Free-breathing 3D whole-heart joint T1/T2 mapping and water/fat imaging at 0.55 T.

PURPOSE: To develop and validate a highly efficient motion compensated free-breathing isotropic resolution 3D whole-heart joint T1/T2 mapping sequence with anatomical water/fat imaging at 0.55 T. METHODS: The proposed sequence takes advantage of shorter T1 at 0.55 T to acquire three interleaved water/fat volumes with inversion-recovery preparation, no preparation, and T2 preparation, respectively. Image navigators were used to facilitate nonrigid motion-compensated image reconstruction. T1 and T2 maps were jointly calculated by a dictionary matching method. Validations were performed with simulation, phantom, and in vivo experiments on 10 healthy volunteers and 1 patient. The performance of the proposed sequence was compared with conventional 2D mapping sequences including modified Look-Locker inversion recovery and T2-prepared balanced steady-SSFP sequence. RESULTS: The proposed sequence has a good T1 and T2 encoding sensitivity in simulation, and excellent agreement with spin-echo reference T1 and T2 values was observed in a standardized T1/T2 phantom (R2 = 0.99). In vivo experiments provided good-quality co-registered 3D whole-heart T1 and T2 maps with 2-mm isotropic resolution in a short scan time of about 7 min. For healthy volunteers, left-ventricle T1 mean and SD measured by the proposed sequence were both comparable with those of modified Look-Locker inversion recovery (640 ± 35 vs. 630 ± 25 ms [p = 0.44] and 49.9 ± 9.3 vs. 54.4 ± 20.5 ms [p = 0.42]), whereas left-ventricle T2 mean and SD measured by the proposed sequence were both slightly lower than those of T2-prepared balanced SSFP (53.8 ± 5.5 vs. 58.6 ± 3.3 ms [p < 0.01] and 5.2 ± 0.9 vs. 6.1 ± 0.8 ms [p = 0.03]). Myocardial T1 and T2 in the patient measured by the proposed sequence were in good agreement with conventional 2D sequences and late gadolinium enhancement. CONCLUSION: The proposed sequence simultaneously acquires 3D whole-heart T1 and T2 mapping with anatomical water/fat imaging at 0.55 T in a fast and efficient 7-min scan. Further investigation in patients with cardiovascular disease is now warranted.

Increased water content in multifidus muscles of young adults with chronic nonspecific low back pain detected by dual-energy CT and MRI.

OBJECTIVES: To demonstrate the feasibility of better diagnosing young adults with chronic nonspecific low back pain (CNLBP) by measuring water content in paraspinal muscles using water-muscle decomposition technique in dual-energy CT (DECT) and T2-mapping in MRI. METHODS: This prospective cross-sectional study included 110 young individuals (56 with CNLBP at age of 25.7 ± 2.0 years and 54 of asymptomatic at age of 25.1 ± 1.9 years) who underwent both MRI and DECT on the spine. T2 values on T2 mapping in MRI and water density (WD) value on water(muscle) images in DECT were generated at the L1-L4 levels for erector spinae muscle and L2-L5 for multifidus muscle. Pain duration time, Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) were recorded for CNLBP patients. Difference of T2 value and WD between the two patient groups, and correlations between T2 value and WD, and T2 value and WD with clinical indicators were analyzed. RESULTS: Compared with asymptomatic participants, the mean WD of multifidus muscle at L4-L5 and mean T2 values of multifidus muscle at L5 were significantly higher in CNLBP patients (all P < 0.05). T2 values had moderate to strong positive correlations (r = 0.34-0.60, all P < 0.05) with DECT WD in CNLBP patients and healthy volunteers. There was a weak correlation between VAS and WD in L5-level multifidus muscle (r = 0.29, P < 0.05). CONCLUSIONS: The T2 values in MRI and WD in DECT are higher in multifidus muscles of lower vertebra levels for young CNLBP patients, and there exists positive correlation between WD and T2 values, providing useful information for diagnosing CNLBP.

Frequency shifts of free water signals from compact bone: Simulations and measurements using a UTE-FID sequence.

