Wideband black-blood late gadolinium enhancement imaging for improved myocardial scar assessment in patients with cardiac implantable electronic devices.

PURPOSE: Wideband phase-sensitive inversion recovery (PSIR) late gadolinium enhancement (LGE) enables myocardial scar imaging in implantable cardioverter defibrillators (ICD) patients, mitigating hyperintensity artifacts. To address subendocardial scar visibility challenges, a 2D breath-hold single-shot electrocardiography-triggered black-blood (BB) LGE sequence was integrated with wideband imaging, enhancing scar-blood contrast. METHODS: Wideband BB, with increased bandwidth in the inversion pulse (0.8-3.8 kHz) and T2 preparation refocusing pulses (1.6-5.0 kHz), was compared with conventional and wideband PSIR, and conventional BB, in a phantom and sheep with and without ICD, and in six patients with cardiac devices and known myocardial injury. ICD artifact extent was quantified in the phantom and specific absorption rate (SAR) was reported for each sequence. Image contrast ratios were analyzed in both phantom and animal experiments. Expert radiologists assessed image quality, artifact severity, and scar segments in patients and sheep. Additionally, histology was performed on the sheep's heart. RESULTS: In the phantom, wideband BB reduced ICD artifacts by 62% compared to conventional BB while substantially improving scar-blood contrast, but with a SAR more than 24 times that of wideband PSIR. Similarly, the animal study demonstrated a considerable increase in scar-blood contrast with wideband BB, with superior scar detection compared with wideband PSIR, the latter confirmed by histology. In alignment with the animal study, wideband BB successfully eliminated severe ICD hyperintensity artifacts in all patients, surpassing wideband PSIR in image quality and scar detection. CONCLUSION: Wideband BB may play a crucial role in imaging ICD patients, offering images with reduced ICD artifacts and enhanced scar detection.

Unsupervised cycle-consistent network using restricted subspace field map for removing susceptibility artifacts in EPI.

PURPOSE: To design an unsupervised deep neural model for correcting susceptibility artifacts in single-shot Echo Planar Imaging (EPI) and evaluate the model for preclinical and clinical applications. METHODS: This work proposes an unsupervised cycle-consistent model based on the restricted subspace field map to take advantage of both the deep learning (DL) and the reverse polarity-gradient (RPG) method for single-shot EPI. The proposed model consists of three main components: (1) DLRPG neural network (DLRPG-net) to obtain field maps based on a pair of images acquired with reversed phase encoding; (2) spin physical model-based modules to obtain the corrected undistorted images based on the learned field map; and (3) cycle-consistency loss between the input images and back-calculated images from each cycle is explored for network training. In addition, the field maps generated by DLRPG-net belong to a restricted subspace, which is a span of predefined cubic splines to ensure the smoothness of the field maps and avoid blurring in the corrected images. This new method is trained and validated on both preclinical and clinical datasets for diffusion MRI. RESULTS: The proposed network could effectively generate smooth field maps and correct susceptibility artifacts in single-shot EPI. Simulated and in vivo preclinical/clinical experiments demonstrated that our method outperforms the state-of-the-art susceptibility artifact correction methods. Furthermore, the ablation experiments of the cycle-consistent network and the restricted subspace in generating field maps did show the advantages of DLRPG-net. CONCLUSION: The proposed method (DLRPG-net) can effectively correct susceptibility artifacts for preclinical and clinical single-shot EPI sequences.

Diffusion-weighted imaging in the assessment of cervical cancer: comparison of reduced field-of-view diffusion-weighted imaging and conventional techniques.

BACKGROUND: Cervical cancer (CC) is the second most common cancer in women worldwide. Diffusion-weighted imaging (DWI) plays an important role in the diagnosis of CC, but the conventional techniques are affected by many factors. PURPOSE: To compare reduced-field-of-view (r-FOV) and full-field-of-view (f-FOV) DWI in the diagnosis of CC. MATERIAL AND METHODS: Preoperative magnetic resonance imaging (MRI) with r-FOV and f-FOV DWI images were collected. Two radiologists reviewed the images using a subjective 4-point scale for anatomical features, magnetic susceptibility artifacts, visual distortion, and overall diagnostic confidence for r-FOV and f-FOV DWI. The objective features included the region of interest (ROI) signal intensity of the cervical lesion (SIlesion) and gluteus maximus muscle (SIgluteus), standard deviation of the background noise (SDbackground), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). The differences of measured apparent diffusion coefficient (ADC) values between the two examinations in pathological grades and FIGO tumor stages were compared. RESULTS: A total of 200 patients were included (170 with squamous cell carcinoma and 30 with adenocarcinoma). The scores of anatomical features, magnetic susceptibility artifacts, visual distortion, and overall diagnostic confidence for r-FOV DWI were significantly higher than those for f-FOV DWI. There was no difference in SNR and CNR between r-FOV DWI and f-FOV DWI. There were significant differences in ADC values between the two groups in all comparisons (P < 0.05). CONCLUSION: Compared with f-FOV DWI, r-FOV DWI might provide clearer imaging, fewer artifacts, less distortion, and higher image quality for the diagnosis of CC and might assist in the detection of CC.

