Usability of magnetic resonance images acquired at a novel low-field 0.55 T scanner for brain radiotherapy treatment planning.

Background and Purpose: Low-field magnetic resonance imaging (MRI) may offer specific advantages over high-field MRI, e.g. lower susceptibility-dependent distortions and simpler installation. The study aim was to evaluate if a novel 0.55 T MRI scanner provides sufficient image accuracy and quality for radiotherapy (RT) treatment planning. Material and methods: The geometric accuracy of images acquired at a low-field MRI scanner was evaluated in phantom measurements regarding gradient non-linearity-related distortions. Patient-induced B0-susceptibility changes were investigated via B0-field-mapping in ten volunteers. Patients were positioned in RT-setup using a 3D-printed insert for the head/neck-coil that was tested for sufficient signal-to-noise-ratio (SNR). The suitability of the MRI-system for detection of metastases was evaluated in eleven patients. In comparison to diagnostic images, acquired at ≥1.5 T, three physicians evaluated the detectability of metastases by counting them in low- and high-field-images, respectively. Results: The phantom measurements showed a high imaging fidelity after 3D-distortion-correction with (1.2 ± 0.9) mm geometric distortion in 10 cm radius from isocentre. At the edges remaining distortions were greater than at 1.5 T. The mean susceptibility-induced distortions in the head were (0.05 ± 0.05) mm and maximum 0.69 mm. SNR analysis showed that optimised positioning of RT-patients without signal loss in the head/neck-coil was possible with the RT-insert. No significant differences (p = 0.48) in detectability of metastases were found. Conclusion: The 0.55 T MRI system provided sufficiently geometrically accurate and high-resolution images that can be used for RT-planning for brain metastases. Hence, modern low-field MRI may contribute to simply access MRI for RT-planning after further investigations.

Comparison of 3T and 7T MRI for the visualization of globus pallidus sub-segments.

The success of deep brain stimulation (DBS) targeting the internal globus pallidus (GPi) depends on the accuracy of electrode localization inside the GPi. In this study, we sought to compare visualization of the medial medullary lamina (MML) and accessory medullary lamina (AML) between proton density-weighted (PDW) and T2-weighted (T2W) sequences on 3T and 7T MRI scanners. Eleven healthy participants (five men and six women; age, 19-28 years; mean, 21.5) and one 61-year-old man were scanned using two-dimensional turbo spin-echo PDW and T2W sequences on 3T and 7T MRI scanners with a 32-channel receiver head coil and a single-channel transmission coil. Profiles of signal intensity were obtained from the pixel values of straight lines over the GP regions crossing the MML and AML. Contrast ratios (CRs) for GPe/MML, GPie/MML, GPie/AML, and GPii/AML were calculated. Qualitatively, 7T visualized both the MML and AML, whereas 3T visualized the MML less clearly and hardly depicted the AML. The T2W sequence at 7T yielded significantly higher CRs for GPie/MML, GPie/AML, and GPii/AML than the PDW sequence at 7T or 3T. The T2W sequence at 7T allows visualization of the internal structures of GPi segments with high signal intensity and contrast.

Dielectric pads and low- B1+ adiabatic pulses: complementary techniques to optimize structural T1 w whole-brain MP2RAGE scans at 7 tesla.

