The use of 7T MRI in multiple sclerosis: review and consensus statement from the North American Imaging in Multiple Sclerosis Cooperative.

The use of ultra-high-field 7-Tesla (7T) MRI in multiple sclerosis (MS) research has grown significantly over the past two decades. With recent regulatory approvals of 7T scanners for clinical use in 2017 and 2020, the use of this technology for routine care is poised to continue to increase in the coming years. In this context, the North American Imaging in MS Cooperative (NAIMS) convened a workshop in February 2023 to review the previous and current use of 7T technology for MS research and potential future research and clinical applications. In this workshop, experts were tasked with reviewing the current literature and proposing a series of consensus statements, which were reviewed and approved by the NAIMS. In this review and consensus paper, we provide background on the use of 7T MRI in MS research, highlighting this technology's promise for identification and quantification of aspects of MS pathology that are more difficult to visualize with lower-field MRI, such as grey matter lesions, paramagnetic rim lesions, leptomeningeal enhancement and the central vein sign. We also review the promise of 7T MRI to study metabolic and functional changes to the brain in MS. The NAIMS provides a series of consensus statements regarding what is currently known about the use of 7T MRI in MS, and additional statements intended to provide guidance as to what work is necessary going forward to accelerate 7T MRI research in MS and translate this technology for use in clinical practice and clinical trials. This includes guidance on technical development, proposals for a universal acquisition protocol and suggestions for research geared towards assessing the utility of 7T MRI to improve MS diagnostics, prognostics and therapeutic efficacy monitoring. The NAIMS expects that this article will provide a roadmap for future use of 7T MRI in MS.

From strength to precision: A systematic review exploring the clinical utility of 7-Tesla magnetic resonance imaging in abdominal imaging.

BACKGROUND: After approval for clinical use in 2017 early investigations of ultra-high-field abdominal magnetic resonance imaging (MRI) have demonstrated the feasibility as well as diagnostic capabilities of liver, kidney, and prostate MRI at 7-Tesla. However, the elevation of the field strength to 7-Tesla not only brought advantages to abdominal MRI but also presented considerable challenges and drawbacks, primarily stemming from heightened artifacts and limitations in Specific Absorption Rate, etc. Furthermore, evidence in the literature is relatively scarce concerning human studies in comparison to phantom/animal studies which necessitates an investigation into the evidence so far in humans and summarizing all relevant evidence. AIM: To offer a comprehensive overview of current literature on clinical abdominal 7T MRI that emphasizes current trends, details relevant challenges, and provides a concise set of potential solutions. METHODS: This systematic review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A PubMed search, utilizing Medical Subject Headings terms such as "7-Tesla" and organ-specific terms, was conducted for articles published between January 1, 1985, and July 25, 2023. Eligibility criteria included studies exploring 7T MRI for imaging human abdominal organs, encompassing various study types (in-vivo/ex-vivo, method development, reviews/meta-analyses). Exclusion criteria involved animal studies and those lacking extractable data. Study selection involved initial identification via title/abstract, followed by a full-text review by two researchers, with discrepancies resolved through discussion. Data extraction covered publication details, study design, population, sample size, 7T MRI protocol, image characteristics, endpoints, and conclusions. RESULTS: The systematic review included a total of 21 studies. The distribution of clinical 7T abdominal imaging studies revealed a predominant focus on the prostate (n = 8), followed by the kidney (n = 6) and the hepatobiliary system (n = 5). Studies on these organs, and in the pancreas, demonstrated clear advantages at 7T. However, small bowel studies showed no significant improvements compared to traditional MRI at 1.5T. The majority of studies evaluated originated from Germany (n = 10), followed by the Netherlands (n = 5), the United States (n = 5), Austria (n = 2), the United Kingdom (n = 1), and Italy (n = 1). CONCLUSION: Further increase of abdominal clinical MRI field strength to 7T demonstrated high imaging potential, yet also limitations mainly due to the inhomogeneous radiofrequency (RF) excitation field relative to lower field strengths. Hence, further optimization of dedicated RF coil elements and pulse sequences are expected to better optimize clinical imaging at high magnetic field strength.