PURPOSE: Free water in cortical bone is either contained in nearly cylindrical structures (mainly Haversian canals oriented parallel to the bone axis) or in more spherically shaped pores (lacunae). Those cavities have been reported to crucially influence bone quality and mechanical stability. Susceptibility differences between bone and water can lead to water frequency shifts dependent on the geometric characteristics. The purpose of this study is to calculate and measure the frequency distribution of the water signal in MRI in dependence of the microscopic bone geometry. METHODS: Finite element modeling and analytical approaches were performed to characterize the free water components of bone. The previously introduced UTE-FID technique providing spatially resolved FID-spectra was used to measure the frequency distribution pixel-wise for different orientations of the bone axis. RESULTS: The frequency difference between free water in spherical pores and in canals parallel to B0 amounts up to approximately 100 Hz at 3T. Simulated resonance frequencies showed good agreement with the findings in UTE-FID spectra. The intensity ratio of the two signal components (parallel canals and spherical pores) was found to vary between periosteal and endosteal regions. CONCLUSION: Spatially resolved UTE-FID examinations allow the determination of the frequency distribution of signals from free water in cortical bone. This frequency distribution indicates the composition of the signal contributions from nearly spherical cavities and cylindrical canals which allows for further characterization of bone structure and status.

Water-Fat Separation for the Knee on a 50 mT Portable MRI Scanner.

OBJECTIVE: The Dixon method is frequently employed in clinical and scientific research for fat suppression, because it has lower sensitivity to static magnetic field inhomogeneity compared to chemical shift selective saturation or its variants and maintains image signal-to-noise ratio (SNR). Recently, research on very-low-field (VLF < 100 mT) magnetic resonance imaging (MRI) has regained popularity. However, there is limited literature on water-fat separation in VLF MRI. Here, we present a modified two-point Dixon method specifically designed for VLF MRI. METHODS: Most experiments were performed on a homemade 50 mT portable MRI scanner. The receiving coil adopted a homemade quadrature receiving coil. The data were acquired using spin-echo and gradient-echo sequences. We considered the T2* effect, and added priori information to existing two-point Dixon method. Then, the method used regional iterative phasor extraction (RIPE) to extract the error phasor. Finally, least squares solutions for water and fat were obtained and fat signal fraction was calculated. RESULTS: For phantom evaluation, water-only and fat-only images were obtained and the local fat signal fractions were calculated, with two samples being 0.94 and 0.93, respectively. For knee imaging, cartilage, muscle and fat could be clearly distinguished. The water-only images were able to highlight areas such as cartilage that could not be easily distinguished without separation. CONCLUSION: This work has demonstrated the feasibility of using a 50 mT MRI scanner for water-fat separation. SIGNIFICANCE: To the best of our knowledge, this is the first reported result of water-fat separation at a 50 mT portable MRI scanner.

Reducing the ambiguity of field inhomogeneity and chemical shift effect for fat-water separation by field factor.

PURPOSE: To reduce the ambiguity between chemical shift and field inhomogeneity with flexible TE combinations by introducing a variable (field factor). THEORY AND METHODS: The ambiguity between chemical shift and field inhomogeneity can be eliminated directly from the multiple in-phase images acquired at different TEs; however, it is only applicable to few echo combinations. In this study, we accommodated such an implementation in flexible TE combinations by introducing a new variable (field factor). The effects of the chemical shift were removed from the field inhomogeneity in the candidate solutions, thus reducing the ambiguity problem. To validate this concept, multi-echo MRI data acquired from various anatomies with different imaging parameters were tested. The derived fat and water images were compared with those of the state-of-the-art fat-water separation algorithms. RESULTS: Robust fat-water separation was achieved with the accurate solution of field inhomogeneity, and no apparent fat-water swap was observed. In addition to the good performance, the proposed method is applicable to various fat-water separation applications, including different sequence types and flexible TE choices. CONCLUSION: We propose an algorithm to reduce the ambiguity of chemical shift and field inhomogeneity and achieved robust fat-water separation in various applications.

A field map updating algorithm to improve fat-water spiral imaging.