PURPOSE: To evaluate the combination of low-B1 (+) adiabatic pulses and high permittivity (εr ≈ 165) dielectric pads effectiveness to reproducibly improve the inversion efficiency for whole-brain MP2RAGE scans, at ultra-high field. MATERIALS AND METHODS: Two low-B1 (+) adiabatic pulses, HS8 and TR-FOCI, were compared with the conventional HS1 adiabatic pulse in MP2RAGE acquisitions of four subjects at 7 Tesla. The uniform MP2RAGE images were qualitatively assessed for poor inversion artifacts by trained observers. Each subject was rescanned using dielectric pads. Eight further subjects underwent two MP2RAGE scan sessions using dielectric pads and the TR-FOCI adiabatic pulse. RESULTS: The HS8 and TR-FOCI pulses improved inversion coverage in all subjects compared with the HS1 pulse. However, in subjects whose head lengths are large (≥136 mm) relative to the coil's z-coverage, the B1 (+) field over the cerebellum was insufficient to cause inversion. Dielectric pads increase the B1 (+) field, by ∼50%, over the cerebellum, which in conjunction with the TR-FOCI pulse, reproducibly improves the inversion efficiency over the whole brain for subjects with head lengths ≤155 mm. Minor residual inversion artifacts were present in three of eight subjects (head lengths ≥155 mm). CONCLUSION: The complementary techniques of low-B1 (+) adiabatic RF pulses and high permittivity dielectric pads allow whole-brain structural T1 w images to be reliably acquired at ultra-high field. J. Magn. Reson. Imaging 2014;40:804-812. © 2013 Wiley Periodicals, Inc.

Continuously moving table MRI with sliding multislice for rectal cancer staging: image quality and lesion detection.

PURPOSE: To determine image quality and lesion detection of sliding multislice (SMS), a recently developed moving table MRI technique, in patients with rectal cancer. MATERIALS AND METHODS: Twenty-seven paired SMS (Avanto, Siemens Medical Solutions) and MDCT (Sensation 64, Siemens Medical Solutions) examinations of abdomen and pelvis were performed in patients with rectal cancer and compared for detection of liver, lymph node and bone metastases by two independent observers. A contrast-enhanced, fat saturated 2D gradient echo sequence (TE, 2.0 ms; TR, 102 ms; slice, 5 mm) was acquired with SMS and a standard contrast-enhanced protocol (100 ml @ 2.5 ml/s; slice, 5 mm) was used for abdominal MDCT. Standard of reference consisted of a consensus evaluation of SMS, MDCT, and all available follow-up examinations after a period of 6 months. Artifact burden and image quality of SMS was assessed in comparison to stationary gradient echo sequences obtained in an age-matched group of 27 patients. RESULTS: Whereas SMS achieved a mean quality score of 3.65 (scale, 0-4) for the liver, representing very good diagnostic properties, strong breathing artifacts in the intestinal region were observed in 19 cases by both observers. The retroperitoneum still achieved a mean quality score of 3.52, although breathing artifacts were noted in 12 and 15 cases (observers 1 and 2, respectively). The sensitivities of SMS to detect hepatic metastases were 91.2% and 94.1% for both observers, respectively, compared to 98.5%/98.5% for MDCT. The sensitivities for lymph node metastases were 87.5%/81.3% for SMS compared to 78.1%/81.3% for MDCT. The sensitivities for bone metastases were 91.7%/100% for SMS compared to 8.3%/16.7% for MDCT. CONCLUSION: With slightly reduced image quality in the intestinal region, SMS exhibits equal detection of lymph node and liver metastases compared to MDCT. SMS MRI proved to be superior to MDCT in detection of bone metastases.

Sliding multislice MRI for abdominal staging of patients with pelvic malignancies: a pilot study.

PURPOSE: To integrate SMS (sliding multislice imaging technique for acquiring axial images during continuous table motion) into a high-resolution pelvic MRI protocol for additional staging of the entire abdomen within one examination. MATERIALS AND METHODS: Axial two-dimensional images were acquired during continuous table motion using a fat-saturated contrast-enhanced T1-weighted gradient echo sequence. Patients held their breath during the first 20 s of the examination and breathed normally afterward while data acquisition continued. Measurement parameters were adjusted to optimize image quality throughout the total field of view. The method was investigated in 22 patients with pelvic malignancies. Two readers independently compared SMS image quality to conventional abdominal MR images, generated by a stationary multi-breath-hold gradient echo sequence. RESULTS: Qualitative evaluation yielded high diagnostic value of SMS data in body regions with no or minor breathing motion, and in those acquired during the initial breath-hold. Image quality in the upper abdomen, retroperitoneum, and pelvis is reproducible and equivalent to stationary MRI. Interfering artifacts are related to the intestine in the mid-abdomen. CONCLUSION: SMS is a promising technique that may have the potential for a first-line abdominal staging tool in patients with pelvic malignancies.