Evaluation of 3-dimensional stereotactic surface projection rendering of arterial spin labeling data in a clinical cohort.

BACKGROUND AND PURPOSE: To assess the feasibility of 3-dimensional stereotactic surface projection (3D-SSP) as applied to arterial spin labeling (ASL) in a clinical pilot study. METHODS: A retrospective sample of 10 consecutive patients who underwent ASL as part of a clinically indicated MR examination was collected during this pilot study. Five additional subjects with normal cerebral perfusion served as a control group. Following voxel-wise M0-correction, cerebral blood flow (CBF) quantification, and stereotactic anatomic standardization, voxel-wise CBF from an individual's ASL dataset was extracted to a set of predefined surface pixels (3D-SSP). A normal database was created from averaging the extracted CBF datasets of the control group. Patients' datasets were compared individually with the normal database by calculating a Z-score on a pixel-by-pixel basis and were displayed in 3D-SSP views for visual inspection. Independent, two-expert reader assessment, using a 3-point scale, compared standard quantitative CBF images to the 3D-SSP maps. RESULTS: Patterns and severities of regionally reduced CBF were identified, by both independent readers, in the 3D-SSP maps. Reader assessment demonstrated preference for 3D-SSP over traditionally displayed standard quantitative CBF images in three of four evaluated imaging metrics (p = .026, .031, and .013, respectively); 3D-SSP maps were never found to be inferior to the standard quantitative CBF images. CONCLUSIONS: Three-dimensional SSP maps are feasible in a clinical population and enable quantitative data extraction and localization of perfusion abnormalities by means of stereotactic coordinates in a condensed display. The proposed method is a promising approach for interpreting cerebrovascular pathophysiology.

The Dangers of Fabric in MRI.

Thermal burns are the most common injury sustained during MRI. Textiles such as clothing and blankets, and most recently fabric face masks are emerging as key factors when considering such thermal injuries. Fabric can trap heat and sweat close to the body and fabric containing metallic fibers can interact with MRI's RF waves to induce burns, which represents the majority of reported fabric-related thermal injury cases. This may be exacerbated by a lack of comprehensive labeling when fabrics contain trace amounts of metals. This review outlines case reports and makes suggestions that may reduce the frequency of these burns. The single most effective way to reduce the danger of fabric-induced MRI burns is to require all patients to change into MR-safe clothing, such as approved hospital gowns, prior to imaging.

Motion resilience of the balanced steady-state free precession geometric solution.

PURPOSE: Many MRI sequences are sensitive to motion and its associated artifacts. The linearized geometric solution (LGS), a balanced steady-state free precession (bSSFP) off-resonance signal demodulation technique, is evaluated with respect to motion artifact resilience. THEORY AND METHODS: The mechanism and extent of LGS motion artifact resilience is examined in simulated, flow phantom, and in vivo clinical imaging. Motion artifact correction capabilities are decoupled from susceptibility artifact correction when feasible to permit controlled analysis of motion artifact correction when comparing the LGS with standard and phase-cycle-averaged (complex sum) bSSFP imaging. RESULTS: Simulations reveal that the LGS demonstrates motion artifact reduction capabilities similar to standard clinical bSSFP imaging techniques, with slightly greater resilience in high SNR regions and for shorter-duration motion. Flow phantom experiments assert that the LGS reduces shorter-duration motion artifact error by ∼24%-65% relative to the complex sum, whereas reconstructions exhibit similar error reduction for constant motion. In vivo analysis demonstrates that in the internal auditory canal/orbits, the LGS was deemed to have less artifact in 24%/49% and similar artifact in 76%/51% of radiological assessments relative to the complex sum, and the LGS had less artifact in 97%/81% and similar artifact in 3%/16% of assessments relative to standard bSSFP. Only 2 of 63 assessments deemed the LGS inferior to either complex sum or standard bSSFP in terms of artifact reduction. CONCLUSION: The LGS provides sufficient bSSFP motion artifact resilience to permit robust elimination of susceptibility artifacts, inspiring its use in a wide variety of applications.