PURPOSE: An accurate field map is essential to separate fat and water signals in a dual-echo chemical shift encoded spiral MRI scan. A rapid low-resolution B0 map prescan is usually performed before each exam. Occasional inaccuracy in these field map estimates can lead to misclassification of the water and fat signals as well as blurring artifacts in the reconstruction. The present work proposes a self-consistent model to evaluate residual field offsets according to the image data to improve the reconstruction quality and facilitate the scan efficiency. THEORY AND METHODS: The proposed method compares the phase differences of the two-echo data after correcting for fat frequency offsets. A more accurate field map is approximated according to the phase discrepancies and improved image quality. Experiments were conducted with simulated off-resonance on a numerical phantom, five volunteer head scans, and four volunteer abdominal scans for validation. RESULTS: The initial reconstruction of the demonstrated examples exhibit blurring artifacts and misregistration of fat and water because of the inaccuracy of the field map. The proposed method updates the field map to amend the fat and water estimation and improve image quality. CONCLUSIONS: This work presents a model to improve the quality of fat-water imaging of the spiral MRI by estimating a better field map from the acquired data. It allows reducing the field map pre-scans before each spiral scan under normal circumstances to increase scan efficiency.

Assessment of fluid removal using ultrasound, bioimpedance and anthropometry in pediatric dialysis: a pilot study.

BACKGROUND: Fluid overload is associated with morbidity and mortality in children receiving dialysis. Accurate clinical assessment is difficult, and using deuterium oxide (D2O) to measure total body water (TBW) is impractical. We investigated the use of ultrasound (US), bioimpedance spectroscopy (BIS), and anthropometry to assess fluid removal in children receiving maintenance hemodialysis (HD). METHODS: Participants completed US, BIS, and anthropometry immediately before and 1-2 h after HD for up to five sessions. US measured inferior vena cava (IVC) diameter, lung B-lines, muscle elastography, and dermal thickness. BIS measured the volume of extracellular (ECF) and intracellular (ICF) fluid. Anthropometry included mid-upper arm, calf and ankle circumferences, and triceps skinfold thickness. D2O was performed once pre-HD. We assessed the change in study measures pre- versus post-HD, and the correlation of change in study measures with percent change in body weight (%∆BW). We also assessed the agreement between TBW measured by BIS and D2O. RESULTS: Eight participants aged 3.4-18.5 years were enrolled. Comparison of pre- and post-HD measures showed significant decrease in IVC diameters, lung B-lines, dermal thickness, BIS %ECF, mid-upper arm circumference, ankle, and calf circumference. Repeated measures correlation showed significant relationships between %∆BW and changes in BIS ECF (rrm =0.51, 95% CI 0.04, 0.80) and calf circumference (rrm=0.80, 95% CI 0.51, 0.92). BIS TBW correlated with D2O TBW but overestimated TBW by 2.2 L (95% LOA, -4.75 to 0.42). CONCLUSION: BIS and calf circumference may be helpful to assess changes in fluid status in children receiving maintenance HD. IVC diameter, lung B-lines and dermal thickness are potential candidates for future studies.

Assessing Tissue Hydration Dynamics Based on Water/Fat Separated MRI.

BACKGROUND: Optimal fluid status is an important issue in hemodialysis. Clinical evaluation of volume status and different diagnostic tools are used to determine hydration status in these patients. However, there is still no accurate method for this assessment. PURPOSE: To propose and evaluate relative lean water signal (LWSrel ) as a water-fat MRI-based tissue hydration measurement. STUDY TYPE: Prospective. POPULATION: A total of 16 healthy subjects (56 ± 6 years, 0 male) and 11 dialysis patients (60.3 ± 12.3 years, 9 male; dialysis time per week 15 ± 3.5 hours, dialysis duration 31.4 ± 27.9 months). FIELD STRENGTH/SEQUENCE: A 3 T; 3D spoiled gradient echo. ASSESSMENT: LWSrel , a measurement of the water concentration of tissue, was estimated from fat-referenced MR images. Segmentations of total adipose tissue as well as thigh and calf muscles were used to measure LWSrel and tissue volumes. LWSrel was compared between healthy subjects and dialysis patients, the latter before and after dialysis. Bioimpedance-based body composition monitor over hydration (BCM OH) was also measured. STATISTICAL TESTS: T-tests were used to compare differences between the healthy subjects and dialysis patients, as well as changes between before and after dialysis. Pearson correlation was calculated between MRI and non-MRI biomarkers. A P value <0.05 was considered statistically significant. RESULTS: The LWSrel in adipose tissue was significantly higher in the dialysis cohort compared with the healthy cohort (246.8% ± 60.0% vs. 100.0% ± 10.8%) and decreased significantly after dialysis (246.8 ± 60.0% vs. 233.8 ± 63.4%). Thigh and calf muscle volumes also significantly decreased by 3.78% ± 1.73% and 2.02% ± 2.50% after dialysis. There was a significant correlation between changes in adipose tissue LWSrel and ultrafiltration volume (r = 87), as well as with BCM OH (r = 0.66). DATA CONCLUSION: MRI-based LWSrel and tissue volume measurements are sensitive to tissue hydration changes occurring during dialysis. EVIDENCE LEVEL: 2. TECHNICAL EFFICACY: Stage 3.

