Correlation of Ktrans derived from dynamic contrast-enhanced MRI with treatment response and survival in locally advanced NSCLC patients undergoing induction immunochemotherapy and concurrent chemoradiotherapy.

PURPOSE: This study aimed to investigate the prognostic significance of pretreatment dynamic contrast-enhanced (DCE)-MRI parameters concerning tumor response following induction immunochemotherapy and survival outcomes in patients with locally advanced non-small cell lung cancer (NSCLC) who underwent immunotherapy-based multimodal treatments. MATERIAL AND METHODS: Unresectable stage III NSCLC patients treated by induction immunochemotherapy, concurrent chemoradiotherapy (CCRT) with or without consolidative immunotherapy from two prospective clinical trials were screened. Using the two-compartment Extend Tofts model, the parameters including Ktrans, Kep, Ve, and Vp were calculated from DCE-MRI data. The apparent diffusion coefficient was calculated from diffusion-weighted-MRI data. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to assess the predictive performance of MRI parameters. The Cox regression model was used for univariate and multivariate analysis. RESULTS: 111 unresectable stage III NSCLC patients were enrolled. Patients received two cycles of induction immunochemotherapy and CCRT, with or without consolidative immunotherapy. With the median follow-up of 22.3 months, the median progression-free survival (PFS) and overall survival (OS) were 16.3 and 23.8 months. The multivariate analysis suggested that Eastern Cooperative Oncology Group score, TNM stage and the response to induction immunochemotherapy were significantly related to both PFS and OS. After induction immunochemotherapy, 67 patients (59.8%) achieved complete response or partial response and 44 patients (40.2%) had stable disease or progressive disease. The Ktrans of primary lung tumor before induction immunochemotherapy yielded the best performance in predicting the treatment response, with an AUC of 0.800. Patients were categorized into two groups: high-Ktrans group (n=67, Ktrans＞164.3×10-3/min) and low-Ktrans group (n=44, Ktrans≤164.3×10-3/min) based on the ROC analysis. The high-Ktrans group had a significantly higher objective response rate than the low-Ktrans group (85.1% (57/67) vs 22.7% (10/44), p<0.001). The high-Ktrans group also presented better PFS (median: 21.1 vs 11.3 months, p=0.002) and OS (median: 34.3 vs 15.6 months, p=0.035) than the low-Ktrans group. CONCLUSIONS: Pretreatment Ktrans value emerged as a significant predictor of the early response to induction immunochemotherapy and survival outcomes in unresectable stage III NSCLC patients who underwent immunotherapy-based multimodal treatments. Elevated Ktrans values correlated positively with enhanced treatment response, leading to extended PFS and OS durations.

Complex multi-dimensional integration for T2* and R2* mapping.

A dual Multi-Dimensional Integration (dMDI) method was proposed and demonstrated for T2* and R2* mapping. By constructing and jointly using both the original MDI term and an inversed MDI term, T2* and R2* mapping can be performed independently with intrinsic background noise suppression and spike elimination, allowing for high quantitative accuracy and robustness over a wide range of T2*. dMDI was compared to original MDI and curve fitting methods in terms of quantitative specificity, accuracy, reliability and computational efficiency. All methods were tested and compared via simulation and in vivo data. With high signal-to-noise-ratio (SNR), the proposed dMDI method yielded T2*and R2* values similar to curve fitting methods. For low SNR and background noise signals, the dMDI yielded low T2* and R2* values, thus effectively suppressing all background noise. Virtually zero spikes were observed in dMDI T2* and R2* maps in all simulation and imaging results. The dMDI method has the potential to provide improved and reliable T2* and R2* mapping results in routine and SNR-challenging scenarios.

Augmented T1 -weighted steady state magnetic resonance imaging.