Correlating the Radiological Assessment of Patient Motion with the Incidence of Repeat Sequences Documented by Log Files.

OBJECTIVE: To correlate a radiological assessment of MR motion artifacts with the incidence of repeated sequences and delays derived from modality log files (MLFs) and investigate the suitability of log files for quantifying the operational impact of patient motion. MATERIALS AND METHODS: An experienced, blinded neuroradiologist retrospectively evaluated one full calendar month of sequentially obtained clinical MR exams of the head and/or brain for the presence of motion artifacts using a previously defined clinical grading scale. MLF data were analyzed to extract the occurrence of repeated sequences during the examinations. Statistical analysis included the determination of 95% confidence intervals for repetition ratios, and Welch's t-test to exclude the hypothesis of equal means for different groups of sequences. RESULTS: A total of 213 examinations were evaluated, comprising 1681 MLF-documented sequences, from which 1580 were archived. Radiological motion assessment scores (0, none to 4, severe) were assigned to each archived sequence. Higher motion scores correlated with a higher MLF-derived repetition probability, reflected by the average motion scores assigned to sequences that would be repeated (group 1, mean=2.5), those that are a repeat (group 2, mean=1.9), and those that are not repeated (group 3, mean=1.1) within an exam. The hypothesis of equal means was rejected with P = 5.9 × 10-5 for groups 1 and 2, P = 9.39 × 10-16 for groups 1 and 3, and P = 1.55 × 10-12 for groups 2 and 3. The repetition probability and associated time loss could be quantified for individual sequence types. The total time loss due to repeat sequence acquisition derived from MLFs was greater than four hours. CONCLUSION: Log file data may help assess patterns of scanner and exam performance and may be useful in identifying pitfalls to diagnostic imaging in a clinical environment, particularly with respect to patient motion.

A Best Practices Case Study for Scientific Collaboration between Researchers and Managers.

Effective engagement among scientists, government agency staff, and policymakers is necessary for solving fisheries challenges, but remains challenging for a variety of reasons. We present seven practices learned from a collaborative project focused on invasive species in the Great Lakes region (USA-CAN). These practices were based on a researcher-manager model composed of a research team, a management advisory board, and a bridging organization. We suggest this type of system functions well when (1) the management advisory board is provided compelling rationale for engagement; (2) the process uses key individuals as communicators; (3) the research team thoughtfully selects organizations and individuals involved; (4) the funding entity provides logistical support and allows for (5) a flexible structure that prioritizes management needs; (6) a bridging organization sustains communication between in-person meetings; and (7) the project team determines and enacts a project endpoint. We predict these approaches apply equally effectively to other challenges at the research-management-policy interface, including reductions of water pollution, transitions to renewable energy, increasing food security, and addressing climate change.

MR Imaging Safety Events: Analysis and Improvement.

Multiple factors, including tight patient scheduling, complex electronic medical records, and increasing numbers of implanted devices, increase chances of MR imaging safety event occurrence. Several MR imaging safety incidents are described in this article, including the safety conditions and other factors that contributed to the events. MR imaging safety policy and procedural improvements that address these are also described. Specific new revision points in the American College of Radiology Manual on MR Safety are viewed in the context of these events, with emphasis on how their implementation could reduce probability of similar event recurrence.

Simulating Tissues with 3D-Printed and Castable Materials.

Manufacturing technologies continue to be developed and utilized in medical prototyping, simulations, and imaging phantom production. For radiologic image-guided simulation and instruction, models should ideally have similar imaging characteristics and physical properties to the tissues they replicate. Due to the proliferation of different printing technologies and materials, there is a diverse and broad range of approaches and materials to consider before embarking on a project. Although many printed materials' biomechanical parameters have been reported, no manufacturer includes medical imaging properties that are essential for realistic phantom production. We hypothesize that there are now ample materials available to create high-fidelity imaging anthropomorphic phantoms using 3D printing and casting of common commercially available materials. A material database of radiological, physical, manufacturing, and economic properties for 29 castable and 68 printable materials was generated from samples fabricated by the authors or obtained from the manufacturer and scanned with CT at multiple tube voltages. This is the largest study assessing multiple different parameters associated with 3D printing to date. These data are being made freely available on GitHub, thus affording medical simulation experts access to a database of relevant imaging characteristics of common printable and castable materials. Full data available at: https://github.com/nmcross/Material-Imaging-Characteristics .

