Variable Refocusing Flip Angle Research Articles

Three-dimensional T2-weighted imaging for liver MRI: Clinical values of tissue-specific variable refocusing flip-angle turbo spin echo imaging

To assess the clinical utility of tissue-specific variable refocusing flip-angle (VRFA) turbo-spin echo imaging for three-dimensional T2-weighted imaging (3D-T2WI) of the liver. Fifty-nine patients were scanned with three types of fat-suppressed T2WI for the comparison: two-dimensional single-shot turbo spin echo T2WI (ssT2WI), 3D-T2WI with tissue-specific VRFA (VISTA-TSV), and 3D-T2WI with low-constant VRFA (VISTA). Qualitatively, artifacts in the left and right lobes of the liver and black-blood effects in the liver were compared using the Wilcoxon signed-rank test with the Bonferroni correction. The detection and correct characterization rates of liver lesions were compared using McNemar's test. VISTA-TSV showed reduced artifacts in the left and right lobes of the liver compared with VISTA (P < 0.017). The artifacts shown by VISTA-TSV were equivalent to those shown by ssT2WI. The black-blood effects of VISTA-TSV and VISTA were better than that of ssT2WI (P < 0.017). VISTA-TSV showed the best detection and correct characterization rate of liver lesions among the three imaging techniques (P < 0.05). 3D-T2WI with tissue-specific VRFA can reduce artifacts of the liver, sufficiently suppress the signal in blood vessels, and has a potential to improve the detection and correct characterization rates of liver lesions.

Accuracy of Postcontrast 3D Turbo Spin-Echo MR Sequence for the Detection of Enhanced Inflammatory Lesions in Patients with Multiple Sclerosis

Therapeutic strategies for patients with MS partly rely on contrast-enhanced MR imaging. Our aim was to assess the diagnostic performance of 3D turbo spin-echo MR imaging with variable refocusing flip angles at 3T for the detection of enhanced inflammatory lesions in patients with multiple sclerosis. Fifty-six patients with MS were prospectively investigated by using postcontrast T1-weighted axial 2D spin-echo and 3D TSE MR images. The order in which both sequences were performed was randomized. Axial reformats from 3D T1 TSE were generated to match the 2D spin-echo images. The reference standard was defined by using clinical data and all MR images available. Three separate sets of MR images (2D spin-echo images, axial reformats, and multiplanar images from 3D TSE sequences) were examined in a blinded fashion by 2 neuroradiologists separately for the detection of enhanced MS lesions. Image artifacts and contrast were evaluated. No artifacts related to vascular pulsation were observed on 3D TSE images, whereas image artifacts were demonstrated on 2D spin-echo images in 41 patients. One hundred twelve enhanced MS lesions were identified in 19 patients. Sixty-four lesions were correctly diagnosed by using 2D spin-echo images; 90, by using 3D TSE axial reformatted views; and 106, by using multiplanar analysis of the 3D TSE sequence. Multiplanar analysis was 94.7% sensitive and 100% specific for the diagnosis of patients with at least 1 enhanced lesion. Contrast of enhanced MS lesions was significantly improved by using the 3D TSE sequence (P < .011). The 3D TSE sequence with multiplanar analysis is a useful tool for the detection of enhanced MS lesions.

Rapid hybrid encoding for high‐resolution whole‐brain fluid‐attenuated imaging

Single-slab three-dimensional (3D) turbo spin-echo (TSE) imaging combined with inversion recovery (IR), which employs short, spatially non-selective refocusing pulses and signal prescription based variable refocusing flip angles (VFA) to increase imaging efficiency, was recently introduced to produce fluid-attenuated brain images for lesion detection. Despite the advantages, the imaging efficiency in this approach still remains limited because a substantially long time of inversion is needed to selectively suppress the signal intensity of cerebrospinal fluid (CSF) while fully recovering that of brain tissues. The purpose of this work is to develop a novel, rapid hybrid encoding method for highly efficient whole-brain fluid-attenuated imaging. In each time of repetition, volumetric data are continuously encoded using the hybrid modular acquisition in a sequential fashion even during IR signal transition, wherein reversed fast imaging with steady-state free precession (PSIF) is employed to encode intermediate-to-high spatial frequency signals prior to CSF nulling, while VFA-TSE is used to collect low-to-intermediate spatial frequency signals afterwards. Gradient-induced spin de-phasing between a pair of neighboring radio-frequency (RF) pulses in both PSIF and TSE modules is kept identical to avoid the occurrence of multiple echoes in a single acquisition window. Additionally, a two-step, alternate RF phase-cycling scheme is employed in the low spatial frequency region to eliminate free induction decay induced edge artifacts. Numerical simulations of the Bloch equations were performed to evaluate signal evolution of brain tissues along the echo train while optimizing imaging parameters. In vivo studies demonstrate that the proposed technique produces high-resolution isotropic fluid-attenuated whole-brain images in a clinically acceptable imaging time with substantially high signal-to-noise ratio for white matter while retaining lesion conspicuity.

