Do Disinfectant Solutions during Gargling Reach the Pharynx?

INTRODUCTION: In times of COVID-19, gargling disinfectant is commonly used. Disinfectant solutions seem to decrease the infection's symptoms. For disinfection, several techniques are reported. So far, there are no data about the regions in the upper airways achieved by gargled fluid. METHODS: Ten healthy volunteers without any dysphagia were investigated with a high-sensitivity flexible endoscopic evaluation of swallowing (hsFEES®) during and after gargling colored water. One volunteer repeated the gargling process in fast and real-time MRI. RESULTS: In all cases, no color accumulation was detected on the posterior pharyngeal wall, epi- or hypopharynx during gargling. The MRI scans confirmed the results. CONCLUSIONS: hsFEES® and fast MRI provide an insight into the gargling pattern. Data show that during gargling, the fluid covers the soft tissue in the oral cavity and the anterior part of the soft palate, but not the posterior pharyngeal wall nor the epi- and hypopharynx.

Assessment of resolution and noise in magnetic resonance images reconstructed by data driven approaches.

INTRODUCTION: Deep learning-based approaches are increasingly being used for the reconstruction of accelerated MRI scans. However, presented analyses are frequently lacking in-detail evaluation of basal measures like resolution or signal-to-noise ratio. To help closing this gap, spatially resolved maps of image resolution and noise enhancement (g-factor) are determined and assessed for typical model- and data-driven MR reconstruction methods in this paper. METHODS: MR data from a routine brain scan of a patient were undersampled in retrospect at R = 4 and reconstructed using two data-driven (variational network (VN), U-Net) and two model based reconstructions methods (GRAPPA, TV-constrained compressed sensing). Local resolution was estimated by the width of the main-lobe of a local point-spread function, which was determined for every single pixel by reconstructing images with an additional small perturbation. G-factor maps were determined using a multiple replica method. RESULTS: GRAPPA showed good spatial resolution, but increased g-factors (1.43-1.84, 75% quartile) over all other methods. The images delivered from compressed sensing suffered most from low local resolution, in particular in homogeneous areas of the image. VN and U-Net show similar resolution with mostly moderate local blurring, slightly better for U-Net. For all methods except GRAPPA the resolution as well as the g-factors depend on the anatomy and the direction of undersampling. CONCLUSION: Objective image quality parameters, local resolution and g-factors have been determined. The examined data driven methods show less local blurring than compressed sensing. The noise enhancement for reconstructions using CS, VN and U-Net is elevated at anatomical contours but is drastically reduced with respect to GRAPPA. Overall, the applied framework provides the possibility for more detailed analysis of novel reconstruction approaches incorporating non-linear and non-stationary transformations.

Lung Function in Patients with Cystic Fibrosis before and during CFTR-Modulator Therapy Using 3D Ultrashort Echo Time MRI.

Background The triple combination of the cystic fibrosis transmembrane regulator (CFTR) modulators elexacaftor, tezacaftor, and ivacaftor (hereafter, elexacaftor/tezacaftor/ivacaftor) has a positive effect on lung function in patients with cystic fibrosis (CF). Purpose To compare three-dimensional (3D) ultrashort echo time (UTE) MRI functional lung data to common functional lung parameters in assessing lung function in patients with CF undergoing elexacaftor/tezacaftor/ivacaftor therapy. Materials and Methods In this prospective feasibility study, 16 participants with CF consented to undergo pulmonary MRI with a breath-hold 3D UTE sequence at baseline (April 2018-June 2019) and follow-up (April-July 2021). Eight participants received elexacaftor/tezacaftor/ivacaftor after baseline, and eight participants with unchanged treatment served as the control group. Lung function was assessed with body plethysmography and lung clearance index (LCI). Image-based functional lung parameters, such as ventilation inhomogeneity and ventilation defect percentage (VDP), were calculated from signal intensity change between MRI scans at inspiration and expiration. Metrics at baseline and follow-up were compared within groups (permutation test), correlation was tested (Spearman rank correlation), and 95% CIs were calculated (bootstrapping technique). Results MRI ventilation inhomogeneity correlated with LCI at baseline (r = 0.92, P < .001) and follow-up (r = 0.81, P = .002). Mean MRI ventilation inhomogeneity (baseline, 0.74 ± 0.15 [SD]; follow-up, 0.64 ± 0.11; P = .02) and mean VDP (baseline, 14.1% ± 7.4; follow-up, 8.5% ± 3.3; P = .02) decreased from baseline to follow-up in the treatment group. Lung function was stable over time (mean LCI: 9.3 turnovers ± 4.1 at baseline vs 11.5 turnovers ± 7.4 at follow-up; P = .34) in the control group. In all participants, correlation of forced expiratory volume in 1 second with MRI ventilation inhomogeneity was good at baseline (r = -0.61, P = .01) but poor during follow-up (r = -0.06, P = .82). Conclusion Noncontrast 3D UTE lung MRI functional parameters of ventilation inhomogeneity and VDP can be used to assess lung function over time in patients with CF and can add regional information to established global parameters, such as LCI. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Iwasawa in this issue.

