Average SAR prediction, validation, and evaluation for a compact MR scanner head-sized RF coil.

A recently developed compact 3 T (C3T) MRI scanner with high performance gradients [1, 2] has a dedicated radiofrequency (RF) transmit coil that exposes only the head, neck and a small portion of the upper body region during head-first scanning. Due to the unique coil geometry and patient positioning, the established SAR model used for a conventional whole-body scanner cannot be directly translated to the C3T. Here a specific absorption rate (SAR) estimation and validation framework was developed and used to implement a dedicated and accurate SAR prediction model for the C3T. Two different SAR prediction models for the C3T were defined and evaluated: one based on an anatomically derived exposed mass, and one using a fixed anatomical position located caudally to the RF coil to determine the exposed mass. After coil modeling and virtual human body simulation, the designed SAR prediction model was implemented on the C3T and verified with calorimetry and in vivo scan power monitoring. The fixed-demarcation exposed mass model was selected as appropriate exposed mass region to accurately estimate the SAR deposition in the patient on the C3T.

Gradient nonlinearity calibration and correction for a compact, asymmetric magnetic resonance imaging gradient system.

Due to engineering limitations, the spatial encoding gradient fields in conventional magnetic resonance imaging cannot be perfectly linear and always contain higher-order, nonlinear components. If ignored during image reconstruction, gradient nonlinearity (GNL) manifests as image geometric distortion. Given an estimate of the GNL field, this distortion can be corrected to a degree proportional to the accuracy of the field estimate. The GNL of a gradient system is typically characterized using a spherical harmonic polynomial model with model coefficients obtained from electromagnetic simulation. Conventional whole-body gradient systems are symmetric in design; typically, only odd-order terms up to the 5th-order are required for GNL modeling. Recently, a high-performance, asymmetric gradient system was developed, which exhibits more complex GNL that requires higher-order terms including both odd- and even-orders for accurate modeling. This work characterizes the GNL of this system using an iterative calibration method and a fiducial phantom used in ADNI (Alzheimer's Disease Neuroimaging Initiative). The phantom was scanned at different locations inside the 26 cm diameter-spherical-volume of this gradient, and the positions of fiducials in the phantom were estimated. An iterative calibration procedure was utilized to identify the model coefficients that minimize the mean-squared-error between the true fiducial positions and the positions estimated from images corrected using these coefficients. To examine the effect of higher-order and even-order terms, this calibration was performed using spherical harmonic polynomial of different orders up to the 10th-order including even- and odd-order terms, or odd-order only. The results showed that the model coefficients of this gradient can be successfully estimated. The residual root-mean-squared-error after correction using up to the 10th-order coefficients was reduced to 0.36 mm, yielding spatial accuracy comparable to conventional whole-body gradients. The even-order terms were necessary for accurate GNL modeling. In addition, the calibrated coefficients improved image geometric accuracy compared with the simulation-based coefficients.

Automatic assignment of 1H-NMR spectra of small molecules.

A novel data-evaluation procedure for the automatic atom to peak or multiplet assignment of 1H-NMR spectra of small molecules has been developed using a fast and robust expert system. The applicability and reliability of the method are demonstrated by comparison of a manually assigned database of 1H-NMR spectra with the assignments produced by the automatic procedure. The results of this analysis show an excellent success ratio, indicating that this new algorithm can have a major impact as a time saving tool for the organic chemist. A new graphical feature used to illustrate both the stability and quality of the elementary assignments is also introduced.

Wide, short bore magnetic resonance at 1.5 t: reducing the failure rate in claustrophobic patients.

PURPOSE: Claustrophobic reactions in patients undergoing magnetic resonance imaging (MRI) have a significant impact on the workflow, patient acceptance and ultimately the costs involved in obtaining a diagnostic scan. The purpose of this study was to determine if the use of a wide, short bore MRI scanner could reduce the need for general anesthesia assistance in these cases. METHODS: Between September 2006 and March 2008, all patients for whom MRI examinations of the head and/or spine were canceled or prematurely terminated due to claustrophobia on a standard 60 cm bore, 1.5 T scanner were scheduled to be re-scanned on a 70 cm wide bore, 1.25 m long 1.5 T scanner. This re-scanning attempt was made 2 or more days prior to a scheduled anesthesia-assisted MRI appointment. If the patient successfully completed the wide bore MRI examination then the anesthesia-assisted MRI appointment was canceled. RESULTS: A total of 56 patients were included in this study. The examinations included individual body regions as well as combination examinations (head and cervical spine, entire spine etc.). A total of 72 body regions were examined in 56 patients. Of these regions, 65 (90%) were completed successfully, 50 patients (89%) successfully completed a diagnostic examination on the 70 cm scanner and 6 patients (11%), all of whom were scheduled for examinations which included the head, were unable to complete the examination on the wide bore scanner. CONCLUSIONS: A 1.5 T wide short bore scanner increases the examination success rate in patients with claustrophobia and substantially reduces the need for anesthesia-assisted MRI examinations even when claustrophobia is severe.