MRI of intracranial vertebral artery dissection: evaluation of intramural haematoma using a black blood, variable-flip-angle 3D turbo spin-echo sequence

We investigated the efficacy of three-dimensional black blood T1-weighted imaging (3D-BB-T1WI) using a variable refocusing flip angle turbo spin-echo sequence in the diagnosis of intracranial vertebral artery dissection (VAD). Sixteen consecutive patients diagnosed with intracranial VAD underwent magnetic resonance imaging that included 3D time-of-flight-MRA, axial spin-echo T1-weighted images (SE-T1WI) and oblique coronal 3D-BB-T1WI sequences. The visualization, morphology and extent of intramural haematomas were assessed and compared among the sequences. Results obtained by digital subtraction angiography (DSA), 3D-angiography and/or 3D-CT angiography (CTA) were used as standards of reference. 3D-BB-T1WI revealed intramural haematomas in all cases, whereas SE-T1WI and magnetic resonance angiography (MRA) failed to reveal a haematoma in one case and three cases, respectively. The mean visualization grading score for the intramural haematoma was the highest for 3D-BB-T1WI, and there was a statistically significant difference among the sequences (p < 0.001). At least a portion of the intramural haematoma was distinguishable from the lumen on 3D-BB-T1WI, whereas the haematomas were entirely indistinguishable from intraluminal signals on MRA in two cases (12.5%) and on SE-T1WI in one case (6.3%). 3D-BB-T1WI revealed the characteristic crescent shape of the intramural haematoma in 14 cases (87.5%), whereas SE-T1WI and MRA revealed a crescent shape in only 7 cases (43.8%) and 8 cases (50%), respectively. In a consensus reading, 3D-BB-T1WI was considered the most consistent sequence in representing the extent and morphology of the lesion in 14 cases (87.5%), compared to DSA and CTA. 3D-BB-T1WI is a promising method to evaluate intramural haematoma in patients with suspected intracranial VAD.

SNR‐optimized phase‐sensitive dual‐acquisition turbo spin echo imaging: A fast alternative to FLAIR

Phase-sensitive dual-acquisition single-slab three-dimensional turbo spin echo imaging was recently introduced, producing high-resolution isotropic cerebrospinal fluid attenuated brain images without long inversion recovery preparation. Despite the advantages, the weighted-averaging-based technique suffers from noise amplification resulting from different levels of cerebrospinal fluid signal modulations over the two acquisitions. The purpose of this work is to develop a signal-to-noise ratio-optimized version of the phase-sensitive dual-acquisition single-slab three-dimensional turbo spin echo. Variable refocusing flip angles in the first acquisition are calculated using a three-step prescribed signal evolution while those in the second acquisition are calculated using a two-step pseudo-steady state signal transition with a high flip-angle pseudo-steady state at a later portion of the echo train, balancing the levels of cerebrospinal fluid signals in both the acquisitions. Low spatial frequency signals are sampled during the high flip-angle pseudo-steady state to further suppress noise. Numerical simulations of the Bloch equations were performed to evaluate signal evolutions of brain tissues along the echo train and optimize imaging parameters. In vivo studies demonstrate that compared with conventional phase-sensitive dual-acquisition single-slab three-dimensional turbo spin echo, the proposed optimization yields 74% increase in apparent signal-to-noise ratio for gray matter and 32% decrease in imaging time. The proposed method can be a potential alternative to conventional fluid-attenuated imaging.