Practical Considerations for Radiologists in Implementing a Patient-friendly MRI Experience.

For many patients, numerous unpleasant features of the magnetic resonance imaging (MRI) experience such as scan duration, auditory noise, spatial confinement, and motion restrictions can lead to premature termination or low diagnostic quality of imaging studies. This article discusses practical, patient-oriented considerations that are helpful for radiologists contemplating ways to improve the MRI experience for patients. Patient friendly scanner properties are discussed, with an emphasis on literature findings of effectiveness in mitigating patient claustrophobia, other anxiety, or motion and on reducing scan incompletion rates or need for sedation. As shorter scanning protocols designed to answer specific diagnostic questions may be more practical and tolerable to the patient than a full-length standard-of-care examination, a few select protocol adjustments potentially useful for specific clinical settings are discussed. In addition, adjunctive devices such as audiovisual or other sensory aides that can be useful distractive approaches to reduce patient discomfort are considered. These modifications to the MRI scanning process not only allow for a more pleasant experience for patients, but they may also increase patient compliance and decrease patient movement to allow more efficient acquisition of diagnostic-quality images.

Making Magnets More Attractive: Physics and Engineering Contributions to Patient Comfort in MRI.

Patient comfort is an important factor of a successful magnetic resonance (MR) examination, and improvements in the patient's MR scanning experience can contribute to improved image quality, diagnostic accuracy, and efficiency in the radiology department, and therefore reduced cost. Magnet designs that are more open and accessible, reduced auditory noise of MR examinations, light and flexible radiofrequency (RF) coils, and faster motion-insensitive imaging techniques can all significantly improve the patient experience in MR imaging. In this work, we review the design, development, and implementation of these physics and engineering approaches to improve patient comfort.

ACR guidance document on MR safe practices: Updates and critical information 2019.

The need for a guidance document on MR safe practices arose from a growing awareness of the MR environment's potential risks and adverse event reports involving patients, equipment, and personnel. Initially published in 2002, the American College of Radiology White Paper on MR Safety established de facto industry standards for safe and responsible practices in clinical and research MR environments. The most recent version addresses new sources of risk of adverse events, increases awareness of dynamic MR environments, and recommends that those responsible for MR medical director safety undergo annual MR safety training. With regular updates to these guidelines, the latest MR safety concerns can be accounted for to ensure a safer MR environment where dangers are minimized. Level of Evidence: 1 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:331-338.

A Framework for Aquatic Invasive Species Surveillance Site Selection and Prioritization in the US waters of the Laurentian Great Lakes.

Risk-based prioritization for early detection monitoring is of utmost importance to prevent and mitigate invasive species impacts. The Great Lakes Water Quality Agreement, a binational commitment between the United States and Canada to restore and protect the waters of the Laurentian Great Lakes, identifies aquatic invasive species (AIS) as one of ten priority issues (annexes) that must be addressed to ensure the chemical, physical, and biological integrity of the Great Lakes. The Agreement calls out the need for a comprehensive strategy for detecting and tracking new and potentially invasive species. Yet, with a surface water area of 95, 000 square miles (246, 049 square km) and shoreline length of 10, 210 miles (16, 431 km), the Great Lakes represent a daunting challenge for prioritizing where AIS surveillance activities should occur. Our goal was to develop a spatially-explicit and quantitative approach for identifying the highest risk sites for AIS introduction into the US waters of the Great Lakes based on the cumulative risk of new introductions (including range expansions) from a range of pathways and associated taxa. We estimate "invasion risk" scores for nearly 6,000 sites (9 km x 9 km) across the Great Lakes basin using proxy measures for propagule pressure weighted by the proportion of taxa associated with each proxy variable. Proxy variables include human population, number of ship visits, marina size, number of ponds, and number of natural or artificial aquatic connections. In total, we identify more than 1,800 sites with invasion risk scores >0. A small subset of these 1,800+ sites accounts for a majority of predicted propagule pressure and are therefore logical targets for future surveillance and AIS prevention efforts. Many of the highest risk sites are located in western Lake Erie, southern Lake Michigan, and the St. Clair-Detroit River System.

