Blood-brain barrier integrity is linked to cognitive function, but not to cerebral arterial pulsatility, among elderly.

Blood-brain barrier (BBB) disruption may contribute to cognitive decline, but questions remain whether this association is more pronounced for certain brain regions, such as the hippocampus, or represents a whole-brain mechanism. Further, whether human BBB leakage is triggered by excessive vascular pulsatility, as suggested by animal studies, remains unknown. In a prospective cohort (N = 50; 68-84 years), we used contrast-enhanced MRI to estimate the permeability-surface area product (PS) and fractional plasma volume ( v p ), and 4D flow MRI to assess cerebral arterial pulsatility. Cognition was assessed by the Montreal Cognitive Assessment (MoCA) score. We hypothesized that high PS would be associated with high arterial pulsatility, and that links to cognition would be specific to hippocampal PS. For 15 brain regions, PS ranged from 0.38 to 0.85 (·10-3 min-1) and v p from 0.79 to 1.78%. Cognition was related to PS (·10-3 min-1) in hippocampus (ß = - 2.9; p = 0.006), basal ganglia (ß = - 2.3; p = 0.04), white matter (ß = - 2.6; p = 0.04), whole-brain (ß = - 2.7; p = 0.04) and borderline-related for cortex (ß = - 2.7; p = 0.076). Pulsatility was unrelated to PS for all regions (p > 0.19). Our findings suggest PS-cognition links mainly reflect a whole-brain phenomenon with only slightly more pronounced links for the hippocampus, and provide no evidence of excessive pulsatility as a trigger of BBB disruption.

Cerebral arterial stiffness is linked to white matter hyperintensities and perivascular spaces in older adults - A 4D flow MRI study.

White matter hyperintensities (WMH), perivascular spaces (PVS) and lacunes are common MRI features of small vessel disease (SVD). However, no shared underlying pathological mechanism has been identified. We investigated whether SVD burden, in terms of WMH, PVS and lacune status, was related to changes in the cerebral arterial wall by applying global cerebral pulse wave velocity (gcPWV) measurements, a newly described marker of cerebral vascular stiffness. In a population-based cohort of 190 individuals, 66-85 years old, SVD features were estimated from T1-weighted and FLAIR images while gcPWV was estimated from 4D flow MRI data. Additionally, the gcPWV's stability to variations in field-of-view was analyzed. The gcPWV was 10.82 (3.94) m/s and displayed a significant correlation to WMH and white matter PVS volume (r = 0.29, p < 0.001; r = 0.21, p = 0.004 respectively from nonparametric tests) that persisted after adjusting for age, blood pressure variables, body mass index, ApoB/A1 ratio, smoking as well as cerebral pulsatility index, a previously suggested early marker of SVD. The gcPWV displayed satisfactory stability to field-of-view variations. Our results suggest that SVD is accompanied by changes in the cerebral arterial wall that can be captured by considering the velocity of the pulse wave transmission through the cerebral arterial network.

Improving MR image quality with a multi-task model, using convolutional losses.

PURPOSE: During the acquisition of MRI data, patient-, sequence-, or hardware-related factors can introduce artefacts that degrade image quality. Four of the most significant tasks for improving MRI image quality have been bias field correction, super-resolution, motion-, and noise correction. Machine learning has achieved outstanding results in improving MR image quality for these tasks individually, yet multi-task methods are rarely explored. METHODS: In this study, we developed a model to simultaneously correct for all four aforementioned artefacts using multi-task learning. Two different datasets were collected, one consisting of brain scans while the other pelvic scans, which were used to train separate models, implementing their corresponding artefact augmentations. Additionally, we explored a novel loss function that does not only aim to reconstruct the individual pixel values, but also the image gradients, to produce sharper, more realistic results. The difference between the evaluated methods was tested for significance using a Friedman test of equivalence followed by a Nemenyi post-hoc test. RESULTS: Our proposed model generally outperformed other commonly-used correction methods for individual artefacts, consistently achieving equal or superior results in at least one of the evaluation metrics. For images with multiple simultaneous artefacts, we show that the performance of using a combination of models, trained to correct individual artefacts depends heavily on the order that they were applied. This is not an issue for our proposed multi-task model. The model trained using our novel convolutional loss function always outperformed the model trained with a mean squared error loss, when evaluated using Visual Information Fidelity, a quality metric connected to perceptual quality. CONCLUSION: We trained two models for multi-task MRI artefact correction of brain, and pelvic scans. We used a novel loss function that significantly improves the image quality of the outputs over using mean squared error. The approach performs well on real world data, and it provides insight into which artefacts it detects and corrects for. Our proposed model and source code were made publicly available.

