Free-breathing, fat-corrected T1 mapping of the liver with stack-of-stars MRI, and joint estimation of T1, PDFF, R 2 * , and B 1 + .

PURPOSE: Quantitative T1 mapping has the potential to replace biopsy for noninvasive diagnosis and quantitative staging of chronic liver disease. Conventional T1 mapping methods are confounded by fat and B 1 + $$ {B}_1^{+} $$ inhomogeneities, resulting in unreliable T1 estimations. Furthermore, these methods trade off spatial resolution and volumetric coverage for shorter acquisitions with only a few images obtained within a breath-hold. This work proposes a novel, volumetric (3D), free-breathing T1 mapping method to account for multiple confounding factors in a single acquisition. THEORY AND METHODS: Free-breathing, confounder-corrected T1 mapping was achieved through the combination of non-Cartesian imaging, magnetization preparation, chemical shift encoding, and a variable flip angle acquisition. A subspace-constrained, locally low-rank image reconstruction algorithm was employed for image reconstruction. The accuracy of the proposed method was evaluated through numerical simulations and phantom experiments with a T1/proton density fat fraction phantom at 3.0 T. Further, the feasibility of the proposed method was investigated through contrast-enhanced imaging in healthy volunteers, also at 3.0 T. RESULTS: The method showed excellent agreement with reference measurements in phantoms across a wide range of T1 values (200 to 1000 ms, slope = 0.998 (95% confidence interval (CI) [0.963 to 1.035]), intercept = 27.1 ms (95% CI [0.4 54.6]), r2 = 0.996), and a high level of repeatability. In vivo imaging studies demonstrated moderate agreement (slope = 1.099 (95% CI [1.067 to 1.132]), intercept = -96.3 ms (95% CI [-82.1 to -110.5]), r2 = 0.981) compared to saturation recovery-based T1 maps. CONCLUSION: The proposed method produces whole-liver, confounder-corrected T1 maps through simultaneous estimation of T1, proton density fat fraction, and B 1 + $$ {B}_1^{+} $$ in a single, free-breathing acquisition and has excellent agreement with reference measurements in phantoms.

Comparison of data-driven and general temporal constraints on compressed sensing for breast DCE MRI.

PURPOSE: Current breast DCE-MRI strategies provide high sensitivity for cancer detection but are known to be insufficient in fully capturing rapidly changing contrast kinetics at high spatial resolution across both breasts. Advanced acquisition and reconstruction strategies aim to improve spatial and temporal resolution and increase specificity for disease characterization. In this work, we evaluate the spatial and temporal fidelity of a modified data-driven low-rank-based model (known as MOCCO, model consistency condition) compressed-sensing (CS) reconstruction compared to CS with temporal total variation with radial acquisition for high spatial-temporal breast DCE MRI. METHODS: Reconstruction performance was characterized using numerical simulations of a golden-angle stack-of-stars breast DCE-MRI acquisition at 5-second temporal resolution. Specifically, MOCCO was compared with CS total variation and conventional SENSE reconstructions. The temporal model for MOCCO was prelearned over the source data, whereas CS total variation was performed using a first-order temporal gradient sparsity transform. RESULTS: The MOCCO reconstruction was able to capture rapid lesion kinetics while providing high image quality across a range of optimal regularization values. It also recovered kinetics in small lesions (1.5 mm) in line-profile analysis and error images, whereas g-factor maps showed relatively low and constant values with no significant artifacts. The CS-TV method demonstrated either recovery of high spatial resolution with reduced temporal accuracy using large regularization values, or recovery of rapid lesion kinetics with reduced image quality using low regularization values. CONCLUSION: Simulations demonstrated that MOCCO with radial acquisition provides a robust imaging technique for improving temporal fidelity, while maintaining high spatial resolution and image quality in the setting of bilateral breast DCE MRI.

An Intra-individual Comparison between Free-breathing Dynamic MR Imaging of the Liver Using Stack-of-stars Acquisition and the Breath-holding Method Using Cartesian Sampling or View-sharing.