Sheared two-dimensional radiofrequency excitation for off-resonance robustness and fat suppression in reduced field-of-view imaging.

PURPOSE: Two-dimensional (2D) echo-planar radiofrequency (RF) pulses are widely used for reduced field-of-view (FOV) imaging in applications such as diffusion-weighted imaging. However, long pulse durations render the 2D RF pulses sensitive to off-resonance effects, causing local signal losses in reduced-FOV images. This work aims to achieve off-resonance robustness for 2D RF pulses via a sheared trajectory design. THEORY AND METHODS: A sheared 2D RF pulse design is proposed to reduce pulse durations while covering identical excitation k-space extent as a standard 2D RF pulse. For a given shear angle, the number of sheared trajectory lines is minimized to obtain the shortest pulse duration, such that the excitation replicas are repositioned outside the slice stack to guarantee unlimited slice coverage. A target fat/water signal ratio of 5% is chosen to achieve robust fat suppression. RESULTS: Simulations, imaging experiments on a custom head and neck phantom, and in vivo imaging experiments in the spinal cord at 3 T demonstrate that the sheared 2D RF design provides significant improvement in image quality while preserving profile sharpnesses. In regions with high off-resonance effects, the sheared 2D RF pulse improves the signal by more than 50% when compared to the standard 2D RF pulse. CONCLUSION: The proposed sheared 2D RF design successfully reduces pulse durations, exhibiting significantly improved through-plane off-resonance robustness, while providing unlimited slice coverage and high fidelity fat suppression. This method will be especially beneficial in regions suffering from a variety of off-resonance effects, such as spinal cord and breast.

Post-exercise accumulation of interstitial lung water is greater in hypobaric than normobaric hypoxia in adults born prematurely.

We aimed to gauge the interstitial lung water accumulation following moderate-intensity exercise under normobaric and hypobaric hypoxic conditions in a group of preterm born but otherwise healthy young adults. Sixteen pre-term-born individuals (age = 21±2yrs.; gestational age = 29±3wk.; birth weight = 1160±273 g) underwent two 8 -h hypoxic/altitude exposures in a cross-over manner: 1) Normobaric hypoxic exposure (NH; FIO2 = 0.142±0.001; PIO2 = 90.6±0.9 mmHg) 2) Hypobaric hypoxic exposure (HH; terrestrial high-altitude 3840 m; PIO2 = 90.2±0.5 mmHg). Interstitial lung water was assessed via quantification of B-Lines (using lung ultrasound) before (normoxia) and after 4-h and 8-h of respective exposures. At each time point, B-Lines were quantified before (Pre) and immediately after (Post) a 6-min moderate-intensity exercise. The baseline B-lines count were comparable between both conditions (P = 0.191). A higher B-lines count was noted at Pre-H4 in HH versus NH (P = 0.0420). At Post-H8 B-lines score was significantly higher in HH (4.6 ± 1.6) than in NH (3.1 ± 1.4; P = 0.0073). Furthermore, at this time point, a significantly higher number of individuals with B-line scores ≥5 was observed in HH (n = 7) than in NH (n = 3; P = 0.0420). These findings suggest that short moderate-intensity exercise provokes a significant increase in the interstitial lung water accumulation after 8 h of exposure to terrestrial but not simulated altitude (≈3840 m) in prematurely born adults. Further work is needed to elucidate the exact mechanisms of (moderate-intensity) exercise-induced interstitial lung water accumulation in this population and directly compare the obtained data to full-term born adults.