Towards MR contrast independent synthetic CT generation.

The use of synthetic CT (sCT) in the radiotherapy workflow would reduce costs and scan time while removing the uncertainties around working with both MR and CT modalities. The performance of deep learning (DL) solutions for sCT generation is steadily increasing, however most proposed methods were trained and validated on private datasets of a single contrast from a single scanner. Such solutions might not perform equally well on other datasets, limiting their general usability and therefore value. Additionally, functional evaluations of sCTs such as dosimetric comparisons with CT-based dose calculations better show the impact of the methods, but the evaluations are more labor intensive than pixel-wise metrics. To improve the generalization of an sCT model, we propose to incorporate a pre-trained DL model to pre-process the input MR images by generating artificial proton density, T1 and T2 maps (i.e. contrast-independent quantitative maps), which are then used for sCT generation. Using a dataset of only T2w MR images, the robustness towards input MR contrasts of this approach is compared to a model that was trained using the MR images directly. We evaluate the generated sCTs using pixel-wise metrics and calculating mean radiological depths, as an approximation of the mean delivered dose. On T2w images acquired with the same settings as the training dataset, there was no significant difference between the performance of the models. However, when evaluated on T1w images, and a wide range of other contrasts and scanners from both public and private datasets, our approach outperforms the baseline model. Using a dataset of T2w MR images, our proposed model implements synthetic quantitative maps to generate sCT images, improving the generalization towards other contrasts. Our code and trained models are publicly available.

Denoising and uncertainty estimation in parameter mapping with approximate Bayesian deep image priors.

PURPOSE: To mitigate the problem of noisy parameter maps with high uncertainties by casting parameter mapping as a denoising task based on Deep Image Priors. METHODS: We extend the concept of denoising with Deep Image Prior (DIP) into parameter mapping by treating the output of an image-generating network as a parametrization of tissue parameter maps. The method implicitly denoises the parameter mapping process by filtering low-level image features with an untrained convolutional neural network (CNN). Our implementation includes uncertainty estimation from Bernoulli approximate variational inference, implemented with MC dropout, which provides model uncertainty in each voxel of the denoised parameter maps. The method is modular, so the specifics of different applications (e.g., T1 mapping) separate into application-specific signal equation blocks. We evaluate the method on variable flip angle T1 mapping, multi-echo T2 mapping, and apparent diffusion coefficient mapping. RESULTS: We found that deep image prior adapts successfully to several applications in parameter mapping. In all evaluations, the method produces noise-reduced parameter maps with decreased uncertainty compared to conventional methods. The downsides of the proposed method are the long computational time and the introduction of some bias from the denoising prior. CONCLUSION: DIP successfully denoise the parameter mapping process and applies to several applications with limited hyperparameter tuning. Further, it is easy to implement since DIP methods do not use network training data. Although time-consuming, uncertainty information from MC dropout makes the method more robust and provides useful information when properly calibrated.

Assessing cerebral arterial pulse wave velocity using 4D flow MRI.