PURPOSE: To compare the quality of dynamic imaging between stack-of-stars acquisition without breath-holding (DISCO-Star) and the breath-holding method (Cartesian LAVA and DISCO). METHODS: This retrospective study was conducted between October 2019 and February 2020. Two radiologists performed visual assessments of respiratory motion or pulsation artifacts, streak artifacts, liver edge sharpness, and overall image quality using a 5-point scale for two datasets: Dataset 1 (n = 107), patients with Cartesian LAVA and DISCO-Star; Dataset 2 (n = 41), patients with DISCO and DISCO-Star at different time points. Diagnosable image quality was defined as ≥ 3 points in overall image quality. Whether the scan timing of the arterial phase (AP) was appropriate was evaluated, and results between the pulse sequences were compared. In cases of inappropriate scan timing in the DISCO-Star group, retrospective reconstruction with a high frame rate (80 phases, 3 s/phase) was added. RESULTS: The overall image quality of Cartesian LAVA was better than that of DISCO-Star in AP. However, noninferiority was shown in the ratio of diagnosable images between Cartesian LAVA and DISCO-Star in AP. There was no significant difference in the ratio of appropriate scan timing between DISCO-Star and Cartesian LAVA; however, the ratio of appropriate scan timing in DISCO-Star with high frame rate reconstruction was significantly higher than that in Cartesian LAVA in both readers. Overall image quality scores between DISCO and DISCO-Star were not significantly different in AP. There was no significant difference in the ratio of appropriate scan timing between DISCO-Star with high frame rate reconstruction and DISCO in both readers. CONCLUSION: The use of DISCO-Star with high frame rate reconstruction is a good solution to obtain appropriate AP scan timing compared with Cartesian LAVA. DISCO-Star showed equivalent image quality in all phases and in the ratio of appropriate AP scan timing compared with DISCO.

Evaluation of a Deep Learning Reconstruction for High-Quality T2-Weighted Breast Magnetic Resonance Imaging.

Deep learning (DL) reconstruction techniques to improve MR image quality are becoming commercially available with the hope that they will be applicable to multiple imaging application sites and acquisition protocols. However, before clinical implementation, these methods must be validated for specific use cases. In this work, the quality of standard-of-care (SOC) T2w and a high-spatial-resolution (HR) imaging of the breast were assessed both with and without prototype DL reconstruction. Studies were performed using data collected from phantoms, 20 retrospectively collected SOC patient exams, and 56 prospectively acquired SOC and HR patient exams. Image quality was quantitatively assessed via signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and edge sharpness. Qualitatively, all in vivo images were scored by either two or four radiologist readers using 5-point Likert scales in the following categories: artifacts, perceived sharpness, perceived SNR, and overall quality. Differences in reader scores were tested for significance. Reader preference and perception of signal intensity changes were also assessed. Application of the DL resulted in higher average SNR (1.2-2.8 times), CNR (1.0-1.8 times), and image sharpness (1.2-1.7 times). Qualitatively, the SOC acquisition with DL resulted in significantly improved image quality scores in all categories compared to non-DL images. HR acquisition with DL significantly increased SNR, sharpness, and overall quality compared to both the non-DL SOC and the non-DL HR images. The acquisition time for the HR data only required a 20% increase compared to the SOC acquisition and readers typically preferred DL images over non-DL counterparts. Overall, the DL reconstruction demonstrated improved T2w image quality in clinical breast MRI.

Automated Placement of Scan and Pre-Scan Volumes for Breast MRI Using a Convolutional Neural Network.

Graphically prescribed patient-specific imaging volumes and local pre-scan volumes are routinely placed by MRI technologists to optimize image quality. However, manual placement of these volumes by MR technologists is time-consuming, tedious, and subject to intra- and inter-operator variability. Resolving these bottlenecks is critical with the rise in abbreviated breast MRI exams for screening purposes. This work proposes an automated approach for the placement of scan and pre-scan volumes for breast MRI. Anatomic 3-plane scout image series and associated scan volumes were retrospectively collected from 333 clinical breast exams acquired on 10 individual MRI scanners. Bilateral pre-scan volumes were also generated and reviewed in consensus by three MR physicists. A deep convolutional neural network was trained to predict both the scan and pre-scan volumes from the 3-plane scout images. The agreement between the network-predicted volumes and the clinical scan volumes or physicist-placed pre-scan volumes was evaluated using the intersection over union, the absolute distance between volume centers, and the difference in volume sizes. The scan volume model achieved a median 3D intersection over union of 0.69. The median error in scan volume location was 2.7 cm and the median size error was 2%. The median 3D intersection over union for the pre-scan placement was 0.68 with no significant difference in mean value between the left and right pre-scan volumes. The median error in the pre-scan volume location was 1.3 cm and the median size error was -2%. The average estimated uncertainty in positioning or volume size for both models ranged from 0.2 to 3.4 cm. Overall, this work demonstrates the feasibility of an automated approach for the placement of scan and pre-scan volumes based on a neural network model.