Comparison of diagnostic quality of 3D ultrashort-echo-time techniques for pulmonary magnetic resonance imaging in free-breathing.

BACKGROUND: Ultrashort-echo-time (UTE) sequences have been developed to overcome technical limitations of pulmonary magnetic resonance imaging (MRI). Recently, it has been shown that UTE sequences with breath-hold allow rapid image acquisition with sufficient image quality. However, patients with impaired respiration require alternative acquisition strategies while breathing freely. PURPOSE: To compare the diagnostic performance of free-breathing three-dimensional (3D)-UTE sequences with different trajectories based on pulmonary imaging of immunocompromised patients. MATERIAL AND METHODS: In a prospective study setting, two 3D-UTE sequences performed in free-breathing and exploiting non-Cartesian trajectories-one using a stack-of-spirals and the other exploiting a radial trajectory-were acquired at 3 T in patients undergoing hematopoietic stem cell transplantation. Two radiologists assessed the images regarding presence of pleural effusions and pulmonary infiltrations. Computed tomography (CT) was used as reference. RESULTS: A total of 28 datasets, each consisting of free-breathing 3D-UTE MRI with the two sequence techniques and a reference CT scan, were acquired in 20 patients. Interrater agreement was substantial for pulmonary infiltrations using both sequence techniques (κ = 0.77 - 0.78). Regarding pleural effusions, agreement was almost perfect in the stack-of-spirals (κ = 0.81) and moderate in the radial sequence (κ = 0.59). No significant differences in detectability of the assessed pulmonary pathologies were observed between both 3D-UTE sequence techniques (P > 0.05), and their level of agreement was substantial throughout (κ = 0.62-0.81). Both techniques provided high sensitivities and specificities (79%-100%) for the detection of pulmonary infiltrations and pleural effusions compared to reference CT. CONCLUSION: The diagnostic performance of the assessed 3D-UTE MRI sequences was similar. Both sequences enable the detection of typical inflammatory lung pathologies.

Fast measurement of the gradient system transfer function at 7 T.

PURPOSE: In this work, a new method to determine the gradient system transfer function (GSTF) with high frequency resolution and high SNR is presented, using fast and simple phantom measurements. The GSTF is an effective instrument for hardware characterization and calibration, which can be used to correct for gradient distortions, or enhance gradient fidelity. METHODS: The thin-slice approach for phantom-based measurements of the GSTF is expanded by adding excitations that are shifted after the application of the probing gradient, to capture long-lasting field fluctuations with high SNR. A physics-informed regularization procedure is implemented to derive high-quality transfer functions from a small number of measurements. The resulting GSTFs are evaluated by means of gradient time-course estimation and pre-emphasis of a trapezoidal test gradient on a 7T scanner. RESULTS: The GSTFs determined with the proposed method capture sharp mechanical resonances with a high level of detail. The measured trapezoidal gradient progressions are authentically reproduced by the GSTF estimations on all three axes. The GSTF-based pre-emphasis considerably improves the gradient fidelity in the plateau phase of the test gradient and almost completely eliminates lingering field oscillations. CONCLUSION: The presented approach allows fast and simple characterization of gradient field fluctuations caused by long-living eddy current and vibration effects, which become more pronounced at ultrahigh field strengths.

Non-invasive assessment of tissue sodium content in patients with primary adrenal insufficiency.