Cardiovascular magnetic resonance images with susceptibility artifacts: artificial intelligence with spatial-attention for ventricular volumes and mass assessment.

BACKGROUND: Segmentation of cardiovascular magnetic resonance (CMR) images is an essential step for evaluating dimensional and functional ventricular parameters as ejection fraction (EF) but may be limited by artifacts, which represent the major challenge to automatically derive clinical information. The aim of this study is to investigate the accuracy of a deep learning (DL) approach for automatic segmentation of cardiac structures from CMR images characterized by magnetic susceptibility artifact in patient with cardiac implanted electronic devices (CIED). METHODS: In this retrospective study, 230 patients (100 with CIED) who underwent clinically indicated CMR were used to developed and test a DL model. A novel convolutional neural network was proposed to extract the left ventricle (LV) and right (RV) ventricle endocardium and LV epicardium. In order to perform a successful segmentation, it is important the network learns to identify salient image regions even during local magnetic field inhomogeneities. The proposed network takes advantage from a spatial attention module to selectively process the most relevant information and focus on the structures of interest. To improve segmentation, especially for images with artifacts, multiple loss functions were minimized in unison. Segmentation results were assessed against manual tracings and commercial CMR analysis software cvi42(Circle Cardiovascular Imaging, Calgary, Alberta, Canada). An external dataset of 56 patients with CIED was used to assess model generalizability. RESULTS: In the internal datasets, on image with artifacts, the median Dice coefficients for end-diastolic LV cavity, LV myocardium and RV cavity, were 0.93, 0.77 and 0.87 and 0.91, 0.82, and 0.83 in end-systole, respectively. The proposed method reached higher segmentation accuracy than commercial software, with performance comparable to expert inter-observer variability (bias ± 95%LoA): LVEF 1 ± 8% vs 3 ± 9%, RVEF - 2 ± 15% vs 3 ± 21%. In the external cohort, EF well correlated with manual tracing (intraclass correlation coefficient: LVEF 0.98, RVEF 0.93). The automatic approach was significant faster than manual segmentation in providing cardiac parameters (approximately 1.5 s vs 450 s). CONCLUSIONS: Experimental results show that the proposed method reached promising performance in cardiac segmentation from CMR images with susceptibility artifacts and alleviates time consuming expert physician contour segmentation.

An equal-TE ultrafast 3D gradient-echo imaging method with high tolerance to magnetic susceptibility artifacts: Application to BOLD functional MRI.

PURPOSE: To develop an ultrafast 3D gradient echo-based MRI method with constant TE and high tolerance to B0 inhomogeneity, dubbed ERASE (equal-TE rapid acquisition with sequential excitation), and to introduce its use in BOLD functional MRI (fMRI). THEORY AND METHODS: Essential features of ERASE, including spin behavior, were characterized, and a comparison study was conducted with conventional EPI. To demonstrate high tolerance to B0 inhomogeneity, in vivo imaging of the mouse brain with a fiber-optic implant was performed at 9.4 T, and human brain imaging (including the orbitofrontal cortex) was performed at 3 T and 7 T. To evaluate the performance of ERASE in BOLD-fMRI, the characteristics of SNR and temporal SNR were analyzed for in vivo rat brains at 9.4 T in comparison with multislice gradient-echo EPI. Percent signal changes and t-scores are also presented. RESULTS: For both mouse brain and human brain imaging, ERASE exhibited a high tolerance to magnetic susceptibility artifacts, showing much lower distortion and signal dropout, especially in the regions involving large magnetic susceptibility effects. For BOLD-fMRI, ERASE provided higher temporal SNR and t-scores than EPI, but exhibited similar percent signal changes in in vivo rat brains at 9.4 T. CONCLUSION: When compared with conventional EPI, ERASE is much less sensitive, not only to EPI-related artifacts such as Nyquist ghosting, but also to B0 inhomogeneity including magnetic susceptibility effects. It is promising for use in BOLD-fMRI, providing higher temporal SNR and t-scores with constant TE when compared with EPI, although further optimization is needed for human fMRI.

