgART treatment of prostate radiotherapy. Future work will validate the method in a large cohort of patients and investigate the limitations of the method in the adaptive workflow.

Radiomics analysis of T2 -weighted images for differentiating invasive placentas in women at high risks.

To develop and validate an MRI-based radiomics model for differentiating invasive placentas in patients with high risks. A total of 181 pregnant women suspected of placenta accreta spectrum (PAS) disorders and who underwent MRI for placenta evaluation were retrospectively enrolled. The data set was randomly divided into the training (n=125; invasive=63, noninvasive=62) and test (n=56; invasive=28, noninvasive=28) groups. Radiomics features were extracted from half-Fourier acquisition single-shot turbo spin echo (HASTE) and sagittal true fast imaging in steady-state precession (TRUFISP) sequences independently and mainly selected based on their correlations with invasive placentas to construct two radiomics signatures including HASTE-Radscore and TRUFISP-Radscore. Then, the predictive performance of radiomic signatures, clinical features, radiographic features, and their combination were evaluated. The model with the best predictive performance was validated with its discrimination ability, calibration, and clinical usefulness. Five radiomics features from HASTE and three radiomics features from TRUFISP were retained, respectively, for predicting invasive placentas. The combination of radiomics signatures and clinical features including prior cesarean delivery, placenta previa, and radiographic feature, the placental thickness resulted in the best discrimination ability, with area under the curve of 0.898 (95% confidence interval [CI] 0.844-0.9522) and 0.858 (95% confidence interval 0.7514-0.9655) in the training and test cohort, respectively. The combined model showed a significantly better area under the curve performance and clinical usefulness than independent clinical or radiographic model according to DeLong test (p < .05), net reclassification improvement and integrated discrimination improvement analysis (positive improvement) and decision curve analysis (higher net benefit). The T2 -weighted imaging MRI radiomics model could serve as a potential prenatal diagnosis tool for identifying invasive placentas in patients with high risks.

Application of Magnetization-prepared True Fast Imaging with Steady-state Precession Sequence in Brain Tumor Enhancement

Objective To evaluate the application of two-dimensional magnetization-prepared true fast imaging with steady-state precession(2D-MP-TrueFISP)sequence in brain tumor enhancement.Methods In this study,60 cases of brain tumor patients who underwent enhanced magnetic resonance imaging of brain were scanned with 2D-MP-TrueFISP/two-dimensional spoiled gradient-recalled echo(2D-SPGR)before and after enhancement.The scores of lesions on the images of 2D-MP-TrueFISP/2D-SPGR were compared.At the same level of 2D-SPGE and 2D-MP-TrueFISP,the signal intensities(SIs)of lesions,white matter,and cerebrospinal fluid were measured before and after enhancement,and the contrast ratios(CRs)of lesions were calculated.The CRs before and after 2D-SPGR/2D-MP-TrueFISP enhancement and those between 2D-SPGR and 2D-MP-TrueFISP after enhancement were compared.Results The scores of lesions after 2D-MP-TrueFISP/2D-SPGR T1WI enhancement were 9.0(9.0,9.0)and 7.0(6.0,7.0),respectively,with significant difference(Z=-6.86,P=0.00).CRs showed significant difference before and after enhancement with 2D-SPGR and 2D-MP-TrueFISP(all P<0.01).The CRs of lesion compared with white matter and cerebrospinal fluid(1.58±0.46 and 8.50±2.47,respectively)after 2D-MP-TrueFISP enhancement were significantly higher than those[0.57±0.29(t=-17.38,P=0.00)and 2.64±0.85(t=-19.71,P=0.00),respectively]after 2D-SPGR enhancement.Conclusion Compared with 2D-SPGR,2D-MP-TrueFISP demonstrated improved enhancement and uniformity as well as clear boundary and display of edema around the lesion.