Objective: Replacement therapy in primary adrenal insufficiency (PAI) with corticosteroids modulates sodium homeostasis. Serum sodium is, however, prone to osmotic shifts induced by several additional factors besides corticosteroids and does not always reliably reflect treatment quality. Non-osmotic tissue storage can be visualized by sodium MRI (23Na-MRI) and might better reflect corticosteroid activity. Design: Longitudinal study of 8 patients with newly diagnosed PAI and cross-sectional study in 22 patients with chronic PAI is reported here. Comparison was made with matched healthy controls. Methods: Using a 23Na-MRI protocol on a 3T scanner, relative sodium signal intensities (rSSI) to signal intensities of the reference vial with 100 mmol/L of sodium were determined in the muscle and skin of the lower calf. Results: In newly diagnosed patients, tissue rSSI (median, range) were reduced and significantly increased after treatment initiation reaching levels similar to healthy controls (muscle: from 0.15 (0.08, 0.18) to 0.18 (0.14, 0.27), P = 0.02; skin: from 0.12 (0.09, 0.18) to 0.18 (0.14, 0.28), P < 0.01). Muscle rSSI was significantly higher in patients with chronic PAI compared to controls (0.19 (0.14, 0.27) vs 0.16 (0.12, 0.20), P < 0.01). In chronic PAI, skin rSSI significantly correlated with plasma renin concentration. Conclusion: 23Na-MRI provides an additional insight into sodium homeostasis, and thus the quality of replacement therapy in PAI, as tissue sodium significantly changes once therapy is initiated. The increased tissue sodium in patients with chronic PAI might be an indication of over-replacement.

Real-time cardiac MRI using an undersampled spiral k-space trajectory and a reconstruction based on a variational network.

PURPOSE: Cardiac MRI represents the gold standard to determine myocardial function. However, the current clinical standard protocol, a segmented Cartesian acquisition, is time-consuming and can lead to compromised image quality in the case of arrhythmia or dyspnea. In this article, a machine learning-based reconstruction of undersampled spiral k-space data is presented to enable free breathing real-time cardiac MRI with good image quality and short reconstruction times. METHODS: Data were acquired in free breathing with a 2D spiral trajectory corrected by the gradient system transfer function. Undersampled data were reconstructed by a variational network (VN), which was specifically adapted to the non-Cartesian sampling pattern. The network was trained with data from 11 subjects. Subsequently, the imaging technique was validated in 14 subjects by quantifying the difference to a segmented reference acquisition, an expert reader study, and by comparing derived volumes and functional parameters with values obtained using the current clinical gold standard. RESULTS: The scan time for the entire heart was below 1 min. The VN reconstructed data in about 0.9 s per image, which is considerably shorter than conventional model-based approaches. The VN furthermore performed better than a U-Net and not inferior to a low-rank plus sparse model in terms of achieved image quality. Functional parameters agreed, on average, with reference data. CONCLUSIONS: The proposed VN method enables real-time cardiac imaging with both high spatial and temporal resolution in free breathing and with short reconstruction time.

Primary hyperaldosteronism induces congruent alterations of sodium homeostasis in different skeletal muscles: a 23Na-MRI study.

Background: Sodium homeostasis is disrupted in many cardiovascular diseases, which makes non-invasive sodium storage assessment desirable. In this regard, sodium MRI has shown its potential to reveal differences in sodium content between healthy and diseased tissues as well as treatment-related changes of sodium content. When different tissues are affected disparately, simultaneous assessment of these compartments is expected to provide better information about sodium distribution, reduce examination time, and improve clinical efficiency. Objectives: The objectives were (1) to investigate sodium storage levels in calf and pectoral muscle in healthy controls and patients and quantify changes following medical treatment and (2) to demonstrate homogeneous disruption in skeletal muscle sodium storage in patients with primary hyperaldosteronism (PHA). Methods: We assessed sodium storage levels (relative sodium signal intensity, rSSI) in the calf and pectoral muscles of eight patients with PHA prior and after treatment and 12 age- and sex-matched healthy volunteers. Results: Calf and pectoral muscle compartments exhibited similar sodium content both in healthy subjects (calf vs pectoral rSSI: 0.14 ± 0.01 vs 0.14 ± 0.03) and PHA patients (calf vs pectoral rSSI: 0.19 ± 0.03 vs 0.18 ± 0.03). Further, we observed similar treatment-related changes in pectoral and calf muscles in the patients (proportional rSSI change calf: 26%; pectoral: 28%). Conclusion: We found that sodium was distributed uniformly and behaved equally in different skeletal muscles in Conn's syndrome. This allows to measure both heart and skeletal muscle sodium signals simultaneously by a single measurement without repositioning the patient. This increases 23Na-MRI's clinical feasibility as an innovative technique to monitor sodium storage.

Evaluation of combined late gadolinium-enhancement and functional cardiac magnetic resonance imaging using spiral real-time acquisition.