Carbon fiber-reinforced PEEK versus titanium implants: an in vitro comparison of susceptibility artifacts in CT and MR imaging.

Artifacts in computed tomography (CT) and magnetic resonance imaging (MRI) due to titanium implants in spine surgery are known to cause difficulties in follow-up imaging, radiation planning, and precise dose delivery in patients with spinal tumors. Carbon fiber-reinforced polyetheretherketon (CFRP) implants aim to reduce these artifacts. Our aim was to analyze susceptibility artifacts of these implants using a standardized in vitro model. Titanium and CFRP screw-rod phantoms were embedded in 3% agarose gel. Phantoms were scanned with Siemens Somatom AS Open and 3.0-T Siemens Skyra scanners. Regions of interest (ROIs) were plotted and analyzed for CT and MRI at clinically relevant localizations. CT voxel-based imaging analysis showed a significant difference of artifact intensity and central overlay between titanium and CFRP phantoms. For the virtual regions of the spinal canal, titanium implants (ti) presented - 30.7 HU vs. 33.4 HU mean for CFRP (p < 0.001), at the posterior margin of the vertebral body 68.9 HU (ti) vs. 59.8 HU (CFRP) (p < 0.001) and at the anterior part of the vertebral body 201.2 HU (ti) vs. 70.4 HU (CFRP) (p < 0.001), respectively. MRI data was only visually interpreted due to the low sample size and lack of an objective measuring system as Hounsfield units in CT. CT imaging of the phantom with typical implant configuration for thoracic stabilization could demonstrate a significant artifact reduction in CFRP implants compared with titanium implants for evaluation of index structures. Radiolucency with less artifacts provides a better interpretation of follow-up imaging, radiation planning, and more precise dose delivery.

Correcting Susceptibility Artifacts of MRI Sensors in Brain Scanning: A 3D Anatomy-Guided Deep Learning Approach.

Echo planar imaging (EPI), a fast magnetic resonance imaging technique, is a powerful tool in functional neuroimaging studies. However, susceptibility artifacts, which cause misinterpretations of brain functions, are unavoidable distortions in EPI. This paper proposes an end-to-end deep learning framework, named TS-Net, for susceptibility artifact correction (SAC) in a pair of 3D EPI images with reversed phase-encoding directions. The proposed TS-Net comprises a deep convolutional network to predict a displacement field in three dimensions to overcome the limitation of existing methods, which only estimate the displacement field along the dominant-distortion direction. In the training phase, anatomical T1-weighted images are leveraged to regularize the correction, but they are not required during the inference phase to make TS-Net more flexible for general use. The experimental results show that TS-Net achieves favorable accuracy and speed trade-off when compared with the state-of-the-art SAC methods, i.e., TOPUP, TISAC, and S-Net. The fast inference speed (less than a second) of TS-Net makes real-time SAC during EPI image acquisition feasible and accelerates the medical image-processing pipelines.

Detectability and reproducibility of the olfactory fMRI signal under the influence of magnetic susceptibility artifacts in the primary olfactory cortex.

For human olfactory functional MRI studies, the primary olfactory cortex (POC) suffers severe magnetic susceptibility artifacts, which adversely influences the detectability and reproducibility of the olfactory fMRI data and its clinical applications. The goal of this work is to assess the impacts of the image artifacts on the detectability and reproducibility of the olfactory activation in the POC. The severity of artifacts in the POC were classified into three levels using a Subjective Artifact score (SA_score). The mean temporal signal-to-noise ratio (tSNR) of the fMRI data acquired by a given MRI sequence and olfactory activation (ß value) in POC were evaluated and compared to the concurrent activations in the primary visual cortex (Brodmann area 17, BA17) by an odor-visual association paradigm using ninety-nine normal human subjects. Our study revealed that the mean tSNR in POC was above the threshold for reliable detection of the functional activation signal, and, consequently, the mean olfactory activations in the POC were not significantly different from those in BA17. The reproducibility of the activation in the POC was assessed by a random half-split stimulation of a test-retest experiment. The overlap of the activation maps for all the trials (n = 1000) in the POC were not statistically different from that observed in BA17. These results show that the detectability and reproducibility of olfactory activation in the presence of susceptibility artifacts in the POC was at similar level of that in the visual cortex.

