Multisite reproducibility of quantitative susceptibility mapping and effective transverse relaxation rate in deep gray matter at 3 T using locally optimized sequences in 24 traveling heads.

Iron concentration in the human brain plays a crucial role in several neurodegenerative diseases and can be monitored noninvasively using quantitative susceptibility mapping (QSM) and effective transverse relaxation rate (R2 *) mapping from multiecho T2 *-weighted images. Large population studies enable better understanding of pathologies and can benefit from pooling multisite data. However, reproducibility may be compromised between sites and studies using different hardware and sequence protocols. This work investigates QSM and R2 * reproducibility at 3 T using locally optimized sequences from three centers and two vendors, and investigates possible reduction of cross-site variability through postprocessing approaches. Twenty-four healthy subjects traveled between three sites and were scanned twice at each site. Scan-rescan measurements from seven deep gray matter regions were used for assessing within-site and cross-site reproducibility using intraclass correlation coefficient (ICC) and within-subject standard deviation (SDw) measures. In addition, multiple QSM and R2 * postprocessing options were investigated with the aim to minimize cross-site sequence-related variations, including: mask generation approach, echo-timing selection, harmonizing spatial resolution, field map estimation, susceptibility inversion method, and linear field correction for magnitude images. The same-subject cross-site region of interest measurements for QSM and R2 * were highly correlated (R2 ≥ 0.94) and reproducible (mean ICC of 0.89 and 0.82 for QSM and R2 *, respectively). The mean cross-site SDw was 4.16 parts per billion (ppb) for QSM and 1.27 s-1 for R2 *. For within-site measurements of QSM and R2 *, the mean ICC was 0.97 and 0.87 and mean SDw was 2.36 ppb and 0.97 s-1 , respectively. The precision level is regionally dependent and is reduced in the frontal lobe, near brain edges, and in white matter regions. Cross-site QSM variability (mean SDw) was reduced up to 46% through postprocessing approaches, such as masking out less reliable regions, matching available echo timings and spatial resolution, avoiding the use of the nonconsistent magnitude contrast between scans in field estimation, and minimizing streaking artifacts.

Quantitative susceptibility mapping at 3 T: comparison of acquisition methodologies.

Quantitative susceptibility mapping (QSM) is fast becoming a routine clinical tool in the evaluation and assessment of neurological diseases. Unfortunately, there is currently no established standard scanning protocol, and it is uncertain whether different acquisition strategies alter the derived estimates of magnetic susceptibility. Here, we compare some key deep grey matter susceptibility values in healthy adults acquired from various QSM sequences using either unipolar or bipolar readout gradients, accelerated imaging or not, and gradient-warp correction or not. Four healthy adult volunteers were scanned three times each within 4 days at 3 T. The eight different QSM combinations were acquired in different randomised order for each session, and then co-registered to an anatomical atlas. The average and standard deviations of magnetic susceptibilities in the caudate, putamen, red nucleus, internal and external globus pallidus were used in a linear mixed effects model to determine the influence of the various acquisition parameters. Gradient-warp correction was the only statistically significant fixed effect (p < 0.01), but its impact was small (~5% change) compared with the overall fixed effects. The random effects coefficients (i.e. the various tissues) were statistically significant. Based on our limited multiple observations in healthy adult volunteers, the susceptibilities in deep grey matter are statistically equivalent when QSM source data are acquired with or without accelerated imaging using either unipolar or bipolar readout gradients. There is, however, a statistically meaningful, but small, difference if gradient-warp correction is used or not. Copyright © 2016 John Wiley & Sons, Ltd.

Multislice T1 -prepared 2D single-shot EPI: analysis of a clinical T1 mapping method unbiased by B0 or B1 inhomogeneity.

Quantitative MR imaging is as sensitive in detecting lesions as qualitative imaging, but it is potentially more specific in differentiating disease. T1 mapping in particular might help to assess acute ischemic stroke, multiple sclerosis, epilepsy and Alzheimer's disease better. Thus, a rapid and robust clinical technique is vital. In 1990, Ordidge and colleagues developed the multislice T1 -prepared two-dimensional (2D) single-shot echo planar imaging technique. Subsequent studies demonstrated its clinical viability, but none performed an in-depth analysis of the strengths and advantages of this T1 mapping method. Herein, theoretical and experimental evidence shows that the technique accounts for 2D slice profile effects and is unbiased by B0 or B1 inhomogeneity. This is verified explicitly by varying the linear shims, the T1 preparation flip angle and the excitation flip angle. Furthermore, it is shown that the repetition time (and hence scan time) can be reduced without a loss of T1 accuracy. Copyright © 2016 John Wiley & Sons, Ltd.