T1 contrasts obtained using short-TR incoherent steady state gradient echo (GRE) methods are generally suboptimal, to which non-T1 factors in the signals play a major part. In this work, we proposed an augmented T1 -weighted (aT1 W) method to extract the signal ratio between routine GRE T1 W and proton density-weighted signals that effectively removes the non-T1 effects from the original T1 W signals, including proton density, T2 * decay, and coil sensitivity. A recently proposed multidimensional integration (MDI) technique was incorporated in the aT1 W calculation for better signal-to-noise ratio (SNR) performance. For comparison between aT1 W and T1 W results, Monte Carlo noise analysis was performed via simulation and on scanned data, and region-of-interest (ROI) analysis and comparison was performed on the system phantom. For brain scans, the image contrast, noise behavior, and SNR of aT1 W images were compared with routine GRE and inversion-recovery-based T1 W images. The proposed aT1 W method yielded saliently improved T1 contrasts (potentially > 30% higher contrast-to-noise ratio [CNR]) than routine GRE T1 W images. Good spatial homogeneity and signal consistency as well as high SNR/CNR were achieved in aT1 W images using the MDI technique. For contrast-enhanced (CE) imaging, aT1 W offered stronger post-CE contrast and better boundary delineation than T1 MPRAGE images while using a shorter scan time.

MULTI-parametric MR imaging with fLEXible design (MULTIPLEX).

PURPOSE: To introduce a gradient echo (GRE) -based method, namely MULTIPLEX, for single-scan 3D multi-parametric MRI with high resolution, signal-to-noise ratio (SNR), accuracy, efficiency, and acquisition flexibility. THEORY: With a comprehensive design with dual-repetition time (TR), dual flip angle (FA), multi-echo, and optional flow modulation features, the MULTIPLEX signals contain information on radiofrequency (RF) B1t fields, proton density, T1 , susceptibility and blood flows, facilitating multiple qualitative images and parametric maps. METHODS: MULTIPLEX was evaluated on system phantom and human brains, via visual inspection for image contrasts and quality or quantitative evaluation via simulation, phantom scans and literature comparison. Region-of-interest (ROI) analysis was performed on parametric maps of the system phantom and brain scans, extracting the mean and SD of the T1 , T2∗ , proton density (PD), and/or quantitative susceptibility mapping (QSM) values for comparison with reference values or literature. RESULTS: One MULTIPLEX scan offers multiple sets of images, including but not limited to: composited PDW/T1 W/ T2∗ W, aT1 W, SWI, MRA (optional), B1t map, T1 map, T2∗ / R2∗ maps, PD map, and QSM. The quantitative error of phantom T1 , T2∗ and PD mapping were <5%, and those in brain scans were in good agreement with literature. MULTIPLEX scan times for high resolution (0.68 × 0.68 × 2 mm3 ) whole brain coverage were about 7.5 min, while processing times were <1 min. With flow modulation, additional MRA images can be obtained without affecting the quality or accuracy of other images. CONCLUSION: The proposed MUTLIPLEX method possesses great potential for multi-parametric MR imaging.

The Influence of Demographics and Vascular Risk Factors on Glymphatic Function Measured by Diffusion Along Perivascular Space.

Assessing glymphatic function using in-vivo imaging method is of great value for understanding its contribution to major brain diseases. In the present study, we aim to validate the association between a variety of risk factors and a potential index of glymphatic function-Diffusion Tensor Image Analysis Along the Perivascular Space (ALPS index). We enrolled 142 subjects from communities and performed multi-modality magnetic resonance imaging scans. The ALPS index was calculated from diffusion tensor imaging data, and its associations with demographic factors, vascular factors were investigated using regression analyses. We found that the ALPS index was negatively associated with age (ß = -0.284, p < 0.001). Compared to males, females had significantly higher ALPS index (ß = -0.243, p = 0.001). Hypertensive subjects had significantly lower ALPS index compared to non-hypertensive subjects (ß = -0.189, p = 0.013). Furthermore, venous disruption could decrease ALPS index (ß = -0.215, p = 0.003). In general, our results are in consistent with previous conceptions and results from animal studies about the pathophysiology of glymphatic dysfunction. Future studies utilizing this method should consider introducing the above-mentioned factors as important covariates.

A multi-dimensional integration (MDI) strategy for MR T2 * mapping.