Detection of Changes in Renal Blood Flow Using Arterial Spin Labeling MRI

Background: Alteration in kidney perfusion is an early marker of renal damage. The purpose of this study was to evaluate if changes in renal blood flow (RBF) could be detected using MRI with arterial spin labeling (ASL) technique. Methods: RBF as assessed by cortical (CRBF), medullary, and total renal blood flow (TRBF) were measured by MRI with arterial spin labeling (ASL-MRI) using flow-sensitive alternating inversion recovery true fast imaging with steady-state precession sequence. In 11 normotensive healthy individuals (NT) and 11 hypertensive patients (HT), RBF was measured at baseline and after both feet were covered with cold ice packs (cold pressor test) that activates the sympathetic nervous system. In another experiment, RBF was measured in 10 patients with CKD before and after a pharmacological intervention. We compared RBF measurements between the 3 study populations. Results: A significant reduction in CRBF (p = 0.042) and a trend in TRBF (p = 0.053) were observed in response to the activation of the sympathetic nervous system. A trend toward reduction of CRBF (p = 0.051) and TRBF (p = 0.059) has been detected after pharmacological intervention. TRBF was significantly lower in patients with HT and CKD patients compared to NT individuals (NT vs. HT, p = 0.014; NT vs. CKD, p = 0.004). TRBF was lower in patients with CKD compared to HT (p = 0.047). Conclusion: Our data indicate that both acute and short-term changes in RBF could be detected using ASL-MRI. We were able to detect differences in RBF between healthy and diseased individuals by needing only small sample size per group. Thus, ASL-MRI offers an advantage in conducting clinical trials compared to other technologies.

HYDRA: Hybrid deep magnetic resonance fingerprinting.

Magnetic resonance fingerprinting (MRF) methods typically rely on dictionary matching to map the temporal MRF signals to quantitative tissue parameters. Such approaches suffer from inherent discretization errors, as well as high computational complexity as the dictionary size grows. To alleviate these issues, we propose a HYbrid Deep magnetic ResonAnce fingerprinting (HYDRA) approach, referred to as HYDRA. HYDRA involves two stages: a model-based signature restoration phase and a learning-based parameter restoration phase. Signal restoration is implemented using low-rank based de-aliasing techniques while parameter restoration is performed using a deep nonlocal residual convolutional neural network. The designed network is trained on synthesized MRF data simulated with the Bloch equations and fast imaging with steady-state precession (FISP) sequences. In test mode, it takes a temporal MRF signal as input and produces the corresponding tissue parameters. We validated our approach on both synthetic data and anatomical data generated from a healthy subject. The results demonstrate that, in contrast to conventional dictionary matching-based MRF techniques, our approach significantly improves inference speed by eliminating the time-consuming dictionary matching operation, and alleviates discretization errors by outputting continuous-valued parameters. We further avoid the need to store a large dictionary, thus reducing memory requirements. Our approach demonstrates advantages in terms of inference speed, accuracy, and storage requirements over competing MRF methods.

True FISP Cardiac Gated CSF Flow Dynamic Imaging of Chiari Malformation

Abstract INTRODUCTION Brain pulsation and related CSF dynamics is a well-known intraoperative characteristic, but methods for its visualization on magnetic resonance imaging (MRI) have until now been very limited. Best characterized techniques including phase-contrast MRI and cine echo-planar imaging, although of significant value, lack a detailed spatial and temporal resolution needed to investigate CSF and structural dynamics in an adequate manner to address preoperative decision making. Electrocardiographic (ECG)-gated true fast imaging with steady-state precession (FISP) sequences has been widely used to investigate cardiac motion and is capable of demonstrating brain pulsations and movements of intracranial structures surrounded by CSF with high temporal and spatial precision. We feature here the application of true FISP cardiac-gated imaging to the management of 2 patients with Chiari Malformation Type 1 and associated syringohydromyelia. METHODS Two children with Chiari Malformation Type 1 and concurrent syringohydromyelia underwent true FISP cardiac-gated imaging at our institution. RESULTS While conventional imaging studies such as T1 and phase-contrast cine MRI appeared to demonstrate obstruction of CSF flow secondary to tonsillar herniation, true FISP showed patent peritonsillar CSF flow and the presence of a pulsatile arachnoid veil. Subsequently, open surgery confirmed the presence of an arachnoid veil, and postoperative true FISP imaging revealed restoration of CSF flow following arachnoid veil fenestration. CONCLUSION We demonstrated 2 patients who presented with Chiari 1 malformation, where true FISP cardiac imaging was very instructive in visualizing dynamic images of an arachnoid veil and its possible role in the development of syringomyelia without a significant obstruction of outflow by cerebellar tonsils at the foramen of Magendie. We advocate use of this technology will aid in pre and post-surgical decision making, providing a more representative image of posterior fossa pathology in patients with Chiari 1 malformation.

