Impact of a fast free-breathing 3-T abdominal MRI protocol on improving scan time and image quality for pediatric patients with tuberous sclerosis complex.

BACKGROUND: Magnetic resonance imaging (MRI) of the abdomen can be especially challenging in pediatric patients because of image quality degradation from respiratory motion. Abdominal MR protocols tailored for free-breathing children can potentially improve diagnostic image quality and reduce scan time. OBJECTIVE: To evaluate the performance of a free-breathing 3-T MRI protocol for renal evaluation in pediatric patients with tuberous sclerosis complex (TSC). MATERIALS AND METHODS: A single institution, Institutional Review Board-approved, retrospective database query identified pediatric TSC patients who underwent a free-breathing 3-T MR abdominal protocol including radial and respiratory-triggered pulse sequences and who also had a prior abdominal MRI on the same scanner using a traditional MR protocol utilizing signal averaging and Cartesian k-space sampling. Scan times and use of sedation were recorded. MR image quality was compared between the two protocols using a semiquantitative score for overall image quality and sharpness. RESULTS: Forty abdominal MRI studies in 20 patients were evaluated. The mean scan time of the fast free-breathing protocol was significantly lower (mean: 42.5±9.8 min) compared with the traditional protocol (58.7±11.7 min; P=<0.001). Image sharpness was significantly improved for radial T2-weighted and T1-weighted triggered Dixon and radial T1-weighted fat-suppressed post-contrast images in the free-breathing protocol, while image quality was significantly higher on radial and Dixon T1-weighted sequences. CONCLUSION: A free-breathing abdominal MR protocol in pediatric TSC patients decreases scan time and improves image quality and should be considered more widely for abdominal MRI in children.

Simultaneous multi-slice accelerated turbo spin echo of the knee in pediatric patients.

PURPOSE: To compare knee MRI performed with the integrated parallel acquisition technique (PAT) and simultaneous multislice (SMS) turbo spin echo (TSE) T2-weighted (T2w) sequences with conventional TSE sequences in pediatric patients. MATERIALS AND METHODS: This was a retrospective IRB-approved study. Seventy-four subjects (26 male, 48 female, mean age 15.3 years, range 8-20) underwent 3-T MRI of the knee with a T2w TSE pulse sequence prototype with four-fold PAT and SMS acceleration as well as the standard PAT-only accelerated sequences. Images were anonymized and two study folders were created: one examination with only T2w PAT2 images (conventional examination) and one examination with only T2w SMS2/PAT2 sequences (SMS examination). Two readers rated examinations for 15 specific imaging findings and 5 quality metrics. Interreader agreement was measured. Signal to noise (SNR) and contrast to noise (CNR) were measured for SMS and conventional T2w sequences. RESULTS: Consensus review demonstrated diagnostic quality performance of SMS examinations with respect to all 15 structures. Average area under the curve (AROC) was 0.95 and 0.97 for readers 1 and 2, respectively. The conventional sequence was favored over SMS for four out of five quality metrics (p < 0.001). SNR and CNR were higher for the conventional sequences compared to SMS. CONCLUSION: SMS accelerated T2w TSE sequences offer a faster alternative for knee imaging in pediatric patients without compromise in diagnostic performance despite diminished SNR. The four-fold acceleration of SMS is beneficial to pediatric patients who often have difficulty staying still for long MRI examinations.

Simultaneous Multislice-Based 5-Minute Lumbar Spine MRI Protocol: Initial Experience in a Clinical Setting.

