Delayed Ferumoxtran-10-Enhanced Magnetic Resonance Neurography of the Lumbosacral Plexus: Impact on Vascular Suppression and Image Quality.

BACKGROUND: Intravenous Ferumoxtran-10 belongs to ultra-small superparamagnetic iron oxide particles and can be used for magnetic resonance neurography (MRN) as an alternative to other imaging methods which use contrast agents. PURPOSE: To examine the impact of intravenous Ferumoxtran-10 on vascular suppression and compare image quality to gadolinium (Gd)-enhanced image acquisition in MRN of lumbosacral plexus (LS). STUDY TYPE: Prospective. POPULATION/SUBJECTS: 17 patients with Ferumoxtran-10-enhanced MRN, and 20 patients with Gd-enhanced MRN. FIELDSTRENGTH/SEQUENCE: 3T/3D STIR sequence. ASSESSMENT: Image quality, nerve visibility and vascular suppression were evaluated by 3 readers using a 5-point Likert scale. STATISTICAL TESTS: Inter-reader agreement (IRA) was calculated using intraclass coefficients (ICC). Quantitative analysis of image quality was performed by signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements and compared using Student's t-testing. RESULTS: Image quality, nerve visibility and vascular suppression were significantly higher for Ferumoxtran-10-enhanced MRN compared to Gd-enhanced MRN sequences (p < 0.05). IRA for image quality of nerves was good in Gd-enhanced and Ferumoxtran-10 MRN with ICC values of 0.76 and 0.89, respectively. IRA for nerve visibility was good in Gd- and Ferumoxtran-10 enhanced MR neurography (ICC 0.72 and 0.90). Mean SNR was significantly higher in Ferumoxtran-10-enhanced MRN for all analyzed structures, while mean CNR was for significantly better for S1 ganglion and femoral nerve in Ferumoxtran-10-enhanced MRN (p < 0.05). DATA CONCLUSION: Ferumoxtran-10-enhanced MRN of the LS plexus showed significantly higher image quality and nerve visibility with better vascular suppression as compared to Gd-enhanced MRN. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 3.

Deep learning-based pseudo-CT synthesis from zero echo time MR sequences of the pelvis.

OBJECTIVES: To generate pseudo-CT (pCT) images of the pelvis from zero echo time (ZTE) MR sequences and compare them to conventional CT. METHODS: Ninety-one patients were prospectively scanned with CT and MRI including ZTE sequences of the pelvis. Eleven ZTE image volumes were excluded due to implants and severe B1 field inhomogeneity. Out of the 80 data sets, 60 were used to train and update a deep learning (DL) model for pCT image synthesis from ZTE sequences while the remaining 20 cases were selected as an evaluation cohort. CT and pCT images were assessed qualitatively and quantitatively by two readers. RESULTS: Mean pCT ratings of qualitative parameters were good to perfect (2-3 on a 4-point scale). Overall intermodality agreement between CT and pCT was good (ICC = 0.88 (95% CI: 0.85-0.90); p < 0.001) with excellent interreader agreements for pCT (ICC = 0.91 (95% CI: 0.88-0.93); p < 0.001). Most geometrical measurements did not show any significant difference between CT and pCT measurements (p > 0.05) with the exception of transverse pelvic diameter measurements and lateral center-edge angle measurements (p = 0.001 and p = 0.002, respectively). Image quality and tissue differentiation in CT and pCT were similar without significant differences between CT and pCT CNRs (all p > 0.05). CONCLUSIONS: Using a DL-based algorithm, it is possible to synthesize pCT images of the pelvis from ZTE sequences. The pCT images showed high bone depiction quality and accurate geometrical measurements compared to conventional CT. CRITICAL RELEVANCE STATEMENT: pCT images generated from MR sequences allow for high accuracy in evaluating bone without the need for radiation exposure. Radiological applications are broad and include assessment of inflammatory and degenerative bone disease or preoperative planning studies. KEY POINTS: pCT, based on DL-reconstructed ZTE MR images, may be comparable with true CT images. Overall, the intermodality agreement between CT and pCT was good with excellent interreader agreements for pCT. Geometrical measurements and tissue differentiation were similar in CT and pCT images.

Diagnostic value of T1- and T2-weighted 3-Tesla MRI for postmortem detection and age stage classification of myocardial infarction.