Utility of Stack-of-stars Acquisition for Hepatobiliary Phase Imaging without Breath-holding.

PURPOSE: Post-contrast liver magnetic resonance imaging is typically performed with breath-hold 3D gradient echo sequences. However, breath-holding for >10 s is difficult for some patients. In this study, we compared the quality of hepatobiliary phase (HBP) imaging without breath-holding using the prototype pulse sequences stack-of-stars liver acquisition with volume acceleration (LAVA) (LAVA Star) with or without navigator echoes (LAVA Starnavi+ and LAVA Starnavi-) and Cartesian LAVA with navigator echoes (Cartesian LAVAnavi+). METHODS: Seventy-two patients were included in this single-center, retrospective, cross-sectional study. HBP imaging using the three LAVA sequences (Cartesian LAVAnavi+, LAVA Starnavi-, and LAVA Starnavi+) without breath-holding was performed for all patients using a 3T magnetic resonance system. Two independent radiologists qualitatively analyzed (overall image quality, liver edge sharpness, hepatic vein clarity, streak artifacts, and respiratory motion/pulsation artifacts) HBP images taken by the three sequences using a five-point scale. Quantitative evaluations were also performed by calculating the liver-to-spleen, -lesion, and -portal vein (PV) signal intensity ratios. The results were compared between the three sequences using the Friedman test. RESULTS: LAVA Starnavi+ showed the best image quality and hepatic vein clarity (P < 0.0001). LAVA Starnavi- showed the lowest image quality (P < 0.0001-0.0106). LAVA Starnavi+ images showed fewer streak artifacts than LAVA Starnavi- images (P < 0.0001), while Cartesian LAVAnavi+ images showed no streak artifacts. Cartesian LAVAnavi+ images showed stronger respiratory motion/pulsation artifacts than the others (P < 0.0001). LAVA Starnavi- images showed the highest liver-to-spleen ratios (P < 0.0001-0.0005). Cartesian LAVAnavi+ images showed the lowest liver-to-lesion and -PV ratios (P < 0.0001-0.0108). CONCLUSION: In terms of image quality, the combination of stack-of-stars acquisition and navigator echoes is the best for HBP imaging without breath-holding.

Radial sliding-window magnetic resonance angiography (MRA) with highly-constrained projection reconstruction (HYPR).

Sufficient temporal resolution is required to image the dynamics of blood flow, which may be critical for accurate diagnosis and treatment of various intracranial vascular diseases, such as arteriovenous malformations (AVMs) and aneurysms. Highly-constrained projection reconstruction (HYPR) has recently become a technique of interest for high-speed contrast-enhanced magnetic resonance angiography (CE-MRA). HYPR provides high frame rates by preferential weighting of radial projections while maintaining signal-to-noise ratio (SNR) by using a high SNR composite. An analysis was done to quantify the effects of HYPR on SNR, contrast-to-noise ratio (CNR), and temporal blur compared to the previously developed radial sliding-window technique using standard filtered backprojection or regridding methods. Computer simulations were performed to study the effects of HYPR processing on image error and the temporal information. Additionally, in vivo imaging was done on patients with angiographically confirmed AVMs to measure the effects of alteration of various HYPR parameters on SNR as well as the fidelity of the temporal information. The images were scored by an interventional radiologist in a blinded read and were compared with X-ray digital subtraction angiography (DSA). It was found that with the right choice of parameters, modest improvements in both SNR and dynamic information can be achieved as compared to radial sliding-window MRA.

Advanced noninvasive imaging of spinal vascular malformations.

Spinal vascular malformations (SVMs) are an uncommon, heterogeneous group of vascular anomalies that can render devastating neurological consequences if they are not diagnosed and treated in a timely fashion. Imaging SVMs has always presented a formidable challenge because their clinical and imaging presentations resemble those of neoplasms, demyelination diseases, and infection. Advancements in noninvasive imaging modalities (MR and CT angiography) have increased during the last decade and have improved the ability to accurately diagnose spinal vascular anomalies. In addition, intraoperative imaging techniques have been developed that aid in the intraoperative assessment before, during, and after resection of these lesions with minimal and/or optimal use of spinal digital subtraction angiography. In this report, the authors review recent advancements in the imaging of SVMs that will likely lead to more timely diagnoses and treatment while reducing procedural risk exposure to the patients who harbor these uncommon spinal lesions.