BACKGROUND AND PURPOSE: Previous studies have used parallel imaging (PI) techniques to decrease spine magnetic resonance imaging (MRI) protocol acquisition times. Recently developed MRI sequences allow even faster acquisitions. Our purpose was to develop a lumbar spine MRI protocol using PI with GRAPPA (generalized autocalibrating partially parallel acquisition) and a simultaneous multislice (SMS)-based sequence and to evaluate its diagnostic performance compared to a standard lumbar spine MRI protocol. METHODS: Ten patients were scanned in a 3-Tesla scanner (MAGNETOM Skyra, Siemens Healthcare). Each patient was imaged using a standard protocol and an optimized fast protocol acquiring the same contrasts and planes. The fast protocol included sagittal T1, T2, and fat suppressed T2 sequences accelerated with GRAPPA and an SMS-based axial T2-weighted sequence using a high-density spine coil (Siemens MR, 30 channel spine). Two blinded neuroradiologists independently assessed image quality and diagnostic accuracy for clinically relevant imaging findings. RESULTS: The fast protocol acquisition time was 5:28 minutes, compared with 16:30 minutes for the standard protocol. Both protocols had a similar performance for definition of anatomical structures, diagnostic quality, and identification of clinically relevant imaging findings. There were more artifacts in the SMS Turbo Spin Echo (P = .014) sequence without compromising diagnostic performance. Artifacts in the remaining non-SMS sequences were similar in both protocols (P > .180). The sensitivity, specificity, and accuracy of the 5-minute protocol were 92.3%, 100.0%, and 99.6%, respectively, for the clinically relevant findings (P = 1.0, interrater agreement .57). CONCLUSIONS: A 5-minute SMS-based MRI protocol for lumbar spine imaging is feasible and can be achieved without significant impact in the overall diagnostic quality.

PET/MRI in the Presence of Metal Implants: Completion of the Attenuation Map from PET Emission Data.

We present a novel technique for accurate whole-body attenuation correction in the presence of metallic endoprosthesis, on integrated non-time-of-flight (non-TOF) PET/MRI scanners. The proposed implant PET-based attenuation map completion (IPAC) method performs a joint reconstruction of radioactivity and attenuation from the emission data to determine the position, shape, and linear attenuation coefficient (LAC) of metallic implants. Methods: The initial estimate of the attenuation map was obtained using the MR Dixon method currently available on the Siemens Biograph mMR scanner. The attenuation coefficients in the area of the MR image subjected to metal susceptibility artifacts are then reconstructed from the PET emission data using the IPAC algorithm. The method was tested on 11 subjects presenting 13 different metallic implants, who underwent CT and PET/MR scans. Relative mean LACs and Dice similarity coefficients were calculated to determine the accuracy of the reconstructed attenuation values and the shape of the metal implant, respectively. The reconstructed PET images were compared with those obtained using the reference CT-based approach and the Dixon-based method. Absolute relative change (aRC) images were generated in each case, and voxel-based analyses were performed. Results: The error in implant LAC estimation, using the proposed IPAC algorithm, was 15.7% ± 7.8%, which was significantly smaller than the Dixon- (100%) and CT- (39%) derived values. A mean Dice similarity coefficient of 73% ± 9% was obtained when comparing the IPAC- with the CT-derived implant shape. The voxel-based analysis of the reconstructed PET images revealed quantification errors (aRC) of 13.2% ± 22.1% for the IPAC- with respect to CT-corrected images. The Dixon-based method performed substantially worse, with a mean aRC of 23.1% ± 38.4%. Conclusion: We have presented a non-TOF emission-based approach for estimating the attenuation map in the presence of metallic implants, to be used for whole-body attenuation correction in integrated PET/MR scanners. The Graphics Processing Unit implementation of the algorithm will be included in the open-source reconstruction toolbox Occiput.io.

In vivo estimation of gamma-aminobutyric acid levels in the neonatal brain.

Gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the brain, and plays a key role in brain development. However, the in vivo levels of brain GABA in early life are unknown. Using edited MRS, in vivo GABA can be detected as GABA+ signal with contamination of macromolecule signals. GABA+ is evaluated as the peak ratio of GABA+/reference compound, for which creatine (Cr) or water is typically used. However, the concentrations and T1 and T2 relaxation times of these references change during development. Thus, the peak ratio comparison between neonates and children may be inaccurate. The aim of this study was to measure in vivo neonatal brain GABA+ levels, and to investigate the dependency of GABA levels on brain region and age. The basal ganglia and cerebellum of 38 neonates and 12 children were measured using GABA-edited MRS. Two different approaches were used to obtain GABA+ levels: (i) multiplying the GABA/water ratio by the water concentration; and (ii) multiplying the GABA+/Cr by the Cr concentration. Neonates exhibited significantly lower GABA+ levels compared with children in both regions, regardless of the approach employed, consistent with previous ex vivo data. A similar finding of lower GABA+/water and GABA+/Cr in neonates compared with children was observed, except for GABA+/Cr in the cerebellum. This contrasting finding resulted from significantly lower Cr concentrations in the neonate cerebellum, which were approximately 52% of those of children. In conclusion, care should be taken to consider Cr concentrations when comparing GABA+/Cr levels between different-aged subjects.