Intracranial arterial stiffening is a potential early marker of emerging cerebrovascular dysfunction and could be mechanistically involved in disease processes detrimental to brain function via several pathways. A prominent consequence of arterial wall stiffening is the increased velocity at which the systolic pressure pulse wave propagates through the vasculature. Previous non-invasive measurements of the pulse wave propagation have been performed on the aorta or extracranial arteries with results linking increased pulse wave velocity to brain pathology. However, there is a lack of intracranial "target-organ" measurements. Here we present a 4D flow MRI method to estimate pulse wave velocity in the intracranial vascular tree. The method utilizes the full detectable branching structure of the cerebral vascular tree in an optimization framework that exploits small temporal shifts that exists between waveforms sampled at varying depths in the vasculature. The method is shown to be stable in an internal consistency test, and of sufficient sensitivity to robustly detect age-related increases in intracranial pulse wave velocity.

Bayesian non-linear regression with spatial priors for noise reduction and error estimation in quantitative MRI with an application in T1 estimation.

PURPOSE: To develop a method that can reduce and estimate uncertainty in quantitative MR parameter maps without the need for hand-tuning of any hyperparameters. METHODS: We present an estimation method where uncertainties are reduced by incorporating information on spatial correlations between neighbouring voxels. The method is based on a Bayesian hierarchical non-linear regression model, where the parameters of interest are sampled, using Markov chain Monte Carlo (MCMC), from a high-dimensional posterior distribution with a spatial prior. The degree to which the prior affects the model is determined by an automatic hyperparameter search using an information criterion and is, therefore, free from manual user-dependent tuning. The samples obtained further provide a convenient means to obtain uncertainties in both voxels and regions. The developed method was evaluated on T 1 estimations based on the variable flip angle method. RESULTS: The proposed method delivers noise-reduced T 1 parameter maps with associated error estimates by combining MCMC sampling, the widely applicable information criterion, and total variation-based denoising. The proposed method results in an overall decrease in estimation error when compared to conventional voxel-wise maximum likelihood estimation. However, this comes with an increased bias in some regions, predominately at tissue interfaces, as well as an increase in computational time. CONCLUSIONS: This study provides a method that generates more precise estimates compared to the conventional method, without incorporating user subjectivity, and with the added benefit of uncertainty estimation.

Sensitivity analysis of different quality assurance methods for magnetic resonance imaging in radiotherapy.

BACKGROUND AND PURPOSE: There are currently no standard quality assurance (QA) methods for magnetic resonance imaging (MRI) in radiotherapy (RT). This work was aimed at evaluating the ability of two QA protocols to detect common events that affect quality of MR images under RT settings. MATERIALS AND METHODS: The American College of Radiology (ACR) MRI QA phantom was repeatedly scanned using a flexible coil and action limits for key image quality parameters were derived. Using an exploratory survey, issues that reduce MR image quality were identified. The most commonly occurring events were introduced as provocations to produce MR images with degraded quality. From these images, detection sensitivities of the ACR MRI QA protocol and a commercial geometric accuracy phantom were determined. RESULTS: Machine-specific action limits for key image quality parameters set at mean ± 3 σ were comparable with the ACR acceptable values. For the geometric accuracy phantom, provocations from uncorrected gradient nonlinearity effects and a piece of metal in the bore of the scanner resulted in worst distortions of 22.2 mm and 3.4 mm, respectively. The ACR phantom was sensitive to uncorrected signal variations, electric interference and a piece of metal in the bore of the scanner but could not adequately detect individual coil element failures. CONCLUSIONS: The ACR MRI QA phantom combined with the large field-of-view commercial geometric accuracy phantom were generally sensitive in identifying some common MR image quality issues. The two protocols when combined may provide a tool to monitor the performance of MRI systems in the radiotherapy environment.

Gray-level invariant Haralick texture features.

Haralick texture features are common texture descriptors in image analysis. To compute the Haralick features, the image gray-levels are reduced, a process called quantization. The resulting features depend heavily on the quantization step, so Haralick features are not reproducible unless the same quantization is performed. The aim of this work was to develop Haralick features that are invariant to the number of quantization gray-levels. By redefining the gray-level co-occurrence matrix (GLCM) as a discretized probability density function, it becomes asymptotically invariant to the quantization. The invariant and original features were compared using logistic regression classification to separate two classes based on the texture features. Classifiers trained on the invariant features showed higher accuracies, and had similar performance when training and test images had very different quantizations. In conclusion, using the invariant Haralick features, an image pattern will give the same texture feature values independent of image quantization.

