Weighted Gradient Echo Sequences Research Articles

Cervical spinal cord susceptibility-weighted MRI at 7T: Application to multiple sclerosis

BackgroundSusceptibility-weighted imaging (SWI) has been extensively studied in the brain and in diseases of the central nervous system such as multiple sclerosis (MS) providing unique opportunities to visualize cerebral vasculature and disease-related pathology, including the central vein sign (CVS) and paramagnetic rim lesions (PRLs). However, similar studies evaluating SWI in the spinal cord of patients with MS remain severely limited. PurposeBased on our previous findings of enlarged spinal vessels in MS compared to healthy controls (HCs), we developed high-field SWI acquisition and processing methods for the cervical spinal cord with application in people with MS (pwMS) and HCs. Here, we demonstrate the vascular variability between the two cohorts and unique MS lesion features in the cervical cord. MethodsIn this retrospective, exploratory pilot study conducted between March 2021 and March 2022, we scanned 12 HCs and 9 pwMS using an optimized non-contrast 2D T2*-weighted gradient echo sequence at 7 tesla. The overall appearance of the white and gray matter as well as tissue vasculature were compared between the two cohorts and areas of MS pathology in the patient group were assessed using both the magnitude and processed SWI images. ResultsWe show improved visibility of vessels and more pronounced gray and white matter contrast in the MS group compared to HCs, hypointensities surrounding the cord in the MS cohort, and identify signal changes indicative of the CVS and paramagnetic rims in 66 % of pwMS with cervical spinal lesions. ConclusionIn this first study of SWI at 7T in the human spinal cord, SWI holds promise in advancing our understanding of disease processes in the cervical cord in MS.

Abstract TP138: Prevalence And Risk Factors Associated With Cerebral Microbleeds In Patients With Acute Respiratory Distress Syndrome

Introduction: Acute respiratory distress syndrome (ARDS) is associated with pulmonary vascular endothelial injury. Cerebral microbleeds (CMB) have been reported in patients with critical illness such as ARDS, particularly involving the splenium of the corpus callosum and immediate subcortical white matter. We aimed to examine the prevalence and risk factors of CMB in ARDS. Methods: We reviewed patient data from an ARDS registry at a tertiary medical center from January 2010 to October 2018. Patients were excluded if MRI imaging was motion degraded or did not include susceptibility weighted imaging (SWI) or T2*weighted gradient echo sequences. CMB were defined as hypointense SWI or T2* lesions <5 mm. Microbleeds were labeled as diffuse if there were ≥10 present in a region. ARDS rescue therapies included extracorporeal membrane oxygenation, inhaled vasodilators, recruitment maneuvers, high frequency oscillatory ventilation, neuromuscular blockade, and proning. Univariate analysis was performed to examine association with CMB. Results: Of the 678 patients with ARDS, 61 had MRI’s meeting inclusion criteria. CMB were present in 12 patients, with median age 62.5 years. Ten patients had lobar CMB, of which 4 were diffuse and also involved the cerebellum. There were 3 patients with CMB in the corpus callosum, all involving the splenium, of which 2 were diffuse among patients who had diffuse lobar involvement. Acute Physiology and Chronic Health Evaluation III and Sequential Organ Failure Assessment scores did not differ between those with and without CMB, but ARDS rescue therapies were more commonly used in patients with CMB (66.7% vs 22.4%, p=.003). CMB was associated with acute cerebral ischemia on MRI (41.7% with CMB vs 10.2% without CMB, p=.008). Conclusions: CMB are common in ARDS, mostly involving the cerebral lobes and cerebellum. CMB might be associated with ARDS rescue therapies and higher risk for ischemic infarcts.

Modifying LI-RADS on Gadoxetate Disodium-Enhanced MRI: A Secondary Analysis of a Prospective Observational Study.