Ultrafast Brain MRI: Clinical Deployment and Comparison to Conventional Brain MRI at 3T.

BACKGROUND AND PURPOSE: To compare an ultrafast brain magnetic resonance imaging (MRI) protocol to the conventional protocol in motion-prone inpatient clinical settings. METHODS: This retrospective study was HIPAA compliant and approved by the Institutional Review Board with waived inform consent. Fifty-nine inpatients (30 males, 29 females; mean age 55.1, range 23-93 years)who underwent 3-Tesla brain MRI using ultrafast and conventional protocols, both including five sequences, were included in the study. The total scan time for five ultrafast sequences was 4 minutes 59 seconds. The ideal conventional acquisition time was 10 minutes 32 seconds but the actual acquisition took 15-20 minutes. The average scan times for ultrafast localizers, T1-weighted, T2-weighted, fluid-attenuated inversion recovery (FLAIR), diffusion-weighted, T2*-weighted sequences were 14, 41, 62, 96, 80, 6 seconds, respectively. Two blinded neuroradiologists independently assessed three aspects: (1) image quality, (2) gray-white matter (GM-WM) differentiation, and (3) diagnostic concordance for the detection of six clinically relevant imaging findings. Wilcoxon signed-rank test was used to compare image quality and GM-WM scores. Interobserver reproducibility was calculated. RESULTS: The ultrafast T1-weighted sequence demonstrated significantly better image quality (P = .005) and GM-WM differentiation (P < .001) compared to the conventional sequence. There was high agreement (>85%) between both protocols for the detection of mass-like lesion, hemorrhage, diffusion restriction, WM FLAIR hyperintensities, subarachnoid FLAIR hyperintensities, and hydrocephalus. CONCLUSIONS: The ultrafast protocol achieved at least comparable image quality and high diagnostic concordance compared to the conventional protocol. This fast protocol can be a viable option to replace the conventional protocol in motion-prone inpatient clinical settings.

Pulsed arterial spin labelling at ultra-high field with a B 1 (+) -optimised adiabatic labelling pulse.

OBJECTIVE: Arterial spin labelling (ASL) techniques benefit from the increased signal-to-noise ratio and the longer T 1 relaxation times available at ultra-high field. Previous pulsed ASL studies at 7 T concentrated on the superior regions of the brain because of the larger transmit radiofrequency inhomogeneity experienced at ultra-high field that hinders an adequate inversion of the blood bolus when labelling in the neck. Recently, researchers have proposed to overcome this problem with either the use of dielectric pads, through dedicated transmit labelling coils, or special adiabatic inversion pulses. MATERIALS AND METHODS: We investigate the performance of an optimised time-resampled frequency-offset corrected inversion (TR-FOCI) pulse designed to cause inversion at much lower peak B 1 (+) . In combination with a PICORE labelling, the perfusion signal obtained with this pulse is compared against that obtained with a FOCI pulse, with and without dielectric pads. RESULTS: Mean grey matter perfusion with the TR-FOCI was 52.5 ± 10.3 mL/100 g/min, being significantly higher than the 34.6 ± 2.6 mL/100 g/min obtained with the FOCI pulse. No significant effect of the dielectric pads was observed. CONCLUSION: The usage of the B 1 (+) -optimised TR-FOCI pulse results in a significantly higher perfusion signal. PICORE-ASL is feasible at ultra-high field with no changes to operating conditions.

Reducing sensitivity losses due to respiration and motion in accelerated echo planar imaging by reordering the autocalibration data acquisition.