Using multi-echo simultaneous multi-slice (SMS) EPI to improve functional MRI of the subcortical nuclei of the basal ganglia at ultra-high field (7T).

The nuclei of the basal ganglia pose a special problem for functional MRI, especially at ultra-high field, because T2* variations between different regions result in suboptimal BOLD sensitivity when using gradient-echo echo-planar imaging (EPI). Specifically, the iron-rich lentiform nucleus of the basal ganglia, including the putamen and globus pallidus, suffers from substantial signal loss when imaging is performed using conventional single-echo EPI with echo times optimized for the cortex. Multi-echo EPI acquires several echoes at different echo times for every imaging slice, allowing images to be reconstructed with a weighting of echo times that is optimized individually for each voxel according to the underlying tissue or T2* properties. Here we show that multi-echo simultaneous multi-slice (SMS) EPI can improve functional activation of iron-rich subcortical regions while maintaining sensitivity within cortical areas. Functional imaging during a motor task known to elicit strong activations in the cortex and the subcortex (basal ganglia) was performed to compare the performance of multi-echo SMS EPI to single-echo SMS EPI. Notably within both the caudate nucleus and putamen of the basal ganglia, multi-echo SMS EPI yielded higher tSNR (an average 84% increase) and CNR (an average 58% increase), an approximate 3-fold increase in supra-threshold voxels, and higher t-values (an average 39% increase). The degree of improvement in the group level t-statistics was negatively correlated to the underlying T2* of the voxels, such that the shorter the T2*, as in the iron-rich nuclei of the basal ganglia, the higher the improvement of t-values in the activated region.

Radial MRI with variable echo times: reducing the orientation dependency of susceptibility artifacts of an MR-safe guidewire.

OBJECTIVES: Guidewires are indispensable tools for intravascular MR-guided interventions. Recently, an MR-safe guidewire made from a glass-fiber/epoxy compound material with embedded iron particles was developed. The size of the induced susceptibility artifact, and thus the guidewire's visibility, depends on its orientation against B 0. We present a radial acquisition scheme with variable echo times that aims to reduce the artifact's orientation dependency. MATERIALS AND METHODS: The radial acquisition scheme uses sine-squared modulated echo times depending on the physical direction of the spoke to balance the susceptibility artifact of the guidewire. The acquisition scheme was studied in simulations based on dipole fields and in phantom experiments for different orientations of the guidewire against B 0. The simulated and measured artifact widths were quantitatively compared. RESULTS: Compared to acquisitions with non-variable echo times, the proposed acquisition scheme shows a reduced angular variability. For the two main orientations (i.e., parallel and perpendicular to B 0), the ratio of the artifact widths was reduced from about 2.2 (perpendicular vs. parallel) to about 1.2 with the variable echo time approach. CONCLUSION: The reduction of the orientation dependency of the guidewire's artifact via sine-squared varying echo times could be verified in simulations and measurements. The more balanced artifact allows for a better overall visibility of the guidewire.

Correction of metal-induced susceptibility artifacts for functional MRI during deep brain stimulation.

Functional magnetic resonance imaging (fMRI) is an emerging tool for investigating brain activation associated with, or modulated by, deep brain stimulation (DBS). However, DBS-fMRI generally suffers from severe susceptibility to artifacts in regions near the metallic stimulation electrodes, as well as near tissue/air boundaries of the brain. These result in strong intensity and geometric distortions along the phase-encoding (PE) (i.e., blipped) direction in gradient-echo echo-planar imaging (GE-EPI). Distortion presents a major challenge to conducting reliable data analysis and in interpreting the findings. A recent study showed that the point spread function (PSF) mapping-based reverse gradient approach has a potential to correct for distortions not only in spin-echo EPI, but also in GE-EPI acquired in both the forward and reverse PE directions. In this study, we adapted that approach in order to minimize severe metal-induced susceptibility artifacts for DBS-fMRI, and to evaluate the performance of the approach in a phantom study and a large animal DBS-fMRI study. The method combines the distortion-corrected GE-EPI pair with geometrically different intensity distortions due to the opposing encoding directions. The results demonstrate that the approach can minimize susceptibility artifacts that appear around the metallic electrodes, as well as in the regions near the tissue/air boundaries in the brain. We also demonstrated that an accurate geometric correction is important in improving BOLD contrast in the group dataset, especially in regions where strong susceptibility artifacts appear.

