Intervertebral Disk Health Following Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: A Preliminary Study.

BACKGROUND: Interest in vertebral body tethering (VBT) as an alternative to posterior spinal fusion for adolescent idiopathic scoliosis (AIS) continues to grow. The purpose of this study was to prospectively assess intervertebral disk health on magnetic resonance imaging (MRI) at 1 year following VBT in AIS patients. METHODS: AIS patients were enrolled in a prospective surgeon-sponsored Food and Drug Administration (FDA) Investigational Device Exemption (IDE) Study and underwent MRI at 1-year following VBT. All spanned disks and the untethered disks immediately adjacent to the upper instrumented vertebra and lowest instrumented vertebra levels were evaluated according to Pfirrmann grading criteria. Associations between patient factors and preoperative and postoperative disk health and patient-reported outcomes were evaluated. RESULTS: Twenty-two patients were enrolled with a postoperative MRI (25 curves, 188 disks), and 7 patients (7 curves) had both preoperative and postoperative MRIs (67 disks). The mean age was 12.7 years. Most were Risser 0 (65%) and either Sanders Skeletal Maturity Score 3 (35%) or 4 (53%). In the 7 patients with preoperative and postoperative MRI, the mean Pfirrmann grade of the disks spanned by the tether was 1.88 preoperatively and 2.31 postoperatively ( P =0.0075). No statistically significant differences in preoperative versus postoperative Pfirrmann grade were identified in the disks adjacent to the upper or lower instrumented vertebrae. No association was found between patient-reported outcomes and Pfirrmann grade. CONCLUSION: At 1 year postoperatively, increased degenerative changes in disks spanned by the tether was identifiable on MRI without evidence of adjacent segment disk disease. These changes were not associated with patient-reported outcomes. LEVEL OF EVIDENCE: Level III.

Identification and mitigation of interference sources present in SSB-based wireless MRI receiver arrays.

PURPOSE: Single sideband amplitude modulation (SSB) is an appealing platform for highly parallel wireless MRI detector arrays because the spacing between channels is ideally limited only by the MRI signal bandwidth. However this assumes that no other sources of interference are present outside that bandwidth. This work investigates the practical interference between multiple SSB-encoded MRI signals. METHODS: Noise from coil preamplifiers and carrier bleed-through are identified as sources of interference. Two different SSB systems were designed for 1.5 T with different noise filtering properties. We show how the differences between the filtered noise profiles impact the received MR signal's dynamic range (DRsig ) and image signal-to-noise ratio through simulation, bench measurements, and phantom imaging experiments. RESULTS: When operating individually in the MR scanner, both SSB systems were shown to minimally impact the original DRsig and signal-to-noise ratio. Conversely, when all eight channels were operating simultaneously, an average signal-to-noise ratio loss was observed to be 12% in the one system, while a second system with more complex filtering was able to achieve a 3% loss in signal-to-noise ratio. CONCLUSION: Successful wireless transmission of multiple SSB-encoded MRI signals is possible as long as channel interference is properly managed through design and simulation.

On-coil multiple channel transmit system based on class-D amplification and pre-amplification with current amplitude feedback.

A complete high-efficiency transmit amplifier unit designed to be implemented in on-coil transmit arrays is presented. High power capability, low power dissipation, scalability, and cost minimization were some of the requirements imposed to the design. The system is composed of a current mode class-D amplifier output stage and a voltage mode class-D preamplification stage. The amplitude information of the radio frequency pulse was added through a customized step-down DC-DC converter with current amplitude feedback that connects to the current mode class-D stage. Benchtop measurements and imaging experiments were carried out to analyze system performance. Direct control of B1 was possible and its load sensitivity was reduced to less than 10% variation from unloaded to full loaded condition. When using the amplifiers in an array configuration, isolation above 20 dB was achieved between neighboring coils by the amplifier decoupling method. High output current operation of the transmitter was proved on the benchtop through output power measurements and in a 1.5T scanner through flip angle quantification. Finally, single and multiple channel excitations with the new hardware were demonstrated by receiving signal with the body coil of the scanner.