PURPOSE: To reduce the sensitivity of echo-planar imaging (EPI) auto-calibration signal (ACS) data to patient respiration and motion to improve the image quality and temporal signal-to-noise ratio (tSNR) of accelerated EPI time-series data. METHODS: ACS data for accelerated EPI are generally acquired using segmented, multishot EPI to distortion-match the ACS and time-series data. The ACS data are, therefore, typically collected over multiple TR periods, leading to increased vulnerability to motion and dynamic B0 changes. The fast low-angle excitation echo-planar technique (FLEET) is adopted to reorder the ACS segments so that segments within any given slice are acquired consecutively in time, thereby acquiring ACS data for each slice as rapidly as possible. RESULTS: Subject breathhold and motion phantom experiments demonstrate that artifacts in the ACS data reduce tSNR and produce tSNR discontinuities across slices in the accelerated EPI time-series data. Accelerated EPI data reconstructed using FLEET-ACS exhibit improved tSNR and increased tSNR continuity across slices. Additionally, image quality is improved dramatically when bulk motion occurs during the ACS acquisition. CONCLUSION: FLEET-ACS provides reduced respiration and motion sensitivity in accelerated EPI, which yields higher tSNR and image quality. Benefits are demonstrated in both conventional-resolution 3T and high-resolution 7T EPI time-series data.

Imaging human connectomes at the macroscale.

At macroscopic scales, the human connectome comprises anatomically distinct brain areas, the structural pathways connecting them and their functional interactions. Annotation of phenotypic associations with variation in the connectome and cataloging of neurophenotypes promise to transform our understanding of the human brain. In this Review, we provide a survey of magnetic resonance imaging­based measurements of functional and structural connectivity. We highlight emerging areas of development and inquiry and emphasize the importance of integrating structural and functional perspectives on brain architecture.

The Human Connectome Project and beyond: initial applications of 300 mT/m gradients.

The engineering of a 3 T human MRI scanner equipped with 300 mT/m gradients - the strongest gradients ever built for an in vivo human MRI scanner - was a major component of the NIH Blueprint Human Connectome Project (HCP). This effort was motivated by the HCP's goal of mapping, as completely as possible, the macroscopic structural connections of the in vivo healthy, adult human brain using diffusion tractography. Yet, the 300 mT/m gradient system is well suited to many additional types of diffusion measurements. Here, we present three initial applications of the 300 mT/m gradients that fall outside the immediate scope of the HCP. These include: 1) diffusion tractography to study the anatomy of consciousness and the mechanisms of brain recovery following traumatic coma; 2) q-space measurements of axon diameter distributions in the in vivo human brain and 3) postmortem diffusion tractography as an adjunct to standard histopathological analysis. We show that the improved sensitivity and diffusion-resolution provided by the gradients are rapidly enabling human applications of techniques that were previously possible only for in vitro and animal models on small-bore scanners, thereby creating novel opportunities to map the microstructure of the human brain in health and disease.

[Decreased occipital GABA concentrations in patients with first-episode major depressive disorder: a magnetic resonance spectroscopy study].

Gamma amino butyric acid (GABA) is the major inhibitory neurotransmitter in the human brain. Alterations in GABAergic function are associated with a variety of neurological and psychiatric disorders. However, noninvasive in vivo measurement of GABA is difficult because of its low concentration and the presence of overlapping resonances. To study GABA concentration in the occipital cortex in major depressive disorder (MDD), a group of medication-naive, first episode depressed patients (n = 18, HAMD > 17), and a group of healthy controls (n = 23) were investigated using a Point Resolved Spectroscopy (MEGA-PRESS) on a 3.0 T MR scanner. The results showed that occipital GABA levels were significantly lower (P < 0.001) in the patient group than those in the healthy controls, yet the correlations between the severity of MDD (HAMD, BDI) and the GABA concentration is insignificant. Therefore, our data suggest that patients with first episode, unmedicated MDD have changes in cortical concentrations of GABA. This biochemical abnormality may be a marker of a trait vulnerability to mood disorder, and may explain the visual problem of severe MDD patients.