Detection of Small Metastatic Brain Tumors

Early and accurate diagnosis of small metastatic brain tumors may affect outcomes and treatment strategies. For this reason, 3-dimensional (3D) thin-section imaging is preferred. However, with conventional contrast-enhanced (CE) 3D imaging, such as magnetization-prepared rapid gradient echo (MP-RAGE), many visually enhanced vessels may mimic small metastatic tumors, hindering tumor detection. CE black-blood single-slab 3D turbo-spin echo imaging (BB-ssTSE) was recently developed, which uses variable refocusing flip angles and flow-sensitizing gradient schemes, to enhance metastatic brain tumors while selectively suppressing blood vessels. The purpose of this work was to investigate the efficiency of the proposed CE BB-ssTSE in detecting small metastatic brain tumors as compared with conventional MP-RAGE. Numerical comparisons of MP-RAGE and BB-ssTSE were performed by simulation studies to investigate the signal/contrast behaviors of flowing blood and stationary CE tumors. For in vivo studies, we enrolled 35 patients (18 women; mean age, 58.1 years) with breast or lung cancer who underwent brain magnetic resonance imaging. After administering a double dose of contrast medium, whole-brain 2-dimensional T1-weighted imaging followed by high-resolution isotropic 3D BB-ssTSE and MP-RAGE was performed at 3.0 T. Two reviewers independently evaluated the presence of metastatic brain tumors using: (1) MP-RAGE; (2) BB-ssTSE; and (3) MP-RAGE + BB-ssTSE sequentially in 3 review sessions, 2 weeks apart. The lesions were classified by size into 2 groups: large (≥5 mm) and small (<5 mm). Both reviewers marked all tumors detected at each session. Another reviewer combined the results of the 2 reviewers and compared the detection rates of metastatic brain tumors between BB-ssTSE and MP-RAGE by using follow-up imaging. Intraclass correlation coefficients between the 2 reviewers were measured. Numerical simulations showed that the proposed BB-ssTSE effectively attenuated the signal intensity of flowing blood over the entire echo train, resulting in CE tumor-to-white matter contrast comparable with conventional MP-RAGE. The combined evaluation of MP-RAGE + BB-ssTSE showed 242 tumors in 28 patients. Of these, 153 lesions were <5 mm. MP-RAGE found 111 small metastatic brain tumors, BB-ssTSE found 150, and MP-RAGE + BB-ssTSE found 153. Significantly, more small tumors were detected by BB-ssTSE than MP-RAGE (P = 0.001, Wilcoxon signed-rank test). All large tumors were detected similarly by both MP-RAGE and BB-ssTSE. By combined results for MP-RAGE + BB-ssTSE, sensitivities for detection of small metastatic tumors were 72.5% for MP-RAGE and 98.0% for BB-ssTSE (P < 0.0001, McNemar test). Intraclass correlation coefficients between the 2 reviewers were 0.826 for MP-RAGE and 0.954 for BB-ssTSE. Compared with conventional MP-RAGE, the proposed CE BB-ssTSE imaging, which enhances tumors while selectively suppressing blood vessels, leads to significantly better detection of small metastatic brain tumors <5 mm.

Water‐silicone separated volumetric MR acquisition for rapid assessment of breast implants

To develop a robust T(2) -weighted volumetric imaging technique with uniform water-silicone separation and simultaneous fat suppression for rapid assessment of breast implants in a single acquisition. A three-dimensional (3D) fast spin echo sequence that uses variable refocusing flip angles was combined with a three-point chemical-shift technique (IDEAL) and short tau inversion recovery (STIR). Phase shifts of -π/6, +π/2, and +7π/6 between water and silicone were used for IDEAL processing. For comparison, two-dimensional images using 2D-FSE-IDEAL with STIR were also acquired in axial, coronal, and sagittal orientations. Near-isotropic (true spatial resolution-0.9 × 1.3 × 2.0 mm(3) ) volumetric breast images with uniform water-silicone separation and simultaneous fat suppression were acquired successfully in clinically feasible scan times (7:00-10:00 min). The 2D images were acquired with the same in-plane resolution (0.9 × 1.3 mm(2) ), but the slice thickness was increased to 6 mm with a slice gap of 1 mm for complete coverage of the implants in a reasonable scan time, which varied between 18:00 and 22:30 min. The single volumetric acquisition with uniform water and silicone separation enables images to be reformatted into any orientation. This allows comprehensive assessment of breast implant integrity in less than 10 min of total examination time.

Contrast-enhanced, three-dimensional, whole-brain, black-blood imaging: Application to small brain metastases

Contrast-enhanced three-dimensional T(1)-weighted imaging based on magnetization-prepared rapid-gradient recalled echo is widely used for detecting small brain metastases. However, since contrast materials remain in both blood and the tumor parenchyma and thus increase the signal intensity of both regions, it is often challenging to distinguish brain tumors from blood. In this work, we develop a T(1)-weighted, black-blood version of single-slab three-dimensional turbo/fast spin echo whole-brain imaging, in which the signal intensity of the brain tumor is selectively enhanced while that of blood is suppressed. For blood suppression, variable refocusing flip angles with flow-sensitizing gradients are employed. To avoid a signal loss resulting from the flow-sensitizing scheme, the first refocusing flip angle is forced to 180 degrees. Composite restore pulses at the end of refocusing pulse train are applied to achieve partial inversion recovery for the T(1)-weighted contrast. Simulations and in vivo volunteer and patient experiments are performed, demonstrating that this approach is highly efficient in detecting small brain metastases.