Metallic implant geometry and susceptibility estimation using multispectral B0 field maps.

PURPOSE: To estimate the susceptibility and the geometry of metallic implants from multispectral imaging (MSI) information, to separate the metal implant region from the surrounding signal loss region. THEORY AND METHODS: The susceptibility map of signal-void regions is estimated from MSI B0 field maps using total variation (TV) regularized inversion. Voxels with susceptibility estimates above a predetermined threshold are identified as metal. The accuracy of the estimated susceptibility and implant geometry was evaluated in simulations, phantom, and in vivo experiments. RESULTS: The proposed method provided more accurate susceptibility estimation compared with a previous method without TV regularization, in both simulations and phantom experiments. In the phantom experiment where the actual implant was 40% of the signal-void region, the mean estimated susceptibility was close to the susceptibility in literature, and the precision and recall of the estimated geometry was 85% and 93%. In vivo studies in subjects with hip implants also demonstrated that the proposed method can distinguish implants from surrounding low-signal tissues, such as cortical bone. CONCLUSION: The proposed method can improve the delineation of metallic implant geometry by distinguishing metal voxels from artificial signal voids and low-signal tissues by estimating the susceptibility maps. Magn Reson Med 77:2402-2413, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

The role of CT myelography in sparing the spinal cord during definitive radiotherapy in vertebral hemangioma.

INTRODUCTION: The spinal cord is poorly visualized on CT images but is well visualized in MRI images. However, implants used for spinal stabilization can produce artifacts on the MRI images which can interfere with identification of the cord. CT myelography in conjunction with CT simulation helps to clearly delineate the cord. MATERIALS AND METHODS: CT simulation was done in a patient with vertebral hemangioma. Pre- and post myelography images were obtained. Two plans were generated on pre and post myelography CT images using Eclipse™ treatment planning system (TPS) version 10.0, Varian Medical Systems, USA. The prescribed total dose to PTV was 40 Gy in 20 fractions. RESULTS: The cord was poorly visualized in the premyelogram CT images. The titanium implants used for spinal cord stabilization produced artifacts in the MRI images. Figure  Post myelogram, the contrast lit up the spinal cord. There was an overlap of 0.75 cc volume of the spinal cord with the PTV in the premyelogram images. This volume was reduced to 0 cc in the post myelogram images. There was an overlap of 5.4 cc volume of the PRV of spinal cord with the PTV in the premyelogram images which was reduced to 1 cc in the post myelogram images. The overlap region between the PTV and spinal cord received around 71% of the prescribed dose in premyelogram CT could be reduced to 0% in the post myelogram CT. The mean dose received by the overlap PRV spinal cord and PTV could be increased from 70% in the premyelogram to 92% in the post myelogram plans. CONCLUSION: CT myelogram in conjunction with CT simulation is particularly useful in cases where the tumor margin is very close to the cord and spinal implants are causing distortion of magnetic resonance images.

Automated slice-specific simultaneous z-shim method for reducing B1 inhomogeneity and susceptibility-induced signal loss with parallel transmission at 3T.

PURPOSE: Through-plane susceptibility-induced signal loss in gradient recalled echo (GRE)-based sequences can considerably impair both the clinical diagnosis and functional analysis of certain brain areas. In this work, a fully automated simultaneous z-shim approach is proposed on the basis of parallel transmit (pTX) to reduce those signal dropouts at 3T. THEORY AND METHODS: The approach uses coil-specific time-delayed excitations to impose a z-shim phase. It was extended toward B1 inhomogeneity mitigation and adequate slice-specific signal-dephasing cancellation on the basis of the prevailing B0 and B1 spatial information. Local signal recovery level and image quality preservation were analyzed using multi-slice FLASH experiments in humans and compared to the standard excitation. Spatial blood-oxygen-level-dependent (BOLD) activation coverage was further compared in breath-hold functional MRI. RESULTS: The pTX z-shim approach recovered approximately 47% of brain areas affected by signal loss in standard excitation images across all subjects. At the same time, B1 shading effects could be substantially reduced. In these areas, BOLD activation coverage could be also increased by approximately 57%. CONCLUSION: The proposed fully automated pTX z-shim method enables time-efficient and robust signal recovery in GRE-based sequences on a clinical scanner using two standard whole-body transmit coils.