3 T: the good, the bad and the ugly.

It is around 20 years since the first commercial 3 T MRI systems became available. The theoretical promise of twice the signal-to-noise ratio of a 1.5 T system together with a greater sensitivity to magnetic susceptibility-related contrast mechanisms, such as the blood oxygen level dependent effect that is the basis for functional MRI, drove the initial market in neuroradiology. However, the limitations of the increased field strength soon became apparent, including the increased radiofrequency power deposition, tissue-dependent changes in relaxation times, increased artifacts, and greater safety concerns. Many of these issues are dependent upon MR physics and workarounds have had to be developed to try and mitigate their effects. This article reviews the underlying principles of the good, the bad and the ugly aspects of 3 T, discusses some of the methods used to improve image quality and explains the remaining challenges and concerns.

Spatiotemporal characterisation of ischaemic lesions in transient stroke animal models using diffusion free water elimination and mapping MRI with echo time dependence.

BACKGROUND AND PURPOSE: The excess fluid as a result of vasogenic oedema and the subsequent tissue cavitation obscure the microstructural characterisation of ischaemic tissue by conventional diffusion and relaxometry MRI. They lead to a pseudo-normalisation of the water diffusivity and transverse relaxation time maps in the subacute and chronic phases of stroke. Within the context of diffusion MRI, the free water elimination and mapping method (FWE) with echo time dependence has been proposed as a promising approach to measure the amount of free fluid in brain tissue robustly and to eliminate its biasing effect on other biomarkers. In this longitudinal study of transient middle cerebral artery occlusion (MCAo) in the rat brain, we investigated the use of FWE MRI with echo time dependence for the characterisation of the tissue microstructure and explored the potential of the free water fraction as a novel biomarker of ischaemic tissue condition. METHODS: Adult rats received a transient MCAo. Diffusion- and transverse relaxation-weighted MRI experiments were performed longitudinally, pre-occlusion and on days 1, 3, 4, 5, 6, 7 and 10 after MCAo on four rats. Histology was performed for non-stroke and 1, 3 and 10 days after MCAo on three different rats at each time point. RESULTS: The free water fraction was homogeneously increased in the ischaemic cortex one day after stroke. Between three and ten days after stroke, the core of the ischaemic tissue showed a progressive normalisation in the amount of free water, whereas the inner and outer border zones of the ischaemic cortex depicted a large, monotonous increase with time. The specific lesions in brain sections were verified by H&E and immunostaining. The tissue-specific diffusion and relaxometry MRI metrics in the ischaemic cortex were significantly different compared to their conventional counterpart. CONCLUSIONS: Our results demonstrate that the free water fraction in FWE MRI with echo time dependence is a valuable biomarker, sensitive to the progressive degeneration in ischaemic tissue. We showed that part of the heterogeneity previously observed in conventional parameter maps can be accounted for by a heterogeneous distribution of free water in the tissue. Our results suggest that the temporal evolution of the free fluid fraction map at the core and inner border zone can be associated with the pathological changes linked to the evolution of vasogenic oedema. Namely, the homogeneous increase in free water one day after stroke and its tendency to normalise in the core of the ischaemic cortex starting three days after stroke, followed by a progressive increase in free water at the inner border zone from three to ten days after stroke. Finally, the monotonous increase in free fluid in the outer border zone of the cortex reflects the formation of fluid-filled cysts.

Temperature dependence and histological correlation of inhomogeneous magnetization transfer and myelin water imaging in ex vivo brain.

PURPOSE: The promise of inhomogeneous magnetization transfer (ihMT) as a new myelin imaging method was studied in ex vivo human brain tissue and in relation to myelin water fraction (MWF). The temperature dependence of both methods was characterized, as well as their correspondence with a histological measure of myelin content. Unfiltered and filtered ihMT protocols were studied by adjusting the saturation scheme to preserve or attenuate signal from tissue with short dipolar relaxation time T1D. METHODS: ihMT ratio (ihMTR) and MWF maps were acquired at 7 T from formalin-fixed human brain samples at 22.5 °C, 30 °C and 37 °C. The impact of temperature on unfiltered ihMTR, filtered ihMTR and MWF was investigated and compared to myelin basic protein staining. RESULTS: Unfiltered ihMTR exhibited no temperature dependence, whereas filtered ihMTR increased with increasing temperature. MWF decreased at higher temperature, with an increasing prevalence of areas where the myelin water signal was unreliably determined, likely related to a reduction in T2 peak separability at higher temperatures ex vivo. MWF and ihMTR showed similar per-sample correlation with myelin staining at room temperature. At 37 °C, filtered ihMTR was more strongly correlated with myelin staining and had increased dynamic range compared to unfiltered ihMTR. CONCLUSIONS: Given the temperature dependence of filtered ihMT, increased dynamic range, and strong myelin specificity that persists at higher temperatures, we recommend carefully controlled temperatures close to 37 °C for filtered ihMT acquisitions. Unfiltered ihMT may also be useful, due to its independence from temperature, higher amplitude values, and sensitivity to short T1D components. Ex vivo myelin water imaging should be performed at room temperature, to avoid fitting issues found at higher temperatures.