Abdominal MR elastography with multiple driver arrays: performance and repeatability.

PURPOSE: To evaluate the performance and repeatability assessing liver, spleen, and kidney stiffness with magnetic resonance elastography (MRE), using arrays of pneumatic passive drivers. METHODS: An array of four flexible, pneumatically activated passive drivers for abdominal MRE were developed and tested in this study. Multiple MRE acquisitions were performed prospectively in a series of eleven volunteers, with activation of all combinations of the four drivers, individually and simultaneously. MRE exams were repeated three times to study within-day and between-day test-retest repeatability. Semi-quantitative evaluation of wave propagation and penetration, and quantitative assessment of tissue stiffness was conducted for liver, spleen, and kidneys. RESULTS: When driver location and amplitude were sufficient to achieve necessary shear wave illumination in any given region of interest, the results showed excellent test-retest repeatability in abdominal organ stiffness with both single and multiple driver configurations. The results confirmed that multiple driver arrays provided suitable shear wave illumination over a larger region of the abdomen, allowing more reliable stiffness measurements in multiple organs. MRE assessment of the spleen was found to be prone to effects of excessive shear wave amplitude, however. CONCLUSION: A multiple driver array provides shear wave illumination over a larger region of the abdomen than obtained with a single driver, for MRE assessment of multiple abdominal organs, providing excellent test-retest repeatability in stiffness measurements. However, careful tuning of the location and amplitude of each driver is essential to achieve consistent results.

Parallel excitation for B-field insensitive fat-saturation preparation.

Multichannel transmission has the potential to improve many aspects of MRI through a new paradigm in excitation. In this study, multichannel transmission is used to address the effects that variations in B(0) homogeneity have on fat-saturation preparation through the use of the frequency, phase, and amplitude degrees of freedom afforded by independent transmission channels. B(1) homogeneity is intrinsically included via use of coil sensitivities in calculations. A new method, parallel excitation for B-field insensitive fat-saturation preparation, can achieve fat saturation in 89% of voxels with M(z) ≤ 0.1 in the presence of ± 4 ppm B(0) variation, where traditional CHESS methods achieve only 40% in the same conditions. While there has been much progress to apply multichannel transmission at high field strengths, particular focus is given here to application of these methods at 1.5 T.

Assessment of agreement between manual and automated processing of liver MR elastography for shear stiffness estimation in children and young adults with autoimmune liver disease.

PURPOSE: To compare automated versus standard of care manual processing of 2D gradient recalled echo (GRE) liver MR Elastography (MRE) in children and young adults. MATERIALS AND METHODS: 2D GRE liver MRE data from research liver MRI examinations performed as part of an autoimmune liver disease registry between March 2017 and March 2020 were analyzed retrospectively. All liver MRE data were acquired at 1.5 T with 60 Hz mechanical vibration frequency. For manual processing, two independent readers (R1, R2) traced regions of interest on scanner generated shear stiffness maps. Automated processing was performed using MREplus+ (Resoundant Inc.) using 90% (A90) and 95% (A95) confidence masks. Agreement was evaluated using intra-class correlation coefficients (ICC) and Bland-Altman analyses. Classification performance was evaluated using receiver operating characteristic curve (ROC) analyses. RESULTS: In 65 patients with mean age of 15.5 ± 3.8 years (range 8-23 years; 35 males) median liver shear stiffness was 2.99 kPa (mean 3.55 ± 1.69 kPa). Inter-reader agreement for manual processing was very strong (ICC = 0.99, mean bias = 0.01 kPa [95% limits of agreement (LoA): - 0.41 to 0.44 kPa]). Correlation between manual and A95 automated processing was very strong (R1: ICC = 0.988, mean bias = 0.13 kPa [95% LoA: - 0.40 to 0.68 kPa]; R2: ICC = 0.987, mean bias = 0.13 kPa [95% LoA: - 0.44 to 0.69 kPa]). Automated measurements were perfectly replicable (ICC = 1.0; mean bias = 0 kPa). CONCLUSION: Liver shear stiffness values obtained using automated processing showed excellent agreement with manual processing. Automated processing of liver MRE was perfectly replicable.