Detailing magnetic field strength dependence and segmental artifact distribution of myocardial effective transverse relaxation rate at 1.5, 3.0, and 7.0 T.

PURPOSE: Realizing the challenges and opportunities of effective transverse relaxation rate (R2 *) mapping at high and ultrahigh fields, this work examines magnetic field strength (B0 ) dependence and segmental artifact distribution of myocardial R2 * at 1.5, 3.0, and 7.0 T. METHODS: Healthy subjects were considered. Three short-axis views of the left ventricle were examined. R2 * was calculated for 16 standard myocardial segments. Global and mid-septum R2 * were determined. For each segment, an artifactual factor was estimated as the deviation of segmental from global R2 * value. RESULTS: The global artifactual factor was significantly enlarged at 7.0 T versus 1.5 T (P = 0.010) but not versus 3.0 T. At 7.0 T, the most severe susceptibility artifacts were detected in the inferior lateral wall. The mid-septum showed minor artifactual factors at 7.0 T, similar to those at 1.5 and 3.0 T. Mean R2 * increased linearly with the field strength, with larger changes for global heart R2 * values. CONCLUSION: At 7.0 T, segmental heart R2 * analysis is challenging due to macroscopic susceptibility artifacts induced by the heart-lung interface and the posterior vein. Myocardial R2 * depends linearly on the magnetic field strength. The increased R2 * sensitivity at 7.0 T might offer means for susceptibility-weighted and oxygenation level-dependent MR imaging of the myocardium.

Minimizing susceptibility-induced BOLD sensitivity loss in multi-band accelerated fMRI using point spread function mapping and gradient reversal.

Objective. Interleaved reverse-gradient fMRI (RG-fMRI) with a point-spread-function (PSF) mapping-based distortion correction scheme has the potential to minimize signal loss in echo-planar-imaging (EPI). In this work, the RG-fMRI is further improved by imaging protocol optimization and application of reverse Fourier acquisition.Approach. Multi-band imaging was adapted for RG-fMRI to improve the temporal and spatial resolution. To better understand signal dropouts in forward and reverse EPIs, a simple theoretical relationship between echo shift and geometric distortion was derived and validated by the reliable measurements using PSF mapping method. After examining practical imaging protocols for RG-fMRI in three subjects on both a conventional whole-body and a high-performance compact 3 T, the results were compared and the feasibility to further improve the RG-fMRI scheme were explored. High-resolution breath-holding RG-fMRI was conducted with nine subjects on the compact 3 T and the fMRI reliability improvement in high susceptibility brain regions was demonstrated. Finally, reverse Fourier acquisition was applied to RG-fMRI, and its benefit was assessed by a simulation study based on the breath-holding RG-fMRI data.Main results. The temporal and spatial resolution of the multi-band RG-fMRI became feasible for whole-brain fMRI. Echo shift measurements from PSF mapping well estimated signal dropout effects in the EPI pair and were useful to further improve the RG-fMRI scheme. Breath-holding RG-fMRI demonstrated improved fMRI reliability in high susceptibility brain regions. Reverse partial Fourier acquisition omitting the late echoes could further improve the temporal or spatial resolution for RG-fMRI without noticeable signal degradation and spatial resolution loss.Significance. With the improved imaging scheme, RG-fMRI could reliably investigate the functional mechanisms of the human brain in the temporal and frontal areas suffering from susceptibility-induced functional sensitivity loss.

In vivo assessment of artefacts in MRI images caused by conventional twistflex and various fixed orthodontic CAD/CAM retainers.