The Liver Imaging Reporting and Data System (LI-RADS) is widely used for diagnosing hepatocellular carcinoma (HCC), however, with unsatisfactory sensitivity, complex ancillary features, and inadequate integration with gadoxetate disodium (EOB)-enhanced MRI. To modify LI-RADS (mLI-RADS) on EOB-MRI. Secondary analysis of a prospective observational study. Between July 2015 and September 2018, 224 consecutive high-risk patients (median age, 51 years; range, 26-83; 180 men; training/testing sets: 169/55 patients) with 742 (median size, 13 mm; interquartile range, 7-27; 498 HCCs) LR-3/4/5 observations. 3.0 TT2 -weighted fast spin-echo, diffusion-weighted spin-echo based echo-planar, and 3D T1 -weighted gradient echo sequences. Three radiologists (with 5, 5, and 10 years of experience in liver MR imaging, respectively) blinded to the reference standard (histopathology or imaging follow-up) reviewed all MR images independently. In the training set, the optimal LI-RADS version 2018 (v2018) features selected by Random Forest analysis were used to develop mLI-RADS via decision tree analysis. In an independent testing set, diagnostic performances of mLI-RADS, LI-RADS v2018, and the Korean Liver Cancer Association (KLCA) guidelines were computed using a generalized estimating equation model and compared with McNemar's test. A two-tailed P < 0.05 was statistically significant. Five features (nonperipheral "washout," restricted diffusion, nonrim arterial phase hyperenhancement [APHE], mild-moderate T2 hyperintensity, and transitional phase hypointensity) constituted mLI-RADS, and mLR-5 was nonperipheral washout coupled with either nonrim APHE or restricted diffusion. In the testing set, mLI-RADS was significantly more sensitive (72%) and accurate (80%) than LI-RADS v2018 (sensitivity, 61%; accuracy 74%; both P < 0.001) and the KLCA guidelines (sensitivity, 64%; accuracy 74%; both P < 0.001), without sacrificing positive predictive value (mLI-RADS, 94%; LI-RADS v2018, 94%; KLCA guidelines, 92%). In high-risk patients, the EOB-MRI-based mLI-RADS was simpler and more sensitive for HCC than LI-RADS v2018 while maintaining high positive predictive value. 2 TECHNICAL EFFICACY: Stage 2.

White Matter Hyperintensities and Cerebral Microbleeds in Ataxia-Telangiectasia.

Background and ObjectivesTo systematically assess the occurrence of cerebral microbleeds (CMBs) and white matter hyperintensities (WMHs) in the largest published cohort of adults with ataxia-telangiectasia (AT).MethodsWe assessed 38 adults with AT (age range 18–55 years) including 15 classic and 23 variant AT, evaluated by two independent assessors. WMHs were quantified on T2-fluid attenuated inversion recovery images using the semiquantitative modified Scheltens and Fazekas scales and CMB on susceptibility-weighted imaging and T2*-weighted gradient echo sequences using the Brain Observer MicroBleed Scale.ResultsCMBs were more frequently found in classic AT compared with variant AT (66.7% vs 5.9%) predominantly in cortical and subcortical regions. WMHs were seen in 25 (73.5%) probands and CMBs in 9 (31.0%). The burden of WMHs increased with age, and WMHs were focused in periventricular and deep white matter regions. WMHs were more frequently seen in variant than classic AT.DiscussionThis cohort study confirms that WMHs and CMBs are a frequent finding in AT. Further longitudinal studies are required to understand how WMHs and CMBs relate to the neurodegeneration that occurs in AT and the predisposition to cerebral hemorrhage.

Feasibility of ultrasound-induced blood-brain barrier disruption with a single-element transducer under three different frequencies in two non-human primates in vivo: Case report

BackgroundSingle-element focused transducers applied in blood-brain barrier (BBB) disruption experiments to optimize intravascular therapies in CNS diseases have the advantage of low cost and portability. Most of the in vivo studies on non-human primates report the use of single-element transducers with an annular spherical shape and a central frequency of 500 kHz. High-frequency ultrasound has smaller focal area and less standing-wave effect but lower transcranial penetration efficiency. Our study reports the feasibility and safety concerns of BBB opening by single-element spherical transducers with central frequencies of 300, 650 and 800 kHz on two rhesus macaques. MethodsPulsed ultrasound exposure (3-minute duration, 0.5–1% duty cycle) combined with microbubble injection (SonoVue, 0.2uL/g) was used to disrupt the BBB of the monkeys under the magnetic resonance imaging (MRI) guidance. Gadolinium contrast-enhanced MRI was used to confirm and evaluate the BBB opening after sonication. T2-weighted fast spin echo and T2 * -weighted gradient echo sequences were used to check the post-sonication complications, such as edema and micro-bleeding. ResultsContrast enhancement was found on the post-sonication T1 weighted images for all experiments, showing that the BBB was successfully opened under all the three frequencies on both monkeys. The enhanced area was largest at the lowest frequency. No obvious hypo-intensity or hyper-intensity was observed on either the T2 * weighted gradient echo images or T2-weighted fast-spin echo images, implying the safety of the opening procedure. However, signal enhancement was also observed in the subarachnoid space of the sulci for all frequencies, indicating that the BBB was also disrupted in the propagation path outside the focal area. ConclusionsThe feasibility of BBB opening with single-element transducer under frequencies ranging from 300 kHz to 800 kHz was confirmed by experiments in two non-human primates in vivo. Further investigation into the off-target effects and transducer configurations is needed for safety optimization.