Embodied Synaptic Plasticity With Online Reinforcement Learning.

The endeavor to understand the brain involves multiple collaborating research fields. Classically, synaptic plasticity rules derived by theoretical neuroscientists are evaluated in isolation on pattern classification tasks. This contrasts with the biological brain which purpose is to control a body in closed-loop. This paper contributes to bringing the fields of computational neuroscience and robotics closer together by integrating open-source software components from these two fields. The resulting framework allows to evaluate the validity of biologically-plausibe plasticity models in closed-loop robotics environments. We demonstrate this framework to evaluate Synaptic Plasticity with Online REinforcement learning (SPORE), a reward-learning rule based on synaptic sampling, on two visuomotor tasks: reaching and lane following. We show that SPORE is capable of learning to perform policies within the course of simulated hours for both tasks. Provisional parameter explorations indicate that the learning rate and the temperature driving the stochastic processes that govern synaptic learning dynamics need to be regulated for performance improvements to be retained. We conclude by discussing the recent deep reinforcement learning techniques which would be beneficial to increase the functionality of SPORE on visuomotor tasks.

Safety Considerations of 7-T MRI in Clinical Practice.

Although 7-T MRI has recently received approval for use in clinical patient care, there are distinct safety issues associated with this relatively high magnetic field. Forces on metallic implants and radiofrequency power deposition and heating are safety considerations at 7 T. Patient bioeffects such as vertigo, dizziness, false feelings of motion, nausea, nystagmus, magnetophosphenes, and electrogustatory effects are more common and potentially more pronounced at 7 T than at lower field strengths. Herein the authors review safety issues associated with 7-T MRI. The rationale for safety concerns at this field strength are discussed as well as potential approaches to mitigate risk to patients and health care professionals.

MRI Radiomic Features Are Independently Associated With Overall Survival in Soft Tissue Sarcoma.

PURPOSE: Soft tissue sarcomas (STS) represent a heterogeneous group of diseases, and selection of individualized treatments remains a challenge. The goal of this study was to determine whether radiomic features extracted from magnetic resonance (MR) images are independently associated with overall survival (OS) in STS. METHODS AND MATERIALS: This study analyzed 2 independent cohorts of adult patients with stage II-III STS treated at center 1 (N = 165) and center 2 (N = 61). Thirty radiomic features were extracted from pretreatment T1-weighted contrast-enhanced MR images. Prognostic models for OS were derived on the center 1 cohort and validated on the center 2 cohort. Clinical-only (C), radiomics-only (R), and clinical and radiomics (C+R) penalized Cox models were constructed. Model performance was assessed using Harrell's concordance index. RESULTS: In the R model, tumor volume (hazard ratio [HR], 1.5) and 4 texture features (HR, 1.1-1.5) were selected. In the C+R model, both age (HR, 1.4) and grade (HR, 1.7) were selected along with 5 radiomic features. The adjusted c-indices of the 3 models ranged from 0.68 (C) to 0.74 (C+R) in the derivation cohort and 0.68 (R) to 0.78 (C+R) in the validation cohort. The radiomic features were independently associated with OS in the validation cohort after accounting for age and grade (HR, 2.4; P = .009). CONCLUSIONS: This study found that radiomic features extracted from MR images are independently associated with OS when accounting for age and tumor grade. The overall predictive performance of 3-year OS using a model based on clinical and radiomic features was replicated in an independent cohort. Optimal models using clinical and radiomic features could improve personalized selection of therapy in patients with STS.

Avoiding MRI-Related Accidents: A Practical Approach to Implementing MR Safety.