Serial MRI and CSF biomarkers in normal aging, MCI, and AD.

OBJECTIVE: To compare the annual change in MRI and CSF biomarkers in cognitively normal (CN), amnestic mild cognitive impairment (aMCI), and Alzheimer disease (AD). Comparisons were based on intergroup discrimination, correlation with concurrent cognitive/functional changes, relationships to APOE genotype, and sample sizes for clinical trials. METHODS: We used data from the Alzheimer's Disease Neuroimaging Initiative study consisting of CN, aMCI, and AD cohorts with both baseline and 12-month follow-up CSF and MRI. The annual change in CSF (total-tau [t-tau], Abeta(1-42)) and MRI (change in ventricular volume) was obtained in 312 subjects (92 CN, 149 aMCI, 71 AD). RESULTS: There was no significant average annual change in either CSF biomarker in any clinical group except t-tau in CN; moreover, the annual change did not differ by clinical group in pairwise comparisons. In contrast, annual increase in ventricular volume increased in the following order, AD > aMCI > CN, and differences were significant between all clinical groups in pairwise comparisons. Ventricular volume increase correlated with concurrent worsening on cognitive/functional indices in aMCI and AD whereas evidence of a similar correlation with change in CSF measures was unclear. The annual changes in MRI differed by APOE epsilon4 status overall and among aMCI while annual changes in CSF biomarkers did not. Estimated sample sizes for clinical trials are notably less for MRI than the CSF or clinical measures. CONCLUSIONS: Unlike the CSF biomarkers evaluated, changes in serial structural MRI are correlated with concurrent change on general cognitive and functional indices in impaired subjects, track with clinical disease stage, and are influenced by APOE genotype.

A simple flowcell for reaction monitoring by NMR.

A simple, cheap and flexible flowcell based on a standard 5 mm NMR tube, designed for the monitoring of reactions but of wide applicability, is described. No modification of the NMR instrument is needed, allowing the system to be employed with any conventional NMR probe and magnet. The system is robust and economical in use of reagents, and can be used for studying both homogeneous and heterogeneous reactions.

A prospective trial of 3T and 1.5T time-of-flight and contrast-enhanced MR angiography in the follow-up of coiled intracranial aneurysms.

BACKGROUND AND PURPOSE: Endovascularly coiled intracranial aneurysms are increasingly being followed up with noninvasive MRA imaging to evaluate for aneurysm recurrences. It has not been well-established which MRA techniques are best for this application, however. Our aim was to prospectively compare 4 MRA techniques, TOF and CE-MRA at 1.5T and 3T, to a reference standard of DSA in the evaluation of previously endovascularly coiled intracranial aneurysms. MATERIALS AND METHODS: Fifty-eight subjects with 63 previously coiled intracranial aneurysms underwent all 4 MRA techniques within 8 days of DSA. There were 2 outcome variables: coil occlusion class (class 1, complete; class 2, dog ear; class 3, residual neck; class 4, aneurysm filling) and change in degree of occlusion since the previous comparison. Sensitivity and specificity were computed for each MRA technique relative to the reference standard of DSA. Differences among the MRA techniques were evaluated in pair-wise fashion by using the McNemar test. RESULTS: For the detection of any aneurysm remnant, the sensitivity was 85%-90% for all MRA techniques. Sensitivity dropped to 50%-67% when calculated for the detection of only the class 3 and 4 aneurysm remnants, because several class 3 and 4 remnants were misclassified as class 2 by MRA. CE-MRA at 1.5T and 3T misclassified fewer of the class 3 and 4 remnants than did TOF-MRA at 1.5T, as reflected by the significantly greater sensitivity for larger aneurysm remnants with CE-MRA relative to TOF-MRA at 1.5T (P = .0455 for both comparisons). CONCLUSIONS: CE-MRA is more likely than TOF-MRA to classify larger aneurysm remnants appropriately. We recommend performing both CE-MRA and TOF-MRA in the follow-up of coiled intracranial aneurysms and at 3T if available.

State of the art: 3T imaging of the membranous labyrinth.