Improving the sensitivity of spin-echo fMRI at 3T by highly accelerated acquisitions.

Spin-echo (SE) functional MRI (fMRI) can be highly advantageous compared to gradient-echo (GE) fMRI with respect to magnetic field-inhomogeneity artifacts. However, at 3T, the majority of blood oxygenation level-dependent (BOLD) fMRI experiments are performed using -weighted GE sequences because of their superior sensitivity compared to SE-fMRI. The presented SE implementation of a highly accelerated GE pulse sequence therefore aims to improve the sensitivity of SE-fMRI while profiting from a reduction of susceptibility-induced signal dropout. Spin-echo MR encephalography (SE-MREG) is compared with the more conventionally used spin-echo echo-planar imaging (SE-EPI) and spin-echo simultaneous multislice (SE-SMS) at 3T in terms of capability to detect neuronal activations and resting-state functional connectivity. For activation analysis, healthy subjects underwent consecutive SE-MREG (pulse repetition time [TR] = 0.25 seconds), SE-SMS (TR = 1.3 seconds), and SE-EPI (TR = 4.4 seconds) scans in pseudorandomized order applied to a visual block design paradigm for generation of t-statistics maps. For the investigation of functional connectivity, additional resting-state data were acquired for 5 minutes and a seed-based correlation analysis using Stanford's FIND (Functional Imaging in Neuropsychiatric Disorders) atlas was performed. The increased sampling rate of SE-MREG relative to SE-SMS and SE-EPI improves the sensitivity to detect BOLD activation by 33% and 54%, respectively, and increases the capability to extract resting-state networks. Compared with a brain region that is not affected by magnetic field inhomogeneities, SE-MREG shows 2.5 times higher relative signal strength than GE-MREG in mesial temporal structures. SE-MREG offers a viable possibility for whole-brain fMRI with consideration of brain regions that are affected by strong susceptibility-induced magnetic field gradients.

Understanding Early Hemophilic Arthropathy in Children and Adolescents Through MRI T2 Mapping.

Persons with hemophilia experience hemarthrosis, which can lead to cartilage degeneration, causing physical impairment. MRI T2 mapping has the potential to be used as a tool to evaluate early arthropathic changes and cartilage degeneration in patients with hemophilia. To assess the value of MRI-T2 mapping as a tool for investigating the cartilage status of children and adolescents with hemophilic arthropathy. Prospective, cross-sectional. Twenty-eight boys with hemophilia (aged 5-17 years) and 23 healthy boys (aged 7-17 years). A multiecho spin-echo T2 -weighted gradient echo sequence was used on a 3.0T magnet. MRI-T2 maps of ankle (tibia-talus) (n = 19) or knee (femur-tibia) (n = 9) cartilage were assessed in hemophilia and healthy groups. An anatomically-based MRI score was also assigned to each ankle/knee. Pearson's correlation coefficient (r), linear regression, intraclass correlation coefficient (ICC), and analysis of variance (ANOVA) test. Negative associations between age and ankle/knee cartilage T2 relaxation times were found in hemophilia (r = -0.72 [P = 0.03] to -0.55 [P = 0.01]) and healthy (r = -0.84 [P < 0.001] to -0.55 [P = 0.20]) groups. There were nonsignificant associations between ankle cartilage T2 relaxation times and MRI scores (r = -0.15 [P = 0.54] to 0.31 [P = 0.19]). Results of this clinical investigation emphasize the potential importance of MRI-T2 maps as a tool to understand the functional status of cartilage in children and adolescents with hemophilic arthropathy, while holding promise for the detection of early cartilage degeneration prior to macroscopic characterization by conventional MRI. MRI-T2 mapping may provide novel information that is not reflected in the anatomically-based MRI scoring system. 3 TECHNICAL EFFICACY STAGE: 2.