MRI is a ubiquitous medical imaging technology typically using superconductivity to generate a strong, homogeneous, and generally ceaseless magnetic field. MRI and its magnetic field pose many safety hazards, including magnetic forces on metals, tissue heating and burns, nerve stimulation, bioeffects, acoustic noise, and contrast agent complications. The primary concern is that a wide variety of patients, staff members, technologists, and physicians can approach the incessant magnetic field, creating great potential for accidents that could occur if metals from the environment, adornments, implants, and other unintended sources are also present in or near the field. Many accidents have occurred and are occasionally reported in the United States and countries all over the world. Through carefully structured oversight and the establishment of strict guidelines regarding access, responsibilities, and training, these risks can be mitigated, and accidents can be prevented. Fortunately, there is currently a wide variety of resources available to facilitate the successful implementation of an effective MRI safety program. This article presents a general overview of and the authors' experience with an MRI safety program in terms of risk management and training. The MR safety program requirements and regulations in the United States devised by The Joint Commission and the ACR are also discussed. With these resources and a carefully selected team, the risk for MRI-related accidents can be vastly reduced if not completely eliminated.

Gate-tunable frequency combs in graphene-nitride microresonators.

Optical frequency combs, which emit pulses of light at discrete, equally spaced frequencies, are cornerstones of modern-day frequency metrology, precision spectroscopy, astronomical observations, ultrafast optics and quantum information1-7. Chip-scale frequency combs, based on the Kerr and Raman nonlinearities in monolithic microresonators with ultrahigh quality factors8-10, have recently led to progress in optical clockwork and observations of temporal cavity solitons11-14. But the chromatic dispersion within a laser cavity, which determines the comb formation15,16, is usually difficult to tune with an electric field, whether in microcavities or fibre cavities. Such electrically dynamic control could bridge optical frequency combs and optoelectronics, enabling diverse comb outputs in one resonator with fast and convenient tunability. Arising from its exceptional Fermi-Dirac tunability and ultrafast carrier mobility17-19, graphene has a complex optical dispersion determined by its optical conductivity, which can be tuned through a gate voltage20,21. This has brought about optoelectronic advances such as modulators22,23, photodetectors 24 and controllable plasmonics25,26. Here we demonstrate the gated intracavity tunability of graphene-based optical frequency combs, by coupling the gate-tunable optical conductivity to a silicon nitride photonic microresonator, thus modulating its second- and higher-order chromatic dispersions by altering the Fermi level. Preserving cavity quality factors up to 106 in the graphene-based comb, we implement a dual-layer ion-gel-gated transistor to tune the Fermi level of graphene across the range 0.45-0.65 electronvolts, under single-volt-level control. We use this to produce charge-tunable primary comb lines from 2.3 terahertz to 7.2 terahertz, coherent Kerr frequency combs, controllable Cherenkov radiation and controllable soliton states, all in a single microcavity. We further demonstrate voltage-tunable transitions from periodic soliton crystals to crystals with defects, mapped by our ultrafast second-harmonic optical autocorrelation. This heterogeneous graphene microcavity, which combines single-atomic-layer nanoscience and ultrafast optoelectronics, will help to improve our understanding of dynamical frequency combs and ultrafast optics.

MRI sport-specific pulley imaging.

OBJECTIVE: We aim to create a novel MRI methodology that employs sport-specific stress views for imaging finger pulley injuries in the evaluation of post-operative healing effectiveness. The goal is to measure the bone to tendon distance (BTD), which is the current standard for determining pulley injuries. MATERIALS AND METHODS: The athlete was imaged in a crimp-grip stressed position to emulate sport-specific biomechanics. A Gradient Echo technique was modified to maximize the signal to noise ratio and minimize distortion near the bone and tendon, simplifying the determination of the BTD. RESULTS: A stress-crimped hand position is imaged in less than one half-minute to enable diagnostic visualization of a normal proximal phalanx' bone and tendon via measurement of their BTD. CONCLUSION: This novel stress methodology allows for sport-specific imaging, which is ideal for determining functional compromise of the hand's pulley mechanism. Surgical outcomes may be more sensitively compared when using stress views, and these comparisons may then direct optimal repair technique. Future studies will utilize this technique to attempt early-stage detection of pulley injuries prior to complete rupture.