This article reviews the anatomy of the membranous labyrinth and demonstrates the ability of high-resolution MR imaging at 3T to visualize the neurosensory epithelium by using the latest fast spin-echo techniques.

Fat signal suppression in head and neck imaging using fast spin-echo-IDEAL technique.

We present our initial experience with the use of a modified 3-point Dixon technique to obtain reliable fast spin-echo T1- and T2-weighted fat-suppressed images in the soft-tissue neck. The method has less sensitivity to magnetic field inhomogeneity than frequency-selective radiofrequency fat saturation and provides uniform fat suppression even near tissue-tissue and air-tissue interfaces. Clinical advantages and limitations of the method are discussed and several examples are shown.

Feathering: Vertebral artery pseudostenosis with elliptical centric contrast-enhanced MR angiography.

Elliptical centric contrast-enhanced MR angiography of the cervical vasculature is a well-established technique that in many practices has replaced conventional angiography for several clinical indications, including atherosclerotic disease and dissections. Occasionally blurring or loss of signal intensity occurs in the vertebral arteries, especially in young patients with rapid circulation times. This ringing artifact, which we termed "feathering," results from rapidly changing signal intensity in small vascular structures during the sampling of the center of k-space.

High-resolution intracranial and cervical MRA at 3.0T: technical considerations and initial experience.

Initial experience with intracranial and cervical MRA at 3.0T is reported. Phantom measurements (corrected for relaxation effects) show S/N (3.0T) = 2.14 +/- 0.08 x S/N (1.5T) in identical-geometry head coils. A 3.0T 3DTOF intracranial imaging protocol with higher-order autoshimming was developed and compared to 1.5T 3DTOF in 12 patients with aneurysms. A comparison by two radiologists showed the 3.0T to be significantly better (P < 0.001) for visualization of the aneurysms. The feasibility of cervical and intracranial contrast enhanced MR angiography (CEMRA) at 3.0T is also examined. The relaxivity of the gadolinium contrast agent decreases by only about 4-7% when the field strength is increased from 1.5 to 3.0T. Cervical 3.0T CEMRA was obtained in eight patients, two of whom had 1.5T studies available for direct comparison. Image comparison suggests 3.0T to be a favorable field strength for cervical CEMRA. Voxel volumes of 0.62-0.73 mm(3) (not including zero-filling) were readily achieved at 3.0T with the use of a single-channel transmit-receive head or cervical coil, a 25 mL bolus of gadoteridol, and a 3D pulse sequence with a 66% sampling efficiency. This spatial resolution allowed visualization of intracranial aneurysms, carotid dissections, and atherosclerotic disease including ulcerations. Potential drawbacks of 3.0T MRA are increased SAR and T(*)(2) dephasing compared to 1.5T. Image comparison suggests signal loss due to T(*)(2) dephasing will not be substantially more problematic than at 1.5T. The dependence of RF power deposition on TR for CEMRA is calculated and discussed.

Contrast-enhanced magnetic resonance angiography of the cervical vessels: experience with 422 patients.

BACKGROUND AND PURPOSE: Contrast-enhanced magnetic resonance angiography (CEMRA) permits acquisition of high-spatial-resolution, venous-suppressed, 3D MR angiograms of the cervical carotid and vertebral arteries. In this study, an elliptic centric-view ordering with either MR fluoroscopic triggering or test bolus timing was used. The use of CEMRA of the cervical vessels has changed our clinical practice and is replacing conventional angiography for the evaluation of most carotid and vertebral artery diseases. METHODS: We retrospectively reviewed our experience with the use of CEMRA performed in 422 patients from January through December 1999. RESULTS: CEMRA was performed to evaluate transient ischemic attack and ischemic stroke in 239 patients, asymptomatic carotid bruit in 88 patients, and other neurological symptoms in 95 patients. Carotid endarterectomies were performed in 97 patients (103 procedures), and conventional angiography was performed in 12 of these patients. CEMRA was used to evaluate for the presence of an arterial dissection in 85 of the 239 patients with transient ischemic attack and ischemic stroke. Of this group, 32 patients had cervical arterial dissection, and pseudoaneurysm was detected in 11 of these patients. Compared with ultrasonography of the cervical vessels, CEMRA provided additional information in 43 of 422 patients and led to changes in the decision as to whether to perform carotid endarterectomy in 5 patients. CONCLUSIONS: Use of CEMRA permits noninvasive evaluation of patients suspected of having carotid or vertebral disease and avoids the potential complications of conventional angiography.

Effect of windowing and zero-filled reconstruction of MRI data on spatial resolution and acquisition strategy.