Dosimetric Impact of MRI Distortions: A Study on Head and Neck Cancers.

PURPOSE: To evaluate the effect of magnetic resonance (MR) imaging (MRI) geometric distortions on head and neck radiation therapy treatment planning (RTP) for an MRI-only RTP. We also assessed the potential benefits of patient-specific shimming to reduce the magnitude of MR distortions for a 3-T scanner. METHODS AND MATERIALS: Using an in-house Matlab algorithm, shimming within entire imaging volumes and user-defined regions of interest were simulated. We deformed 21 patient computed tomography (CT) images with MR distortion fields (gradient nonlinearity and patient-induced susceptibility effects) to create distorted CT (dCT) images using bandwidths of 122 and 488 Hz/mm at 3 T. Field parameters from volumetric modulated arc therapy plans initially optimized on dCT data sets were transferred to CT data to compute a new plan. Both plans were compared to determine the impact of distortions on dose distributions. RESULTS: Shimming across entire patient volumes decreased the percentage of voxels with distortions of more than 2 mm from 15.4% to 2.0%. Using the user-defined region of interest (ROI) shimming strategy, (here the Planning target volume (PTV) was the chosen ROI volume) led to increased geometric for volumes outside the PTV, as such voxels within the spinal cord with geometric shifts above 2 mm increased from 11.5% to 32.3%. The worst phantom-measured residual system distortions after 3-dimensional gradient nonlinearity correction within a radial distance of 200 mm from the isocenter was 2.17 mm. For all patients, voxels with distortion shifts of more than 2 mm resulting from patient-induced susceptibility effects were 15.4% and 0.0% using bandwidths of 122 Hz/mm and 488 Hz/mm at 3 T. Dose differences between dCT and CT treatment plans in D50 at the planning target volume were 0.4% ± 0.6% and 0.3% ± 0.5% at 122 and 488 Hz/mm, respectively. CONCLUSIONS: The overall effect of MRI geometric distortions on data used for RTP was minimal. Shimming over entire imaging volumes decreased distortions, but user-defined subvolume shimming introduced significant errors in nearby organs and should probably be avoided.

Statistical learning in computed tomography image estimation.

PURPOSE: There is increasing interest in computed tomography (CT) image estimations from magnetic resonance (MR) images. The estimated CT images can be utilized for attenuation correction, patient positioning, and dose planning in diagnostic and radiotherapy workflows. This study aims to introduce a novel statistical learning approach for improving CT estimation from MR images and to compare the performance of our method with the existing model-based CT image estimation methods. METHODS: The statistical learning approach proposed here consists of two stages. At the training stage, prior knowledge about tissue types from CT images was used together with a Gaussian mixture model (GMM) to explore CT image estimations from MR images. Since the prior knowledge is not available at the prediction stage, a classifier based on RUSBoost algorithm was trained to estimate the tissue types from MR images. For a new patient, the trained classifier and GMMs were used to predict CT image from MR images. The classifier and GMMs were validated by using voxel-level tenfold cross-validation and patient-level leave-one-out cross-validation, respectively. RESULTS: The proposed approach has outperformance in CT estimation quality in comparison with the existing model-based methods, especially on bone tissues. Our method improved CT image estimation by 5% and 23% on the whole brain and bone tissues, respectively. CONCLUSIONS: Evaluation of our method shows that it is a promising method to generate CT image substitutes for the implementation of fully MR-based radiotherapy and PET/MRI applications.

Density estimation of grey-level co-occurrence matrices for image texture analysis.