A systematic optimization of 19F MR image acquisition to detect macrophage invasion into an ECM hydrogel implanted in the stroke-damaged brain

19F-MR imaging of perfluorocarbon (PFC)-labeled macrophages can provide a unique insight into their participation and spatio-temporal dynamics of inflammatory events, such as the biodegradation of an extracellular matrix (ECM) hydrogel implanted into a stroke cavity. To determine the most efficient acquisition strategy for 19F-MR imaging, five commonly used sequences were optimized using a design of experiment (DoE) approach and compared based on their signal-to-noise ratio (SNR). The fast imaging with steady-state precession (FISP) sequence produced the most efficient detection of a 19F signal followed by the rapid acquisition with relaxation enhancement (RARE) sequence. The multi-slice multi-echo (MSME), fast low angle shot (FLASH), and zero echo time (ZTE) sequences were significantly less efficient. Imaging parameters (matrix/voxel size; slice thickness, number of averages) determined the accuracy (i.e. trueness and precision) of object identification by reducing partial volume effects, as determined by analysis of the point spread function (PSF). A 96 × 96 matrix size (0.35 mm3) produced the lowest limit of detection (LOD) for RARE (2.85 mM PFPE; 119 mM 19F) and FISP (0.43 mM PFPE; 18.1 mM 19F), with an SNR of 2 as the detection threshold. Imaging of a brain phantom with PFC-labeled macrophages invading an ECM hydrogel further illustrated the impact of these parameter changes. The systematic optimization of sequence and imaging parameters provides the framework for an accurate visualization of 19F-labeled macrophage distribution and density in the brain. This will enhance our understanding of the contribution of periphery-derived macrophages in bioscaffold degradation and its role in brain tissue regeneration.

Value of Visualization of the Intraparotid Facial Nerve and Parotid Duct Using a Micro Surface Coil and Three-Dimensional Reversed Fast Imaging With Steady-State Precession and Diffusion-Weighted Imaging Sequence.

To explore the value of micro surface coil combined with three-dimensional reversed fast imaging with steady-state precession and diffusion-weighted imaging (3D-PSIF-DWI) in displaying intraparotid facial nerves and parotid ducts. In total 24 healthy volunteers with no parotid disease underwent scanning of head and neck coil and 4-cm micro surface coil combined with 3D-PSIF-DWI prospectively. The obtained original images were processed through maximum intensity projection, multiplanar reconstruction, and curved planar reconstruction. The magnetic resonance imaging (MRI) signal characteristics of intraparotid structure, the subjective score of image quality, the signal intensity ratio (SIR) of facial nerve/parotid tissues (SIRN), and SIR of parotid duct/parotid tissues (SIRD) were calculated, and the displaying rates of the facial nerves and parotid ducts were observed. The Wilcoxon matched-sample signed rank sum test was used to compare the scores of head and neck coil and micro surface coil 3D-PSIF-DWI sequence images; paired-t test was used to compare SIRN and SIRD of the 2 groups; χ test was used to compare the displaying rate of the facial nerves and parotid ducts in the 2 groups. In total 24 volunteers successfully underwent MRI scan of parotid glands. On 3D-PSIF-DWI images, the parotid gland showed slightly low signal intensity, muscle tissues showed intermediate intensity, while the vessels showed slightly high or equal intensity; the parotid segment of facial nerves was displayed as a tortuous line-like high intensity, and the parotid duct showed curved high intensity, lymph nodes showed kidney-shaped, oval, or spindle-shaped high intensity. The subjective scores for head and neck coil and small coil images were (2.2 ± 0.7) and (1.5 ± 0.3) respectively, with significant difference (Z = -2.714, P = 0.007), and image quality of micro surface coils was better than that of head and neck coil. The SIRNs of head and neck coil and micro surface coil images were 1.6 ± 0.5 and 2.2 ± 1.1 respectively; the SIRDs were 2.0 ± 0.6 and 2.8 ± 1.4 respectively, which showed significant differences (t = 3.440, 3.639 respectively, P value was 0.001, 0.001 respectively). All facial nerve trunks could be displayed by head and neck coils and micro surface coils. On head and neck coil images, 46 sides of temporofacial division, 47 sides of cervicofacial division, 21 sides of temporal branches, 22 sides of zygomatic branches, 29 sides of buccal branches, 30 sides of marginal mandibular branches, 32 sides of cervical branches, and 28 sides of the parotid duct could be displayed. On micro coil images, 48 sides of temporofacial division, 48 sides of cervicofacial division, 37 sides of temporal branches, 39 sides of zygomatic branches, 42 sides of buccal branches, 35 sides of marginal mandibular branches, 46 sides of cervical branches, and 28 sides of the parotid duct could be displayed. The display number of first branches of the intraparotid facial nerve by these 2 methods had no significant difference, the number of the secondary branches and parotid duct had significant differences. Micro surface coil surpassed parotid MRI with 3D-PSIF-DWI sequence than neck coil, which can simultaneously clearly display the trunk and branches of the intraparotid facial nerves and parotid ducts.

