[Diagnostics and treatment of organic intraorbital foreign bodies]. / Diagnostik und Therapie organischer intraorbitaler Fremdkörper.

BACKGROUND: Orbital injuries with organic foreign bodies are a clinical challenge as they can cause a variety of complications and sometimes lead to irreversible visual impairment. MATERIAL AND METHODS: We report five consecutive cases of patients with organic orbital foreign bodies who presented between 2012 and 2022. Documented parameters include age, gender, time of injury, mechanism of injury, best-corrected visual acuity (BCVA), presence of pain, restriction of motility, performed imaging, location and type of foreign body, treatment and complications. RESULTS: The mean patient age was 61.8 ± 32.3 years and the gender ratio was 4:1 (female:male). In 4 cases the injury had been reported on average 4.6 days (0/14 days min/max) previously. Best corrected visual acuity at first presentation was 0.5 ± 0.2 decimal and after a mean follow-up of 12.7 months (0.5/38 months min/max) at last presentation 0.67 ± 0.3 decimal (p = 0.2). The reason for initial presentation was pain (n = 3) and/or double vision (n = 2). All patients underwent computer tomography (CT). The diagnosis was confirmed in two cases by means of CT. In all five cases the foreign body material could be completely surgically removed, while one patient needed repeated surgery due to retained foreign body material. The organic foreign body material included wood (4) and wax (1). In two cases, a foreign body-induced infection was successfully treated with systemic antibiotics. There were no other complications. CONCLUSION: In orbital trauma a thorough wound exploration must be performed, especially if the mechanism of injury is uncertain and residual foreign bodies or a perforation injury cannot be excluded. The imaging of choice is CT, which may have to be performed again in the postoperative course.

J-difference-edited MRS measures of γ-aminobutyric acid before and after acute caffeine administration.

PURPOSE: The aim of this study was to investigate potential effects of acute caffeine intake on J-difference-edited MRS measures of the primary inhibitory neurotransmitter γ-aminobutyric acid (GABA). METHODS: J-difference-edited Mescher-Garwood PRESS (MEGA-PRESS) and conventional PRESS data were acquired at 3T from voxels in the anterior cingulate and occipital area of the brain in 15 healthy subjects, before and after oral intake of a 200-mg caffeine dose. MEGA-PRESS data were analyzed with the MATLAB-based Gannet tool to estimate GABA+ macromolecule (GABA+) levels, while PRESS data were analyzed with LCModel to estimate levels of glutamate, glutamate+glutamine, N-acetylaspartate, and myo-inositol. All metabolites were quantified with respect to the internal reference compounds creatine and tissue water, and compared between the pre- and post-caffeine intake condition. RESULTS: For both MRS voxels, mean GABA+ estimates did not differ before and after caffeine intake. Slightly lower estimates of myo-inositol were observed after caffeine intake in both voxels. N-acetylaspartate, glutamate, and glutamate+glutamine did not show significant differences between conditions. CONCLUSION: Mean GABA+ estimates from J-difference-edited MRS in two different brain regions are not altered by acute oral administration of caffeine. These findings may increase subject recruitment efficiency for MRS studies.

Functional MRI in transplanted kidneys.

Renal transplantation is the therapy of choice for patients with end-stage renal diseases. Improvement of immunosuppressive therapy has significantly increased the half-life of renal allografts over the past decade. Nevertheless, complications can still arise. An early detection of allograft dysfunction is mandatory for a good outcome. New advances in magnetic resonance imaging (MRI) have enabled the noninvasive assessment of different functional renal parameters in addition to anatomic imaging. Most of these techniques were widely tested on renal allografts in past decades and a lot of clinical data are available. The following review summarizes the comprehensive, functional MRI techniques for the noninvasive assessment of renal allograft function and highlights their potential for the investigations of different etiologies of graft dysfunction.

Non-gaussian diffusion evaluation of the human kidney by Padé exponent model.