MRI signals are intrinsically multi-dimensional, and signal behavior may be orthogonal among different dimensions. Such dimensional orthogonality can be utilized to eliminate unwanted effects and facilitate mathematical simplicity during image processing for improved outcomes. In this work, we will demonstrate and analyze the principles and performance of a newly developed multi-dimensional integration (MDI) strategy in MR T2 * mapping. By constructing a complex signal function to extract the inter-echo signal changes, MDI solves an optimization problem by processing all signal dimensions (eg echoes, flip angles and coil channels) in one integrative step. MDI was compared with routine curve fitting methods on noise behavior, quantification accuracy and computational efficiency. All methods were tested and compared on simulation, phantom and knee data. Monte Carlo simulations were performed on simulation and all MRI data to investigate noise propagation from k space to T2 * maps. For phantom tests, T2 * values in regions of interest were extracted on a voxel-wise basis and analyzed using a paired t-test between scanning parameters and mapping methods, with p < 0.05 being significantly different. MDI facilitated a straightforward processing procedure, yielding homogeneous, high-signal-to-noise-ratio (SNR) and artifact-free T2 * maps without explicit coil combination or additional measures. Compared with routine fitting methods, MDI offered significantly (p < 0.05) improved SNR and quantitative accuracy/robustness, with two to three orders higher computational efficiency. MDI also represented low-SNR signals with low T2 * values, avoiding misinterpretation with long-T2 * species.

Nigral Iron Deposition Is Associated With Levodopa-Induced Dyskinesia in Parkinson's Disease.

OBJECTIVE: To investigate iron deposition in the substantia nigra (SN) of Parkinson's disease (PD) patients associated with levodopa-induced dyskinesia (LID). METHODS: Seventeen PD patients with LID, 17 PD patients without LID, and 16 healthy controls were recruited for this study. The mean QSM values of the whole, left, and right SN were compared among the three groups. A multivariate logistic regression model was constructed to determine the factors associated with increased risk of LID. The receiver operating characteristic curve of the QSM value of SN in discriminating PD with and without LID was evaluated. RESULTS: The mean QSM values of the whole and right SN in the PD with LID were higher than those in the PD without LID (∗ P = 0.03, ∗ P = 0.03). Multivariate logistic regression analysis revealed that the QSM value of whole, left, or right SN was a predictor of the development of LID (∗ P = 0.03, ∗ P = 0.04, and ∗ P = 0.04). The predictive accuracy of LID in adding the QSM value of the whole, left, and right SN to LID-related clinical risk factors was 70.6, 64.7, and 67.6%, respectively. The QSM cutoff values between PD with and without LID of the whole, left, and right SN were 148.3, 165.4, and 152.7 ppb, respectively. CONCLUSION: This study provides the evidence of higher iron deposition in the SN of PD patients with LID than those without LID, suggesting that the QSM value of the SN may be a potential early diagnostic neuroimaging biomarker for LID.

Seed prioritized unwrapping (SPUN) for MR phase imaging.

BACKGROUND: Region-growing-based phase unwrapping methods have the potential for lossless phase aliasing removal, but generally suffer from unwrapping error propagation associated with discontinuous phase and/or long calculation times. The tradeoff point between robustness and efficiency of phase unwrapping methods in the region-growing category requires improvement. PURPOSE: To demonstrate an accurate, robust, and efficient region-growing phase unwrapping method for MR phase imaging applications. STUDY TYPE: Prospective. SUBJECTS, PHANTOM: normal human subjects (10) / brain surgery patients (2) / water phantoms / computer simulation. FIELD STRENGTH/SEQUENCE: 3 T/gradient echo sequences (2D and 3D). ASSESSMENT: A seed prioritized unwrapping (SPUN) method was developed based on single-region growing, prioritizing only a portion (eg, 100 seeds or 1% seeds) of available seed voxels based on continuity quality during each region-growing iteration. Computer simulation, phantom, and in vivo brain and pelvis scans were performed. The error rates, seed percentages, and calculation times were recorded and reported. SPUN unwrapped phase images were visually evaluated and compared with Laplacian unwrapped results. STATISTICAL TESTS: Monte Carlo simulation was performed on a 3D dipole phase model with a signal-to-noise ratio (SNR) of 1-9 dB, to obtain the mean and standard deviation of calculation error rates and calculation times. RESULTS: Simulation revealed a very robust unwrapping performance of SPUN, reaching an error rate of <0.4% even with SNR as low as 1 dB. For all in vivo data, SPUN was able to robustly unwrap the phase images of modest SNR and complex morphology with visually minimal errors and fast calculation speed (eg, <4 min for 368 × 312 × 128 data) when using a proper seed priority number, eg, Nsp = 1 or 10 voxels for 2D and Nsp = 1% for 3D data. DATA CONCLUSION: SPUN offers very robust and fast region-growing-based phase unwrapping, and does not require any tissue masking or segmentation, nor poses a limitation over imaging parameters. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:62-70.

Quantifying the changes in oxygen extraction fraction and cerebral activity caused by caffeine and acetazolamide.