Contrast‐driven approach to intracranial segmentation using a combination of T2‐ and T1‐weighted 3D MRI data sets

To develop a strategy for structural brain imaging when using FSL software for segmentation and subsequent volumetry. Three-dimensional (3D) structural MRI of 1-mm isotropic resolution was performed on a 3-Tesla clinical imaging system. Prescribed signal evolution of a multiple spin-echo (SE) sequence with variable refocusing flip angle for T2 weighting, and a modified driven equilibrium Fourier transform (MDEFT) sequence were used for T1 weighting. Postprocessing included rigid-body coregistration, brain extraction, and segmentation using the tools of the FSL 3.2 software package. T2 weighting provided reliable delineation of the subarachnoidal space, while T1 weighting provided better segmentation of gray matter (GM) and white matter (WM). The combination of T1-weighted (T1-w) and T2-w data allowed the identification of a T2-hypointense class of "nonbrain" (NB) representing larger vessels and structures of connective tissue, as well as partial volume of bone and air-filled cavities. Brain extraction on T2-w data and subsequent segmentation of the combined T1- and T2-w intensity distribution into four classes are recommended.

Fast spin echo sequences with very long echo trains: Design of variable refocusing flip angle schedules and generation of clinical T2 contrast

Reducing and continuously varying the flip angle of the refocusing RF pulses in a rapid acquisition with relaxation enhancement (RARE; fast/turbo spin echo) sequence is a useful means of addressing high RF power deposition and modulation transfer function (MTF) distortion due to relaxation. This work presents a streamlined technique to generate a sequence of refocusing flip angles on a per-prescription basis that produces relatively high SNR and limits blurring in a wide range of materials encountered in vivo. Since the "effective TE" (traditionally defined as the time at which the center of k-space is sampled) no longer corresponds to the expected amount of spin-echo T2 contrast due to the mixing of stimulated and spin echoes, a "contrast-equivalent" TE is defined and experimentally demonstrated that allows annotation of a more accurate effective TE that matches the contrast produced by 180 degrees refocusing. Furthermore, contrast is shown to be manipulable by the addition of magnetization preparation pulse sequence segments, such as T2-prep, to produce clinically desirable contrast for routine head and body imaging.

Multiecho sequences with variable refocusing flip angles: optimization of signal behavior using smooth transitions between pseudo steady states (TRAPS).

A variation of the rapid acquisition with relaxation enhancement (RARE) sequence (also called turbo spin-echo (TSE) or fast spin-echo (FSE)) is presented. This technique uses variable flip angles along the echo train such that magnetization is initially prepared into the static pseudo steady state (PSS) for a low refocusing flip angle (alpha < 180 degrees ). It is shown that after such a preparation, magnetization will always stay very close to the static PSS even after significant variation of the subsequent refocusing flip angles. This allows the design of TSE sequences in which high refocusing flip angles yielding 100% of the attainable signal are applied only for the important echoes encoding for the center of k-space. It is demonstrated that a reduction of the RF power (RFP) by a factor of 2.5-6 can be achieved without any loss in signal intensity. The contribution of stimulated-echo pathways leads to a reduction of the effective TE by a factor f(t), which for typical implementations is on the order of 0.5-0.8. This allows the use of longer echo readout times, and thus longer echo trains, for acquiring images with a given T(2) contrast.

45.可変Refocusing Flip Angleを用いたFast SE法の検討(1.5T MRI)

45.可変Refocusing Flip Angleを用いたFast SE法の検討(1.5T MRI)

Dynamic spin-echo imaging: theoretical assessment and implementation.

A spin-echo method for obtaining dynamic magnetic resonance (MR) images is described. The method combines the RARE (rapid acquisition with relaxation enhancement) pulse sequence with a data acquisition scheme in which only a centric fraction of the raw data is sampled to increase the time resolution of the dynamic images. The missing high-resolution data are supplied from reference images. By these means, an effective time resolution of about 10 seconds per image is achieved, which is suitable for diagnostic assessment of contrast enhancement procedures. A promising clinical application is contrast-enhanced MR imaging of the pituitary. Although the resolution of small objects in this size range is potentially degraded, this shortcoming is compensated for with use of variable refocusing flip angles. In the context of pituitary imaging, the centric 30%-40% of the raw data is shown to be the optimal fraction to acquire for the low-resolution dynamic images. Ten patients with previous history of pituitary disease have been imaged with dynamic and conventional spin-echo techniques. In six of these patients, an equivalent diagnosis was reached with dynamic and conventional images, while in two, only the dynamic images showed the lesion; in the final two patients, only the conventional images showed the lesion.