Diffusion imaging in humans at 7T using readout-segmented EPI and GRAPPA.

Anatomical MRI studies at 7T have demonstrated the ability to provide high-quality images of human tissue in vivo. However, diffusion-weighted imaging at 7T is limited by the increased level of artifact associated with standard, single-shot, echo-planar imaging, even when parallel imaging techniques such as generalized autocalibrating partially parallel acquisitions (GRAPPA) are used to reduce the effective echo spacing. Readout-segmented echo-planar imaging in conjunction with parallel imaging has the potential to reduce these artifacts by allowing a further reduction in effective echo spacing during the echo-planar imaging readout. This study demonstrates that this approach does indeed provide a substantial improvement in image quality by reducing image blurring and susceptibility-based distortions, as well as by allowing the acquisition of diffusion-weighted images with a high spatial resolution. A preliminary application of the technique to high-resolution diffusion tensor imaging provided a high level of neuroanatomical detail, which should prove valuable in a wide range of applications.

Evaluation of optimized inversion-recovery fat-suppression techniques for T2-weighted abdominal MR imaging.

PURPOSE: To test the theoretical benefits of a spectral attenuated inversion-recovery (SPAIR) fat-suppression (FS) technique in clinical abdominal MRI by comparison to conventional inversion-recovery (IR) FS combined with T2-weighted (T2W) partial Fourier single shot fast spin echo (SSFSE). MATERIALS AND METHODS: 1.5T MRI studies of the abdomen were performed in 28 patients with liver lesions (hemangiomas n = 14; metastases n = 14). T2W sequences were acquired using IR and SPAIR SSFSE. Measurements included retroperitoneal and mesenteric fat signal-to-noise (SNR) to evaluate FS; liver lesion contrast-to-noise (CNR) to evaluate bulk water signal recovery effects; and bowel wall delineation to evaluate susceptibility and physiological motion effects. RESULTS: SPAIR-SSFSE images produce significantly improved FS and liver lesion CNR. The mean SNR of the retroperitoneal and mesenteric fat for SPAIR SSFSE was 20.5 +/- 10.2 (+/-1 SD) and 12.7 +/- 6.2, compared to 43.2 +/- 24.1 (P = 0.000006) and 29.3 +/- 16.8 (P = 0.0000005) for IR-SSFSE. SPAIR-SSFSE images produced higher CNR for both hemangiomas CNR = 164 +/- 88 vs. 126 +/- 83 (P = 0.00005) and metastases CNR = 75 +/- 27 vs. 53 +/- 19 (P = 0.007). Bowel wall visualization was significantly improved using SPAIR-SSFSE (P = 0.002). CONCLUSION: The theoretical benefits of SPAIR over conventional IR FS translate into significant multiple improvements that can be measured on clinical abdominal MRI scans.

Cross-validation-based kernel support selection for improved GRAPPA reconstruction.

The extended version of the generalized autocalibrating partially parallel acquisition (GRAPPA) technique incorporates multiple lines and multiple columns of measured k-space data to estimate missing data. For a given accelerated dataset, the selection of the measured data points for fitting a missing datum (i.e., the kernel support) that provides optimal reconstruction depends on coil array configuration, noise level in the acquired data, imaging configuration, and number and position of autocalibrating signal lines. In this work, cross-validation is used to select the kernel support that best balances the conflicting demands of fit accuracy and stability in GRAPPA reconstruction. The result is an optimized tradeoff between artifacts and noise. As demonstrated with experimental data, the method improves image reconstruction with GRAPPA. Because the method is simple and applied in postprocessing, it can be used with GRAPPA routinely.

Auto-calibrated parallel spiral imaging.