Probing the myelin water compartment with a saturation-recovery, multi-echo gradient-recalled echo sequence.

PURPOSE: To investigate the effect of varying levels of T1 -weighting on the evolution of the complex signal from white matter in a multi-echo gradient-recalled echo (mGRE) saturation-recovery sequence. THEORY AND METHODS: Analysis of the complex signal evolution in an mGRE sequence allows the contributions from short- and long- T2∗ components to be separated, thus providing a measure of the relative strength of signals from the myelin water, and the external and intra-axonal compartments. Here we evaluated the effect of different levels of T1 -weighting on these signals, expecting that the previously reported, short T1 of the myelin water would lead to a relative enhancement of the myelin water signal in the presence of signal saturation. Complex, saturation-recovery mGRE data from the splenium of the corpus callosum from 5 healthy volunteers were preprocessed using a frequency difference mapping (FDM) approach and analyzed using the 3-pool model of complex signal evolution in white matter. RESULTS: An increase in the apparent T1 as a function of echo time was demonstrated, but this increase was an order of magnitude smaller than that expected from previously reported myelin water T1 -values. This suggests the presence of magnetization transfer and exchange effects which counteract the T1 -weighting. CONCLUSION: Variation of the B1+ amplitude in a saturation-recovery mGRE sequence can be used to modulate the relative strength of signals from the different compartments in white matter, but the modulation is less than predicted from previously reported T1 -values.

The Spatial Distribution of Water Components with Similar T2 May Provide Insight into Pathways for Large Molecule Transportation in the Brain.

PURPOSE: Although there is no lymphatic system in the central nervous system (CNS), there seems to be a mechanism to remove macro molecules from the brain. Cerebrospinal fluid (CSF) and interstitial fluid (ISF) are thought to be parts of this pathway, but the details are not known. In this study, MR signal of the extracellular water was decomposed into components with distinct T2's, to obtain some information about distribution of waste material in the brain. METHODS: Images were acquired using a Curr, Purcell, Meiboom, Gill (CPMG) imaging sequence. In order to reduce T1 contamination and the signal oscillation, hard pulses were used as refocusing pulses. The signal was then decomposed into many T2 components using non-negative least squares (NNLS) in pixel-by-pixel basis. Finally, a color map was generated by assigning different color for each T2 component, then adding them together. RESULTS: From the multi-echo images, it was possible to decompose the decaying signal into separate T2 components. By adjusting the color table to create the color map, it is possible to visualize the extracellular water distribution, as well as their T2 values. Several observation points include: (1) CSF inside ventricles has very long T2 (~2 s), and seems to be relatively homogeneous, (2) subarachnoid CSF also have long T2, but there are short T2 component at the brain surface, at the surface of dura, at the blood vessels in the subarachnoid space, etc., (3) in the brain parenchyma, short T2 components (longer than intracellular component but shorter than CSF) exists along the white matter, in the choroid plexus, etc. These can be considered as distribution of macromolecules (waste materials) in the brain. CONCLUSION: From T2 component analysis it is possible to obtain some insight into pathways for the transport of large molecules in the CNS, where no lymphatic system is present.

Robustness of a Combined Modified Dixon and PROPELLER Sequence with Two Interleaved Echoes in Clinical Head and Neck MRI.

