Polynomial chaos expansion of SAR and temperature increase variability in 3 T MRI due to stochastic input data.

OBJECTIVE: Numerical simulations are largely adopted to estimate dosimetric quantities, e.g., specific absorption rate (SAR) and temperature increase, in tissues to assess the patient exposure to the radiofrequency field generated during magnetic resonance imaging (MRI). Simulations rely on reference anatomical human models and tabulated data of electromagnetic and thermal properties of biological tissues. However, concerns may arise about the applicability of the computed results to any phenotype, introducing a significant degree of freedom in the simulation input data. In addition, simulation input data can be affected by uncertainty in relative positioning of the anatomical model with respect to the radiofrequency coil. The objective of this work is the to estimate the variability of SAR and temperature increase at 3 T head MRI due to different sources of variability in input data, with the final aim to associate a global uncertainty to the dosimetric outcomes. APPROACH: A stochastic approach based on arbitrary Polynomial Chaos Expansion is used to evaluate the effects of several input variabilities (anatomy, tissue properties, body position) on dosimetric outputs, referring to head imaging with a 3 T MRI scanner. MAIN RESULTS: It is found that head anatomy is the prevailing source of variability for the considered dosimetric quantities, rather than the variability due to tissue properties and head positioning. From knowledge of the variability of the dosimetric quantities, an uncertainty can be attributed to the results obtained using a generic anatomical head model when SAR and temperature increase values are compared with safety exposure limits. SIGNIFICANCE: This work associates a global uncertainty to SAR and temperature increase predictions, to be considered when comparing the numerically evaluated dosimetric quantities with reference exposure limits. The adopted methodology can be extended to other exposure scenarios for MRI safety purposes.

Fast high-resolution electric properties tomography using three-dimensional quantitative transient-state imaging-based water fraction estimation.

In this study, we aimed to develop a fast and robust high-resolution technique for clinically feasible electrical properties tomography based on water content maps (wEPT) using Quantitative Transient-state Imaging (QTI), a multiparametric transient state-based method that is similar to MR fingerprinting. Compared with the original wEPT implementation based on standard spin-echo acquisition, QTI provides robust electrical properties quantification towards B1 + inhomogeneities and full quantitative relaxometry data. To validate the proposed approach, 3D QTI data of 12 healthy volunteers were acquired on a 1.5 T scanner. QTI-provided T1 maps were used to compute water content maps of the tissues using an empirical relationship based on literature ex-vivo measurements. Assuming that electrical properties are modulated mainly by tissue water content, the water content maps were used to derive electrical conductivity and relative permittivity maps. The proposed technique was compared with a conventional phase-only Helmholtz EPT (HH-EPT) acquisition both within whole white matter, gray matter, and cerebrospinal fluid masks, and within different white and gray matter subregions. In addition, QTI-based wEPT was retrospectively applied to four multiple sclerosis adolescent and adult patients, compared with conventional contrast-weighted imaging in terms of lesion delineation, and quantitatively assessed by measuring the variation of electrical properties in lesions. Results obtained with the proposed approach agreed well with theoretical predictions and previous in vivo findings in both white and gray matter. The reconstructed maps showed greater anatomical detail and lower variability compared with standard phase-only HH-EPT. The technique can potentially improve delineation of pathology when compared with conventional contrast-weighted imaging and was able to detect significant variations in lesions with respect to normal-appearing tissues. In conclusion, QTI can reliably measure conductivity and relative permittivity of brain tissues within a short scan time, opening the way to the study of electric properties in clinical settings.

Repeatability and Reproducibility Uncertainty in Magnetic Resonance-Based Electric Properties Tomography of a Homogeneous Phantom.