PURPOSE: To evaluate the feasibility of renal diffusion quantification using the Padé exponent model (PEM) in healthy subjects. MATERIALS AND METHODS: Diffusion measurements were completed in 10 healthy subjects (mean age, 32.4 ± 8.9 years) on a 3T MRI scanner (Magnetom Trio, Siemens AG, Germany). A respiratory-triggered echo planar imaging sequence (15 slices with 6 mm thickness; 16 b-values [0-750 s/mm2 ]; three diffusion directions; field of view: 400 × 375 mm; Matrix 192 × 192; repetition time/echo time: 3000/74 ms) was acquired in the coronal direction. Parameter maps were calculated for the monoexponential, biexponential, kurtosis models, and the PEM. A regression analysis using an R2 -test and corrected Akaike information criterion (AICc) was performed to identify the best mathematical fitting to the measured diffusion-weighted imaging signal decay. RESULTS: The mathematical accuracy of the PEM was significantly higher than for the other three-parameter and the monoexponential model (P < 0.05), which enables more precise information about the deviation of the Gaussian behavior of the diffusion signal by the PEM. The biexponential model showed better fitting to the diffusion signal (medullar Rbi2 0.989 ± 0.008, AICcbi 113.3 ± 6.6; cortical Rbi2 0.992 ± 0.006, AICcbi 113.3 ± 5.2) than the three-parameter models (medullar RPadé2 0.965 ± 0.016, AICcPadé 122.6 ± 6.4, RK2 0.954 ± 0.019, AICcK 128.5 ± 6.0; cortical RPadé2 0.989 ± 0.005, AICcPadé 116.3 ± 4.4, RK2 0.985 ± 0.007, AICcK 120.4 ± 4.8). The monoexponential model fits least to the diffusion signal in the kidney (medullar Rmono2 0.898 ± 0.039, AICcmono 141.4 ± 5.6; cortical Rmono2 0.961 ± 0.013, AICcmono 135.4 ± 4.8). CONCLUSION: The PEM is a novel promising approach to quantify diffusion properties in the human kidney and might further improve functional renal MR imaging. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:160-167.

CT pulmonary angiography: simultaneous low-pitch dual-source acquisition mode with 70 kVp and 40 ml of contrast medium and comparison with high-pitch spiral dual-source acquisition with automated tube potential selection.

OBJECTIVE: To assess the feasibility of a 70-kVp CT pulmonary angiography (CTPA) protocol using simultaneous dual-source (SimDS) acquisition mode with 40 ml of contrast medium (CM) and comparison with a high-pitch spiral dual-source (SpiralDS) acquisition protocol with automated tube potential selection (ATPS). METHODS: Following the introduction of a new 70-kVp/40-ml SimDS-CTPA protocol in December 2014 for all patients with a body mass index (BMI) below 35 kg m(-2), the first 35 patients were retrospectively included in this study and assigned to Group A (BMI: 27 ± 4 kg m(-2), age: 66 ± 15 years). The last 35 patients with a BMI below 35 kg m(-2) who had received SpiralDS-CTPA with ATPS were included for comparison (Group B) (70 ml CM; BMI: 27 ± 4 kg m(-2), age: 68 ± 16 years). Subjective image quality (image quality) was assessed by two radiologists (from 1, non-diagnostic, to 4, excellent). Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), volumetric CT dose index (CTDIvol), dose-length product (DLP) and effective dose were assessed. RESULTS: All examinations were of diagnostic image quality. Subjective image quality, SNR and CNR were comparable between Groups A and B (3.7 ± 0.6 vs 3.7 ± 0.5, 14.6 ± 6.0 vs 13.9 ± 3.7 and 12.4 ± 5.7 vs 11.6 ± 3.3, respectively; p > 0.05). CTDIvol, DLP and effective dose were significantly lower in Group A than in Group B (4.5 ± 1.6 vs 7.5 ± 2.1 mGy, 143.3 ± 44.8 vs 278.3 ± 79.44 mGy cm and 2.0 ± 0.6 vs 3.9 ± 1.1 mSv, respectively; p < 0.05). CONCLUSION: 70-kVp SimDS-CTPA with 40 ml of CM is feasible and provides diagnostic image quality, while radiation dose and CM can be reduced by almost 50% and 40%, respectively, compared with a SpiralDS-CTPA protocol with ATPS. ADVANCES IN KNOWLEDGE: 70-kVp SimDS-CTPA with 40 ml of CM is feasible in patients with a BMI up to 35 kg m(-2) and can help reduce radiation exposure and CM in these patients.

CT angiography of the aorta using 80 kVp in combination with sinogram-affirmed iterative reconstruction and automated tube current modulation: Effects on image quality and radiation dose.

INTRODUCTION: The objective of this study was to evaluate image quality and radiation dose of a CT angiography (CTA) protocol using 80 kVp in combination with iterative reconstruction and automated tube current modulation. METHODS: Ninety-five aortic CTA examinations were included in this study. A novel 80 kVp aortic CTA-protocol with iterative reconstruction was introduced in our department in March 2012 for patients with a body mass index (BMI) below 32 kg/m(2). The first 72 consecutive examinations were retrospectively assigned to group A (56 patients, 42 men, 14 women, mean age 69.6 ± 10.7 years, BMI range 19.7-31.1 kg/m(2)). For comparison, the last 23 consecutive examinations performed with the old protocol (100 kVp) were assigned to group B (21 patients, 13 men, 8 women, mean age 67.4 ± 11.1 years, BMI range 19.7-31.9 kg/m(2)). Thoracic and abdominal contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and aortic attenuation were assessed. Subjective image quality was rated on a 5-point scale (1 = non diagnostic; 5 = excellent). Furthermore, dose length product (DLP) and volumetric computed tomography dose index (CTDIvol) were analysed. RESULTS: All examinations achieved diagnostic image quality. Attenuation of the aorta was significantly higher in group A compared with B (thoracic: 443.5 ± 90.5 Hounsfield units (HU) vs. 296.0 ± 61.0 HU; abdominal: 426.3 ± 94.2 HU vs. 283.6 ± 60.5 HU; P < 0.05, respectively). CNR, SNR and subjective image quality were comparable between both groups (CNR: 12.8 ± 3.7 vs. 13.0 ± 7.4; SNR 14.4 ± 3.9 vs. 14.9 ± 8.2; subjective image quality: 4.3 ± 0.6 vs. 4.5 ± 0.6; P > 0.05, respectively). CTDIvol and DLP were significantly lower in group A (1.9 ± 0.5 mGy; 139.2 ± 41.1 mGy × cm) as compared with group B (4.2 ± 1.4 mGy; 292.1 ± 91.5 mGy × cm; P < 0.001, respectively). CONCLUSION: Low-dose CTA of the aorta using 80 kVp with iterative reconstruction enables a significant dose reduction of up to 50% compared with a 100 kVp protocol in patients with a BMI below 32 kg/m(2) while diagnostic image quality is maintained.