The aims of this study are to retrospectively evaluate the diagnostic value of T1- and T2-weighted 3-T magnetic resonance imaging (MRI) for postmortem detection of myocardial infarction (MI) in terms of sensitivity and specificity and to compare the MRI appearance of the infarct area with age stages. Postmortem MRI examinations (n = 88) were retrospectively reviewed for the presence or absence of MI by two raters blinded to the autopsy results. The sensitivity and specificity were calculated using the autopsy results as the gold standard. A third rater, who was not blinded to the autopsy findings, reviewed all cases in which MI was detected at autopsy for MRI appearance (hypointensity, isointensity, hyperintensity) of the infarct area and the surrounding zone. Age stages (peracute, acute, subacute, chronic) were assigned based on the literature and compared with the age stages reported in the autopsy reports. The interrater reliability between the two raters was substantial (κ = 0.78). Sensitivity was 52.94% (both raters). Specificity was 85.19% and 92.59%. In 34 decedents, autopsy identified an MI (peracute: n = 7, acute: n = 25, chronic: n = 2). Of 25 MI classified as acute at autopsy, MRI classified peracute in four cases and subacute in nine cases. In two cases, MRI suggested peracute MI, which was not detected at autopsy. MRI could help to classify the age stage and may indicate the area for sampling for further microscopic examination. However, the low sensitivity requires further additional MRI techniques to increase the diagnostic value.

Deep Learning Convolutional Neural Network Reconstruction and Radial k-Space Acquisition MR Technique for Enhanced Detection of Retropatellar Cartilage Lesions of the Knee Joint.

OBJECTIVES: To assess diagnostic performance of standard radial k-space (PROPELLER) MRI sequences and compare with accelerated acquisitions combined with a deep learning-based convolutional neural network (DL-CNN) reconstruction for evaluation of the knee joint. METHODS: Thirty-five patients undergoing MR imaging of the knee at 1.5 T were prospectively included. Two readers evaluated image quality and diagnostic confidence of standard and DL-CNN accelerated PROPELLER MR sequences using a four-point Likert scale. Pathological findings of bone, cartilage, cruciate and collateral ligaments, menisci, and joint space were analyzed. Inter-reader agreement (IRA) for image quality and diagnostic confidence was assessed using intraclass coefficients (ICC). Cohen's Kappa method was used for evaluation of IRA and consensus between sequences in assessing different structures. In addition, image quality was quantitatively evaluated by signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements. RESULTS: Mean acquisition time of standard vs. DL-CNN sequences was 10 min 3 s vs. 4 min 45 s. DL-CNN sequences showed significantly superior image quality and diagnostic confidence compared to standard MR sequences. There was moderate and good IRA for assessment of image quality in standard and DL-CNN sequences with ICC of 0.524 and 0.830, respectively. Pathological findings of the knee joint could be equally well detected in both sequences (κ-value of 0.8). Retropatellar cartilage could be significantly better assessed on DL-CNN sequences. SNR and CNR was significantly higher for DL-CNN sequences (both p < 0.05). CONCLUSIONS: In MR imaging of the knee, DL-CNN sequences showed significantly higher image quality and diagnostic confidence compared to standard PROPELLER sequences, while reducing acquisition time substantially. Both sequences perform comparably in the detection of knee-joint pathologies, while DL-CNN sequences are superior for evaluation of retropatellar cartilage lesions.

3D zero-echo time and 3D T1-weighted gradient-echo MRI sequences as an alternative to CT for the evaluation of the lumbar facet joints and lumbosacral transitional vertebrae.

BACKGROUND: Computed tomography (CT) is the reference standard for assessment of the bone. Magnetic resonance imaging (MRI) developments enable a CT-like visualization of the osseous structures. PURPOSE: To assess the diagnostic performance of 3D zero-echo time (3D-ZTE) and 3D T1-weighted gradient-echo (3D-T1GRE) MRI sequences for the evaluation of lumbar facet joints (LFJs) and the detection of lumbosacral transitional vertebrae (LSTV) using CT as the reference standard. MATERIAL AND METHODS: In total, 87 adult patients were included in this prospective study. Evaluation of degenerative changes of the facet joints at the L3/L4, L4/L5, and L5/S1 levels on both sides was performed by two readers using a 4-point Likert scale. LSTV were classified according to Castelvi et al. Image quality was quantitatively measured using the signal-to-noise (SNR) and contrast-to-noise (CNR) ratios. Intra-reader, inter-reader, and inter-modality reliability were calculated using Cohen's kappa statistic. RESULTS: Intra-reader agreement for 3D-ZTE, 3D-T1GRE, and CT was 0.607, 0.751, and 0.856 and inter-reader agreement was 0.535, 0.563, and 0.599, respectively. The inter-modality agreement between 3D-ZTE and CT was 0.631 and between 3D-T1GRE and CT 0.665. A total of LSTV were identified in both MR sequences with overall comparable accuracy compared to CT. Mean SNR for bone, muscle, and fat was highest for 3D-T1GRE and mean CNR was highest for CT. CONCLUSION: 3D-ZTE and 3D-T1GRE MRI sequences can assess the LFJs and LSTV and may serve as potential alternatives to CT.