A statistical method for characterizing the noise in nonlinearly reconstructed images from undersampled MR data: the POCS example.

The projection-onto-convex-sets (POCS) algorithm is a powerful tool for reconstructing high-resolution images from undersampled k-space data. It is a nonlinear iterative method that attempts to estimate values for missing data. The convergence of the algorithm and its other deterministic properties are well established, but relatively little is known about how noise in the source data influences noise in the final reconstructed image. In this paper, we present an experimental treatment of the statistical properties in POCS and investigate 12 stochastic models for its noise distribution beside its nonlinear point spread functions. Statistical results show that as the ratio of the missing k-space data increases, the noise distribution in POCS images is no longer Rayleigh as with conventional linear Fourier reconstruction. Instead, the probability density function for the noise is well approximated by a lognormal distribution. For small missing data ratios, however, the noise remains Rayleigh distributed. Preliminary results show that in the presence of noise, POCS images are often dominated by POCS-enhanced noise rather than POCS-induced artifacts. Implicit in this work is the presentation of a general statistical method that can be used to assess the noise properties in other nonlinear reconstruction algorithms.

Cavitation after acute symptomatic lacunar stroke depends on time, location, and MRI sequence.

BACKGROUND AND PURPOSE: Definitions for chronic lacunar infarcts vary. Recent retrospective studies suggest that many acute lacunar strokes do not develop a cavitated appearance. We determined the characteristics of acute lacunar infarcts on follow-up MRI in consecutive patients participating in prospective research studies. METHODS: Patients with acute lacunar infarction on diffusion-weighted imaging were selected from 3 prospective cohort studies of minor stroke imaged within <24 hours of onset. Follow-up MRI was performed at 30 days (Vascular Imaging of Acute Stroke for Identifying Predictors of Clinical Outcome and Recurrent Ischemic Events [VISION] study, n=21) or 90 days (VISION-2 and CT and MRI in the Triage of TIA and Minor Cerebrovascular Events to Identify High Risk Patients [CATCH] studies, n=34). Evidence of cavitation on MRI was rated separately on fluid-attenuated inversion recovery, T1, and T2 sequences by 2 independent study physicians; discrepant readings were resolved by consensus. RESULTS: Probable or definite cavitation on any sequence was more common at 90 days compared with 30 days (P≤0.001 for all sequences). At 90 days, evidence of cavitation was seen on at least 1 sequence in 33 of 34 patients (97%). The T1-weighted sequence was most sensitive to the presence of cavitation (94% at 90 days). By contrast, the fluid-attenuated inversion recovery sequence frequently failed to show evidence of cavitation in the brain stem or thalamus (only 10 of 18 [56%] showed cavitation). CONCLUSIONS: MRI scanning at 90 days with T1-weighted imaging reveals evidence of cavitation in nearly all cases of acute lacunar infarction. By contrast, reliance on fluid-attenuated inversion recovery alone will miss many cavitated lesions in the thalamus and brain stem. These factors should be taken into account in the development of standardized criteria for lacunar infarction on MRI.

Algebraic T2 estimation improves detection of right temporal lobe epilepsy by MR T2 relaxometry.

Seizure related abnormalities may be detected with T2 relaxometry, which involves quantitative estimation of T2 values. Accounting for the partial-volume effect of cerebrospinal fluid (CSF) is important, especially for voxel-based relaxometry, VBR. With a mono-exponential decay model, this can be accomplished by including a baseline constant. An algebraic calculation, which accommodates this constant, offers improved T2 estimation speed over the commonly used non-linear fitting approach. Our objective was to compare the algebraic approach against three fitting approaches for the detection of seizure related abnormalities. We tested the performance of the four methods in the presence of noise using simulated data as well as real data acquired at 3 T with a Carr-Purcell-Meiboom-Gill sequence from 45 healthy subjects and 24 patients with confirmed right temporal lobe epilepsy. A quantitative analysis was performed on spatially normalized data by measuring T2 in various regions and with a whole brain tissue segmentation analysis. The detection rate of hippocampal T2 changes in patients was assessed by comparing the regional T2 measurements from each patient against the control data with a z-score threshold of 2.33. The algebraic method yielded high sensitivity for detection of hippocampal abnormalities in the epileptic patients in regional assessment and in follow-up single-subject VBR. This can be attributed to the relatively small variance across healthy subjects and improved precision in the presence of CSF and noise in simulation. In conclusion, the algebraic method is better than fitting based on faster calculation speed and better sensitivity for detecting seizure-related T2 changes.