The purpose of the current study was to implement and validate joint real-time acquisition of functional and late gadolinium-enhancement (LGE) cardiac magnetic resonance (MR) images during free breathing. Inversion recovery cardiac real-time images with a temporal resolution of 50 ms were acquired using a spiral trajectory (IR-CRISPI) with a pre-emphasis based on the gradient system transfer function during free breathing. Functional and LGE cardiac MR images were reconstructed using a low-rank plus sparse model. Late gadolinium-enhancement appearance, image quality, and functional parameters of IR-CRISPI were compared with clinical standard balanced steady-state free precession breath-hold techniques in 10 patients. The acquisition of IR-CRISPI in free breathing of the entire left ventricle took 97 s on average. Bland-Altman analysis and Wilcoxon tests showed a higher artifact level for the breath-hold technique (p = 0.003), especially for arrhythmic patients or patients with dyspnea, but an increased noise level for IR-CRISPI of the LGE images (p = 0.01). The estimated transmural extent of the enhancement differed by not more than 25% and did not show a significant bias between the techniques (p = 0.50). The ascertained functional parameters were similar for the breath-hold technique and IR-CRISPI, that is, with a minor, nonsignificant (p = 0.16) mean difference of the ejection fraction of 2.3% and a 95% confidence interval from -4.8% to 9.4%. IR-CRISPI enables joint functional and LGE imaging in free breathing with good image quality but distinctly shorter scan times in comparison with breath-hold techniques.

Pulmonary Imaging of Immunocompromised Patients during Hematopoietic Stem Cell Transplantation using Non-Contrast-Enhanced Three-Dimensional Ultrashort Echo Time (3D-UTE) MRI.

PURPOSE: To evaluate the feasibility of non-contrast-enhanced three-dimensional ultrashort echo time (3D-UTE) MRI for pulmonary imaging in immunocompromised patients during hematopoietic stem cell transplantation (HSCT). METHODS: MRI was performed using a stack-of-spirals 3D-UTE sequence (slice thickness: 2.34mm; matrix: 256 × 256; acquisition time: 12.7-17.6 seconds) enabling imaging of the entire thorax within single breath-holds. Patients underwent MRI before HSCT initiation, in the case of periprocedural pneumonia, before discharge, and in the case of re-hospitalization. Two readers separately assessed the images regarding presence of pleural effusions, ground glass opacities (GGO), and consolidations on a per lung basis. A T2-weighted (T2w) multi-shot Turbo Spin Echo sequence (BLADE) was acquired in coronal orientation during breath-hold (slice thickness: 6.00mm; matrix: 320 × 320; acquisition time: 3.1-5.5 min) and read on a per lesion basis. Low-dose CT scans in inspiration were used as reference and were read on a per lung basis. Only scans performed within a maximum of three days were included in the inter-method analyses. Interrater agreement, sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of 3D-UTE MRI were calculated. RESULTS: 67 MRI scans of 28 patients were acquired. A reference CT examination was available for 33 scans of 23 patients. 3D-UTE MRI showed high sensitivity and specificity regarding pleural effusions (n = 6; sensitivity, 92 %; specificity, 100 %) and consolidations (n = 22; sensitivity 98 %, specificity, 86 %). Diagnostic performance was lower for GGO (n = 9; sensitivity, 63 %; specificity, 84 %). Accuracy rates were high (pleural effusions, 98 %; GGO, 79 %; consolidations 94 %). Interrater agreement was substantial for consolidations and pleural effusions (κ = 0.69-0.82) and moderate for GGO (κ = 0.54). Compared to T2w imaging, 3D-UTE MRI depicted the assessed pathologies with at least equivalent quality and was rated superior regarding consolidations and GGO in ~50 %. CONCLUSION: Non-contrast 3D-UTE MRI enables radiation-free assessment of typical pulmonary complications during HSCT procedure within a single breath-hold. Yet, CT was found to be superior regarding the identification of pure GGO changes. KEY POINTS: · 3D-UTE MRI of the thorax can be acquired within a single breath-hold.. · 3D-UTE MRI provides diagnostic imaging of pulmonary consolidations and pleural effusions.. · 3D-UTE sequences improve detection rates of ground glass opacities on pulmonary MRI.. · 3D-UTE MRI depicts pulmonary pathologies at least equivalent to T2-weighted Blade sequence.. CITATION FORMAT: · Metz C, Böckle D, Heidenreich JF et al. Pulmonary Imaging of Immunocompromised Patients during Hematopoietic Stem Cell Transplantation using Non-Contrast-Enhanced Three-Dimensional Ultrashort Echo Time (3D-UTE) MRI. Fortschr Röntgenstr 2022; 194: 39 - 48.

Effect of short-term smoking & L-arginine on coronary endothelial function assessed by cardiac magnetic resonance cold pressor testing: a pilot study.