Standard, MR spin-warp sampling strategies acquire data on a rectangular k-space grid. That method samples data from the "corners" of k-space, i.e., data that lie in a region of k-space outside of an ellipse just inscribed in the rectangular boundary. Illustrative calculations demonstrate that the data in the corners of k-space contribute to the useful resolution only if an interpolation method such as a zero-filled reconstruction is used. The consequences of this finding on data acquisition and data windowing strategies are discussed. A further implication of this result is that the spatial resolution of images reconstructed with zero-filling (but without radial windowing) is expected to display angular dependence, even when the phase- and frequency-encoded resolutions are identical. This hypothesis is experimentally verified with a slit geometry phantom. It is also observed that images reconstructed without zero-filling do not display the angular dependence of spatial resolution predicted solely by the maximal k-space extent of the raw data. The implications of these results for 3D contrast-enhanced angiographic acquisitions with elliptical centric view ordering are explored with simulations.

Magnetic resonance angiography at 3.0 Tesla: initial clinical experience.

Magnetic resonance (MR) angiography has undergone significant development over the past decade. It has gone from being a novelty application of MR with limited clinical use to replacing catheter angiography in some clinical applications. One of the principal limitations inherent to all MR angiographic techniques is that they remain signal limited when pushed to the limits of higher resolution and short acquisition time. Developments in magnetic gradient hardware, coil design, and pulse sequences now are well optimized for MR angiography obtained at 1.5-T main magnetic field (B-field) strength, with acquisition times and imaging matrix size near their optimal limits, respectively. Recently, the United States Food and Drug Administration (FDA) approved use of clinical magnetic resonance imaging with main magnetic field strengths of up to 4 T. Before FDA approval, use of MR with magnetic field strengths much greater than 1.5 T was essentially reserved for investigational or research applications. The main advantage of high B-field imaging is a significant improvement in the signal-to-noise ratio (SNR), which increases in an approximately linear fashion with field strength in the range of 1.5 to 3.0 T. This increased SNR is directly available when performing MR angiographic acquisitions at higher magnetic field strengths, allowing for better resolution and conspicuity of vessels with similar acquisition times. Little has been reported on the benefits of performing MR angiography at magnetic field strengths >1.5 T. The purpose of this article is to summarize our current experience with intracranial and cervical MR angiographic techniques at 3.0 T.

Contrast-enhanced carotid MR angiography with commercially available triggering mechanisms and elliptic centric phase encoding.

OBJECTIVE: The technical feasibility of contrast-enhanced MR angiography of the carotid arteries was evaluated with routinely available timing sequences and elliptic centric acquisition. The image quality of the contrast-enhanced MR angiography was compared with that of multiple overlapping thin-section acquisition MR angiography (MOTSA MR angiography). SUBJECTS AND METHODS: Sixty-three patients were enrolled. A 2-mL test bolus and commercially available software were used to time the gadolinium bolus. High-resolution contrast-enhanced MR angiography was performed with elliptic centric acquisition. RESULTS: The average time of bolus arrival was 17.3 sec (range, 12-25 sec). In 60 of the 63 patients, we had excellent or good visualization of the carotid bifurcation using contrast-enhanced MR angiography with little or no venous contamination. Two observers ranked delineation of stenosis and morphology of proximal internal carotid artery and overall diagnostic confidence statistically significantly higher for contrast-enhanced MR angiography compared with MOTSA: Ulceration, length of stenosis, and slow flow distal to a critical stenosis were better depicted with contrast-enhanced MR angiography than with MOTSA: Venetian blind artifact, saturation of slow or in-plane flow, and artifactual narrowing in carotid artery kinks plagued MOTSA but were not seen on contrast-enhanced MR angiography. MOTSA was graded superior to contrast-enhanced MR angiography in nine of 120 carotid bifurcations analyzed. CONCLUSION: High-resolution carotid contrast-enhanced MR angiography is technically feasible. We found a 95% success rate using commercially available hardware and software. The image quality with carotid contrast-enhanced MR angiography has improved so that it is equal or superior to the longer MOTSA in most patients.

Carotid artery: elliptic centric contrast-enhanced MR angiography compared with conventional angiography.