Does body mass index outperform body weight as a surrogate parameter in the calculation of size-specific dose estimates in adult body CT?

OBJECTIVE: To assess the value of body mass index (BMI) in comparison with body weight as a surrogate parameter for the calculation of size-specific dose estimates (SSDEs) in thoracoabdominal CT. METHODS: 401 CT examinations in 235 patients (196 chest, 205 abdomen; 95 females, 140 males; age 62.5 ± 15.0 years) were analysed in regard to weight, height and BMI (kg m(-2)). Effective diameter (Deff, cm) was assessed on axial CT images. The correlation between BMI, weight and Deff was calculated. SSDEs were calculated based on Deff, weight and BMI and lookup tables were developed. RESULTS: Overall height, weight, BMI and Deff were 172.5 ± 9.9 cm, 79.5 ± 19.1 kg, 26.6 ± 5.6 kg m(-2) and 30.1 ± 4.3 cm, respectively. There was a significant correlation between Deff and BMI as well as weight (r = 0.85 and r = 0.84; p < 0.05, respectively). Correlation was significantly better for BMI in abdominal CT (r = 0.89 vs r = 0.84; p < 0.05), whereas it was better for weight in chest CT (r = 0.87 vs r = 0.81; p < 0.05). Surrogated SSDEs did not differ significantly from the reference standard with a median absolute relative difference of 4.2% per patient (interquartile range 25-75: 3.1-7.89, range 0-25.3%). CONCLUSION: BMI and weight exhibit a significant correlation with Deff in adult patients and can be used as surrogates in the calculation of SSDEs. Using the herein-developed lookup charts, SSDEs can be calculated based on patients' weight and BMI. ADVANCES IN KNOWLEDGE: In abdominal CT, BMI has a superior correlation with effective diameter compared with weight, whereas weight is superior in chest CT. Patients' BMI and weight can be used as surrogates in the calculation of SSDEs.

Age-dependency of glycosaminoglycan content in lumbar discs: A 3t gagcEST study.

PURPOSE: To analyze age-dependency of glycosaminoglycan content using gagCEST (glycosaminoglycan chemical exchange saturation transfer) imaging in lumbar intervertebral discs of healthy volunteers. MATERIALS AND METHODS: In all, 70 volunteers without low back pain (mean age 44 ± 14 years, range: 21-69 years) were examined with T2 -weighted and gagCEST imaging with a 3T MR scanner, with approval of the local Ethics Committee after written informed consent was obtained. Pfirrmann grading and classification into discs without bulging and herniation, discs with bulging, and discs with herniation were performed. Only intervertebral discs without bulging and herniation were analyzed. A region-of-interest-based gagCEST analysis of nucleus pulposus (NP) and annulus fibrosus (AF) was performed. Correlation between age and gagCEST was tested within groups of equal Pfirrmann score. RESULTS: GagCEST effects decreased significantly from 3.09 ± 1.12% in 20-29 years old volunteers to -0.24 ± 1.36% in 50-59 years old volunteers (P < 0.001). In the case of Pfirrmann scores 2 and 3, a significant correlation was observed between gagCEST effect and age (Pfirrmann score 2, NP: ρ = -0.558, P < 0.001; Pfirrmann score 3, NP: ρ = -0.337, P = 0.048). For Pfirrmann scores 1 and 4, no significant correlation was obtained (Pfirrmann score 1, NP: ρ = -0.046, P = 0.824; Pfirrmann score 4, NP: ρ = -0.316, P = 0.188). CONCLUSION: We show a decreased gagCEST effect likely corresponding to decreasing glycosaminoglycans with aging. Hence, age-matched analysis of gagCEST imaging may be necessary in future studies.

Evaluation of a high iodine delivery rate in combination with low tube current for dose reduction in pulmonary computed tomography angiography.