A quantitative estimate of cerebral blood oxygen saturation is of critical importance in the investigation of cerebrovascular disease. We aimed to measure the change in venous oxygen saturation (Yv) before and after the intake of the vaso-dynamic agents caffeine and acetazolamide with high spatial resolution using susceptibility mapping. Caffeine and acetazolamide were administered on separate days to five healthy volunteers to measure the change in oxygen extraction fraction. The internal streaking artifacts in the susceptibility maps were reduced by giving an initial susceptibility value uniformly to the structure-of-interest, based on a priori information. Using this technique, Yv for normal physiological conditions, post-caffeine and post-acetazolamide was measured inside the internal cerebral veins as YNormal = 69.1 ± 3.3%, YCaffeine = 60.5 ± 2.8%, and YAcet = 79.1 ± 4.0%. This suggests that susceptibility mapping can serve as a sensitive biomarker for measuring reductions in cerebro-vascular reserve through abnormal vascular response. The percentage change in oxygen extraction fraction for caffeine and acetazolamide were found to be +27.0 ± 3.8% and -32.6 ± 2.1%, respectively. Similarly, the relative changes in cerebral blood flow in the presence of caffeine and acetazolamide were found to be -30.3% and + 31.5%, suggesting that the cerebral metabolic rate of oxygen remains stable between normal and challenged brain states for healthy subjects.

A fully flow-compensated multiecho susceptibility-weighted imaging sequence: The effects of acceleration and background field on flow compensation.

PURPOSE: To present a fully flow-compensated multiecho gradient echo sequence that can be used for MR angiography (MRA), susceptibility weighted imaging (SWI), and quantitative susceptibility mapping (QSM) and to study the effects of flow acceleration and background field gradients on flow compensation. METHODS: The quality of flow compensation was evaluated using the data from eight volunteers. The effects of flow acceleration were studied by changing the polarities of the readout gradients in two consecutive scans. The background field was used to estimate the phase errors of flow compensation in the presence of field inhomogeneities. SWI and QSM data were generated with confounding arterial phase removed. T2 * maps were obtained from the multiecho data to estimate T2 * of arterial blood. RESULTS: Reasonable flow compensation was achieved. Nevertheless, background field gradients and acceleration-induced phase errors were found to be as large as π/2 and π/3, respectively, both in agreement with theory. T2 * was measured as 82 ± 4 ms and 74 ± 9 ms for arteries inside and outside the brain, respectively, at 3T. CONCLUSION: High-quality MRA, SWI, and QSM data can be obtained simultaneously. Masking out the arteries to remove the phase due to flow acceleration and background field gradients improves the quality of both SWI and QSM data. Magn Reson Med 76:478-489, 2016. © 2015 Wiley Periodicals, Inc.

Evaluating the Role of Reduced Oxygen Saturation and Vascular Damage in Traumatic Brain Injury Using Magnetic Resonance Perfusion-Weighted Imaging and Susceptibility-Weighted Imaging and Mapping.

The cerebral vasculature, along with neurons and axons, is vulnerable to biomechanical insult during traumatic brain injury (TBI). Trauma-induced vascular injury is still an underinvestigated area in TBI research. Cerebral blood flow and metabolism could be important future treatment targets in neural critical care. Magnetic resonance imaging offers a number of key methods to probe vascular injury and its relationship with traumatic hemorrhage, perfusion deficits, venous blood oxygen saturation changes, and resultant tissue damage. They make it possible to image the hemodynamics of the brain, monitor regional damage, and potentially show changes induced in the brain's function not only acutely but also longitudinally following treatment. These methods have recently been used to show that even mild TBI (mTBI) subjects can have vascular abnormalities, and thus they provide a major step forward in better diagnosing mTBI patients.

A Novel Multiparametric Approach to 3D Quantitative MRI of the Brain.

Magnetic Resonance properties of tissues can be quantified in several respects: relaxation processes, density of imaged nuclei, magnetism of environmental molecules, etc. In this paper, we propose a new comprehensive approach to obtain 3D high resolution quantitative maps of arbitrary body districts, mainly focusing on the brain. The theory presented makes it possible to map longitudinal (R1), pure transverse (R2) and free induction decay ([Formula: see text]) rates, along with proton density (PD) and magnetic susceptibility (χ), from a set of fast acquisition sequences in steady-state that are highly insensitive to flow phenomena. A novel denoising scheme is described and applied to the acquired datasets to enhance the signal to noise ratio of the derived maps and an information theory approach compensates for biases from radio frequency (RF) inhomogeneities, if no direct measure of the RF field is available. Finally, the results obtained on sample brain scans of healthy controls and multiple sclerosis patients are presented and discussed.

