Prospective Comparison of Free-Breathing Accelerated Cine Deep Learning Reconstruction Versus Standard Breath-Hold Cardiac MRI Sequences in Patients With Ischemic Heart Disease.

BACKGROUND. Cine cardiac MRI sequences require repeated breath-holds, which can be difficult for patients with ischemic heart disease (IHD). OBJECTIVE. The purpose of the study was to compare a free-breathing accelerated cine sequence using deep learning (DL) reconstruction and a standard breath-hold cine sequence in terms of image quality and left ventricular (LV) measurements in patients with IHD undergoing cardiac MRI. METHODS. This prospective study included patients undergoing 1.5- or 3-T cardiac MRI for evaluation of IHD between March 15, 2023, and June 21, 2023. Examinations included an investigational free-breathing cine short-axis sequence with DL reconstruction (hereafter, cine-DL sequence). Two radiologists (reader 1 [R1] and reader 2 [R2]), in blinded fashion, independently assessed left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and subjective image quality for the cine-DL sequence and a standard breath-hold balanced SSFP sequence; R1 assessed artifacts. RESULTS. The analysis included 26 patients (mean age, 64.3 ± 11.7 [SD] years; 14 men, 12 women). Acquisition was shorter for the cine-DL sequence than the standard sequence (mean ± SD, 0.6 ± 0.1 vs 2.4 ± 0.6 minutes; p < .001). The cine-DL sequence, in comparison with the standard sequence, showed no significant difference for LVEF for R1 (mean ± SD, 51.7% ± 14.3% vs 51.3% ± 14.7%; p = .56) or R2 (53.4% ± 14.9% vs 52.8% ± 14.6%; p = .53); significantly greater LVEDV for R2 (mean ± SD, 171.9 ± 51.9 vs 160.6 ± 49.4 mL; p = .01) but not R1 (171.8 ± 53.7 vs 165.5 ± 52.4 mL; p = .16); and no significant difference in LVESV for R1 (mean ± SD, 88.1 ± 49.3 vs 86.0 ± 50.5 mL; p = .45) or R2 (85.2 ± 48.1 vs 81.3 ± 48.2 mL; p = .10). The mean bias between the cine-DL and standard sequences by LV measurement was as follows: LVEF, 0.4% for R1 and 0.7% for R2; LVEDV, 6.3 mL for R1 and 11.3 mL for R2; and LVESV, 2.1 mL for R1 and 3.9 mL for R2. Subjective image quality was better for cine-DL sequence than the standard sequence for R1 (mean ± SD, 2.3 ± 0.5 vs 1.9 ± 0.8; p = .02) and R2 (2.2 ± 0.4 vs 1.9 ± 0.7; p = .02). R1 reported no significant difference between the cine-DL and standard sequences for off-resonance artifacts (3.8% vs 23.1% examinations; p = .10) and parallel imaging artifacts (3.8% vs 19.2%; p = .19); blurring artifacts were more frequent for the cine-DL sequence than the standard sequence (42.3% vs 7.7% examinations; p = .008). CONCLUSION. A free-breathing cine-DL sequence, in comparison with a standard breath-hold cine sequence, showed very small bias for LVEF measurements and better subjective quality. The cine-DL sequence yielded greater LV volumes than the standard sequence. CLINICAL IMPACT. A free-breathing cine-DL sequence may yield reliable LVEF measurements in patients with IHD unable to repeatedly breath-hold. TRIAL REGISTRATION. ClinicalTrials.gov NCT05105984.

Fluid suppression in amide proton transfer-weighted (APTw) CEST imaging: New theoretical insights and clinical benefits.