PURPOSE: The present study evaluates the combination of a high iodine delivery rate with a low tube current-time product for pulmonary computed tomography angiography (CTA). MATERIALS AND METHODS: One-hundred nineteen consecutive patients undergoing pulmonary CTA for suspected pulmonary embolism were included and imaged on a 128-row computed tomography scanner at 100 kVp using highly concentrated contrast material (85 mL Iomeprol; 400 mg iodine/mL). The protocol entailed a flow rate of 5 mL/s and 90 mAs for group A, 3.5 mL/s and 135 mAs for group B, 5 mL/s and 135 mAs for group C, and 3.5 mL/s and 90 mAs for group D. Signal-to-noise ratio and contrast-to-noise ratio (CNR) were determined for the pulmonary artery. Subjective image quality (IQ) was rated on a 5-point scale (1=nondiagnostic IQ to 5=excellent IQ). RESULTS: CNR did not differ significantly between groups A (43.7±27.7), B (34.5±17.9), and C (38.9±13.8), as well as between groups B and D (29.9±11.2). CNR was higher in groups A and C than in group D (P<0.02). Subjective IQ was higher in group A than in groups B and D (P<0.05). Subjective IQ was significantly higher in group A compared with group D (P=0.026) and in group C compared with group D (P=0.007). CONCLUSIONS: A high iodine delivery rate permits dose reduction in pulmonary CTA and can be recommended in patients with suspected pulmonary embolism.

Evaluation of the impact of organ-specific dose reduction on image quality in pediatric chest computed tomography.

BACKGROUND: Organ-specific dose reduction significantly reduces the radiation exposure of radiosensitive organs. OBJECTIVE: The purpose of this study was to assess the impact of a novel organ-specific dose reduction algorithm on image quality of pediatric chest CT. MATERIALS AND METHODS: We included 28 children (mean age 10.9 ± 4.8 years, range 3-18 years) who had contrast-enhanced chest CT on a 128-row scanner. CT was performed at 100 kV using automated tube current modulation and a novel organ-specific dose-reduction algorithm (XCare™; Siemens, Forchheim, Germany). Seven children had a previous chest CT performed on a 64-row scanner at 100 kV without organ-specific dose reduction. Subjective image quality was assessed using a five-point scale (1-not diagnostic; 5-excellent). Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were assessed in the descending aorta. RESULTS: Overall mean subjective image quality was 4.1 ± 0.6. In the subgroup of the seven children examined both with and without organ-specific dose reduction, subjective image quality was comparable (score 4.4 ± 0.5 with organ-specific dose reduction vs. 4.4 ± 0.7 without it; P > 0.05). There was no significant difference in mean signal-to-noise ratio and contrast-to-noise ratio with organ-specific dose reduction (38.3 ± 10.1 and 28.5 ± 8.7, respectively) and without the reduction (35.5 ± 8.5 and 26.5 ± 7.8, respectively) (P > 0.05). Volume computed tomography dose index (CTDIvol) and size-specific dose estimates did not differ significantly between acquisitions with the organ-specific dose reduction (1.7 ± 0.8 mGy) and without the reduction (1.7 ± 0.8 mGy) (P > 0.05). CONCLUSION: Organ-specific dose reduction does not have an impact on image quality of pediatric chest CT and can therefore be used in clinical practice to reduce radiation dose of radiosensitive organs such as breast and thyroid gland.

Pilot study of Iopamidol-based quantitative pH imaging on a clinical 3T MR scanner.

OBJECTIVE: The objective of this study was to show the feasibility to perform Iopamidol-based pH imaging via clinical 3T magnetic resonance imaging (MRI) using chemical exchange saturation transfer (CEST) imaging with pulse train presaturation. MATERIALS AND METHODS: The pulse train presaturation scheme of a CEST sequence was investigated for Iopamidol-based pH measurements using a 3T magnetic resonance (MR) scanner. The CEST sequence was applied to eight tubes filled with 100-mM Iopamidol solutions with pH values ranging from 5.6 to 7.0. Calibration curves for pH quantification were determined. The dependence of pH values on the concentration of Iopamidol was investigated. An in vivo measurement was performed in one patient who had undergone a previous contrast-enhanced computed tomography (CT) scan with Iopamidol. The pH values of urine measured with CEST MRI and with a pH meter were compared. RESULTS: In the measured pH range, pH imaging using CEST imaging with pulse train presaturation was possible. Dependence between the pH value and the concentration of Iopamidol was not observed. In the in vivo investigation, the pH values in the human bladder measured by the Iopamidol CEST sequence and in urine were consistent. CONCLUSION: Our study shows the feasibility of using CEST imaging with Iopamidol for quantitative pH mapping in vitro and in vivo on a 3T MR scanner.

Radiation exposure of the radiologist's eye lens during CT-guided interventions.