Pneumatical-Mechanical Tactile Stimulation Device for Somatotopic Mapping of Body Surface During fMRI.

There is a need for devices that allow reproducible stimulation of skin areas of humans for investigating somatosensory mapping of the whole-body surface. However, their design is not simple, due to the magnetic field of MRI scanners. To accurately characterize the mapping of somatosensory presentation of the whole-body surface of subjects during functional (f)MRI scans. Prospective. A water phantom and six healthy participants (age 23-27 years; two males) were recruited for the fMRI experiment. T1 -weighted magnetization-prepared rapid acquisition gradient-echo, T2 *-weighted gradient echo sequence at 3T. The stimulation device for somatotopic mapping was composed of three units: an air-generating unit, a control unit, and an execution unit. The fMRI in response to tactile stimulation was measured to characterize somatotopic mapping of the right-side body consisting of hand, arm, and leg in six healthy subjects. Pared-samples t-test for the conditions in SII. The pneumatical-mechanical tactile stimulation offered a wide range of stimulation intensities (0-400 g) in each channel. The predetermined physical pressure was successfully reached within ~5 msec and returned to baseline within 5 msec after the end of stimulation. With this tactile device, the digressive rate of the signal-to-noise ratio (SNR) (271.44 without the device, 269.68 with the device) was 0.65% in the magnetic field environment. For the fMRI experiment, the primary somatosensory activation contralateral to the stimulation site was detected in response to spatial task and attentive task. This stimulation device characterized the mapping of somatosensory representation of the whole-body surface in individual participants during fMRI scans. 2. 1. J. Magn. Reson. Imaging 2020;52:1093-1101.

Deep-Learning-Based Preprocessing for Quantitative Myocardial Perfusion MRI.

BackgroundQuantitative myocardial perfusion cardiac MRI can provide a fast and robust assessment of myocardial perfusion status for the noninvasive diagnosis of myocardial ischemia while being more objective than visual assessment. However, it currently has limited use in clinical practice due to the challenging postprocessing required, particularly the segmentation.PurposeTo evaluate the efficacy of an automated deep learning (DL) pipeline for image processing prior to quantitative analysis.Study TypeRetrospective.PopulationIn all, 175 (350 MRI scans; 1050 image series) clinical patients under both rest and stress conditions (135/10/30 training/validation/test).Field Strength/Sequence3.0T/2D multislice saturation recovery T1‐weighted gradient echo sequence.AssessmentAccuracy was assessed, as compared to the manual operator, through the mean square error of the distance between landmarks and the Dice similarity coefficient of the segmentation and bounding box detection. Quantitative perfusion maps obtained using the automated DL‐based processing were compared to the results obtained with the manually processed images.Statistical TestsBland–Altman plots and intraclass correlation coefficient (ICC) were used to assess the myocardial blood flow (MBF) obtained using the automated DL pipeline, as compared to values obtained by a manual operator.ResultsThe mean (SD) error in the detection of the time of peak signal enhancement in the left ventricle was 1.49 (1.4) timeframes. The mean (SD) Dice similarity coefficients for the bounding box and myocardial segmentation were 0.93 (0.03) and 0.80 (0.06), respectively. The mean (SD) error in the RV insertion point was 2.8 (1.8) mm. The Bland–Altman plots showed a bias of 2.6% of the mean MBF between the automated and manually processed MBF values on a per‐myocardial segment basis. The ICC was 0.89, 95% confidence interval = [0.87, 0.90].Data ConclusionWe showed high accuracy, compared to manual processing, for the DL‐based processing of myocardial perfusion data leading to quantitative values that are similar to those achieved with manual processing. Level of Evidence: 3 Technical Efficacy Stage: 1J. Magn. Reson. Imaging 2020;51:1689–1696.

Biexponential R2* relaxometry for estimation of liver iron concentration in children: A better fit for high liver iron states.