Uncertainty assessment is a fundamental step in quantitative magnetic resonance imaging because it makes comparable, in a strict metrological sense, the results of different scans, for example during a longitudinal study. Magnetic resonance-based electric properties tomography (EPT) is a quantitative imaging technique that retrieves, non-invasively, a map of the electric properties inside a human body. Although EPT has been used in some early clinical studies, a rigorous experimental assessment of the associated uncertainty has not yet been performed. This paper aims at evaluating the repeatability and reproducibility uncertainties in phase-based Helmholtz-EPT applied on homogeneous phantom data acquired with a clinical 3 T scanner. The law of propagation of uncertainty is used to evaluate the uncertainty in the estimated conductivity values starting from the uncertainty in the acquired scans, which is quantified through a robust James-Stein shrinkage estimator to deal with the dimensionality of the problem. Repeatable errors are detected in the estimated conductivity maps and are quantified for various values of the tunable parameters of the EPT implementation. The spatial dispersion of the estimated electric conductivity maps is found to be a good approximation of the reproducibility uncertainty, evaluated by changing the position of the phantom after each scan. The results underpin the use of the average conductivity (calculated by weighting the local conductivity values by their uncertainty and taking into account the spatial correlation) as an estimate of the conductivity of the homogeneous phantom.

Simplified modeling of implanted medical devices with metallic filamentary closed loops exposed to low or medium frequency magnetic fields.

BACKGROUND AND OBJECTIVES: Electric currents are induced in implanted medical devices with metallic filamentary closed loops (e.g., fixation grids, stents) when exposed to time varying magnetic fields, as those generated during certain diagnostic and therapeutic biomedical treatments. A simplified methodology to efficiently compute these currents, to estimate the altered electromagnetic field distribution in the biological tissues and to assess the consequent biological effects is proposed for low or medium frequency fields. METHODS: The proposed methodology is based on decoupling the handling of the filamentary wire and the anatomical body. To do this, a circuital solution is adopted to study the metallic filamentary implant and this solution is inserted in the electromagnetic field solution involving the biological tissues. The Joule losses computed in the implant are then used as a forcing term for the thermal problem defined by the bioheat Pennes' equation. The methodology is validated against a model problem, where a reference solution is available. RESULTS: The proposed simplified methodology is proved to be in good agreement with solutions provided by alternative approaches. In particular, errors in the amplitude of the currents induced in the wires result to be always lower than 3%. After the validation, the methodology is applied to check the interactions between the magnetic field generated by different biomedical devices and a skull grid, which represents a complex filamentary wire implant. CONCLUSIONS: The proposed simplified methodology, suitable to be applied to closed loop wires in the low to intermediate frequency range, is found to be sufficiently accurate and easy to apply in realistic exposure scenarios. This modeling tool allows analyzing different types of small implants, from coronary and biliary duct stents to orthopedic grids, under a variety of exposure scenarios.

Computational dosimetry in MRI in presence of hip, knee or shoulder implants: do we need accurate surgery models?

Objective.To quantify the effects of different levels of realism in the description of the anatomy around hip, knee or shoulder implants when simulating, numerically, radiofrequency and gradient-induced heating in magnetic resonance imaging. This quantification is needed to define how precise the digital human model modified with the implant should be to get realistic dosimetric assessments.Approach. The analysis is based on a large number of numerical simulations where four 'levels of realism' have been adopted in modelling human bodies carrying orthopaedic implants.Main results. Results show that the quantification of the heating due to switched gradient fields does not strictly require a detailed local anatomical description when preparing the digital human model carrying an implant. In this case, a simple overlapping of the implant CAD with the body anatomy is sufficient to provide a quite good and conservative estimation of the heating. On the contrary, the evaluation of the electromagnetic field distribution and heating caused by the radiofrequency field requires an accurate description of the tissues around the prosthesis.Significance. The results of this paper provide hints for selecting the 'level of realism' in the definition of the anatomical models with embedded passive implants when performing simulations that should reproduce, as closely as possible, thein vivoscenarios of patients carrying orthopaedic implants.

3D Extrusion Printing of Biphasic Anthropomorphic Brain Phantoms Mimicking MR Relaxation Times Based on Alginate-Agarose-Carrageenan Blends.

The availability of adapted phantoms mimicking different body parts is fundamental to establishing the stability and reliability of magnetic resonance imaging (MRI) methods. The primary purpose of such phantoms is the mimicking of physiologically relevant, contrast-creating relaxation times T1 and T2. For the head, frequently examined by MRI, an anthropomorphic design of brain phantoms would imply the discrimination of gray matter and white matter (WM) within defined, spatially distributed compartments. Multichannel extrusion printing allows the layer-by-layer fabrication of multiple pastelike materials in a spatially defined manner with a predefined shape. In this study, the advantages of this method are used to fabricate biphasic brain phantoms mimicking MR relaxation times and anthropomorphic geometry. The printable ink was based on purely naturally derived polymers: alginate as a calcium-cross-linkable gelling agent, agarose, ι-carrageenan, and GdCl3 in different concentrations (0-280 µmol kg-1) as the paramagnetic component. The suggested inks (e.g., 3Alg-1Agar-6Car) fulfilled the requirements of viscoelastic behavior and printability of large constructs (>150 mL). The microstructure and distribution of GdCl3 were assessed by scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDX). In closely monitored steps of technological development and characterization, from monophasic and biphasic samples as printable inks and cross-linked gels, we describe the construction of large-scale phantom models whose relaxation times were characterized and checked for stability over time.