BACKGROUND: The effect of smoking on coronary vasomotion has been investigated in the past with various imaging techniques in both short- and long-term smokers. Additionally, coronary vasomotion has been shown to be normalized in long-term smokers by L-Arginine acting as a substrate for NO synthase, revealing the coronary endothelium as the major site of abnormal vasomotor response. Aim of the prospective cohort study was to investigate coronary vasomotion of young healthy short-term smokers via magnetic resonance cold pressor test with and without the administration of L-Arginine and compare obtained results with the ones from nonsmokers. METHODS: Myocardial blood flow (MBF) was quantified with first-pass perfusion MRI on a 1.5 T scanner in healthy short-term smokers (N = 10, age: 25.0 ± 2.8 years, 5.0 ± 2.9 pack years) and nonsmokers (N = 10, age: 34.3 ± 13.6) both at rest and during cold pressor test (CPT). Smokers underwent an additional examination after administration of L-Arginine within a median of 7 days of the naïve examination. RESULTS: MBF at rest turned out to be 0.77 ± 0.30 (smokers with no L-Arginine; mean ± standard deviation), 0.66 ± 0.21 (smokers L-Arginine) and 0.84 ± 0.08 (nonsmokers). Values under CPT were 1.21 ± 0.42 (smokers no L-Arginine), 1.09 ± 0.35 (smokers L-Arginine) and 1.63 ± 0.33 (nonsmokers). In all groups, MBF was significantly increased under CPT compared to the corresponding rest examination (p < 0.05 in all cases). Additionally, MBF under CPT was significantly different between the smokers and the nonsmokers (p = 0.002). MBF at rest was significantly different between the smokers when L-Arginine was given and the nonsmokers (p = 0.035). CONCLUSION: Short-term smokers showed a reduced response to cold both with and without the administration of L-Arginine. However, absolute MBF values under CPT were lower compared to nonsmokers independently of L-Arginine administration.

Three-dimensional Ultrashort Echotime Magnetic Resonance Imaging for Combined Morphologic and Ventilation Imaging in Pediatric Patients With Pulmonary Disease.

PURPOSE: Ultrashort echotime (UTE) sequences aim to improve the signal yield in pulmonary magnetic resonance imaging (MRI). We demonstrate the initial results of spiral 3-dimensional (3D) UTE-MRI for combined morphologic and functional imaging in pediatric patients. METHODS: Seven pediatric patients with pulmonary abnormalities were included in this observational, prospective, single-center study, with the patients having the following conditions: cystic fibrosis (CF) with middle lobe atelectasis, CF with allergic bronchopulmonary aspergillosis, primary ciliary dyskinesia, air trapping, congenital lobar overinflation, congenital pulmonary airway malformation, and pulmonary hamartoma.Patients were scanned during breath-hold in 5 breathing states on a 3-Tesla system using a prototypical 3D stack-of-spirals UTE sequence. Ventilation maps and signal intensity maps were calculated. Morphologic images, ventilation-weighted maps, and signal intensity maps of the lungs of each patient were assessed intraindividually and compared with reference examinations. RESULTS: With a scan time of ∼15 seconds per breathing state, 3D UTE-MRI allowed for sufficient imaging of both "plus" pathologies (atelectasis, inflammatory consolidation, and pulmonary hamartoma) and "minus" pathologies (congenital lobar overinflation, congenital pulmonary airway malformation, and air trapping). Color-coded maps of normalized signal intensity and ventilation increased diagnostic confidence, particularly with regard to "minus" pathologies. UTE-MRI detected new atelectasis in an asymptomatic CF patient, allowing for rapid and successful therapy initiation, and it was able to reproduce atelectasis and hamartoma known from multidetector computed tomography and to monitor a patient with allergic bronchopulmonary aspergillosis. CONCLUSION: 3D UTE-MRI using a stack-of-spirals trajectory enables combined morphologic and functional imaging of the lungs within ~115 second acquisition time and might be suitable for monitoring a wide spectrum of pulmonary diseases.

Cardiac real-time MRI using a pre-emphasized spiral acquisition based on the gradient system transfer function.

PURPOSE: Segmented Cartesian acquisition in breath hold represents the current gold standard for cardiac functional MRI. However, it is also associated with long imaging times and severe restrictions in arrhythmic or dyspneic patients. Therefore, we introduce a real-time imaging technique based on a spoiled gradient-echo sequence with undersampled spiral k-space trajectories corrected by a gradient pre-emphasis. METHODS: A fully automatic gradient waveform pre-emphasis based on the gradient system transfer function was implemented to compensate for gradient inaccuracies, to optimize fast double-oblique spiral MRI. The framework was tested in a phantom study and subsequently transferred to compressed sensing-accelerated cardiac functional MRI in real time. Spiral acquisitions during breath hold and free breathing were compared with this reference method for healthy subjects (N = 7) as well as patients (N = 2) diagnosed with heart failure and arrhythmia. Left-ventricular volumes and ejection fractions were determined and analyzed using a Wilcoxon signed-rank test. RESULTS: The pre-emphasis successfully reduced typical artifacts caused by k-space misregistrations. Dynamic cardiac imaging was possible in real time (temporal resolution < 50 ms) with high spatial resolution (1.34 × 1.34 mm2 ), resulting in a total scan time of less than 50 seconds for whole heart coverage. Comparable image quality, as well as similar left-ventricular volumes and ejection fractions, were observed for the accelerated and the reference method. CONCLUSION: The proposed technique enables high-resolution real-time cardiac MRI with no need for breath holds and electrocardiogram gating, shortening the duration of an entire functional cardiac exam to less than 1 minute.