Albumin and magnetic resonance imaging-liver volume to identify hepatitis B-related cirrhosis and esophageal varices.

AIM: To investigate whether liver lobe volume and albumin (ALB) could predict the presence and severity of liver cirrhosis, and esophageal varices. METHODS: Seventy-one cirrhotic patients with hepatitis B and 21 healthy individuals were enrolled in this study. All the participants underwent abdominal enhanced magnetic resonance imaging to measure each liver lobe volume, and biochemical workup for testing ALB and Child-Pugh class. All cirrhotic patients underwent upper gastrointestinal endoscopy to show the presence of cirrhotic esophageal varices. Right liver lobe volume (RV), left medial liver lobe volume (LMV), left lateral liver lobe volume (LLV), and caudate lobe volume (CV) were measured using enhanced magnetic resonance imaging. The ratios of RV to ALB (RV/ALB), LMV to ALB (LMV/ALB), LLV to ALB (LLV/ALB) and CV to ALB (CV/ALB) were calculated. Statistical analyses were performed to determine whether and how the combination of liver lobe volume measured using magnetic resonance imaging and albumin could predict the presence and severity of liver cirrhosis, and the presence of esophageal varices. RESULTS: RV, LMV, LLV and CV decreased (r = -0.51-0.373; all P < 0.05), while RV/ALB increased (r = 0.424; P < 0.05), with the progress of Child-Pugh class of liver cirrhosis. RV, LMV, CV, LLV/ALB and CV/ALB could identify presence of liver cirrhosis; LLV and LMV could distinguish Child-Pugh class A from B; RV, LMV, LLV, CV, RV/ALB and LLV/ALB could distinguish class A from C; RV and LLV/ALB could differentiate B from C; and RV, RV/ALB and CV/ALB could identify presence of esophageal varices (all P < 0.05). Among these parameters, CV/ALB could best identify the presence of liver cirrhosis, with an area under receiver operating characteristic curve (AUC) of 0.860, a sensitivity of 82.0% and a specificity of 83.0%. LLV could best distinguish class A from B, with an AUC of 0.761, a sensitivity of 74.4% and a specificity of 73.1%. RV could best distinguish class A from C, with an AUC of 0.900, a sensitivity of 90.3% and a specificity of 84.5%. LLV/ALB could best distinguish class B from C, with an AUC of 0.900, a sensitivity of 93.8% and a specificity of 81.5%. RV/ALB could best identify esophageal varices, with an AUC of 0.890, a sensitivity of 80.0% and a specificity of 83.5%. CONCLUSION: The combination of liver lobe volume and ALB has potential to identify presence and severity of cirrhosis, and presence of esophageal varices.

Quantitative susceptibility mapping: current status and future directions.

Quantitative susceptibility mapping (QSM) is a new technique for quantifying magnetic susceptibility. It has already found various applications in quantifying in vivo iron content, calcifications and changes in venous oxygen saturation. The accuracy of susceptibility mapping is dependent on several factors. In this review, we evaluate the entire process of QSM from data acquisition to individual data processing steps. We also show preliminary results of several new concepts introduced in this review in an attempt to improve the quality and accuracy for certain steps. The uncertainties in estimating susceptibility differences using susceptibility maps, phase images, and T2* maps are analyzed and compared. Finally, example clinical applications are presented. We conclude that QSM holds great promise in quantifying iron and becoming a standard clinical tool.

Susceptibility mapping of air, bone, and calcium in the head.