R2* relaxometry's capacity to calculate liver iron concentration (LIC) is limited in patients with severe overload. Hemosiderin increases in these patients, which exhibits a non-monoexponential decay that renders a failed R2* analysis. To evaluate a biexponential R2* relaxometry model in children with different ranges of iron overload. Retrospective. In all, 181 children with different conditions associated with iron overload. 1.5T, T2 *-weighted gradient echo sequence. Bi- and monoexponential R2* relaxometry were measured in the liver using two regions of interest (ROIs) using a nonproprietary software: one encompassing the whole liver parenchyma (ROI-1) and the other only the periphery (ROI-2). These were drawn by a single trained observer. The residuals for each fitting model were estimated. A ratio between the residuals of the mono- and biexponential models was calculated to identify the best fitting model. Patients with 1) residual ratio ≥1.5 and 2) R2*fast ≥R2*slow were considered as having a predominant biexponential behavior. Nonparametric tests, Bland-Altman plots, linear correlation, intraclass correlation coefficient. Patients were divided according to their LIC into stable (n = 23), mild (n = 58), moderate (n = 61), and severe (n = 39). The biexponential model was more suitable for patients with severe iron overload when compared with the other three LIC categories (P < 0.001) for both ROIs. For ROI-1, 37 subjects met criteria for a predominant biexponential behavior. The slow component (5.7%) had a lower fraction than the fast component (94.2%). For ROI-2, 22 subjects met criteria for a predominant biexponential behavior. The slow component (4.7%) had a lower fraction than the fast component (95.2%). The intraobserver variability between both ROIs was excellent. The biexponential R2* relaxometry model is more suitable in children with severe iron overload. 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1191-1198.

Comparison of Maximum Signal Intensity of Magnevist Contrast Agent in Modified T1 Weighted Spin Echo, T1 Weighted Fast Spin Echo and T1 Weighted Gradient Echo Sequences

Comparison of Maximum Signal Intensity of Magnevist Contrast Agent in Modified T1 Weighted Spin Echo, T1 Weighted Fast Spin Echo and T1 Weighted Gradient Echo Sequences

Myocardial Perfusion Reserve Index in Children With Kawasaki Disease.

Coronary artery lesions in patients with Kawasaki disease (KD) can impair myocardial perfusion, yet evaluation of perfusion defects by cardiac magnetic resonance (MR) in children is often qualitative. In this study we aimed to use a quantitative method of myocardial perfusion using stress cardiac MR-derived myocardial perfusion reserve index (MPRI) in children with KD and compare MPRI with ventricular mechanical performance evaluated by cardiac MR strain analysis. This study was a retrospective review. Twenty-one children with a diagnosis of KD who underwent stress perfusion cardiac MR were compared with nine controls. First-pass perfusion imaging using a T1 -weighted gradient echo sequence was performed at rest and stress after administration of adenosine with 1.5T or 3T magnets. The MPRI was calculated as the ratio of maximum slope of myocardial enhancement during stress compared to rest and was evaluated with the American Heart Association 17 segment model. Demographic and clinical characteristics among KD patients and controls were compared using Student's t-test for normally distributed continuous variables, Wilcoxon-rank sum test for nonnormally distributed variables, and χ2 for categorical variables. There was a significant decrease in MPRI in Segment 7 (1.53 vs. 2.23, P = 0.0058) in KD patients compared with controls. The reduction in MPRI in Segment 12 approached statistical significance (1.58 vs. 2.31, P = 0.0636). Three patients who underwent serial studies had decreased MPRI longitudinally. No differences were seen in circumferential or radial strain. MPRI shows impaired myocardial perfusion in patients with KD. MPRI can change over time, suggestive of progressive coronary artery changes, which may precede fibrosis and mechanical decline. MPRI can assess segmental and global perfusion defects in patients with KD and should be a part of routine cardiac MR evaluation in KD. 3 Technical Efficacy Stage 3 J. Magn. Reson. Imaging 2017.