The Haralick texture features are common in the image analysis literature, partly because of their simplicity and because their values can be interpreted. It was recently observed that the Haralick texture features are very sensitive to the size of the GLCM that was used to compute them, which led to a new formulation that is invariant to the GLCM size. However, these new features still depend on the sample size used to compute the GLCM, i.e. the size of the input image region-of-interest (ROI). The purpose of this work was to investigate the performance of density estimation methods for approximating the GLCM and subsequently the corresponding invariant features. Three density estimation methods were evaluated, namely a piece-wise constant distribution, the Parzen-windows method, and the Gaussian mixture model. The methods were evaluated on 29 different image textures and 20 invariant Haralick texture features as well as a wide range of different ROI sizes. The results indicate that there are two types of features: those that have a clear minimum error for a particular GLCM size for each ROI size, and those whose error decreases monotonically with increased GLCM size. For the first type of features, the Gaussian mixture model gave the smallest errors, and in particular for small ROI sizes (less than about [Formula: see text]). In conclusion, the Gaussian mixture model is the preferred method for the first type of features (in particular for small ROIs). For the second type of features, simply using a large GLCM size is preferred.

Parameter estimation using weighted total least squares in the two-compartment exchange model.

PURPOSE: The linear least squares (LLS) estimator provides a fast approach to parameter estimation in the linearized two-compartment exchange model. However, the LLS method may introduce a bias through correlated noise in the system matrix of the model. The purpose of this work is to present a new estimator for the linearized two-compartment exchange model that takes this noise into account. METHOD: To account for the noise in the system matrix, we developed an estimator based on the weighted total least squares (WTLS) method. Using simulations, the proposed WTLS estimator was compared, in terms of accuracy and precision, to an LLS estimator and a nonlinear least squares (NLLS) estimator. RESULTS: The WTLS method improved the accuracy compared to the LLS method to levels comparable to the NLLS method. This improvement was at the expense of increased computational time; however, the WTLS was still faster than the NLLS method. At high signal-to-noise ratio all methods provided similar precisions while inconclusive results were observed at low signal-to-noise ratio. CONCLUSION: The proposed method provides improvements in accuracy compared to the LLS method, however, at an increased computational cost. Magn Reson Med 79:561-567, 2017. © 2017 International Society for Magnetic Resonance in Medicine.

Haralick texture features from apparent diffusion coefficient (ADC) MRI images depend on imaging and pre-processing parameters.

In recent years, texture analysis of medical images has become increasingly popular in studies investigating diagnosis, classification and treatment response assessment of cancerous disease. Despite numerous applications in oncology and medical imaging in general, there is no consensus regarding texture analysis workflow, or reporting of parameter settings crucial for replication of results. The aim of this study was to assess how sensitive Haralick texture features of apparent diffusion coefficient (ADC) MR images are to changes in five parameters related to image acquisition and pre-processing: noise, resolution, how the ADC map is constructed, the choice of quantization method, and the number of gray levels in the quantized image. We found that noise, resolution, choice of quantization method and the number of gray levels in the quantized images had a significant influence on most texture features, and that the effect size varied between different features. Different methods for constructing the ADC maps did not have an impact on any texture feature. Based on our results, we recommend using images with similar resolutions and noise levels, using one quantization method, and the same number of gray levels in all quantized images, to make meaningful comparisons of texture feature results between different subjects.

A comparison of navigators, snap-shot field monitoring, and probe-based field model training for correcting B0 -induced artifacts in T2*-weighted images at 7 T.

PURPOSE: To compare methods for estimating B0 maps used in retrospective correction of high-resolution anatomical images at ultra-high field strength. The B0 maps were obtained using three methods: (1) 1D navigators and coil sensitivities, (2) field probe (FP) data and a low-order spherical harmonics model, and (3) FP data and a training-based model. METHODS: Data from nine subjects were acquired while they performed activities inducing B0 field fluctuations. Estimated B0 fields were compared with reference data, and the reductions of artifacts were compared in corrected T2* images. RESULTS: Reduction of sum-of-squares difference relative to a reference image was evaluated, and Method 1 yielded the largest artifact reduction: 27 ± 15%, 20 ± 18% (mean ± 1 standard deviation) for deep breathing and combined deep breathing and hand motion activities. Method 3 performed almost as well (24 ± 18%, 15 ± 17%), provided that adequate training data were used, and Method 2 gave a similar result (21 ± 16%, 19 ± 17%). CONCLUSION: This study confirms that all of the investigated methods can be used in retrospective image correction. In terms of image quality, Method 1 had a small advantage, whereas the FP-based methods measured the B0 field slightly more accurately. The specific strengths and weaknesses of FPs and navigators should therefore be considered when determining which B0 -estimation method to use. Magn Reson Med 78:1373-1382, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Automated eye blink detection and correction method for clinical MR eye imaging.