Novel use of ViewRay MRI guidance for high-dose-rate brachytherapy in the treatment of cervical cancer

PurposeTo characterize image quality and feasibility of using ViewRay MRI (VR)–guided brachytherapy planning for cervical cancer. Methods and MaterialsCervical cancer patients receiving intracavitary brachytherapy with tandem and ovoids, planned using 0.35T VR MRI at our institution, were included in this series. The high-risk clinical target volume (HR-CTV), visible gross tumor volume, bladder, sigmoid, bowel, and rectum contours for each fraction of brachytherapy were evaluated for dosimetric parameters. Typically, five brachytherapy treatments were planned using the T2 sequence on diagnostic MRI for the first and third fractions, and a noncontrast true fast imaging with steady-state precession sequence on VR or CT scan for the remaining fractions. Most patients received 5.5 Gy × 5 fractions using high-dose-rate Ir-192 following 45 Gy of whole-pelvis radiotherapy. The plan was initiated at 5.5 Gy to point A and subsequently optimized and prescribed to the HR-CTV. The goal equivalent dose in 2 Gy fractions for the combined external beam and brachytherapy dose was 85 Gy. Soft-tissue visualization using contrast-to-noise ratios to distinguish normal tissues from tumor at their interface was compared between diagnostic MRI, CT, and VR. ResultsOne hundred and forty-two fractions of intracavitary brachytherapy were performed from April 2015 to January 2017 on 29 cervical cancer patients, ranging from stages IB1 to IVA. The median HR-CTV was 27.78 cc, with median D90 HR-CTV of 6.1 Gy. The median time from instrument placement to start of treatment using VR was 65 min (scan time 2 min), compared to 105 min using diagnostic MRI (scan time 11 min) (t-test, p < 0.01). The contrast-to-noise ratio of tumor to cervix in both diagnostic MRI and VR had significantly higher values compared to CT (ANOVA and t-tests, p < 0.01). ConclusionsWe report the first clinical use of VR-guided brachytherapy. Time to treatment using this approach was shorter compared to diagnostic MRI. VR also provided significant advantage in visualizing the tumor and cervix compared to CT. This presents a feasible and reliable manner to image and plan gynecologic brachytherapy.

Diffusion-weighting Caused by Spoiler Gradients in the Fast Imaging with Steady-state Precession Sequence May Lead to Inaccurate T2 Measurements in MR Fingerprinting.

Magnetic resonance fingerprinting (MRF) is a promising framework that allows the quantification of multiple magnetic resonance parameters with a single scan. MRF using fast imaging with steady-state precession (MRF-FISP) has robustness to off-resonance artifacts and has many applications in inhomogeneous fields. However, the spoiler gradient used in MRF-FISP is sensitive to diffusion motion, and may lead to quantification errors when the spoiler moment increases. In this study, we examined the effect of the diffusion weighting in MRF-FISP caused by spoiler gradients. The T2 relaxation times were greatly underestimated when large spoiler moments were used. The T2 underestimation was prominent for tissues with large values of T2 and diffusion coefficients. The T2 bias was almost independent of the apparent diffusion coefficient (ADC) and T2 values when the ADC map was measured and incorporated into the matching process. These results reveal that the T2 underestimation resulted from the diffusion weighting caused by the spoiler gradients.