Heating of metallic biliary stents during magnetic hyperthermia of patients with pancreatic ductal adenocarcinoma: an in silico study.

OBJECTIVE: To investigate the eddy current heating that occurs in metallic biliary stents during magnetic hyperthermia treatments and to assess whether these implants should continue to be an exclusion criterion for potential patients. METHODS: Computer simulations were run on stent heating during the hyperthermia treatment of local pancreatic tumors (5-15 mT fields at 300 kHz for 30 min), considering factors such as wire diameter, type of stent alloy, and field orientation. Maxwell's equations were solved numerically in a bile duct model, including the secondary field produced by the stents. The heat exchange problem was solved through a modified version of the Pennes' bioheat equation assuming a temperature dependency of blood perfusion and metabolic heat. RESULTS: The choice of alloy has a large impact on the stent heating, preferring those having a lower electrical conductivity. Only for low field intensities (5 mT) and for some of the bile duct tissue layers the produced heating can be considered safe. The orientation of the applied field with respect to the stent wires can give rise to the onset of regions with different heating levels depending on the shape that the stent has finally adopted according to the body's posture. Bile helps to partially dissipate the heat that is generated in the lumen of the bile duct, but not at a sufficient rate. CONCLUSION: The safety of patients with pancreatic cancer wearing metallic biliary stents during magnetic hyperthermia treatments cannot be fully assured under the most common treatment parameters.

Classification Scheme of Heating Risk during MRI Scans on Patients with Orthopaedic Prostheses.

Due to the large variety of possible clinical scenarios, a reliable heating-risk assessment is not straightforward when patients with arthroplasty undergo MRI scans. This paper proposes a simple procedure to estimate the thermal effects induced in patients with hip, knee, or shoulder arthroplasty during MRI exams. The most representative clinical scenarios were identified by a preliminary frequency analysis, based on clinical service databases, collecting MRI exams of 11,658 implant carrier patients. The thermal effects produced by radiofrequency and switching gradient fields were investigated through 588 numerical simulations performed on an ASTM-like phantom, considering four prostheses, two static field values, seven MR sequences, and seven regions of imaging. The risk assessment was inspired by standards for radiofrequency fields and by scientific studies for gradient fields. Three risk tiers were defined for the radiofrequency, in terms of whole-body and local SAR averages, and for GC fields, in terms of temperature elevation. Only 50 out of 588 scenarios require some caution to be managed. Results showed that the whole-body SAR is not a self-reliant safety parameter for patients with metallic implants. The proposed numerical procedure can be easily extended to any other scenario, including the use of detailed anatomical models.

A contribution to MRI safety testing related to gradient-induced heating of medical devices.

PURPOSE: To theoretically investigate the feasibility of a novel procedure for testing the MRI gradient-induced heating of medical devices and translating the results into clinical practice. METHODS: The concept of index of stress is introduced by decoupling the time waveform characteristics of the gradient field signals from the field spatial distribution within an MRI scanner. This index is also extended to consider the anisotropy of complex bulky metallic implants. Merits and drawbacks of the proposed index of stress are investigated through virtual experiments. In particular, the values of the index of stress evaluated for realistic orthopedic implants placed within an ASTM phantom are compared with accurate heating simulations performed with 2 anatomic body models (a man and a woman) implanted through a virtual surgery procedure. RESULTS: The manipulation of the proposed index of stress allows to identify regions within the MRI bore where the implant could affect the safety of the examinations. Furthermore, the conducted analysis shows that the power dissipated into the implant by the induced eddy currents is a dosimetric quantity that estimates well the maximum temperature increase in the tissues surrounding the implant. CONCLUSION: The results support the adoption of an anisotropic index of stress to regulate the gradient-induced heating of geometrically complex implants. They also pave the way for a laboratory characterization of the implants based on electrical measurements, rather than on thermal measurements. The next step will be to set up a standardized experimental procedure to evaluate the index of stress associated with an implant.