Accelerated aortic 4D flow MRI with wave-CAIPI.

PURPOSE: The aim of this study was to investigate the acceleration potential of wave-CAIPI (controlled aliasing in parallel imaging) for 4D flow MRI, provided that image quality and precision of flow parameters are maintained. METHODS: The 4D flow MRIs with acceleration factor R = 2 were performed on 10 healthy volunteers, using both wave-CAIPI and standard Cartesian/2D-CAIPI sampling for reference. In addition, 1 patient with known aortic valve stenosis was examined. The flow rate ( Q ), net flow ( Qnet ), peak velocity vmax , and net average through-plane velocity ( v¯âŠ¥ ) were calculated in eight analysis planes in the ascending and descending aorta. The acquisitions were retrospectively undersampled (R = 6), and deviations of flow parameters and hemodynamic flow patterns were evaluated. RESULTS: Flow parameters measured with an undersampled wave-CAIPI trajectory showed considerably smaller deviations to the references than the 2D-CAIPI images. For vmax , the mean absolute differences were 6.02±2.08 cm/s versus 14.36±5.68 cm/s; for Qnet , the mean absolute differences were 3.67±1.40 ml versus 5.87±1.91 ml for wave-CAIPI versus 2D-CAIPI, respectively. Noise calculations indicate that the 2D-CAIPI sampling exhibits a 43±38% higher average noise level than the wave-CAIPI technique. Qualitative discrepancies in hemodynamic flow patterns, visualized through streamlines, particle traces and flow velocity vectors, could be reduced by using the undersampled wave-CAIPI trajectory. CONCLUSION: Use of wave-CAIPI instead of 2D-CAIPI sampling in retrospectively 6-fold accelerated 4D flow MRI enhances the precision of flow parameters. The acquisition time of 4D flow measurements could be reduced by a factor of 3, with minimal differences in flow parameters.

Free-breathing self-gated 4D lung MRI using wave-CAIPI.

PURPOSE: The aim of this study was to compare the wave-CAIPI (controlled aliasing in parallel imaging) trajectory to the Cartesian sampling for accelerated free-breathing 4D lung MRI. METHODS: The wave-CAIPI k-space trajectory was implemented in a respiratory self-gated 3D spoiled gradient echo pulse sequence. Trajectory correction applying the gradient system transfer function was used, and images were reconstructed using an iterative conjugate gradient SENSE (CG SENSE) algorithm. Five healthy volunteers and one patient with squamous cell carcinoma in the lung were examined on a clinical 3T scanner, using both sampling schemes. For quantitative comparison of wave-CAIPI and standard Cartesian imaging, the normalized mutual information and the RMS error between retrospectively accelerated acquisitions and their respective references were calculated. The SNR ratios were investigated in a phantom study. RESULTS: The obtained normalized mutual information values indicate a lower information loss due to acceleration for the wave-CAIPI approach. Average normalized mutual information values of the wave-CAIPI acquisitions were 10% higher, compared with Cartesian sampling. Furthermore, the RMS error of the wave-CAIPI technique was lower by 19% and the SNR was higher by 14%. Especially for short acquisition times (down to 1 minute), the undersampled Cartesian images showed an increased artifact level, compared with wave-CAIPI. CONCLUSION: The application of the wave-CAIPI technique to 4D lung MRI reduces undersampling artifacts, in comparison to a Cartesian acquisition of the same scan time. The benefit of wave-CAIPI sampling can therefore be traded for shorter examinations, or enhancing image quality of undersampled 4D lung acquisitions, keeping the scan time constant.

Three-dimensional Ultrashort Echo Time MRI for Functional Lung Imaging in Cystic Fibrosis.