Can homogeneous preparation encoding (HoPE) help reduce scan time in abdominal MRI? A clinical evaluation.

PURPOSE: To evaluate time efficiency, image quality, and diagnostic value of a clinical routine homogeneous preparation encoding (HoPE) imaging protocol in different malign and inflammatory abdominal conditions. MATERIALS AND METHODS: A total of 14 healthy volunteers and 40 patients were examined after written informed consent and approval of the local ethics committee. A standard abdominal T1-weighted (T1W) fat-saturated gradient-echo protocol was compared to the HoPE sequence protocol ensuring for comparable imaging parameters. Examinations were performed on a 1.5-T Siemens Avanto equipped with a multichannel body-array coil. Image analysis was performed with respect to contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR), level of fat suppression (FS), generation of artifacts, and overall image quality by two blinded radiologists. RESULTS: In addition to comparable results in overall image quality and FS level, the HoPE sequence protocol provided a reduction in acquisition time of up to 40%. In addition, artifact generation was same or even reduced with respect to pulsation. Quantitative SNR analysis showed strong correlation between HoPE and the conventional method. CONCLUSION: The HoPE technique is a feasible and time-saving alternative for clinical abdominal MRI. Future studies will have to be conducted on larger patient collectives to strengthen the impact of this promising technique for FS imaging and to prove its accuracy.

T2-weighted balanced SSFP imaging (T2-TIDE) using variable flip angles.

A new technique for acquiring T2-weighted, balanced steady-state free precession (b-SSFP) images is presented. Based on the recently proposed transition into driven equilibrium (TIDE) method, T2-TIDE uses a special flip angle scheme to achieve T2-weighted signal decay during the transient phase. In combination with half-Fourier image acquisition, T2-weighted images can be obtained using T2-TIDE. Numerical simulations were performed to analyze the signal behavior of T2-TIDE in comparison with TSE and b-SSFP. The results indicate identical signal evolution of T2-TIDE and TSE during the transient phase. T2-TIDE was used in phantom experiments, and quantitative ROI analysis shows a linear relationship between TSE and T2-TIDE SNR values. T2-TIDE was also applied to abdominal and head imaging on healthy volunteers. The resulting images were analyzed quantitatively and compared with standard T2-weighted and standard b-SSFP methods. T2-TIDE images clearly revealed T2 contrast and less blurring compared to T2-HASTE images. In combination with a magnetization preparation technique, STIR-weighted images were obtained. T2-TIDE is a robust technique for acquiring T2-weighted images while exploiting the advantages of b-SSFP imaging, such as high signal-to-noise ratio (SNR) and short TRs.

Multicontrast sequences with continuous table motion: a novel acquisition technique for extended field of view imaging.

A novel acquisition technique called multicontrast imaging is presented that provides multiple datasets of different image contrasts covering an extended field of view within one measurement procedure. The technique uses a continuously moving table and is based on the repetitive acquisition of axial volume sections while the patient moves through the scanner once. To compensate for the table motion during the measurement, adaptive slice shifting is applied. Multicontrast imaging is designed to combine the comfort of a moving table examination with the high time efficiency of a multitask protocol and can be used for generating differences in both contrast and spatial parameters of the acquired data. The technique and its properties are demonstrated on healthy human volunteers.

2D axial moving table acquisitions with dynamic slice adaptation.