BACKGROUND: In the past decade the number of computed tomography (CT)-guided procedures performed by interventional radiologists have increased, leading to a significantly higher radiation exposure of the interventionalist's eye lens. Because of growing concern that there is a stochastic effect for the development of lens opacification, eye lens dose reduction for operators and patients should be of maximal interest. PURPOSE: To determine the interventionalist's equivalent eye lens dose during CT-guided interventions and to relate the results to the maximum of the recommended equivalent dose limit. MATERIAL AND METHODS: During 89 CT-guided interventions (e.g. biopsies, drainage procedures, etc.) measurements of eye lens' radiation doses were obtained from a dedicated dosimeter system for scattered radiation. The sensor of the personal dosimeter system was clipped onto the side of the lead glasses which was located nearest to the CT gantry. After the procedure, radiation dose (µSv), dose rate (µSv/min) and the total exposure time (s) were recorded. RESULTS: For all 89 interventions, the median total exposure lens dose was 3.3 µSv (range, 0.03-218.9 µSv) for a median exposure time of 26.2 s (range, 1.1-94.0 s). The median dose rate was 13.9 µSv/min (range, 1.1-335.5 µSv/min). CONCLUSION: Estimating 50-200 CT-guided interventions per year performed by one interventionalist, the median dose of the eye lens of the interventional radiologist does not exceed the maximum of the ICRP-recommended equivalent eye lens dose limit of 20 mSv per year.

Functional evaluation of transplanted kidneys using arterial spin labeling MRI.

PURPOSE: To investigate non-contrast-enhanced arterial spin labeling (ASL) MRI for functional assessment of transplanted kidneys at 1.5 Tesla (T) and 3T. MATERIALS AND METHODS: This study was approved by the local ethics committee, and written informed consent was obtained from all participants. Ninety eight renal allograft recipients (mean age, 51.5 ± 14.6 years) were prospectively included in this study. ASL MRI was performed at 1.5T (n = 65) and 3T (n = 33) using a single-slice flow-sensitive alternating inversion recovery true-fast imaging with steady-state precession (FAIR True-FISP) sequence in the paracoronal plane. ASL perfusion was regional analyzed for the renal cortex on parameter maps. ASL was compared between patients with good or moderate allograft function (Group a; estimated glomerular filtration rate [eGFR] > 30 mL/min/1.73 m(2)) and patients with heavily impaired allograft function (Group b; eGFR ≤ 30 mL/min/1.73 m(2)) and correlated to renal function as determined by eGFR. RESULTS: ASL perfusion and eGFR were comparable at 1.5T (246.9 ± 66.8 mL/100 g/min and 41.9 ± 22.7 mL/min/1.73 m(2)) and 3T (236.5 ± 102.3 mL/100 g/min and 35.9 ± 22.9 mL/min/1.73 m(2)). ASL perfusion was significantly higher in group a (282.7 ± 60.8 mL/100 g/min) as compared to group b (178.2 ± 63.3 mL/100 g/min) (P < 0.0001). ASL perfusion values exhibited a significant correlation with renal function as determined by eGFR (r = 0.59; P < 0.0001). CONCLUSION: Cortical ASL perfusion values differ between patients with good or moderate allograft function and poor allograft function and correlate significantly with allograft function. Our results highlight the potential of ASL MRI for functional evaluation of renal allografts.

Hybrid [¹8F]-FDG PET/MRI including non-Gaussian diffusion-weighted imaging (DWI): preliminary results in non-small cell lung cancer (NSCLC).

PURPOSE: To assess the feasibility of non-Gaussian DWI as part of a FDG-PET/MRI protocol in patients with histologically proven non-small cell lung cancer. MATERIAL AND METHODS: 15 consecutive patients with histologically proven NSCLC (mean age 61 ± 11 years) were included in this study and underwent whole-body FDG-PET/MRI following whole-body FDG-PET/CT. As part of the whole-body FDG-PET/MRI protocol, an EPI-sequence with 5 b-values (0, 100, 500, 1000 and 2000 s/mm(2)) was acquired for DWI of the thorax during free-breathing. Volume of interest (VOI) measurements were performed to determine the maximum and mean standardized uptake value (SUV(max); SUV(mean)). A region of interest (ROI) was manually drawn around the tumor on b=0 images and then transferred to the corresponding parameter maps to assess ADC(mono), D(app) and K(app). To assess the goodness of the mathematical fit R(2) was calculated for monoexponential and non-Gaussian analysis. Spearman's correlation coefficients were calculated to compare SUV values and diffusion coefficients. A Student's t-test was performed to compare the monoexponential and non-Gaussian diffusion fitting (R(2)). RESULTS: T staging was equal between FDG-PET/CT and FDG-PET/MRI in 12 of 15 patients. For NSCLC, mean ADC(mono) was 2.11 ± 1.24 × 10(-3) mm(2)/s, Dapp was 2.46 ± 1.29 × 10(-3) mm(2)/s and mean Kapp was 0.70 ± 0.21. The non-Gaussian diffusion analysis (R(2)=0.98) provided a significantly better mathematical fitting to the DWI signal decay than the monoexponetial analysis (R(2)=0.96) (p<0.001). SUV(max) and SUV(mean) of NSCLC was 13.5 ± 7.6 and 7.9 ± 4.3 for FDG-PET/MRI. ADC(mono) as well as Dapp exhibited a significant inverse correlation with the SUV(max) (ADC(mono): R=-0.67; p<0.01; Dapp: R=-0.69; p<0.01) as well as with SUV(mean) assessed by FDG-PET/MRI (ADC(mono): R=-0.66; p<0.01; Dapp: R=-0.69; p<0.01). Furthermore, Kapp exhibited a significant correlation with SUV(max) (R=0.72; p<0.05) and SUV(mean) as assessed by FDG-PET/MRI (R=0.71; p<0.005). CONCLUSION: Simultaneous PET and non-Gaussian diffusion acquisitions are feasible. Non-Gaussian diffusion parameters show a good correlation with SUV and might provide additional information beyond monoexponential ADC, especially as non-Gaussian diffusion exhibits better mathematical fitting to the decay of the diffusion signal than monoexponential DWI.