Atlas-based topographical scoring for magnetic resonance imaging of acute stroke.

BACKGROUND AND PURPOSE: The Alberta Stroke Program Early CT Score (ASPECTS), a 10-point scale, is a clinical tool for assessment of early ischemic changes after stroke based on the location and extent of a visible stroke lesion. It has been extended for use with MR diffusion-weighted imaging. The purpose of this work was to automate a MR topographical score (MR-TS) using a digital atlas to develop an objective tool for large-scale analyses and possibly reduce interrater variability and slice orientation differences. METHODS: We assessed 30 patients with acute ischemic stroke with a diffusion lesion who provided informed consent. Patients were imaged by CT and MRI within 24 hours of symptom onset. An MR-TS digital atlas was generated using the ASPECTS scoring sheet and anatomic MR data sets. Automated MR topographical scores (auto-MR-TS) were obtained based on the overlap of lesions on apparent diffusion coefficient maps with MR-TS atlas regions. Auto-MR-TS scores were then compared with scores derived manually (man-MR-TS) and with conventional CT ASPECTS scores. RESULTS: Of the 30 patients, 29 were assessed with auto-MR-TS. Auto-MR-TS was significantly lower than CT ASPECTS (P<0.001), but with a median difference of only 1 point. There was no significant difference between the auto-MR-TS and the man-MR-TS with a median difference of 0 points; 86% of patient scores differed by

A simulation-based analysis of the potential of compressed sensing for accelerating passive MR catheter visualization in endovascular therapy.

Passive MRI is a promising approach to visualize catheters in guiding and monitoring endovascular intervention and may offer several clinical advantages over the current x-ray fluoroscopy "gold standard." Endovascular MRI has limitations, however, such as difficulty in visualizing catheters and insufficient temporal resolution. The multicycle projection dephaser method is a background signal suppression technique that improves the conspicuity of passive catheters by generating a sparse (i.e., catheter only) image. One approach to improve the temporal resolution is to undersample the k-space and then apply nonlinear methods, such as compressed sensing, to reconstruct the MR images. This feasibility study investigates the potential synergies between multicycle projection dephaser and compressed sensing reconstruction for real-time passive catheter tracking. The multicycle projection dephaser method efficiently suppressed the background signal, and compressed sensing allowed MR images to be reconstructed with superior catheter conspicuity and spatial resolution when compared to the more conventional zero-filling reconstruction approach. Moreover, compressed sensing allowed the shortening of total acquisition time (by up to 32 times) by vastly undersampling the k-space while simultaneously preserving spatial resolution and catheter conspicuity.

Single-subject voxel-based relaxometry for clinical assessment of temporal lobe epilepsy.

PURPOSE: T2 relaxometry, quantitative assessment of T2 relaxation time in magnetic resonance (MR) data, typically uses manually drawn regions of interest (ROIs). This approach is limited by its subjectivity and its restricted scope of investigation. A recently developed approach called voxel-based relaxometry (VBR) provides an unbiased statistical analysis of the whole brain. Our objective was to assess the clinical utility of single-subject VBR for patients with temporal lobe epilepsy (TLE). METHODS: Forty-five patients with TLE confirmed by history, EEG, and structural MRI and 25 control subjects were scanned at 3T using a modified Carr-Purcell-Meiboom-Gill MR sequence. ROIs were drawn for each patient and control subject, and measurements were made on unregistered T2 maps. VBR was performed on a single-subject basis at a significance level of alpha=0.05. Patients were grouped according to seizure focus (left mesial, right mesial, other), and whether structural MR imaging was normal or abnormal. RESULTS: Up to 85% of patients in the temporal lobe groups demonstrated T2 abnormalities. VBR detected abnormalities either in equal numbers or in more patients (up to 23% more) than ROI analysis for each group. The number of detected abnormalities per patient was higher using VBR (3.38 versus 2.04, p<0.05). VBR also identified abnormalities that were missed by ROI analysis. The rate of VBR detection of abnormalities was higher for patients than controls (76% versus 36%). CONCLUSIONS: VBR can be performed on single subjects with TLE and it detects considerably more abnormalities than ROI analysis. VBR may be a clinically useful tool for the detection of T2 abnormalities at the seizure focus and sites remote from it.