Background In cystic fibrosis (CF), recurrent imaging and pulmonary function tests (PFTs) are needed for the assessment of lung function during disease management. Purpose To assess the clinical feasibility of pulmonary three-dimensional ultrashort echo time (UTE) MRI at breath holding for quantitative image analysis of ventilation inhomogeneity and hyperinflation in CF compared with PFT. Materials and Methods In this prospective study from May 2018 to June 2019, participants with CF and healthy control participants underwent PFTs and functional lung MRI by using a prototypical single breath-hold three-dimensional UTE sequence. Fractional ventilation (FV) was calculated from acquired data in normal inspiration and normal expiration. FV of each voxel was normalized to the whole lung mean (FVN), and interquartile range of normalized ventilation (IQRN; as a measure of ventilation heterogeneity) was calculated. UTE signal intensity (SI) was assessed in full expiration (SIN, normalized to aortic blood). Obtained metrics were compared between participants with CF and control participants. For participants with CF, MRI metrics were correlated with the standard lung clearance index (LCI) and PFT. Mann-Whitney U tests and Spearman correlation were used for statistical analysis. Results Twenty participants with CF (mean age, 17 years ± 9 [standard deviation]; 12 men) and 10 healthy control participants (24 years ± 8; five men) were included. IQRN was higher for participants with CF than for control participants (mean, 0.66 ± 0.16 vs 0.50 ± 0.04, respectively; P = .007). In the 20 participants with CF, IQRN correlated with obstruction markers forced expiratory volume in 1 second-to-forced vital capacity ratio (r = -0.70; 95% confidence interval [CI]: -0.92, -0.28; P < .001), mean expiratory flow 25% (r = 0.78; 95% CI: -0.95, -0.39; P < .001), and with the ventilation inhomogeneity parameter LCI (r = 0.90; 95% CI: 0.69, 0.96; P < .001). Mean SIN in full expiration was lower in participants with CF than in control participants (0.34 ± 0.08 vs 0.39 ± 0.03, respectively; P = .03). Conclusion Three-dimensional ultrashort echo time MRI in the lungs allowed for functional imaging of ventilation inhomogeneity within a few breath holds in patients with cystic fibrosis. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Wielpütz in this issue.

Functional MRI of the Lungs Using Single Breath-Hold and Self-Navigated Ultrashort Echo Time Sequences.

PURPOSE: To evaluate three-dimensional (3D) ultrashort echo time (UTE) MRI regarding image quality and suitability for functional image analysis using gradient-echo sequences in breath-hold and with self-navigation. MATERIALS AND METHODS: In this prospective exploratory study, 10 patients (mean age, 21 years; age range, 5-58 years; five men) and 10 healthy control participants (mean age, 25 years; age range, 10-39 years; five men) underwent 3D UTE MRI at 3.0 T. Imaging was performed with a prototypical stack-of-spirals 3D UTE sequence during single breath holds (echo time [TE], 0.05 msec) and with a self-navigated "Koosh ball" 3D UTE sequence at free breathing (TE, 0.03 msec). Image quality was rated on a four-point Likert scale. Edge sharpness was calculated. After semiautomated segmentation, fractional ventilation was calculated from MRI signal intensity (FVSI) and volume change (FVVol). The air volume fraction (AVF) was estimated from relative signal intensity (aortic blood signal intensity was used as a reference). Means were compared between techniques and participants. The Wilcoxon signed rank test and Spearman rank correlation were used for statistical analyses. RESULTS: Image quality ratings were equal for both techniques. However, stack-of-spirals breath-hold UTE was more susceptible to motion and aliasing artifacts. Mean FVSI was higher during breath hold than at free breathing (mean ± standard deviation in milliliters of gas per milliliters of parenchyma, 0.17 mL/mL ± 0.06 [minimum, 0.07; maximum, 0.34] vs 0.11 mL/mL ± 0.03 [minimum, 0.06; maximum, 0.17], P = .016). Mean FVSI and FVVol were in good agreement (mean difference: at breath hold, -0.008 [95% confidence interval {CI}: 0.007, -0.024]; ρ = 0.97 vs free breathing, -0.004 [95% CI: 0.007, -0.016]; ρ = 0.91). AVF correlated between both techniques (ρ = 0.94). CONCLUSION: Breath-hold and self-navigated 3D UTE sequences yield proton density-weighted images of the lungs that are similar in quality, and both techniques are suitable for functional image analysis.Supplemental material is available for this article.© RSNA, 2020.

The temperature dependence of gradient system response characteristics.