Biexponential analysis of diffusion-weighted imaging: comparison of three different calculation methods in transplanted kidneys.

BACKGROUND: Biexponential analysis has been used increasingly to obtain contributions of both diffusion and microperfusion to the signal decay in diffusion-weighted imaging DWI of different parts of the body. PURPOSE: To compare biexponential diffusion parameters of transplanted kidneys obtained with three different calculation methods. MATERIAL AND METHODS: DWI was acquired in 15 renal allograft recipients (eight men, seven women; mean age, 52.4 ± 14.3 years) using a paracoronal EPI sequence with 16 b-values (b = 0-750 s/mm(2)) and six averages at 1.5T. No respiratory gating was used. Three different calculation methods were used for the calculation of biexponential diffusion parameters: Fp, ADCP, and ADCD were calculated without fixing any parameter a priori (calculation method 1); ADCP was fixed to 12.0 µm(2)/ms, whereas Fp and ADCD were calculated using the biexponential model (calculation method 2); multistep approach with monoexponential fitting of the high b-value portion (b ≥ 250 s/mm(2)) for determination of ADCD and assessment of the low b intercept for determination of Fp (calculation method 3). For quantitative analysis, ROI measurements were performed on the according parameter maps. RESULTS: Mean ADCD values of the renal cortex using calculation method 1 were significantly lower than using calculation methods 2 and 3 (P < 0.001). There was a significant correlation between calculation methods 1 and 2 (r = 0.69 (P < 0.005) and calculation methods 1 and 3 (r = 0.59; P < 0.05) as well as calculation methods 2 and 3 (r = 0.98; P < 0.001). Mean Fp values of the renal cortex were higher with calculation method 1 than with calculation methods 2 and 3 (P < 0.001). For Fp, only the correlation between calculation methods 2 and 3 was significant (r = 0.98; P < 0.001). CONCLUSION: Biexponential diffusion parameters differ significantly depending on the calculation methods used for their calculation.

Impact of blood flow on diffusion coefficients of the human kidney: a time-resolved ECG-triggered diffusion-tensor imaging (DTI) study at 3T.

PURPOSE: To evaluate the impact of renal blood flow on apparent diffusion coefficients (ADC) and fractional anisotropy (FA) using time-resolved electrocardiogram (ECG)-triggered diffusion-tensor imaging (DTI) of the human kidneys. MATERIALS AND METHODS: DTI was performed in eight healthy volunteers (mean age 29.1 ± 3.2) using a single slice coronal echoplanar imaging (EPI) sequence (3 b-values: 0, 50, and 300 s/mm(2)) at the timepoint of minimum (20 msec after R wave) and maximum renal blood flow (200 msec after R wave) at 3T. Following 2D motion correction, region of interest (ROI)-based analysis of cortical and medullary ADC- and FA-values was performed. RESULTS: ADC-values of the renal cortex at maximum blood flow (2.6 ± 0.19 × 10(-3) mm(2)/s) were significantly higher than at minimum blood flow (2.2 ± 0.11 × 10(-3) mm(2)/s) (P < 0.001), while medullary ADC-values did not differ significantly (maximum blood flow: 2.2 ± 0.18 × 10(-3) mm(2)/s; minimum blood flow: 2.15 ± 0.14 × 10(-3) mm(2)/s). FA-values of the renal medulla were significantly greater at maximal blood (0.53 ± 0.05) than at minimal blood flow (0.47 ± 0.05) (P < 0.01). In contrast, cortical FA-values were comparable at different timepoints of the cardiac cycle. CONCLUSION: ADC-values in the renal cortex as well as FA-values in the renal medulla are influenced by renal blood flow. This impact has to be considered when interpreting renal ADC- and FA-values.