Time-efficient breath-hold abdominal MRI at 3.0 T.

OBJECTIVE: The purpose of this study was to increase the allowed number of acquired slices per unit time (i.e., time efficiency) for high-power deposition breath-hold abdominal acquisitions at 3.0 T. MATERIALS AND METHODS: Abdominal MRI protocols include various T1-weighted, T2-weighted, and contrast-enhanced acquisitions that require extended spatial coverage and resolution. Ideally, each acquisition is completed within one breath-hold. At 3.0 T, power deposition (i.e., specific absorption rate [SAR]) concerns can limit achieving these conflicting needs because conventional sequences are based on 6-minute time-average SAR requirements. We optimized abdominal-specific sequences based on an approved short-term 10-second time-average SAR criterion and added a delay time after breath-holding to fulfill the long-term 6-minute time-average power deposition regulation. RESULTS: Using our strategy, image acquisition time efficiency at 3.0 T was increased approximately twofold compared with conventional abdominal breath-hold pulse sequences for 2D dual-echo gradient-recalled echo, single-shot fast spin-echo, and 3D steady-state free precession sequences. Volunteers experienced a slight sensation of warmth for the single-shot fast spin-echo implementation, the most SAR-intensive sequence. CONCLUSION: Our optimization strategy is not vendor-specific, is easily implemented for all conventional scanners (provided one can access and modify the pulse sequences directly, or the vendors can make the necessary changes), yields a higher slice-per-unit-time imaging efficiency, and still satisfies all the regulatory power deposition requirements.

Passive catheter visualization in magnetic resonance-guided endovascular therapy using multicycle projection dephasers.

PURPOSE: To improve upon the conventional projection dephaser (PD) method of background suppression and evaluate the use of multicycle projection dephasers to improve catheter conspicuity in background-suppressed MR images. MATERIALS AND METHODS: Passive visualization of endovascular catheters in MR images is compared using two background suppression techniques: 1) the conventional PD method and 2) the multicycle PD method. Contrast-filled 4-French (1.3 mm) catheters were imaged in homogeneous and heterogeneous phantoms, and in the common carotid artery of a canine using a modified spoiled gradient echo imaging sequence. We used catheter-to-background contrast (ranging from -100% to 100%) as the metric to compare background suppression techniques. RESULTS: In the homogeneous and heterogeneous phantoms, the contrast was -6.9% (catheter darker than background) and 15.0%, respectively, using the conventional PD method, and 50.6% and 44.0%, respectively, using the multicycle PD method. In the canine carotid artery, the contrast was -3.1% using the conventional PD method and 53.0% using the multicycle PD method. CONCLUSION: This work shows that multicycle projection dephasers improve catheter conspicuity over the conventional PD method. The multicycle PD method has potential for use in guiding endovascular procedures.

Stroke imaging at 3.0 T.

Stroke is a devastating disease with a complex pathophysiology. It is a major cause of death and disability in North America. To fully characterize its extent and effects, one requires numerous specialized anatomical and functional MR techniques, specifically diffusion-weighted imaging, MR angiography, and perfusion-weighted imaging. The advent of 3.0 T clinical scanners has the potential to provide higher quality information in potentially less time compared with 1.5 T stroke-specific MR imaging protocols. This article gives a brief overview of stroke, presents the principles and clinical applications of the relevant MR techniques required for diagnostic stroke imaging at high field, and discusses the advantages, challenges, and limitations of 3.0 T imaging as they relate to stroke.

A novel method to derive separate gray and white matter cerebral blood flow measures from MR imaging of acute ischemic stroke patients.