MRI for the measurement of liver iron content, and for the diagnosis and follow-up of iron overload disorders

MRI is now the reference method for detecting and quantifying hepatic and extrahepatic iron overload, regardless of its cause. The decrease of the hepatic signal is proportional to the amount of iron in the tissues. It is more pronounced with T2*-weighted gradient echo sequences. It increases proportionally with the strength of the magnetic field. Thus a 3-T MRI is be more sensitive and probably more accurate to detect a slight iron overload, as seen in dysmetabolic hepatosiderosis. Conversely, a 1.5-T MRI better estimates a high overload. Quantification can be done with the calculation of T2* (or R2*) or by using the liver to muscle signal intensity ratio (SIR). Today with a single multi-echo gradient-echo sequence, obtained in a unique apnea, the two methods can be used simultaneously. An associated quantification of steatosis is also obtained. This same type of sequence is proposed for quantification of iron in other tissues and in particular for the myocardium.

Clinical utility of optimized three-dimensional T1-, T2-, and T2*-weighted sequences in spinal magnetic resonance imaging.

This article reviews the clinical utility of 3D magnetic resonance imaging (MRI) sequences optimized for the evaluation of various intraspinal lesions. First, intraspinal tumors with hypervascular components and arteriovenous malformations (AVM) are clearly shown on contrast-enhanced (CE)-3D T1-weighted gradient-echo (GE) sequences with high spatial resolution. Second, dynamic CE-3D time-resolved magnetic resonance angiography (MRA) shows delineated feeding arteries of intraspinal AVM or arteriovenous fistula (AVF), greatly aiding subsequent digital subtraction angiography (DSA). Third, 3D multiecho T2*-weighted GE sequences are used to visualize intraspinal structures and spinal cord lesions and are sensitive to the magnetic susceptibility of intraspinal hemorrhages. Three-dimensional balanced steady-state free precession (SSFP) and multishot 3D balanced non-SSFP sequences produce contiguous thin images with high signal-to-noise ratio (SNR) in short scanning times. Intraspinal cystic lesions and small nerve-root tumors in subarachnoid space can be viewed using 3D balanced SSFP. Spinal cord myelomalacia and cord compression can be evaluated on fat-suppressed multishot 3D balanced non-SSFP. Finally, a 3D T2-weighted fast spin-echo (FSE) sequence with variable flip angle (FA) refocusing pulse improves through-plane spatial resolution over conventional 2D T2-weighted FSE sequences while matching image contrast.

Accuracy of SWI sequences compared to T2*-weighted gradient echo sequences in the detection of cerebral cavernous malformations in the familial form.

The purpose of this study was to assess the accuracy of susceptibility-weighted imaging (SWI), compared with T2*-weighted gradient echo (GRE) imaging in assessing cerebral cavernous malformations. We retrospectively evaluated 21 patients with a familial form of cavernous malformation. Magnetic resonance (MR) protocol included non-enhanced and contrast-enhanced fast-spin echo (FSE) T1-weighted sequences, FSE T2-weighted sequences, fluid-attenuated inversion-recovery (FLAIR), GRE T2*-weighted and SWI sequences. Images were reviewed in consensus by two expert neuroradiologists to assess the location, number, size and conspicuity of the lesions on T2*-weighted GRE and SWI sequences. Statistical differences in the number, size and conspicuity of the lesions seen on the SWI images and the T2*-weighted GRE images were assessed with the nonparametric Wilcoxon signed rank test. The number of cavernous malformations was significantly higher (p < .001) on the SWI images (n = 152) than on T2*-weighted GRE images (n = 56). Lesion size was significantly higher (p < .001) on SWI images (mean: 0.4 cm, SD ± 0.55) than on T2*-weighted GRE sequences (mean: 0.2 cm, SD ± 0.51) and the differences were statistically significant (p < .001). Lesion conspicuity was significant higher (p < .001) on SWI than on T2*-weighted GRE images. In one patient who underwent a 2-month follow-up for the onset of neurologic symptoms related to cerebral hemorrhage, a cerebral hematoma was identified at the site of a cerebral cavernous malformation that was demonstrated only on the SWI images in the previous MR examination. The SWI sequence, being more sensitive to substances which distort the local magnetic field than the GRE T2*W sequence, showed a higher sensitivity in identifying cerebral cavernous malformations. Thus, routine clinical neuroimaging protocol should contain SWI sequences to evaluate patients with (or suspected) cerebral cavernous malformations.