PURPOSE: To assess magnetic resonance imaging (MRI) artefacts caused by different computer-aided design/computer-aided manufacturing (CAD/CAM) retainers in comparison with conventional hand bent stainless steel twistflex retainers in vivo. MATERIALS AND METHODS: MRI scans (3 Tesla) were performed on a male volunteer with different CAD/CAM retainers (cobalt-chromium, CoCr; nickel-titanium, NiTi; grade 5 titanium, Ti5) and twistflex retainers inserted. A total of 126 landmarks inside and outside the retainer area (RA; from canine to canine) were evaluated by two blinded radiologists using an established five-point visibility scoring (1: excellent, 2: good, 3: moderate, 4: poor, 5: not visible). Friedman and two-tailed Wilcoxon tests were used for statistical analysis (significance level: p < 0.05). RESULTS: Twistflex retainers had the strongest impact on the visibility of all landmarks inside (4.0 ± 1.5) and outside the RA (1.7 ± 1.2). In contrast, artefacts caused by CAD/CAM retainers were limited to the dental area inside the RA (CoCr: 2.2 ± 1.2) or did not impair MRI-based diagnostics in a clinically relevant way (NiTi: 1.0 ± 0.1; Ti5: 1.4 ± 0.6). CONCLUSION: The present study on a single test person demonstrates that conventional stainless steel twistflex retainers can severely impair the diagnostic value in head/neck and dental MRI. By contrast, CoCr CAD/CAM retainers can cause artefacts which only slightly impair dental MRI but not head/neck MRI, whereas NiTi and Ti5 CAD/CAM might be fully compatible with both head/neck and dental MRI.

Simple analytical dual-band spectral-spatial RF pulses for B(1) + and susceptibility artifact reduction in gradient echo MRI.

Susceptibility artifacts and transmission radio frequency (RF) field (B(1) +) inhomogeneity are major limitations in high-field gradient echo MRI. Previously proposed numerical 2D spectral-spatial RF pulses have been shown to be promising for reducing the through-plane signal loss susceptibility artifact by incorporating a frequency-dependent through-plane phase correction. This method has recently been extended to 4D spectral-spatial RF pulse designs for reducing B(1) + inhomogeneity as well as the signal loss. In this manuscript, we present simple analytical pulse designs for constructing 2D and 4D spectral-spatial RF pulses as an alternative to the numerical approaches. The 2D pulse capable of exciting slices with reduced signal loss and is lipid suppressing. The 4D pulse simultaneously corrects signal loss as well as the B(1) + inhomogeneity from a body coil transmitter. The pulses are demonstrated with simulations and with gradient echo phantom and brain images at 3T using a standard RF body coil. The pulses were observed to work well for multiple slices and several volunteers.

Susceptibility artifacts from metallic markers and cardiac catheterization devices on a high-performance 0.55 T MRI system.

INTRODUCTION: Visualization of passive devices during MRI-guided catheterizations often relies on a susceptibility artifact from the device itself or added susceptibility markers that impart a unique imaging signature. High-performance low field MRI systems offer reduced RF-induced heating of metallic devices during MRI-guided invasive procedures, but susceptibility artifacts are expected to diminish with field strength, reducing device visualization. In this study, field strength and orientation dependence of artifacts from susceptibility markers and metallic guidewires were evaluated using a prototype high-performance 0.55 T MRI system. MATERIALS AND METHODS: Artifact volume from nitinol and stainless steel passive susceptibility markers was quantified using histogram analysis of pixel intensities from three-dimensional gradient echo images at 0.55 T, 1.5 T and 3 T. In addition, visibility of commercially available clinical catheterization devices was compared between 0.55 T and 1.5 T using real-time bSSFP in phantoms and in vivo. RESULTS: A low-tensile strength stainless-steel marker produced field strength- and orientation-dependent artifact size (1.7 cm3, 1.95 cm3, 2.21 cm3 at 0.55 T, 1.5 T, 3 T, respectively). Whereas, a high-tensile strength steel marker, of the same alloy, produced field strength- and orientation-independent artifact size (3.35 cm3, 3.41 cm3, 3.42 cm3 at 0.55 T, 1.5 T, 3 T, respectively). Visibility of commercially available nitinol guidewires was reduced at 0.55 T, but imaging signature could be maintained using high-susceptibility stainless steel markers. DISCUSSION AND CONCLUSION: High-susceptibility stainless-steel markers generate field-independent artifacts between 0.55 T, 1.5 T and 3 T, indicating magnetic saturation at fields <0.55 T. Thus, artifact size can be tailored such that interventional devices produce identical imaging signatures across field strengths.

The role of unhenanced CT in a ruptured parathyroid adenoma: A case report.

Acute bleeding is a rare and potentially life-threatening complication of a Parathyroid Adenoma described in just a few cases in literature. We describe the case of a healthy 53-years-old female patient without prior history of parathyroid pathology who presented with acute onset of neck and mediastinal hemorrhage. Ultrasound (US), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) combined with laboratory tests led to the diagnosis of a bleeding Parathyroid adenoma. This case is presented to sensitize both Radiologists and Clinicians about this rare presentation that should be put into differential diagnosis of acute neck swelling and pain.