A method for axial multi-slice imaging during continuous table motion has been developed and implemented on a clinical scanner. Multiple axial slice packages are acquired consecutively and combined to cover an extended longitudinal FOV. To account for the table motion during the acquisition, the RF pulse frequencies are continuously updated according to the actual table velocity and slice position. Different strategies for the spatial-temporal acquisition sequence with extended FOV are proposed. They cover different regimes of scan requirements regarding table velocity, used scan range, and slice resolution. The method is easy to implement and compatible with most kinds of sequences. The robustness of the proposed approach has been tested in phantom studies and healthy volunteers using T1-, T2-, and STIR-weighted multi-slice techniques that are based on gradient and turbo spin echo sequences and compared to a stationary approach usually used in clinical routine. The method provides artifact free gradient echo based images during continuous table motion, while for turbo spin echo sequences limitations in choosing table translations occur due to gradient non-linearity effects.

TRIM: TR independent multislice imaging.

This article introduces a novel concept to overcome the dependence of image contrast on spatial positioning parameters such as the number of slices and slice separation in multislice measurements: TR-independent multislice (TRIM) acquisition allows the number of slices in a single measurement to remain independent of the repetition time TR. Ramped TRIM (rTRIM) allows the distance between the sections excited in each repetition to remain independent of the distance between the reconstructed slices. Even images from overlapping slices can be acquired without crosstalk between the images of adjacent slices due to spatially overlapping excitation profiles. This concept is based on a special reordering scheme: Within a single TR acquisition, steps are only taken from a fraction of all slices. This necessitates attribution of different phase-encoding steps to different slices within each repetition cycle. The reordering scheme can be derived by the use of a design matrix. The imaging properties of the technique are discussed theoretically and illustrated by a point spread function analysis based on simulations and phantom measurements. Potential sources of artifacts are identified and methods for their prevention are developed. Optimized implementations with different T(1)-weighted sequences such as spin echo (SE), turbo spin echo (TSE), and spoiled gradient echo acquisitions are shown on normal volunteers with imaging parameters used in routine diagnosis.

Signal behavior in continuously ramped 2D TrueFISP for whole-body imaging.

A fast and robust imaging technique was developed based on a single-slice TrueFISP acquisition using a slice excitation frequency that is incremented, or spatially "ramped," with each repetition. The short acquisition time of single slices allows artifact-free imaging during free breathing, which demonstrates the potential use of this technique for whole-body screening. Overlapping positioning of consecutively acquired slices was used to provide gapless volume coverage in free-breathing measurements. The image contrast of ramped TrueFISP was analyzed in detail using simulations and experiments. A high ramp speed results in an increased overall signal intensity and in a modification of the known T(2)/T(1) contrast towards a proton density-weighted contrast. A further increase in imaging speed is achieved with z-interleaved phase-encoding trajectories based on weighted transitions between adjacent views.

Homogeneous preparation encoding (HoPE) in multislice imaging.

Fast magnetization preparation techniques acquire a series of echoes after a single magnetization preparation. If these echoes are acquired from different slices using a multislice technique the change in the preparation state of the echoes due to relaxation effects leads to different contrast modification for each slice. Encoding different preparation states along the phase-encoding direction of each slice instead of acquiring each slice in a different preparation state is introduced as a general concept to obtain images of identical contrast and point-spread function. This can be realized either by cycling the slice excitation order several times over the total number of repetitions or by moving the point of time at which the preparation is applied within each repetition. One possible application of this method is chemical shift selective fat saturation imaging. A homogeneous fat suppression across a multislice volume could be achieved using a FLASH sequence at a repetition time of TR = 145 ms, including a single fat saturation preparation. Conventional fat saturated spin-echo imaging at any TR can be accelerated significantly by reducing the number of applied preparations per repetition. A further application of the homogeneous preparation encoding (HoPE) method is described that encodes the spatial self-saturation of the multislice excitation order homogeneously in all slices. Only a reduced number of slices of the total volume are excited in each repetition and the slice excitation order is continuously moved along the imaging volume. This method is applied for time of flight (TOF) imaging. Using a TONE-like series of flip angles for the slice excitations of each repetition homogeneous TOF images can be obtained on the basis of a multislice acquisition.