CoSimPy: An open-source python library for MRI radiofrequency Coil EM/Circuit Cosimulation.

BACKGROUND AND OBJECTIVES: The Electromagnetic/Circuit cosimulation method represents a valuable and effective strategy to address those problems where a radiative structure has to interact with external supporting circuitries. This is of particular concern for Magnetic Resonance Imaging (MRI), radiofrequency (RF) coils design, where the supporting circuitry optimisation represents, generally, a crucial aspect. This article presents CoSimPy, an open-source Python circuit simulation library for Electromagnetic/Circuit cosimulations and specifically optimised for MRI, RF coils design. METHODS: CoSimPy is designed following an Object-orientated programming. In addition to the essential methods aimed to performed the Electromagnetic/Circuit cosimulations, many others are implemented both to simplify the standard workflow and to evaluate the RF coils performance. In this article, the theory which underlies the fundamental methods of CoSimPy is shown together with the basic framework of the library. RESULTS: In the paper, the reliability of CoSimPy is successfully tested against a full-wave electromagnetic simulations involving a reference setup. The library is made available under https://github.com/umbertozanovello/CoSimPy together with a detailed documentation providing guidelines and examples. CoSimPy is distributed under the Massachusetts Institute of Technology (MIT) license. CONCLUSIONS: CoSimPy demonstrated to be an agile tool employable for Electromagnetic/Circuit cosimulations. Its distribution is meant to fulfil the needs of several researchers also avoiding duplication of effort in writing custom implementations. CoSimPy is under constant development and aims to represent a coworking environment where scientists can implement additional methods whose sharing can represent an advantage for the community. Finally, even if CoSimPy is designed with special focus on MRI, it represents an efficient and practical tool potentially employable wherever electronic devices made of radiative and circuitry components are involved.

A fast tool for the parametric analysis of human body exposed to LF electromagnetic fields in biomedical applications.

A numerical procedure for analyzing electromagnetic (EM) fields interactions with biological tissues is presented. The proposed approach aims at drastically reducing the computational burden required by the repeated solution of large scale problems involving the interaction of the human body with EM fields, such as in the study of the time evolution of EM fields, uncertainty quantification, and inverse problems. The proposed volume integral equation (VIE), focused on low frequency applications, is a system of integral equations in terms of current density and scalar potential in the biological tissues excited by EM fields and/or electrodes connected to the human body. The proposed formulation requires the voxelization of the human body and takes advantage of the regularity of such discretization by speeding-up the computational procedure. Moreover, it exploits recent advancements in the solution of VIE by means of iterative preconditioned solvers and ad hoc parametric Model Order Reduction techniques. The efficiency of the proposed tool is demonstrated by applying it to a couple of realistic model problems: the assessment of the peripheral nerve stimulation, performed in terms of evaluation of the induced electric field, due to the gradient coils of a magnetic resonance imaging scanner during a clinical examination and the assessment of the exposure to environmental fields at 50 Hz of live-line workers with uncertain properties of the biological tissues. Thanks to the proposed method, uncertainty quantification analyses and time domain simulations are possible even for large scale problems and they can be performed on standard computers and reasonable computation time. Sample implementation of the method is made publicly available at https://github.com/UniPD-DII-ETCOMP/BioMOR.

In silico assessment of collateral eddy current heating in biocompatible implants subjected to magnetic hyperthermia treatments.