4D radial contrast-enhanced MR angiography with sliding subtraction.

A method is presented for high spatial and temporal resolution 3D contrast-enhanced magnetic resonance angiography. The overall technique involves a set of interrelated components suited to high-frame-rate angiography, including 3D cylindrical k-space sampling, angular undersampling, asymmetric sampling, sliding window reconstruction, pseudorandom view ordering, and a sliding subtraction mask. Computer simulations and volunteer studies demonstrated the utility of each component of the technique. Angiograms of one hemisphere of the intracranial vasculature were acquired with a pixel size of 1.1 x 1.1 x 2.8 mm and a frame rate of 0.35 sec based on a temporal resolution of 3.5 sec. Such a 3D time-resolved, or "4D," technique has the potential to noninvasively acquire diagnostic quality images of certain anatomic regions with a frame rate fast enough to not only ensure the capture of an uncontaminated arterial phase, but even demonstrate contrast bolus flow dynamics. Clinical applications include noninvasive imaging of arteriovenous shunting, which is demonstrated with a patient study.

Renal artery stenosis in swine: feasibility of MR assessment of renal function during percutaneous transluminal angioplasty.

PURPOSE: To prospectively test--in a swine model of renal artery stenosis (RAS)--the hypothesis that magnetic resonance (MR) imaging can reveal changes in renal function at the time of percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS: In this animal care and use committee-approved study, high-grade unilateral RAS was surgically induced in six pigs. MR imaging at 3.0 T was used for intraprocedural assessment of the anatomic and physiologic changes induced by x-ray-guided PTA. With use of MR imaging, changes in single-kidney glomerular filtration rate, extraction fraction, and renal blood flow were assessed during PTA. The arterial diameter of stenosis before and after PTA was assessed by using conventional digital subtraction angiography. Mean changes in functional and anatomic parameters were compared by using the Wilcoxon signed rank test (alpha = .05). RESULTS: At digital subtraction angiography, the mean percentage of stenosis was 69% +/- 10 (standard deviation) before PTA and 26% +/- 10 after PTA (P<.03). Mean pre- and post-PTA extraction fraction values were 0.11 +/- 0.03 and 0.19 +/- 0.06, respectively (P<.03). The mean single-kidney glomerular filtration rate before PTA, 19 mL/min +/- 13, increased to 41 mL/min +/- 33 after PTA (P<.03). There was no significant change in mean renal blood flow after PTA (P=.44). CONCLUSION: In swine, MR imaging can reveal changes in renal function after x-ray-guided PTA for unilateral RAS.

MR imaging assessment of changes in renal function with renal artery stent placement in swine.

PURPOSE: To prospectively test the hypothesis that magnetic resonance (MR) imaging can detect changes in renal function at the time of renal artery stent placement in a swine model of renal artery stenosis (RAS). MATERIALS AND METHODS: In this animal care and use committee-approved study, hemodynamically significant (>50%) RAS was surgically induced in six pigs. MR imaging was employed for assessment of the anatomic and physiologic changes induced by fluoroscopically guided stent placement. With MR imaging, we assessed changes in renal blood flow (RBF), extraction fraction (EF), and single-kidney glomerular filtration rate (skGFR) during the procedure. Arterial diameter stenosis before and after stent placement was assessed with x-ray digital subtraction angiography (DSA). Mean changes in functional and anatomic parameters were compared with the Wilcoxon matched-pairs test, with an alpha level of 0.05. RESULTS: There was no significant change in mean RBF after stent deployment (P=.44). Mean EF increased from 0.19+/-0.08 before stent placement to 0.31+/-0.17 after stent placement (P=.16). Mean skGFR measurements were 25 mL/min+/-16 before stent placement and 41 mL/min+/-28 after stent placement (P<.05). According to x-ray DSA measurements, mean stenosis measurements were 60%+/-12% before stent placement and 24%+/-16% after stent placement (P<.02). CONCLUSIONS: In swine, MR imaging can detect immediate changes in renal function after radiographically guided stent placement for unilateral RAS. This functional MR technique may have applications in the setting of hybrid MR/x-ray DSA procedure suites.

Quantitative CBV measurement from static T1 changes in tissue and correction for intravascular water exchange.