Added value of ultra-short echo time and fast field echo using restricted echo-spacing MR imaging in the assessment of the osseous cervical spine.

PURPOSE: To evaluate the added value of ultra-short echo time (UTE) and fast field echo resembling a CT using restricted echo-spacing (FRACTURE) MR sequences in the assessment of the osseous cervical spine using CT as reference. MATERIALS AND METHODS: Twenty-seven subjects underwent postmortem CT and MRI within 48 h. Datasets were anonymized and analyzed retrospectively by two radiologists. Morphological cervical spine alterations were rated on CT, UTE and FRACTURE images. Afterward, neural foraminal stenosis was graded on standard MR and again after viewing additional UTE/FRACTURE sequences. To evaluate interreader and intermodality reliability, intra-class correlation coefficients (ICC) and for stenosis grading Wilcoxon-matched-pairs testing with multiple comparison correction were calculated. RESULTS: Moderate interreader reliability (ICC = 0.48-0.71) was observed concerning morphological findings on all modalities. Intermodality reliability was good between modalities regarding degenerative vertebral and joint alterations (ICC = 0.69-0.91). Compared to CT neural stenosis grades were more often considered as nonsignificant on all analyzed MR sequences. Neural stenosis grading scores differed also significantly between specific bone imaging sequences, UTE and FRACTURE, to standard MR sequences. However, no significant difference was observed between UTE and FRACTURE sequences. CONCLUSION: Compared to CT as reference, UTE or FRACTURE sequence added to standard MR sequences can deliver comparable information on osseous cervical spine status. Both led to changes in clinically significant stenosis gradings when added to standard MR, mainly reducing the severity of neural foramina stenosis.

Application of deep learning-based image reconstruction in MR imaging of the shoulder joint to improve image quality and reduce scan time.

OBJECTIVES: To compare the image quality and diagnostic performance of conventional motion-corrected periodically rotated overlapping parallel line with enhanced reconstruction (PROPELLER) MRI sequences with post-processed PROPELLER MRI sequences using deep learning-based (DL) reconstructions. METHODS: In this prospective study of 30 patients, conventional (19 min 18 s) and accelerated MRI sequences (7 min 16 s) using the PROPELLER technique were acquired. Accelerated sequences were post-processed using DL. The image quality and diagnostic confidence were qualitatively assessed by 2 readers using a 5-point Likert scale. Analysis of the pathological findings of cartilage, rotator cuff tendons and muscles, glenoid labrum and subacromial bursa was performed. Inter-reader agreement was calculated using Cohen's kappa statistic. Quantitative evaluation of image quality was measured using the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). RESULTS: Mean image quality and diagnostic confidence in evaluation of all shoulder structures were higher in DL sequences (p value = 0.01). Inter-reader agreement ranged between kappa values of 0.155 (assessment of the bursa) and 0.947 (assessment of the rotator cuff muscles). In 17 cases, thickening of the subacromial bursa of more than 2 mm was only visible in DL sequences. The pathologies of the other structures could be properly evaluated by conventional and DL sequences. Mean SNR (p value = 0.01) and CNR (p value = 0.02) were significantly higher for DL sequences. CONCLUSIONS: The accelerated PROPELLER sequences with DL post-processing showed superior image quality and higher diagnostic confidence compared to the conventional PROPELLER sequences. Subacromial bursa can be thoroughly assessed in DL sequences, while the other structures of the shoulder joint can be assessed in conventional and DL sequences with a good agreement between sequences. KEY POINTS: • MRI of the shoulder requires long scan times and can be hampered by motion artifacts. • Deep learning-based convolutional neural networks are used to reduce image noise and scan time while maintaining optimal image quality. The radial k-space acquisition technique (PROPELLER) can reduce the scan time and has potential to reduce motion artifacts. • DL sequences show a higher diagnostic confidence than conventional sequences and therefore are preferred for assessment of the subacromial bursa, while conventional and DL sequences show comparable performance in the evaluation of the shoulder joint.

Impact of acceleration on bone depiction quality by ultrashort echo time magnetic resonance bone imaging sequences in medication-related osteonecrosis of the jaw.