Perfusion-weighted imaging (PWI) measures can predict tissue outcome in acute ischemic stroke. Accuracy might be improved if differential tissue susceptibility to ischemia is considered. We present a novel voxel-by-voxel analysis to characterize cerebral blood flow (CBF) separately in gray (GM) and white matter (WM). Ten patients were scanned with inversion-recovery spin-echo EPI (IRSEPI), diffusion-weighted imaging (DWI), PWI<6 h from onset and fluid attenuated inversion-recovery (FLAIR) at 30 days. Image processing included coregistration to PWI, automatic segmentation of IRSEPI into GM, WM and CSF and semiautomatic segmentation of DWI/FLAIR to derive the acute and 30-day lesions. Five tissue compartments were defined: (1) 'Core' (abnormal acutely and at 30 days), (2) 'Growth' (or 'infarcted penumbra', abnormal only at 30 days), (3) 'Reversed' (abnormal acutely but normal at 30 days), (4) 'MTT-Delayed ' (tissue with delayed mean transit time but not part of the acute or 30-day lesion), and (5) 'Normal' brain. Cerebral blood flow in GM and WM of each compartment was obtained from quantitative maps. Gray matter and WM mean CBF in the growth region differed by 5.5 mL/100 g min (P=0.015). Mean CBF also differed significantly within normal and MTT-Delayed compartments. The difference in the reversed region approached statistical significance. In core, GM and WM CBF did not differ. The results suggest separate ischemic thresholds for GM and WM in stroke penumbra.

MR imaging of hyperacute subarachnoid and intraventricular hemorrhage at 3T: a preliminary report of gradient echo T2*-weighted sequences.

We describe MR imaging findings applying gradient echo (GRE) T2*-weighted and fluid-attenuated inversion recovery (FLAIR) MR images at 3T to three patients with hyperacute subarachnoid and intraventricular hemorrhage from ruptured aneurysms. Hyperacute subarachnoid and intraventricular hemorrhages (SAH and IVH) were more clearly visualized as an area of decreased signal intensity on GRE T2*-weighted sequences than on FLAIR sequences in all three patients. These preliminary results suggest that acute SAH and IVH with GRE T2*-weighted imaging can be reliably diagnosed at 3T.

Magnetic resonance imaging at 3.0 Tesla: challenges and advantages in clinical neurological imaging.

MR imaging at very high field (3.0 T) is a significant new clinical tool in the modern neuroradiological armamentarium. In this report, we summarize our 40-month experience in performing clinical neuroradiological examinations at 3.0 T and review the relevant technical issues. We report on these issues and, where appropriate, their solutions. Issues examined include: increased SNR, larger chemical shifts, additional problems associated with installation of these scanners, challenges in designing and obtaining appropriate clinical imaging coils, greater acoustic noise, increased power deposition, changes in relaxation rates and susceptibility effects, and issues surrounding the safety and compatibility of implanted devices. Some of the these technical factors are advantageous (eg, increased signal-to-noise ratio), some are detrimental (eg, installation, coil design and development, acoustic noise, power deposition, device compatibility, and safety), and a few have both benefits and disadvantages (eg, changes in relaxation, chemical shift, and susceptibility). Fortunately solutions have been developed or are currently under development, by us and by others, for nearly all of these challenges. A short series of 1.5 T and 3.0 T patient images are also presented to illustrate the potential diagnostic benefits of scanning at higher field strengths. In summary, by paying appropriate attention to the discussed technical issues, high-quality neuro-imaging of patients is possible at 3.0 T.

Peak velocity determination using fast Fourier velocity encoding with minimal spatial encoding.

For quantitative peak velocity determination, a technique was developed that uses Fourier velocity encoding (FVE) for the fast acquisition of images of velocity with no spatial encoding other than slice selection. The technique produces images of velocity versus temporal frequency. In applications where the quantity of interest is the peak velocity and in-plane spatial localization is not required, high SNR images are produced with reduced sensitivity to errors due to slice thickness and motion. The technique was validated using steady and pulsatile flow in a straight tube, and compared to both phase contrast measurements and numerical models using steady flow in a 50% and a 75% cosinusoidal stenosis phantom. Results show that for slices as large as 2 cm and/or undergoing periodic motion, FVE can accurately measure the peak velocity in cases where a distribution of velocities exist.