3D MR fingerprinting with accelerated stack-of-spirals and hybrid sliding-window and GRAPPA reconstruction

PurposeWhole-brain high-resolution quantitative imaging is extremely encoding intensive, and its rapid and robust acquisition remains a challenge. Here we present a 3D MR fingerprinting (MRF) acquisition with a hybrid sliding-window (SW) and GRAPPA reconstruction strategy to obtain high-resolution T1, T2 and proton density (PD) maps with whole brain coverage in a clinically feasible timeframe. Methods3D MRF data were acquired using a highly under-sampled stack-of-spirals trajectory with a steady-state precession (FISP) sequence. For data reconstruction, kx-ky under-sampling was mitigated using SW combination along the temporal axis. Non-uniform fast Fourier transform (NUFFT) was then applied to create Cartesian k-space data that are fully-sampled in the in-plane direction, and Cartesian GRAPPA was performed to resolve kz under-sampling to create an alias-free SW dataset. T1, T2 and PD maps were then obtained using dictionary matching. ResultsPhantom study demonstrated that the proposed 3D-MRF acquisition/reconstruction method is able to produce quantitative maps that are consistent with conventional quantification techniques. Retrospectively under-sampled in vivo acquisition revealed that SW + GRAPPA substantially improves quantification accuracy over the current state-of-the-art accelerated 3D MRF. Prospectively under-sampled in vivo study showed that whole brain T1, T2 and PD maps with 1 mm3 resolution could be obtained in 7.5 min. Conclusions3D MRF stack-of-spirals acquisition with hybrid SW + GRAPPA reconstruction may provide a feasible approach for rapid, high-resolution quantitative whole-brain imaging.

Low rank approximation methods for MR fingerprinting with large scale dictionaries

This work proposes new low rank approximation approaches with significant memory savings for large scale MR fingerprinting (MRF) problems. We introduce a compressed MRF with randomized singular value decomposition method to significantly reduce the memory requirement for calculating a low rank approximation of large sized MRF dictionaries. We further relax this requirement by exploiting the structures of MRF dictionaries in the randomized singular value decomposition space and fitting them to low-degree polynomials to generate high resolution MRF parameter maps. In vivo 1.5T and 3T brain scan data are used to validate the approaches. T1 , T2 , and off-resonance maps are in good agreement with that of the standard MRF approach. Moreover, the memory savings is up to 1000 times for the MRF-fast imaging with steady-state precession sequence and more than 15 times for the MRF-balanced, steady-state free precession sequence. The proposed compressed MRF with randomized singular value decomposition and dictionary fitting methods are memory efficient low rank approximation methods, which can benefit the usage of MRF in clinical settings. They also have great potentials in large scale MRF problems, such as problems considering multi-component MRF parameters or high resolution in the parameter space. Magn Reson Med 79:2392-2400, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

RFID-Based Real-Time Navigation for Interventional Magnetic Resonance Imaging: Development and Evaluation of a Novel Tracking System

The purpose of this study was to evaluate the suitability of a novel radio-frequency identification (RFID)-based tracking system for intraoperative magnetic resonance imaging (MRI). A RFID tracking system was modified to fulfill MRI-compatibility and tested according to ASTM and NEMA. The influence of the RFID tracking system on MRI was analyzed in a phantom study using a half-Fourier acquisition single-shot turbospin echo (HASTE) and true fast imaging with steady-state precession sequence (TrueFISP) sequence. The RFID antenna was gradually moved closer to the isocenter of the MR scanner from 90 to 210 cm to investigate the influence of the distance. Furthermore, the RF was gradually changed between 865 and 869 MHz for a distance of 90 cm, 150 cm, and 210 cm to the isocenter of the magnet to investigate the influence of the frequency. The specific spatial resolution was measured with and without a permanent line of sight (LOS). After the modification of the reader, no significant change of the signal-to-noise ratio (SNR) could be observed with increasing distance of the RFID tracking system to the isocenter of the MR scanner. Also, different radio frequencies of the RFID tracking system did not influence the SNR of the MR-images significantly. The specific spatial resolution deviated on average by 8.97 ± 7.33 mm with LOS and 11.23 ± 12.03 mm without LOS from the reference system. The RFID tracking system had no relevant influence on the MR-image quality. RFID tracking solved the LOS problem. However, the spatial accuracy of the RFID tracking system has to be improved for medical usage.