Objectives: To assess the impact on bone depiction quality by decreasing number of radial acquisitions (RA) of a UTE MR bone imaging sequence in MRONJ. Material and methods: UTE MR bone imaging sequences using pointwise encoding time reduction with RA (PETRA) with 60'000, 30'000 and 10'000 RA were acquired in 16 patients with MRONJ and 16 healthy volunteers. Blinded readout sessions were performed by two radiologists. Qualitative analysis compared the detection of osteolytic lesions and productive bony changes in the PETRA sequences of the patients with MRONJ. Quantitative analysis assessed the differences in image artifacts, contrast-to-noise ratio (CNR) and image noise. Results: Acquisition times were reduced from 315 to 165 and 65 s (60'000, 30'000, 10'000 RA, respectively), resulting in a fewer number of severe motion artifacts. Bone delineation was increasingly blurred when reducing the number of RA but without any trade-off in terms of diagnostic performance. Interreader agreement for the detection of pathognomonic osteolysis was moderate (κ = 0.538) for 60'000 RA and decreased to fair (κ = 0.227 and κ = 0.390) when comparing 30'000 and 10'000 RA, respectively. Image quality between sequences was comparable regarding CNR, image noise and artifact dimensions without significant differences (all P > 0.05). Conclusions: UTE MR bone imaging sequences with a lower number of RA provide sufficient image quality for detecting osteolytic lesions and productive bony changes in MRONJ subjects at faster acquisition times compared to the respective standard UTE MR bone imaging sequence.

Comparison of muscle fat fraction measurements in the lower spine musculature with non-contrast-enhanced CT and different MR imaging sequences.

PURPOSE: To assess whether two-point Dixon (TPD) MRI, true fast imaging with steady-state free precession (TRUFI) MRI and non-contrast-enhanced CT (NECT) can accurately measure muscle fat fraction (FF) in the autochthonous back muscles (AM) and the psoas muscle (PM) compared to multi-point Dixon (MPD) MRI. METHOD: 29 oncological patients who received MRI including MPD, TPD and NECT imaging in a period of three months were analyzed retrospectively. A sub-cohort of 16 patients additionally underwent TRUFI MRI and were included in a sub-analysis. Region of interest (ROI) measurements for each muscle compartment of the AM and PM were conducted by two examiners. Additionally, the Goutallier classification was used to quantify the amount of fatty infiltration of each muscle. Intermodality correlations were assessed with the Pearson correlation coefficient (r), and interreader and intrareader agreements with the intraclass correlation coefficient (ICC). RESULTS: Good intermodality correlations were found for NECT (r = 0.969), TPD (r = 0.942) and TRUFI (r = 0.904, all P < 0.001) when assessing FF in the AM and slightly lower in the PM. Interreader agreement showed good correlations and low median deviations (1.1 - 4.1 %, depending on the modality). The Goutallier classification of the AM showed good separation between grades with substantial interreader agreement (κ = 0.627, P < 0.001). CONCLUSIONS: ROI measurements of the AM in NECT, TPD and TRUFI highly correlate with muscle FF measurements in MPD MRI and may be used to assess sarcopenia in oncological patients.

Evaluation of ultrashort echo-time (UTE) and fast-field-echo (FRACTURE) sequences for skull bone visualization and fracture detection - A postmortem study.

BACKGROUND AND PURPOSE: CT is considered the modality of choice in the assessment of the skull due to the fast and accurate depiction of bone structures. Nevertheless, MRI has evolved into a possible alternative due to optimal soft tissue contrast and recent advances with the ability to visualize tissues with shortest T2 times, such as osseous structures. In this study we compare skull bone visualization and fracture detection across two MRI sequences to CT as reference standard. MATERIAL AND METHODS: Twenty subjects underwent CT and MRI with less than 72 h between examination. The MRI protocol included a 2D ultrashort echo time (UTE) and a 3D multi-echo in-phase fast-field-echo (FRACTURE) sequence. Independent raters evaluated qualitative characteristics and fracture detectability in different skull subregions (skull vault, skull base and viscerocranium). Interrater and intermodality agreement was evaluated by calculating intraclass coefficients (ICC). RESULTS: FRACTURE ICC indicated a good agreement in all subregions (ICC = 0.83 - 0.88), whereas UTE had excellent results calculated in the skull vault and viscerocranium (ICC = 0.91 - 0.94). At the skull vault, both MRI sequences received an overall good rating (UTE: 2.63 ± 0.42 FRACTURE. 2.81 ± 0.32). Fracture detection using MRI sequences for the skull vault, was highest compared to other subregions. CONCLUSIONS: Both MRI sequences may provide an alternative e.g. for surgical planning or follow up exams of the osseous neurocranium; although, at the skull base and viscerocranium bone visualization with MRI bone imaging sequences perform inferior to CT standard imaging.