The steady-state (SS) approach has been proposed to measure quantitative cerebral blood volume (CBV). However, it is known that the CBV value in SS (CBVSS) is subject to error resulting from the effects of water diffusion from the intra- to extravascular space. CBVSS measurements were simulated in both fast- and no-water-exchange limits, and compared with measured CBVSS values to determine which limiting case is appropriate. Twenty-eight patients were scanned with a segmented Look-Locker echo-planar imaging (LL-EPI) sequence before and after the injection of 0.1 mmol/kg of a T1-shortening contrast agent. Signal changes and T1 values of brain parenchyma and the blood pool were measured pre- and postcontrast. These signal changes and T1 values, in combination with the simulated results, were used to estimate water-exchange rates. We found that the intra- to extravascular water-exchange rates in white matter (WM) and gray matter (GM) were 0.9 and 1.6 s-1, respectively. With these water-exchange rates, the fast-water-exchange limit of the CBV values showed good agreement with the simulation (r=0.86 in WM, and 0.78 in GM). The CBV values with the correction for water-exchange effects were recalculated as 2.73+/-0.44 and 5.81+/-1.12 of quantitative cerebral blood water volume (%) in WM and GM, respectively.

Comparison of intraarterial MR angiography at 3.0 T with X-ray digital subtraction angiography for detection of renal artery stenosis in swine.

PURPOSE: To compare the accuracy of catheter-directed intraarterial (IA) magnetic resonance (MR) angiography at 3.0 T with that of x-ray digital subtraction angiography (DSA) for the measurement of renal artery stenosis (RAS) in swine. MATERIALS AND METHODS: Unilateral hemodynamically significant RAS (>50%) was induced surgically in six pigs with use of reverse cable ties. One to two weeks after surgery, each pig underwent x-ray DSA and MR angiography before and after percutaneous transluminal balloon angioplasty (PTA). X-ray DSA was performed before and after PTA of RAS by injection of iodinated contrast agent through a 5-F multiple-side hole angiographic catheter placed in the abdominal aorta under fluoroscopic guidance. MR angiography of RAS was performed before and after PTA of RAS on a 3.0-T clinical MR imager with use of gadolinium-based contrast agent. MR angiography and DSA images were analyzed with the full width at half maximum method. Percent stenosis measurements between x-ray DSA and MR angiography were compared with a paired t test and were correlated with linear regression and Bland Altman analysis (alpha = 0.05). RESULTS: Six cases of RAS were induced and imaged successfully with DSA and MR angiography techniques before and after PTA. On x-ray DSA, median stenoses was 64% (95% CI 57%-80%) before PTA and 20% (95% CI 5%-32%) after PTA. Corresponding MR angiography median stenosis measurement was 69% (95% CI 58%-80%) before PTA and 26% (95% CI 16%-36%) after PTA. A paired t test comparison did not show a difference between DSA and MR angiography (P = .16). RAS measurements on MR angiography correlated closely (P < .01) with DSA measurements (r(2) = 0.92). CONCLUSION: In swine, the accuracy of catheter-directed IA MR angiography with use of a clinical 3.0-T MR imaging unit for the measurement of RAS was similar to that of conventional x-ray DSA.

Method for improving the accuracy of quantitative cerebral perfusion imaging.

PURPOSE: To improve the accuracy of dynamic susceptibility contrast (DSC) measurements of cerebral blood flow (CBF) and volume (CBV). MATERIALS AND METHODS: In eight volunteers, steady-state CBV (CBV(SS)) was measured using TrueFISP readout of inversion recovery (IR) before and after injection of a bolus of contrast. A standard DSC (STD) perfusion measurement was performed by echo-planar imaging (EPI) during passage of the bolus and subsequently used to calculate the CBF (CBF(DSC)) and CBV (CBV(DSC)). The ratio of CBV(SS) to CBV(DSC) was used to calibrate measurements of CBV and CBF on a subject-by-subject basis. RESULTS: Agreement of values of CBV (1.77 +/- 0.27 mL/100 g in white matter (WM), 3.65 +/- 1.04 mL/100 g in gray matter (GM)), and CBF (23.6 +/- 2.4 mL/(100 g min) in WM, 57.3 +/- 18.2 mL/(100 g min) in GM) with published gold-standard values shows improvement after calibration. An F-test comparison of the coefficients of variation of the CBV and CBF showed a significant reduction, with calibration, of the variability of CBV in WM (P < 0.001) and GM (P < 0.03), and of CBF in WM (P < 0.0001). CONCLUSION: The addition of a CBV(SS) measurement to an STD measurement of cerebral perfusion improves the accuracy of CBV and CBF measurements. The method may prove useful for assessing patients suffering from acute stroke.