Does positron emission tomography data acquisition impact simultaneous diffusion-weighted imaging in a whole-body PET/MRI system?

OBJECTIVES: The purpose of this study was to test whether the acquisition of positron emission tomography (PET) does interfere with simultaneous diffusion weighted imaging (DWI) in an integrated whole-body PET/MRI system. MATERIAL AND METHODS: Fourteen consecutive oncological patients (9 men, 5 women; age 54 ± 13 years ([mean ± standard deviation]) scheduled for routine [(18)F]-FDG PET/CT were prospectively enrolled. For DWI, an echo planar imaging (EPI) sequence (b=0-500-1000 s/mm(2)) was acquired twice on an integrated whole-body 3T PET/MRI system in each patient; first with simultaneous PET acquisition and a second time with the PET component switched off. The apparent diffusion coefficient (ADC) and the signal-to-noise ratio at b=1000 s/mm(2) (SNR) of the myocardium, paraspinal muscle, liver, spleen, renal cortex and tumor tissue (if present) were measured. In addition, the coefficient of variation (CV) of ADC values was calculated. Student's t-test for paired samples was performed to test for differences of the mean ADC, ADC CV and SNR between DWI with and without simultaneous PET acquisition. RESULTS: There were no significant differences of the ADC [(mean ± standard deviation)] between the DWI acquisitions with and without simultaneous PET acquisition for the myocardium (2572 ± 441 × 10(-6)mm(2)/s and 2586 ± 376 × 10(-6)mm(2)/s, respectively) (P=0.817), paraspinal muscle (1279 ± 254 × 10(-6)mm(2)/s vs. 1219 ± 181 × 10(-6)mm(2)/s) (P=0.318), liver (1245 ± 158 × 10(-6)mm(2)/s vs. 1254 ± 171 × 10(-6)mm(2)/s) (P=0.848), spleen (980 ± 122 × 10(-6)mm(2)/s vs. 1000 ± 187 × 10(-6)mm(2)/s) (P=0.676) and renal cortex (1951 ± 226 × 10(-6)mm(2)/s vs. 1930 ± 273 × 10(-6)mm(2)/s) (P=0.730). Mean ADC of lymph node metastases (n=6) did not differ between with PET acquisition (853 ± 174 × 10(-6)mm(2)/s) and without simultaneous PET (865 ± 170 × 10(-6)mm(2)/s) (P=0.675). There were no significant differences between the CV of ADC values or the SNR values measured in DWI datasets that were acquired with or without simultaneous PET for any evaluated organ site. CONCLUSION: The simultaneous acquisition of DWI and PET on an integrated PET/MRI system does not impact ADC quantification of normal and tumor tissue and does not alter SNR. This knowledge provides a basis for the use of simultaneous multiparametric PET/MRI comprising DWI in diagnostic imaging and quantitative tumor therapy monitoring using repeated ADC measurements.

Kidney transplant: functional assessment with diffusion-tensor MR imaging at 3T.

PURPOSE: To evaluate the feasibility of diffusion-tensor (DT) imaging at 3 T for functional assessment of transplanted kidneys. MATERIALS AND METHODS: This study was approved by the local ethics committee; written informed consent was obtained. Between August 2009 and October 2010, 40 renal transplant recipients were prospectively included in this study and examined with a clinical 3-T magnetic resonance (MR) imager. An echo-planar DT imaging sequence was performed in coronal orientation by using five b values (0, 200, 400, 600, 800 sec/mm(2)) and 20 diffusion directions. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were determined for the cortex and medulla of the transplanted kidney. Relationships between FA, ADC, and allograft function, determined by the estimated glomerular filtration rate (eGFR), were assessed by using Pearson correlation coefficient. ADC and FA were compared between patients with good or moderate allograft function (group A; eGFR > 30 mL/min/1.73 m(2)) and patients with impaired function (group B; eGFR ≤ 30 mL/min/1.73 m(2)) by using a student t test. P < .05 indicated a statistically significant difference. RESULTS: Mean FA of the renal medulla and cortex was significantly higher in group A (0.39 ± 0.06 and 0.17 ± 0.4) compared with group B (0.27 ± 0.05 and 0.14 ± 0.03) (P < .001 and P = .009, respectively). Mean ADCs of renal cortex and medulla were significantly higher in group A than in group B (P = .007 and P = .01, respectively). In group B, mean medullary FA was significantly lower in patients whose renal function did not recover (0.22 ± 0.02) compared with those with stable allograft function at 6 months (0.29 ± 0.05, P < .001). There was significant correlation between eGFR and medullary FA (r = 0.65, P < .001), cortical ADC (r = 0.43, P = .003), and medullary ADC (r = 0.35, P = .01). CONCLUSION: DT imaging is a promising noninvasive technique for functional assessment of renal allografts. FA values in the renal medulla exhibit a good correlation with renal function.