PURPOSE: The combination of modified Dixon (mDixon) and periodically rotated overlapping parallel lines with enhanced reconstruction sequence with two interleaved echoes, which promotes uniform fat-suppression and motion insensitivity, has recently become available for commercial magnetic resonance imaging (MRI) scanners. To compare the robustness of this combination sequence with that of standard Cartesian mDixon sequence for fat-suppressed T2-weighted imaging in clinical head and neck MRI. METHODS: Fifty patients with head and neck tumors were involved this study. All patients underwent MRI using both the combination and standard sequences. Two radiologists independently scored motion artifacts and water-fat separation error using a 4-point scale (1, unacceptable; 4, excellent). Furthermore, comprehensive comparative evaluation was performed using a 5-point scale (1, substantially inferior; 5, substantially superior). Data were statistically analyzed using the Wilcoxon signed-rank test. RESULTS: In the motion artifact assessment, ratings of 3 or 4 points were assigned to 45% (observer-1, 58.0%; observer-2, 32.0%) and 97% (100%; 94.0%) of images for the standard and combination sequences, respectively (P < 0.001). For the water-fat separation error assessment, ratings of 3 or 4 points were assigned to 100% (100%; 100%) and 85% (84.0%; 86.0%) of images, respectively (P < 0.001). In the comprehensive evaluation, of the 100 cases (observer-1, 50; observer-2, 50), 96 were rated at four or five points. In cases with slight or no motion artifacts and water-fat separation errors, the combination sequence was superior to the standard sequence in term of noise and sharpness, and equal in terms of contrast. CONCLUSION: Although water-fat separation errors increased significantly in the combination sequence, most of these were acceptable. The significantly decreased motion artifacts in the combination sequence significantly improved image quality overall.

Quantitative bone marrow magnetic resonance imaging through apparent diffusion coefficient and fat fraction in multiple myeloma patients.

OBJECTIVE: Quantitative bone marrow (BM) MR sequences, as DWI and CSI, were used to evaluate BM water-fat composition. The aim of the study was to assess the potential usefulness of fat fraction (FF) and ADC, calculated by CSI or DWI, in diagnosing and classifying myeloma (MM) patients according to their different BM infiltration patterns. METHODS: The study group included 43 MM patients (19F; 24M; mean age 64 years), 15 asymptomatic, 15 symptomatic with diffuse BM infiltration and 13 symptomatic with focal lesions (FLs). The control group was made up of 15 healthy subjects (7F; 8M; mean age 64 years). MRI examinations consisted of sagittal T1w TSE on the spinal column, axial DWI (b 50-400-800 mm2/s) and coronal T2 Dixon, on the whole body. Mean ADC and FF were calculated placing 1 ROI on 6 vertebras and 2 ROIs on either the pelvis or FL. RESULTS: ANOVA with Bonferroni's correction showed a significant difference in ADC values among the different groups of MM patients (P < 0.05), while FF was only significantly different between patients with diffuse infiltration and patients with FL (P = 0.002). ADC allowed distinguishing MM patients from normal BM patients with diffuse BM infiltration (cutoff value: 0.491 × 10-3 mm2/s; sensitivity 73%, specificity 80%). FF helped better discriminate healthy controls from normal BM patients (cutoff = 0.33, sensitivity 73%, specificity 92%) and patients with diffuse BM infiltration from those with FL (cutoff = 0.16, sensitivity 82%, specificity 92%). CONCLUSION: ADC and FF are potentially useful parameter for the quantitative evaluation of BM infiltration in MM patients.

Estimating myelin-water content from anatomical and diffusion images using spatially undersampled myelin-water imaging through machine learning.

Myelin is vital for healthy neuronal development, and can therefore provide valuable information regarding neuronal maturation. Anatomical and diffusion weighted images (DWI) possess information related to the myelin content and the current study investigates whether quantitative myelin markers can be extracted from anatomical and DWI using neural networks. Thirteen volunteers (mean age 29y) are included, and for each subject, a residual neural network was trained using spatially undersampled reference myelin-water markers. The network is trained on a voxel-by-voxel basis, resulting in a large amount of training data for each volunteer. The inputs used are the anatomical contrasts (cT1w, cT2w), the standardized T1w/T2w ratio, estimates of the relaxation times (T1, T2) and their ratio (T1/T2), and common DWI metrics (FA, RD, MD, λ1, λ2, λ3). Furthermore, to estimate the added value of the DWI metrics, neural networks were trained using either the combined set (DWI, T1w and T2w) or only the anatomical (T1w and T2w) images. The reconstructed myelin-water maps are in good agreement with the reference myelin-water content in terms of the coefficient of variation (CoV) and the intraclass correlation coefficient (ICC). A 6-fold undersampling using both anatomical and DWI metrics resulted in ICC = 0.68 and CoV = 5.9%. Moreover, using twice the training data (3-fold undersampling) resulted in an ICC that is comparable to the reproducibility of the myelin-water imaging itself (CoV = 5.5% vs. CoV = 6.7% and ICC = 0.74 vs ICC = 0.80). To achieve this, beside the T1w, T2w images, DWI is required. This preliminary study shows the potential of machine learning approaches to extract specific myelin-content from anatomical and diffusion-weighted scans.