This work describes an auto-calibrated method for parallel imaging with spiral trajectory. The method is a k-space approach where an interpolation kernel, accounting for coil sensitivity factors, is derived from experimental data and used to interpolate the reduced data set in parallel imaging to estimate the missing k-space data. For the case of spiral imaging, this interpolation kernel is defined along radial directions so that missing spiral interleaves can be estimated directly from neighboring interleaves. This kernel is invariant along the radial direction but varies azimuthally. Therefore, the k-space is divided into angular sectors and sector-specific kernels are used. It is demonstrated experimentally that relatively few sectors are sufficient for accurate reconstruction, allowing for efficient implementation. The interpolation kernels can be derived either from a separate calibration scan or self-calibration data available with a dual-density spiral acquisition. The reconstruction method is implemented with two sampling strategies and experimentally demonstrated to be robust.

New double quantum coherence filter for localized detection of glutathione in vivo.

In this work, a new double quantum filter for glutathione (GSH) editing is introduced, combined with the point-resolved spectroscopy localization sequence (PRESS), and demonstrated in vivo. Compared to the conventional double quantum coherence filter, the new filter has two major advantages. First, it eliminates the need for calibration scans for optimizing the signal yield, making it more efficient and convenient for routine use. Second, it removes the influence of water saturation pulses on the GSH yield, further improving its accuracy. With this method, GSH concentrations in the left and right parietal lobes of five healthy volunteers were determined to be 0.91+/-0.16 mM and 0.89+/-0.16 mM, respectively, in agreement with previous studies.

Progressive magnetic resonance image reconstruction based on iterative solution of a sparse linear system.

Image reconstruction from nonuniformly sampled spatial frequency domain data is an important problem that arises in computed imaging. Current reconstruction techniques suffer from limitations in their model and implementation. In this paper, we present a new reconstruction method that is based on solving a system of linear equations using an efficient iterative approach. Image pixel intensities are related to the measured frequency domain data through a set of linear equations. Although the system matrix is too dense and large to solve by direct inversion in practice, a simple orthogonal transformation to the rows of this matrix is applied to convert the matrix into a sparse one up to a certain chosen level of energy preservation. The transformed system is subsequently solved using the conjugate gradient method. This method is applied to reconstruct images of a numerical phantom as well as magnetic resonance images from experimental spiral imaging data. The results support the theory and demonstrate that the computational load of this method is similar to that of standard gridding, illustrating its practical utility.

Inherent insensitivity to RF inhomogeneity in FLASH imaging.

Radiofrequency (RF) field inhomogeneity is an unavoidable problem in MRI, and it becomes severe at high magnetic fields due to the dependence of B1 on the sample. It leads to nonuniformities in image intensity and contrast, causing difficulties in quantitative interpretation and image segmentation. In this work, it is observed that with the fast low-angle shot (FLASH) sequence, which is often used for anatomic imaging and morphometric studies, sensitivity to RF inhomogeneity can be substantially reduced when the same coil is used for both transmission and reception, and an appropriate nominal flip angle is employed. This observation can help us understand the signal behavior of FLASH in the presence of RF inhomogeneity, and provide a guide for selecting parameters in FLASH imaging.

Floating navigator echo (FNAV) for in-plane 2D translational motion estimation.

A modification of the classical navigator echo (NAV) technique is presented whereby both 2D translational motion components are computed from a single navigator line. Instead of acquiring the NAV at the center of the k-space, a kx line is acquired off-center in the phase-encoding (ky) direction as a floating NAV (FNAV). It is shown that the translational motion in both the readout and phase-encoding directions can be computed from this line. The algorithm used is described in detail and verified experimentally. The new technique can be readily implemented to replace classic NAV in MRI sequences, with little to no additional cost or complexity. The new method can help suppress 2D translational motion and provide more accurate motion estimates for other motion-suppression techniques, such as the diminishing variance algorithm.

Simultaneous acquisition of gradient-echo and asymmetric spin-echo for single-shot z-shim: Z-SAGA.

This article describes the Z-SAGA pulse sequence, a technique for recovering susceptibility losses in EPI images for neuroimaging applications. The pulse sequence is based on an asymmetric spin echo EPI sequence and acquires a gradient echo image and an asymmetric spin echo image in a single shot. For one of the images, a z-shim gradient pulse is applied to compensate for susceptibility-related field distortions. The two images are combined to form an image with reduced signal loss. This sequence is simple to implement and experimentally demonstrated to be effective for BOLD imaging.