Correlation of biexponential diffusion parameters with arterial spin-labeling perfusion MRI: results in transplanted kidneys.

PURPOSE: The purpose of the present study was to explore the correlation between diffusion parameters assessed by biexponential analysis and the tissue perfusion measured by arterial spin labeling (ASL) imaging in renal allografts. MATERIAL AND METHODS: Seventeen recipients of renal allograft (11 men and 6 women; mean [SD] age, 53.6 [14.1] years) were included in this study. For diffusion-weighted imaging, a paracoronal echo-planar imaging sequence was acquired with 16 b values (range, b = 0-750 s/mm²) and 6 averages at 1.5 T. For the quantitative assessment of transplanted kidney perfusion, a flow-sensitive alternating inversion recovery true fast imaging with steady precession-ASL technique was applied. No respiratory gating was used. For quantitative analysis, region of interest measurements were performed on parameter maps. The Spearman correlation coefficients were calculated to determine the association between mean serum creatinine levels, estimated glomerular filtration rate, the apparent diffusion coefficient (ADC) of pure diffusion, the ADC of pseudodiffusion, the monoexponential ADC, the fraction of pseudodiffusion, and the tissue perfusion ASL values. RESULTS: In the renal cortex, the fraction of pseudodiffusion was 17.4% ± 4.0%, the apparent diffusion coefficient of pure diffusion was 160.7 ± 15.0 × 10⁻5 mm²/s, the monoexponential ADC was 193.2 ± 16.7 × 10⁻5 mm²/s, and the ADC of pseudodiffusion was 1421.0 ± 237.7 × 10⁻5 mm²/s. Mean cortical perfusion of renal allografts, as assessed with ASL imaging, was 247.2 ± 75.0 mL/100 g/min. There was a significant correlation between ASL perfusion and the fraction of pseudodiffusion (r = 0.68; P < 0.005) but not with the other diffusion coefficients. Both ASL perfusion and the fraction of pseudodiffusion exhibited a significant correlation with serum creatinine levels (r = 0.51 and r= 0.53, respectively; P < 0.05) and estimated glomerular filtration rate (r = 0.63 and r = 0.54, respectively; P < 0.05). CONCLUSIONS: This is the first study that shows a significant correlation between renal allograft perfusion, as assessed with ASL perfusion measurements, and the fraction of pseudodiffusion derived from biexponential diffusion-weighted imaging measurements.

Arterial spin-labeling MR imaging of renal masses: correlation with histopathologic findings.

PURPOSE: To assess the value of arterial spin-labeling (ASL) perfusion magnetic resonance (MR) imaging in the characterization of solid renal masses by using histopathologic findings as the standard of reference. MATERIALS AND METHODS: This prospective study was compliant with HIPAA and approved by the institutional review board. Informed consent was obtained from all patients before imaging. Forty-two consecutive patients suspected of having renal masses underwent ASL MR imaging before their routine 1.5-T clinical MR examination. Mean and peak tumor perfusion levels were obtained by one radiologist, who was blinded to the final histologic diagnosis, by using region of interest analysis. Perfusion values were correlated with histopathologic findings by using analysis of variance. A linear correlation model was used to evaluate the relationship between tumor size and perfusion in clear cell renal cell carcinoma (RCC). P < .05 was considered indicative of a statistically significant difference. RESULTS: Histopathologic findings were available in 34 patients (28 men, six women; mean age ± standard deviation, 60.4 years ± 11.7). The mean perfusion of papillary RCC (27.0 mL/min/100 g ± 15.1) was lower than that of clear cell RCC (171.6 mL/min/100 g ± 61.2, P = .001), chromophobe RCC (152.9 mL/min/100 g ± 80.7, P = .04), unclassified RCC (208.0 mL/min/100 g ± 41.1, P = .001), and oncocytoma (373.9 mL/min/100 g ± 99.2, P < .001). The mean and peak perfusion levels of oncocytoma (373.9 mL/min/100 g ± 99.2 and 512.3 mL/min/100 g ± 146.0, respectively) were higher than those of papillary RCC (27.0 mL/min/100 g ± 15.1 and 78.2 mL/min/100 g ± 39.7, P < .001 for both), chromophobe RCC (152.9 mL/min/100 g ± 80.7 and 260.9 mL/min/100 g ± 61.9; P < .001 and P = .02, respectively), and unclassified RCC (208.0 mL/min/100 g ± 41.1 and 273.3 mL/min/100 g ± 83.4; P = .01 and P = .03, respectively). The mean tumor perfusion of oncocytoma was higher than that of clear cell RCC (P < .001). CONCLUSION: ASL MR imaging enables distinction among different histopathologic diagnoses in renal masses on the basis of their perfusion level. Oncocytomas demonstrate higher perfusion levels than RCCs, and papillary RCCs exhibit lower perfusion levels than other RCC subtypes.