PURPOSE: Amide proton transfer-weighted (APTw) MRI at 3T provides a unique contrast for brain tumor imaging. However, APTw imaging suffers from hyperintensities in liquid compartments such as cystic or necrotic structures and provides a distorted APTw signal intensity. Recently, it has been shown that heuristically motivated fluid suppression can remove such artifacts and significantly improve the readability of APTw imaging. THEORY AND METHODS: In this work, we show that the fluid suppression can actually be understood by the known concept of spillover dilution, which itself can be derived from the Bloch-McConnell equations in comparison to the heuristic approach. Therefore, we derive a novel post-processing formula that efficiently removes fluid artifact, and explains previous approaches. We demonstrate the utility of this APTw assessment in silico, in vitro, and in vivo in brain tumor patients acquired at MR scanners from different vendors. RESULTS: Our results show a reduction of the CEST signals from fluid environments while keeping the APTw-CEST signal intensity almost unchanged for semi-solid tissue structures such as the contralateral normal appearing white matter. This further allows us to use the same color bar settings as for conventional APTw imaging. CONCLUSION: Fluid suppression has considerable value in improving the readability of APTw maps in the neuro-oncological field. In this work, we derive a novel post-processing formula from the underlying Bloch-McConnell equations that efficiently removes fluid artifact, and explains previous approaches which justify the derivation of this metric from a theoretical point of view, to reassure the scientific and medical field about its use.

Prognostic value of SPECT myocardial perfusion entropy in high-risk type 2 diabetic patients.

PURPOSE: Risk stratification of patients with type 2 diabetes mellitus (T2D) remains suboptimal. We hypothesized that myocardial perfusion entropy (MPE) quantified from SPECT myocardial perfusion images may provide incremental prognostic value in T2D patients independently from myocardial ischemia. METHODS: T2D patients with very high and high cardiovascular risk were prospectively included (n = 166, 65 ± 12 years). Stress perfusion defect was quantified by visual evaluation of SPECT MPI. SPECT MPI was also used for the quantification of rest and stress MPE. The primary end point was major adverse cardiac events (MACEs) defined as cardiac death, myocardial infarction (MI), and myocardial revascularization > 3 months after SPECT. RESULTS: Forty-four MACEs were observed during a 4.6-year median follow-up. Significant differences in stress MPE were observed between patients with and without MACEs (4.19 ± 0.46 vs. 3.93 ± 0.40; P ≤ .01). By Kaplan-Meier analysis, the risk of MACEs was significantly higher in patients with higher stress MPE (log-rank P ≤ 01). Stress MPE and stress perfusion defect (SSS ≥ 4) were significantly associated with the risk of MACEs (hazard ratio 2.77 and 2.06, respectively, P < .05 for both) after adjustment for clinical and imaging risk predictors as identified from preliminary univariate analysis. MPE demonstrated incremental prognostic value over clinical risk factors, stress test EKG and SSS as evidenced by nested models showing improved Akaike information criterion (AIC), reclassification (global continuous net reclassification improvement [NRI]: 63), global integrated discrimination improvement (IDI: 6%), and discrimination (change in c-statistic: 0.66 vs 0.74). CONCLUSIONS: Stress MPE provided independent and incremental prognostic information for the prediction of MACEs in diabetic patients. TRIAL REGISTRATION NUMBER: NCT02316054 (12/12/2014).

Abbreviated breast MRI combining FAST protocol and high temporal resolution (HTR) dynamic contrast enhanced (DCE) sequence.

PURPOSE: We evaluated the diagnostic value of a high temporal resolution (HTR) dynamic contrast enhanced (DCE) sequence added to a FAST protocol. MATERIALS AND METHODS: 120 women (mean age = 55 years (28-88)) who underwent breast MRI between July 2016 and March 2017 and in whom a biopsy was performed (i.e., gold standard) (n = 179: 69 benign, 7 borderline and 103 malignant lesions) were retrospectively and consecutively included. Two readers classified lesions according to the Breast Imaging-Reporting and Data System (BI-RADS) by reading: a FAST protocol (T1W, T2W, T1W-fat saturated 2 min after injection) and then a FULL standard protocol. Independently they determined if lesions were visible and when (Time To Enhancement (TTE)) on the HTR-DCE sequence. An Abbreviated protocol was then built using data from the HTR-DCE sequence added to the FAST protocol. RESULTS: All lesions were visible with the FAST protocol. 171/179 (95.5%) lesions were detected by reading theHTR-DCE sequence. There were a higher number of cancers rated BI-RADS 3 (PPV of malignancy of 27.6% (8/29) in FAST versus 18.7% (3/16) FULL protocol). An early enhancement on the HTR-DCE sequence (TTE < 31 s) was associated with malignancy with an OR 5.6 (CI 95%: 3.3-20.4) (p < 0.0001). Adding a TTE < 31 s to FAST analysis (AUROC = 0.826) significantly improved lesion characterization with a diagnostic gain of 10.6% (19/179) lesions correctly reclassified (p = 0.0034) compared to FAST protocol; with shorter acquisition time (7 min 48 s versus 13 min 54 s). CONCLUSION: Adding an HTR-DCE sequence to a FAST protocol increases diagnostic performance reaching that of the FULL protocol while reducing acquisition time.