Comparison of Maximum Signal Intensity of Magnevist Contrast Agent in Modified T1 Weighted Spin Echo, T1 Weighted Fast Spin Echo and T1 Weighted Gradient Echo Sequences

Background: Nowadays MRI examinations have been widely used in clinical applications for many diagnoses. The use of contrast agent in MRI improves lesion detection and characterization and causes more accurate diagnosis. Objectives: The aim of this study was comparing to optimal dose of Magnevist contrast agent in modified T1W SE (Spin Echo), T1W FSE (Fast Spin Echo) and T1W GRE (GRadient Echo) and effect of scan parameters of these sequences on the maximum SI of Magnevist contrast agent. Material and Method: This study was done on a phantom that was containing test tubes. These test tubes were filled with 30ml saline mixed with different doses of Magnevist contrast agent. In this study, some scan parameters of T1W pulse sequences were changed to achieve optimal parameters for maximum SI of contrast agent. In this study maximum signal intensity of each image was measured by ImageJ software. Results: The results of this study show that there are differences in maximum SI in different T1W pulse sequences with changing scan parameters. This study shows that 0.625 mmol/L of Magnevist has maximum SI in all of sequences. The maximum SI can be seen at GRE, SE and FSE sequences, respectively. Conclusion: Using routine and changed scan parameters, each pulse sequence reaches different maximum SI in specific concentration , which is highest in 2D SPGR (SPoiled GRadient) with flip angle = 75˚ and least in T1W SE with TE (Time of Echo) = 40ms.

Towards Optical Coherence Tomography-based elastographic evaluation of human cartilage

Optical Coherence Tomography (OCT) is an imaging technique that allows the surface and subsurface evaluation of semitransparent tissues by generating microscopic cross-sectional images in real time, to millimetre depths and at micrometre resolutions. As the differentiation of cartilage degeneration remains diagnostically challenging to standard imaging modalities, an OCT- and MRI-compatible indentation device for the assessment of cartilage functional properties was developed and validated in the present study. After describing the system design and performing its comprehensive validation, macroscopically intact human cartilage samples (n=5) were indented under control of displacement (δ1=202µm; δ2=405µm; δ3=607µm; δ4=810µm) and simultaneous OCT imaging through a transparent indenter piston in direct contact with the sample; thus, 3-D OCT datasets from surface and subsurface areas were obtained. OCT-based evaluation of loading-induced changes included qualitative assessment of image morphology and signal characteristics. For inter-method cross referencing, the device׳s compatibility with MRI as well as qualitative morphology changes under analogous indentation loading conditions were evaluated by a series of T2 weighted gradient echo sequences. Cartilage thickness measurements were performed using the needle-probe technique prior to OCT and MRI imaging, and subsequently referenced to sample thickness as determined by MRI and histology. Dynamic indentation testing was performed to determine Young׳s modulus for biomechanical reference purposes. Distinct differences in sample thickness as well as corresponding strains were found; however, no significant differences in cartilage thickness were found between the used techniques. Qualitative assessment of OCT and MRI images revealed either distinct or absent sample-specific patterns of morphological changes in relation to indentation loading. For OCT, the tissue area underneath the indenter piston could be qualitatively assessed and displayed in multiple reconstructions, while for MRI, T2 signal characteristics indicated the presence of water and related tissue pressurisation within the sample. In conclusion, the present indentation device has been developed, constructed and validated for qualitative assessment of human cartilage and its response to loading by OCT and MRI. Thereby, it may provide the basis for future quantitative approaches that measure loading-induced deformations within the tissue to generate maps of local tissue properties as well as investigate their relation to degeneration.

Pre-operative sentinel lymph node localization in breast cancer with superparamagnetic iron oxide MRI: the SentiMAG Multicentre Trial imaging subprotocol.