PURPOSE: To implement an on-line monitoring system to detect eye blinks during ocular MRI using field probes, and to reacquire corrupted k-space lines by means of an automatic feedback system integrated with the MR scanner. METHODS: Six healthy subjects were scanned on a 7 Tesla MRI whole-body system using a custom-built receive coil. Subjects were asked to blink multiple times during the MR-scan. The local magnetic field changes were detected with an external fluorine-based field probe which was positioned close to the eye. The eye blink produces a field shift greater than a threshold level, this was communicated in real-time to the MR system which immediately reacquired the motion-corrupted k-space lines. RESULTS: The uncorrected images, using the original motion-corrupted data, showed severe artifacts, whereas the corrected images, using the reacquired data, provided an image quality similar to images acquired without blinks. CONCLUSION: Field probes can successfully detect eye blinks during MRI scans. By automatically reacquiring the eye blink-corrupted data, high quality MR-images of the eye can be acquired. Magn Reson Med 78:165-171, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

7Tesla MRA for the differentiation between intracranial aneurysms and infundibula.

OBJECTIVE: The differentiation between an aneurysm and an infundibulum with time-of-flight MRA is often difficult. However, this distinction is important because it affects further patient follow-up. The purpose of this study was to assess the added value of high resolution 7Tesla MRA for investigating small vascular lesions suspect for an aneurysm or an infundibulum. MATERIALS AND METHODS: We included patients in whom an intracranial vascular lesion was detected in our University Hospital and in whom the discrimination between a true aneurysms or an infundibulum could not be made on conventional 1.5 or 3T MRI were included in the study. All patients underwent an additional 7T time-of-flight MRA at higher spatial resolution. RESULTS: We included 6 patients. The age range of the patients was 35-65years and 5 of them were women. 1 out of 6 had a 1.5T MRI, the other 5 patients had a 3T MRI previous to the 7T MRI. The lesion size varied between 0.9mm and 2.0mm. In 5 of the 6 patients the presence of an infundibulum could be proven using the high resolution of the 7T MRA. All patients tolerated the 7T MRI well. CONCLUSION: Our results suggest that high resolution and contrast of 7T MRA provides added diagnostic value in discriminating between intracranial aneurysms and infundibula. This finding may have important consequences for patient follow-up and comfort because it might reduce unnecessary follow-up exams and decrease uncertainty about the diagnosis. Larger studies, however, are needed to confirm our findings.

A Monte Carlo study of the dependence of early frame sampling on uncertainty and bias in pharmacokinetic parameters from dynamic PET.