Pulse sequence considerations for simulation and postimplant dosimetry of prostate brachytherapy

PurposeThe purpose of this work is to present a brief review of MRI physics principles pertinent to prostate brachytherapy, and a summary of our experience in optimizing protocols for prostate brachytherapy applications. Methods and MaterialsWe summarized essential MR imaging characteristics and their interplays that need to be considered for prostate brachytherapy applications. These include spatial resolution, signal-to-noise ratio, image contrast, artifacts, geometric distortion, specific absorption rate, and total scan time. We further described the optimization of the protocols for three pulse sequences: three-dimensional (3D) fast-spoiled gradient echo sequence for T1-weighted imaging, 3D fast-spin echo sequence for T2-weighted imaging, and 3D fast imaging in steady-state precession sequence for combined T1 and T2-weighed imaging. The utilization of an endorectal coil was also described. ResultsUsing the optimized protocols, we acquired high-quality images of the entire prostate within 3–5 minutes for each sequence. These images display the desired image contrasts and a spatial resolution that is equal to or better than 0.59 mm × 0.73 mm × 1.2 mm. While 3D fast-spoiled gradient echo sequence and 3D fast-spin echo sequence depict radioactive seed markers and anatomic structures separately, 3D fast imaging in steady-state precession sequence demonstrates great promise for imaging both seed markers and prostate anatomy simultaneously in a single acquisition. ConclusionsWe have optimized current MRI protocols and demonstrated that the anatomic structures and positive contrast radioactive seed markers for prostate post-implant dosimetry can be adequately imaged either separately or simultaneously using different pulse sequences within a total scan time of 3–5 minutes each.

Automatic segmentation of the glenohumeral cartilages from magnetic resonance images

Magnetic resonance (MR) imaging plays a key role in investigating early degenerative disorders and traumatic injuries of the glenohumeral cartilages. Subtle morphometric and biochemical changes of potential relevance to clinical diagnosis, treatment planning, and evaluation can be assessed from measurements derived from in vivo MR segmentation of the cartilages. However, segmentation of the glenohumeral cartilages, using approaches spanning manual to automated methods, is technically challenging, due to their thin, curved structure and overlapping intensities of surrounding tissues. Automatic segmentation of the glenohumeral cartilages from MR imaging is not at the same level compared to the weight-bearing knee and hip joint cartilages despite the potential applications with respect to clinical investigation of shoulder disorders. In this work, the authors present a fully automated segmentation method for the glenohumeral cartilages using MR images of healthy shoulders. The method involves automated segmentation of the humerus and scapula bones using 3D active shape models, the extraction of the expected bone-cartilage interface, and cartilage segmentation using a graph-based method. The cartilage segmentation uses localization, patient specific tissue estimation, and a model of the cartilage thickness variation. The accuracy of this method was experimentally validated using a leave-one-out scheme on a database of MR images acquired from 44 asymptomatic subjects with a true fast imaging with steady state precession sequence on a 3 T scanner (Siemens Trio) using a dedicated shoulder coil. The automated results were compared to manual segmentations from two experts (an experienced radiographer and an experienced musculoskeletal anatomist) using the Dice similarity coefficient (DSC) and mean absolute surface distance (MASD) metrics. Accurate and precise bone segmentations were achieved with mean DSC of 0.98 and 0.93 for the humeral head and glenoid fossa, respectively. Mean DSC scores of 0.74 and 0.72 were obtained for the humeral and glenoid cartilage volumes, respectively. The manual interobserver reliability evaluated by DSC was 0.80 ± 0.03 and 0.76 ± 0.04 for the two cartilages, implying that the automated results were within an acceptable 10% difference. The MASD between the automatic and the corresponding manual cartilage segmentations was less than 0.4 mm (previous studies reported mean cartilage thickness of 1.3 mm). This work shows the feasibility of volumetric segmentation and separation of the glenohumeral cartilages from MR images. To their knowledge, this is the first fully automated algorithm for volumetric segmentation of the individual glenohumeral cartilages from MR images. The approach was validated against manual segmentations from experienced analysts. In future work, the approach will be validated on imaging datasets acquired with various MR contrasts in patients.