Sentinel lymph node biopsy (SLNB) with a superparamagnetic iron oxide (SPIO) tracer was shown to be non-inferior to the standard combined technique in the SentiMAG Multicentre Trial. The MRI subprotocol of this trial aimed to develop a magnetic alternative for pre-operative lymphoscintigraphy (LS). We evaluated the feasibility of using MRI following the administration of magnetic tracer for pre-operative localization of sentinel lymph nodes (SLNs) and its potential for non-invasive identification of lymph node (LN) metastases. Patients with breast cancer scheduled to undergo SLNB were recruited for pre-operative LS, single photon emission CT (SPECT)-CT and SPIO MRI. T1 weighted turbo spin echo and T2 weighted gradient echo sequences were used before and after interstitial injection of magnetic tracer into the breast. SLNs on MRI were defined as LNs with signal drop and direct lymphatic drainage from the injection site. LNs showing inhomogeneous SPIO uptake were classified as metastatic. During surgery, a handheld magnetometer was used for SLNB. Blue or radioactive nodes were also excised. The number of SLNs and MR assessment of metastatic involvement were compared with surgical and histological outcomes. 11 patients were recruited. SPIO MRI successfully identified SLNs in 10 of 11 patients vs 11 of 11 patients with LS/SPECT-CT. One patient had metastatic involvement of four LNs, and this was identified in one node on pre-operative MRI. SPIO MRI is a feasible technique for pre-operative localization of SLNs and, in combination with intraoperative use of a handheld magnetometer, provides an entirely radioisotope-free technique for SLNB. Further research is needed for the evaluation of MRI characterization of LN involvement using subcutaneous injection of magnetic tracer. This study is the first to demonstrate that an interstitially administered magnetic tracer can be used both for pre-operative imaging and intraoperative SLNB, with equal performance to imaging and localization with radioisotopes.

The Dixon technique and the frequency-selective fat suppression technique in three-dimensional T1 weighted MRI of the liver: a comparison of contrast-to-noise ratios of hepatocellular carcinomas-to-liver.

The use of three-dimensional T1 weighted gradient echo sequences such as the Dixon technique and the frequency-selective fat suppression (FS) technique is currently widely accepted method in MRI examinations of the liver. To assess the image qualities of the Dixon technique and the frequency-selective FS technique, the contrast-to-noise ratios (CNRs) of hepatocellular carcinoma (HCC)-to-liver and fat-to-liver were compared between the two techniques in the hepatobiliary phase (HBP) following administration of gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid. MR images of 59 patients with a total of 86 HCCs were retrospectively evaluated. Images were consecutively obtained with the Dixon and frequency-selective FS methods in the HBP and their CNRs of HCC-to-liver and fat-to-liver were compared. CNRs and contrast ratios were calculated by the mean value of the liver parenchyma, HCC, fat and standard deviation of the liver parenchyma. The Wilcoxon signed-ranks test was used for statistical analysis. The median CNRs for the frequency-selective FS and Dixon techniques of HCC-to-liver were 4.3 and 5.4 (p < 0.01), mesenteric fat-to-liver were 9.9 and 12.8 (p < 0.01) and subcutaneous fat-to-liver were 9.9 and 13.2 (p < 0.01), respectively. The Dixon technique yielded higher CNRs of HCC-to-liver than that of the frequency-selective FS technique. There are a limited number of reports on quantitative analysis of the image qualities of the Dixon technique and the frequency-selective FS technique, particularly within the same patient and examination.

Is There an Association between Cerebral Microbleeds and Leukoaraiosis?

Cerebral microbleeds (CMBs) are small dot-like lesions appearing as hyposignals on gradient echo (GRE) T2* magnetic resonance (MR) sequences, whereas the leukoaraiosis (LA) indicates the presence of patchy areas of hypersignal on fluid-attenuated inversion recovery (FLAIR) MR sequences in the periventricular white matter. The purpose of this work was to evaluate the association between LA and CMBs. Eighty-five consecutive (men 55; median age 64 years) patients were retrospectively analyzed using a 1.5 T system; CMBs were studied using a T2*-weighted GRE sequence and classified as absent (grade 1), mild (grade 2; total number of microbleeds, 1-2), moderate (grade 3; total number of microbleeds, 3-10), and severe (grade 4; total number of microbleeds, >10). LA was assessed with FLAIR MR sequences and was graded based on the European Task Force on Age-Related White Matter Changes as follows: 1 (no lesions), 2 (focal lesions > 5 mm), 3 (early confluent lesions), and 4 (diffuse involvement of an entire brain region). We considered 170 cerebral hemispheres. The prevalence of CMBs was 24.7% (42 of 170), whereas the prevalence of LA was 27.1% (46 of 170). A statistically significant correlation was observed between LA and CMBs (correlation rho = .495, P value = .001). Multiple logistic regression analysis showed an association between CMBs and cerebrovascular symptoms (P = .0023). Results of this study suggest an association between CMBs and LA. Moreover, we found that LA is associated with the presence of cerebrovascular symptoms.