PURPOSE: To determine the accuracy of elliptic centric contrast material-enhanced magnetic resonance (MR) angiography by using conventional angiography as the reference standard. MATERIALS AND METHODS: Fifty patients were examined prospectively with contrast-enhanced MR angiography and conventional angiography. The two examinations were performed within 1 week of each other. Two patients underwent conventional angiography of only one carotid artery, which yielded 98 arteries for comparison. RESULTS: With conventional angiography as the reference standard and by using a 70% threshold for internal carotid arterial diameter stenosis, maximum intensity projection (MIP) images had a sensitivity of 93.3%, specificity of 85.1%, and accuracy of 87.6%, whereas reformatted transverse source images had a sensitivity of 83.3%, specificity of 97.0%, and accuracy of 92.8%. Interobserver variability for conventional angiograms was 0.97, for MIP images was 0.91, and for source images was 0.90. The contrast-enhanced MR angiographic technique had a sensitivity of 88.9% and specificity of 58.1% for the presence of irregularity and/or ulceration. All 50 examinations were triggered appropriately so that minimal or no venous signal intensity was depicted. CONCLUSION: Contrast-enhanced elliptic centric three-dimensional MR angiography offers high-spatial-resolution, venous-suppressed images of the carotid arteries that appear to be adequate to replace conventional angiography in most patients examined prior to carotid endarterectomy.

The effect of oral nutritional supplements on habitual dietary quality and quantity in frail elders.

BACKGROUND: Frail institutionalized elders have a high prevalence of nutritional risk factors, undernutrition, weight loss, and nutrition-related morbidity and excess mortality. Little information is available on effective means to intervene in this setting. HYPOTHESES: We tested the hypothesis that addition of multinutrient oral supplements to the diet of frail elders would improve their overall nutritional status and functional level. METHODS: Fifty nursing home residents aged 88+/-1 yr. were followed for 10 weeks in the course of a randomized controlled trial of supplementation with a multinutrient liquid supplement vs. a non-nutritive placebo drink. Three-day food weighing was used to analyze their habitual dietary intake before and during the final week of the intervention. Nutritional status was further assessed with nutritional biochemistries, anthropometric measurements, and body composition analysis as well as physical and functional performance tests. RESULTS: The nutritional supplement was consumed with high compliance, but did not significantly augment total caloric intake. Supplementation was associated with significant reductions in total energy, protein, fat, water, fiber, and many vitamins and minerals in the habitual diet of these nursing home residents. Nutritional status improved in terms of folate levels in serum, but no other measured vitamin or mineral indices. Body composition analysis revealed a small gain in weight, increases in fat stores, but no improvement in lean tissue mass associated with supplemention. No physical performance or functional gains were associated with supplementation. CONCLUSION: Short-term nutritional supplementation in elders at nutritional risk is offset by simultaneous reduction in voluntary food intake. It seems likely that changing other components of energy expenditure such as physical activity levels or basal metabolism may be required to produce overall improvements in nutritional intake in this setting.

Three-dimensional contrast-enhanced MR angiography with real-time fluoroscopic triggering: design specifications and technical reliability in 330 patient studies.

Technical reliability was determined for triggering three-dimensional (3D) contrast material-enhanced magnetic resonance (MR) angiography with MR fluoroscopy. Technical requirements for high reliability were also identified. Reliability was evaluated in 330 consecutive patient studies of the neck, thorax, abdomen, and pelvis. Contrast material arrival was detected fluoroscopically in 325 of the 330 studies (98.5%), and the 3D sequence was successfully triggered in 321 of 330 studies (97.3%). Fluoroscopic triggering of centrically encoded 3D MR angiographic acquisitions is a highly reliable means of obtaining 3D MR angiograms with high spatial resolution.

Association of muscle power with functional status in community-dwelling elderly women.

BACKGROUND: Identification of the physiologic factors most relevant to functional independence in the elderly population is critical for the design of effective interventions. It has been suggested that muscle power may be more directly related to impaired physical performance than muscle strength in elderly persons. We tested the hypothesis that peak muscle power is closely associated with self-reported functional status in sedentary elderly community-dwelling women. METHODS: We used baseline data that were collected as part of a 1-year randomized controlled clinical trial of a combined program of strength, power, and endurance training in 80 elderly women (mean age 74.8 +/- 5.0 years) with 3.2 +/- 1.9 chronic diseases, selected for baseline functional impairment and/or falls. RESULTS: Functional status at baseline was related in univariate analyses to physiologic capacity, habitual physical activity level, neuropsychological status, and medical diagnoses. Leg power had the strongest univariate correlation to self-reported functional status (r = -.47, p < .0001) of any of the physiologic factors we tested. In a forward stepwise regression model, leg press power and habitual physical activity level were the only two factors that contributed independently to functional status (r = .64, p < .0001), accounting for 40% of the variance in functional status. CONCLUSIONS: Leg power is a strong predictor of self-reported functional status in elderly women.