Large-Scale Evidence for an Association Between Peripheral Inflammation and White Matter Free Water in Schizophrenia and Healthy Individuals.

INTRODUCTION: Clarifying the role of neuroinflammation in schizophrenia is subject to its detection in the living brain. Free-water (FW) imaging is an in vivo diffusion-weighted magnetic resonance imaging (dMRI) technique that measures water molecules freely diffusing in the brain and is hypothesized to detect inflammatory processes. Here, we aimed to establish a link between peripheral markers of inflammation and FW in brain white matter. METHODS: All data were obtained from the Australian Schizophrenia Research Bank (ASRB) across 5 Australian states and territories. We first tested for the presence of peripheral cytokine deregulation in schizophrenia, using a large sample (N = 1143) comprising the ASRB. We next determined the extent to which individual variation in 8 circulating pro-/anti-inflammatory cytokines related to FW in brain white matter, imaged in a subset (n = 308) of patients and controls. RESULTS: Patients with schizophrenia showed reduced interleukin-2 (IL-2) (t = -3.56, P = .0004) and IL-12(p70) (t = -2.84, P = .005) and increased IL-6 (t = 3.56, P = .0004), IL-8 (t = 3.8, P = .0002), and TNFα (t = 4.30, P < .0001). Higher proinflammatory signaling of IL-6 (t = 3.4, P = .0007) and TNFα (t = 2.7, P = .0007) was associated with higher FW levels in white matter. The reciprocal increases in serum cytokines and FW were spatially widespread in patients encompassing most major fibers; conversely, in controls, the relationship was confined to the anterior corpus callosum and thalamic radiations. No relationships were observed with alternative dMRI measures, including the fractional anisotropy and tissue-related FA. CONCLUSIONS: We report widespread deregulation of cytokines in schizophrenia and identify inflammation as a putative mechanism underlying increases in brain FW levels.

Elevated early lesion water uptake in acute stroke predicts poor outcome despite successful recanalization - When "tissue clock" and "time clock" are desynchronized.

BACKGROUND: Ischemic water uptake in acute stroke is a reliable indicator of lesion age. Nevertheless, inter-individually varying edema progression has been observed and elevated water uptake has recently been described as predictor of malignant infarction. AIMS: We hypothesized that early-elevated lesion water uptake indicates accelerated "tissue clock" desynchronized with "time clock" and therefore predicts poor clinical outcome despite successful recanalization. METHODS: Acute middle cerebral artery stroke patients with multimodal admission-CT who received successful thrombectomy (TICI 2b/3) were analyzed. Net water uptake (NWU), a quantitative imaging biomarker of ischemic edema, was determined in admission-CT and tested as predictor of clinical outcome using modified Rankin Scale (mRS) after 90 days. A binary outcome was defined for mRS 0-4 and mRS 5-6. RESULTS: Seventy-two patients were included. The mean NWU (SD) in patients with mRS 0-4 was lower compared to patients with mRS 5-6 (5.0% vs. 12.1%; p < 0.001) with similar time from symptom onset to imaging (2.6 h vs. 2.4 h; p = 0.7). Based on receiver operating curve analysis, NWU above 10% identified patients with very poor outcome with high discriminative power (AUC 0.85), followed by Alberta Stroke Program Early CT Score (ASPECTS) (AUC: 0.72) and National Institutes of Health Stroke Scale (NIHSS) (AUC: 0.72). CONCLUSIONS: Quantitative NWU may serve as an indicator of "tissue clock" and pronounced early brain edema with elevated NWU might suggest a desynchronized "tissue clock" with real "time clock" and therefore predict futile recanalization with poor clinical outcome.