PURPOSE: The gradient system transfer function (GSTF) characterizes the frequency transfer behavior of a dynamic gradient system and can be used to correct non-Cartesian k-space trajectories. This study analyzes the impact of the gradient coil temperature of a 3T scanner on the GSTF. METHODS: GSTF self- and B0 -cross-terms were acquired for a 3T Siemens scanner (Siemens Healthcare, Erlangen, Germany) using a phantom-based measurement technique. The GSTF terms were measured for various temperature states up to 45°C. The gradient coil temperatures were measured continuously utilizing 12 temperature sensors which are integrated by the vendor. Different modeling approaches were applied and compared. RESULTS: The self-terms depend linearly on temperature, whereas the B0 -cross-term does not. Effects induced by thermal variation are negligible for the phase response. The self-terms are best represented by a linear model including the three gradient coil sensors that showed the maximum temperature dependence for the three axes. The use of time derivatives of the temperature did not lead to an improvement of the model. The B0 -cross-terms can be modeled by a convolution model which considers coil-specific heat transportation. CONCLUSION: The temperature dependency of the GSTF was analyzed for a 3T Siemens scanner. The self- and B0 -cross-terms can be modeled using a linear and convolution modeling approach based on the three main temperature sensor elements.

A compressed sensing accelerated radial MS-CAIPIRINHA technique for extended anatomical coverage in myocardial perfusion studies on PET/MR systems.

PURPOSE: Simultaneous acquisition of myocardial first-pass perfusion MRI and 18F-FDG PET viability imaging on integrated whole-body PET/MR hybrid systems synergistically delivers both functional and metabolic information on the tissue state. While PET viability scans are inherently three-dimensional, conventional MR myocardial perfusion imaging is typically performed using only three short-axis slices with a temporal resolution of one RR-interval. To improve the integrated diagnostics, an acquisition and image reconstruction method based on "Multi-Slice Controlled Aliasing In Parallel Imaging Results IN Higher Acceleration (MS-CAIPIRINHA)" was developed extending anatomical coverage for MR perfusion imaging to six short-axis slices per RR-interval. METHODS: An ECG-gated radial TurboFLASH MR pulse sequence with dual band excitation was implemented on an integrated whole-body PET/MR system and a model-based reconstruction technique was developed to fully reconstruct the undersampled CAIPIRINHA acquisitions. An 18F-FDG viability PET scan was performed simultaneously to the MR protocol, additionally complemented by a late enhancement MRI acquisition (LGE). RESULTS AND CONCLUSION: The developed imaging technique was tested in five patients with known collateralized coronary total occlusions, resulting in improved characterization of perfusion across areas of decreased tissue viability as indicated by the simultaneously determined 18F-FDG uptake. While conventional MR perfusion with only three slice positions was occasionally missing substantial parts of the viable area, the new approach achieved LV coverage only slightly inferior to LGE imaging and therefore better comparable to PET results. The quality of first-pass enhancement curves was comparable between conventional and radial MS-CAIPIRINHA-based acquisitions.

T1- and ECV-mapping in clinical routine at 3 T: differences between MOLLI, ShMOLLI and SASHA.

BACKGROUND: T1 mapping sequences such as MOLLI, ShMOLLI and SASHA make use of different technical approaches, bearing strengths and weaknesses. It is well known that obtained T1 relaxation times differ between the sequence techniques as well as between different hardware. Yet, T1 quantification is a promising tool for myocardial tissue characterization, disregarding the absence of established reference values. The purpose of this study was to evaluate the feasibility of native and post-contrast T1 mapping methods as well as ECV maps and its diagnostic benefits in a clinical environment when scanning patients with various cardiac diseases at 3 T. METHODS: Native and post-contrast T1 mapping data acquired on a 3 T full-body scanner using the three pulse sequences 5(3)3 MOLLI, ShMOLLI and SASHA in 19 patients with clinical indication for contrast enhanced MRI were compared. We analyzed global and segmental T1 relaxation times as well as respective extracellular volumes and compared the emerged differences between the used pulse sequences. RESULTS: T1 times acquired with MOLLI and ShMOLLI exhibited systematic T1 deviation compared to SASHA. Myocardial MOLLI T1 times were 19% lower and ShMOLLI T1 times 25% lower compared to SASHA. Native blood T1 times from MOLLI were 13% lower than SASHA, while post-contrast MOLLI T1-times were only 5% lower. ECV values exhibited comparably biased estimation with MOLLI and ShMOLLI compared to SASHA in good agreement with results reported in literature. Pathology-suspect segments were clearly differentiated from remote myocardium with all three sequences. CONCLUSION: Myocardial T1 mapping yields systematically biased pre- and post-contrast T1 times depending on the applied pulse sequence. Additionally calculating ECV attenuates this bias, making MOLLI, ShMOLLI and SASHA better comparable. Therefore, myocardial T1 mapping is a powerful clinical tool for classification of soft tissue abnormalities in spite of the absence of established reference values.