Purpose: Bearing partially or fully metallic passive implants represents an exclusion criterion for patients undergoing a magnetic hyperthermia procedure, but there are no specific studies backing this restrictive decision. This work assesses how the secondary magnetic field generated at the surface of two common types of prostheses affects the safety and efficiency of magnetic hyperthermia treatments of localized tumors. The paper also proposes the combination of a multi-criteria decision analysis and a graphical representation of calculated data as an initial screening during the preclinical risk assessment for each patient.Materials and methods: Heating of a hip joint and a dental implant during the treatment of prostate, colorectal and head and neck tumors have been assessed considering different external field conditions and exposure times. The Maxwell equations including the secondary field produced by metallic prostheses have been solved numerically in a discretized computable human model. The heat exchange problem has been solved through a modified version of the Pennes' bioheat equation assuming a temperature dependency of blood perfusion and metabolic heat, i.e. thermorregulation. The degree of risk has been assessed using a risk index with parameters coming from custom graphs plotting the specific absorption rate (SAR) vs temperature increase, and coefficients derived from a multi-criteria decision analysis performed following the MACBETH approach.Results: The comparison of two common biomaterials for passive implants - Ti6Al4V and CoCrMo - shows that both specific absorption rate (SAR) and local temperature increase are found to be higher for the hip prosthesis made by Ti6Al4V despite its lower electrical and thermal conductivity. By tracking the time evolution of temperature upon field application, it has been established that there is a 30 s delay between the time point for which the thermal equilibrium is reached at prostheses and tissues. Likewise, damage may appear in those tissues adjacent to the prostheses at initial stages of treatment, since recommended thermal thresholds are soon surpassed for higher field intensities. However, it has also been found that under some operational conditions the typical safety rule of staying below or attain a maximum temperature increase or SAR value is met.Conclusion: The current exclusion criterion for implant-bearing patients in magnetic hyperthermia should be revised, since it may be too restrictive for a range of the typical field conditions used. Systematic in silico treatment planning using the proposed methodology after a well-focused diagnostic procedure can aid the clinical staff to find the appropriate limits for a safe treatment window.

Heating of hip joint implants in MRI: The combined effect of RF and switched-gradient fields.

PURPOSE: To investigate how the simultaneous exposure to gradient and RF fields affects the temperature rise in patients with a metallic hip prosthesis during an MRI session. METHODS: In silico analysis was performed with an anatomically realistic human model with CoCrMo hip implant in 12 imaging positions. The analysis was performed at 1.5 T and 3 T, considering four clinical sequences: turbo spin-echo, EPI, gradient-echo, and true fast imaging sequence with steady precession. The exposure to gradient and RF fields was evaluated separately and superposed, by adopting an ad hoc computational algorithm. Temperature increase within the body, rather than specific absorption rate, was used as a safety metric. RESULTS: With the exception of gradient-echo, all investigated sequences produced temperature increases higher than 1 K after 360 seconds, at least for one body position. In general, RF-induced heating dominates the turbo spin-echo sequence, whereas gradient-induced heating prevails with EPI; the situation with fast imaging sequence with steady precession is more diversified. The RF effects are enhanced when the implant is within the RF coil, whereas the effects of gradient fields are maximized if the prosthesis is outside the imaging region. Cases for which temperature-increase thresholds were exceeded were identified, together with the corresponding amount of tissue mass involved and the exposure time needed to reach these limits. CONCLUSION: The analysis confirms that risky situations may occur when a patient carrying a hip implant undergoes an MRI exam and that, in some cases, the gradient field heating may be significant. In general, exclusion criteria only based on whole-body specific absorption rate may not be sufficient to ensure patients' safety.

MRI-Related Heating of Implants and Devices: A Review.

During an MRI scan, the radiofrequency field from the scanner's transmit coil, but also the switched gradient fields, induce currents in any conductive object in the bore. This makes any metallic medical implant an additional risk for an MRI patient, because those currents can heat up the surrounding tissues to dangerous levels. This is one of the reasons why implants are, until today, considered a contraindication for MRI; for example, by scanner manufacturers. Due to the increasing prevalence of medical implants in our aging societies, such general exclusion is no longer acceptable. Also, it should be no longer needed, because of a much-improved safety-assessment methodology, in particular in the field of numerical simulations. The present article reviews existing literature on implant-related heating effects in MRI. Concepts for risk assessment and quantification are presented and also some first attempts towards an active safety management and risk mitigation. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 5.

Exposure of Live-Line Workers to Magnetic Fields: A Dosimetric Analysis.