UNLABELLED: Compartmental modeling of dynamic PET data enables quantification of tracer kinetics in vivo, through the calculated model parameters. In this study, we aimed to investigate the effect of early frame sampling and reconstruction method on pharmacokinetic parameters obtained from a 2-tissue model, in terms of bias and uncertainty (SD). METHODS: The GATE Monte Carlo software was used to simulate 2 × 15 dynamic 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) brain PET studies, typical in terms of noise level and kinetic parameters. The data were reconstructed by both 3-dimensional (3D) filtered backprojection with reprojection (3DRP) and 3D ordered-subset expectation maximization (OSEM) into 6 dynamic image sets with different early frame durations of 1, 2, 4, 6, 10, and 15 s. Bias and SD were evaluated for fitted parameter estimates, calculated from regions of interest. RESULTS: The 2-tissue-model parameter estimates K1, k2, and fraction of arterial blood in tissue depended on early frame sampling, and a sampling of 6-15 s generally minimized bias and SD. The shortest sampling of 1 s yielded a 25% and 42% larger bias than the other schemes, for 3DRP and OSEM, respectively, and a parameter uncertainty that was 10%-70% higher. The schemes from 4 to 15 s were generally not significantly different in regards to bias and SD. Typically, the reconstruction method 3DRP yielded less frame-sampling dependence and less uncertain results, compared with OSEM, but was on average more biased. CONCLUSION: Of the 6 sampling schemes investigated in this study, an early frame duration of 6-15 s generally kept both bias and uncertainty to a minimum, for both 3DRP and OSEM reconstructions. Very-short frames of 1 s should be avoided because they typically resulted in the largest parameter bias and uncertainty. Furthermore, 3DRP may be preferred over OSEM for short frames with poor statistics.

Combining phase and magnitude information for contrast agent quantification in dynamic contrast-enhanced MRI using statistical modeling.

PURPOSE: The purpose of this study was to investigate, using simulations, a method for improved contrast agent (CA) quantification in DCE-MRI. METHODS: We developed a maximum likelihood estimator that combines the phase signal in the DCE-MRI image series with an additional CA estimate, e.g. the estimate obtained from magnitude data. A number of simulations were performed to investigate the ability of the estimator to reduce bias and noise in CA estimates. Noise levels ranging from that of a body coil to that of a dedicated head coil were investigated at both 1.5T and 3T. RESULTS: Using the proposed method, the root mean squared error in the bolus peak was reduced from 2.24 to 0.11 mM in the vessels and 0.16 to 0.08 mM in the tumor rim for a noise level equivalent of a 12-channel head coil at 3T. No improvements were seen for tissues with small CA uptake, such as white matter. CONCLUSION: Phase information reduces errors in the estimated CA concentrations. A larger phase response from higher field strengths or higher CA concentrations yielded better results. Issues such as background phase drift need to be addressed before this method can be applied in vivo.

ADC texture--an imaging biomarker for high-grade glioma?

PURPOSE: Survival for high-grade gliomas is poor, at least partly explained by intratumoral heterogeneity contributing to treatment resistance. Radiological evaluation of treatment response is in most cases limited to assessment of tumor size months after the initiation of therapy. Diffusion-weighted magnetic resonance imaging (MRI) and its estimate of the apparent diffusion coefficient (ADC) has been widely investigated, as it reflects tumor cellularity and proliferation. The aim of this study was to investigate texture analysis of ADC images in conjunction with multivariate image analysis as a means for identification of pretreatment imaging biomarkers. METHODS: Twenty-three consecutive high-grade glioma patients were treated with radiotherapy (2 Gy/60 Gy) with concomitant and adjuvant temozolomide. ADC maps and T1-weighted anatomical images with and without contrast enhancement were collected prior to treatment, and (residual) tumor contrast enhancement was delineated. A gray-level co-occurrence matrix analysis was performed on the ADC maps in a cuboid encapsulating the tumor in coronal, sagittal, and transversal planes, giving a total of 60 textural descriptors for each tumor. In addition, similar examinations and analyses were performed at day 1, week 2, and week 6 into treatment. Principal component analysis (PCA) was applied to reduce dimensionality of the data, and the five largest components (scores) were used in subsequent analyses. MRI assessment three months after completion of radiochemotherapy was used for classifying tumor progression or regression. RESULTS: The score scatter plots revealed that the first, third, and fifth components of the pretreatment examinations exhibited a pattern that strongly correlated to survival. Two groups could be identified: one with a median survival after diagnosis of 1099 days and one with 345 days, p = 0.0001. CONCLUSIONS: By combining PCA and texture analysis, ADC texture characteristics were identified, which seems to hold pretreatment prognostic information, independent of known prognostic factors such as age, stage, and surgical procedure. These findings encourage further studies with a larger patient cohort.