One-millimeter isotropic breast diffusion-weighted imaging: Evaluation of a superresolution strategy in terms of signal-to-noise ratio, sharpness and apparent diffusion coefficient.

PURPOSE: To quantitatively evaluate a superresolution technique for 3D, one-millimeter isotropic diffusion-weighted imaging (DWI) of the whole breasts. METHODS: Isotropic 3D DWI datasets are obtained using a combination of (i) a readout-segmented diffusion-weighted-echo-planar imaging (DW-EPI) sequence (rs-EPI), providing high in-plane resolution, and (ii) a superresolution (SR) strategy, which consists of acquiring 3 datasets with thick slices (3 mm) and 1-mm shifts in the slice direction, and combining them into a 1 × 1 × 1-mm3 dataset using a dedicated reconstruction. Two SR reconstruction schemes were investigated, based on different regularization schemes: conventional Tikhonov or Beltrami (an edge-preserving constraint). The proposed SR strategy was compared to native 1 × 1 × 1-mm3 acquisitions (i.e. with 1-mm slice thickness) in 8 healthy subjects, in terms of signal-to-noise ratio (SNR) efficiency, using a theoretical framework, Monte Carlo simulations and region-of-interest (ROI) measurements, and image sharpness metrics. Apparent diffusion coefficient (ADC) values in normal breast tissue were also compared. RESULTS: The SR images resulted in an SNR gain above 3 compared to native 1 × 1 × 1-mm3 using the same acquisition duration (acquisition gain 3 and reconstruction gain >1). Beltrami-SR provided the best results in terms of SNR and image sharpness. The ADC values in normal breast measured from Beltrami-SR were preserved compared to low-resolution images (1.91 versus 1.97 ×10-3 mm2 /s, P = .1). CONCLUSION: A combination of rs-EPI and SR allows 3D, 1-mm isotropic breast DWI data to be obtained with better SNR than a native 1-mm isotropic acquisition. The proposed DWI protocol might be of interest for breast cancer monitoring/screening without injection.

Abbreviated breast magnetic resonance protocol: Value of high-resolution temporal dynamic sequence to improve lesion characterization.

PURPOSE: To evaluate the added value of ULTRAFAST-MR sequence to an abbreviated FAST protocol in comparison with FULL protocol to distinguish benign from malignant lesions in a population of women, regardless of breast MR imaging indication. MATERIALS AND METHODS: From March 10th to September 22th, 2014, we retrospectively included a total of 70 consecutive patients with 106 histologically proven lesions (58 malignant and 48 benign) who underwent breast MR imaging for preoperative breast staging (n=38), high-risk screening (n=7), problem solving (n=18), and nipple discharge (n=4) with 12 time resolved imaging of contrast kinetics (TRICKS) acquisitions during contrast inflow interleaved in a regular high-resolution dynamic MRI protocol (FULL protocol). Two readers scored MR exams as either positive or negative and described significant lesions according to Bi-RADS lexicon with a TRICKS images (ULTRAFAST), an abbreviated protocol (FAST) and all images (FULL protocol). Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for each protocol and compared with McNemar's test. RESULTS: For all readers, the combined FAST-ULTRAFAST protocol significantly improved the reading with a specificity of 83.3% and 70.8% in comparison with FAST protocol or FULL protocol, respectively, without change in sensitivity. By adding ULTRAFAST protocol to FAST protocol, readers 1 and 2 were able to correctly change the diagnosis in 22.9% (11/48) and 10.4% (5/48) of benign lesions, without missing any malignancy, respectively. Both interpretation and image acquisition times for combined FAST-ULTRAFAST protocol and FAST protocol were shorter compared to FULL protocol (p<0.001). CONCLUSION: Compared to FULL protocol, adding ULTRAFAST to FAST protocol improves specificity, mainly in correctly reclassifying benign masses and reducing interpretation and acquisition time, without decreasing sensitivity.