PURPOSE: To demonstrate the mapping of structures with high susceptibility values, such as the sinuses, bones and teeth, using short echo times. METHODS: Four in vivo datasets were collected with a gradient-echo sequence (TE1 = 2.5 ms, TE2 = 5 ms and TE3 = 7.5 ms). Complex division was performed to remove the phase offset term and generate the phase at TE = 2.5 ms. Susceptibility maps were generated from unwrapped phase images, using a geometry-constrained iterative algorithm, by preserving phase information in the extracerebral tissues. The susceptibility results were improved by updating the missing phase information inside structures with no signal using the predicted phase at each iteration step. Simulated phase images of a three-dimensional brain model and tooth phantom were used to validate the proposed method. RESULTS: Improved susceptibility maps were obtained once the phase information in the extracerebral tissue region was incorporated, for both the model and in vivo data. For in vivo data, the average susceptibilities of air (sphenoid sinus), bone and calcium (teeth) were found to be (in ppm): Δχ(sinus-tissue) = +9.2 ± 1.3, Δχ(bone-tissue) = -2.1 ± 0.6 and Δχ(teeth-tissue) = -3.3 ± 1.2, respectively. CONCLUSION: High susceptibility structures with little or no signal can be imaged using quantitative susceptibility mapping and can be used to improve background field removal.

Retrobulbar magnetic resonance angiography using binomial off-resonant rectangular (BORR) pulse.

PURPOSE: Applying a newly developed binomial off-resonant rectangular (BORR) pulse method for high resolution three-dimensional MR angiography (MRA) on retrobulbar ocular vessels, which has not been possible with routine MRA due to background fatty tissues. METHODS: BORR pulse was implemented in a gradient echo sequence by replacing the original excitation pulse, and were optimized for robust orbital fat suppression. Several other MRA methods, with or without fat suppression, were also compared, including time-of-flight, contrast enhanced MRA, and hybrid of opposite-contrast MRA. Nine healthy subjects participated with written informed consents. To reduce eye motion, the subjects were instructed to casually stare at a projected cross during each MRA scan. Major vessels were evaluated by three independent radiologists using a 4-point scale. RESULTS: The BORR method yielded the best MRA results for retrobulbar vessels without contrast enhancement, significantly superior than other MRA methods. BORR results had significantly higher visibility scores than all other methods for small vessels. CONCLUSION: We have successfully revealed orbital vessels in retrobulbar space for the first time using MRA, by using the BORR pulse method. With a clear depiction of the vasculature without the need for contrast enhancement, our method has the potential to provide important diagnostic information for ocular vascular diseases.

Age-related increases in long-range connectivity in fetal functional neural connectivity networks in utero.

Formation of operational neural networks is one of the most significant accomplishments of human fetal brain growth. Recent advances in functional magnetic resonance imaging (fMRI) have made it possible to obtain information about brain function during fetal development. Specifically, resting-state fMRI and novel signal covariation approaches have opened up a new avenue for non-invasive assessment of neural functional connectivity (FC) before birth. Early studies in this area have unearthed new insights about principles of prenatal brain function. However, very little is known about the emergence and maturation of neural networks during fetal life. Here, we obtained cross-sectional rs-fMRI data from 39 fetuses between 24 and 38 weeks postconceptual age to examine patterns of connectivity across ten neural FC networks. We identified primitive forms of motor, visual, default mode, thalamic, and temporal networks in the human fetal brain. We discovered the first evidence of increased long-range, cerebral-cerebellar, cortical-subcortical, and intra-hemispheric FC with advancing fetal age. Continued aggregation of data about fundamental neural connectivity systems in utero is essential to establishing principles of connectomics at the beginning of human life. Normative data provides a vital context against which to compare instances of abnormal neurobiological development.

Improved MR venography using quantitative susceptibility-weighted imaging.

PURPOSE: To remove the geometry dependence of phase-based susceptibility weighting masks in susceptibility-weighted imaging (SWI) and to improve the visualization of the veins and microbleeds. MATERIALS AND METHODS: True SWI (tSWI) was generated using susceptibility-based masks. Simulations were used to evaluate the influence of the characteristic parameters defining the mask. In vivo data from three healthy adult human volunteers were used to compare the contrast-to-noise-ratios (CNRs) of the right septal vein and the left internal cerebral vein as measured from both tSWI and SWI data. A traumatic brain injury (TBI) patient dataset was used to illustrate qualitatively the proper visualization of microbleeds using tSWI. RESULTS: Compared with conventional SWI, tSWI improved the CNR of the two selected veins by a factor of greater than three for datasets with isotropic resolution and greater than 30% for datasets with anisotropic resolution. Veins with different orientations can be properly enhanced in tSWI. Furthermore, the blooming artifact due to the strong dipolar phase of microbleeds in conventional SWI was reduced in tSWI for the TBI case. CONCLUSION: The use of tSWI overcomes the geometric limitations of using phase and provides better visualization of the venous system, especially for data collected with isotropic resolution.