In this paper the authors present the results of a dosimetric analysis related to the exposure of live-line workers to the magnetic fields generated by high voltage overhead lines and substations. The study extends the work published by Dawson et al. in 2002, considering more evolved anatomical models nowadays available, the new reference limits given by the 2013/35/EU Directive, and a new methodology, based on the intercomparison of two alternative solvers and the use of data filtering. Moreover, additional exposure scenarios are here considered with respect to the studies already available in literature. The results show that for the exposure scenario of high voltage live line works with bare hand method, in any analyzed position, the exposure limits for the tissues of the central nervous system, as well as for all other tissues, are never exceeded, despite in some cases the action levels are exceeded. For the exposure of workers in substations near 220 kV and 380 kV line trap coils exposure is compliant with the regulatory limits if the current flowing through the line trap does not exceed the value of 1000 A. Finally, for the exposure of workers in substations near cable connections, electric field values induced in the body are always lower than regulatory limits with a phase current value equal to 1600 A r.m.s.

In silico evaluation of the thermal stress induced by MRI switched gradient fields in patients with metallic hip implant.

This work focuses on the in silico evaluation of the energy deposed by MRI switched gradient fields in bulk metallic implants and the consequent temperature increase in the surrounding tissues. An original computational strategy, based on the subdivision of the gradient coil switching sequences into sub-signals and on the time-harmonic electromagnetic field solution, allows to realistically simulate the evolution of the phenomena produced by the gradient coils fed according to any MRI sequence. Then, Pennes' bioheat equation is solved through a Douglas-Gunn time split scheme to compute the time-dependent temperature increase. The procedure is validated by comparison with laboratory results, using a component of a realistic hip implant embedded within a phantom, obtaining an agreement on the temperature increase better than 5%, lower than the overall measurement uncertainty. The heating generated inside the body of a patient with a unilateral hip implant when undergoing an Echo-Planar Imaging (EPI) MRI sequence is evaluated and the role of the parameters affecting the thermal results (body position, coil performing the frequency encoding, effects of thermoregulation) is discussed. The results show that the gradient coils can generate local increases of temperature up to some kelvin when acting without radiofrequency excitation. Hence, their contribution in general should not be disregarded when evaluating patients' safety.

CSI-EPT in Presence of RF-Shield for MR-Coils.

Contrast source inversion electric properties tomography (CSI-EPT) is a recently developed technique for the electric properties tomography that recovers the electric properties distribution starting from measurements performed by magnetic resonance imaging scanners. This method is an optimal control approach based on the contrast source inversion technique, which distinguishes itself from other electric properties tomography techniques for its capability to recover also the local specific absorption rate distribution, essential for online dosimetry. Up to now, CSI-EPT has only been described in terms of integral equations, limiting its applicability to homogeneous unbounded background. In order to extend the method to the presence of a shield in the domain-as in the recurring case of shielded radio frequency coils-a more general formulation of CSI-EPT, based on a functional viewpoint, is introduced here. Two different implementations of CSI-EPT are proposed for a 2-D transverse magnetic model problem, one dealing with an unbounded domain and one considering the presence of a perfectly conductive shield. The two implementations are applied on the same virtual measurements obtained by numerically simulating a shielded radio frequency coil. The results are compared in terms of both electric properties recovery and local specific absorption rate estimate, in order to investigate the requirement of an accurate modeling of the underlying physical problem.

Assessment of exposure to MRI motion-induced fields based on the International Commission on Non-Ionizing Radiation Protection (ICNIRP) guidelines.

PURPOSE: The goal of this study was to conduct an exposure assessment for workers moving through the stray stationary field of common MRI scanners, performed according to the recent International Commission on Non-Ionizing Radiation Protection (ICNIRP) Guidelines, which aim at avoiding annoying sensory effects. THEORY AND METHODS: The analysis was performed through numerical simulations, using a high-resolution anatomical model that moved along realistic trajectories in proximity to a tubular and open MRI scanner. Both dosimetric indexes indicated by ICNIRP (maximum variation of the magnetic flux density vector and exposure index for the motion-induced electric field) were computed for three statures of the human model. RESULTS: A total of 51 exposure situations were analyzed. None of them exceeded the limit for the maximum variation of the magnetic flux density, whereas some critical cases were found when computing the induced electric field. In the latter case, the exposure indexes computed via Fourier transform and through an equivalent filter result to be consistent. CONCLUSION: The results suggest the adoption of some simple precautionary rules, useful when sensory effects experienced by an operator could reflect upon the patient's safety. Moreover, some open issues regarding the quantification of motion-induced fields are highlighted, putting in evidence the need for clarification at standardization level. Magn Reson Med 76:1291-1300, 2016. © 2015 Wiley Periodicals, Inc.