Pre-excitation gradients for eddy current nulled convex optimized diffusion encoding (Pre-ENCODE).

PURPOSE: To evaluate the use of pre-excitation gradients for eddy current-nulled convex optimized diffusion encoding (Pre-ENCODE) to mitigate eddy current-induced image distortions in diffusion-weighted MRI (DWI). METHODS: DWI sequences using monopolar (MONO), ENCODE, and Pre-ENCODE were evaluated in terms of the minimum achievable echo time (TE min $$ {}_{\mathrm{min}} $$ ) and eddy current-induced image distortions using simulations, phantom experiments, and in vivo DWI in volunteers ( N = 6 $$ N=6 $$ ). RESULTS: Pre-ENCODE provided a shorter TE min $$ {}_{\mathrm{min}} $$ than MONO (71.0 ± $$ \pm $$ 17.7ms vs. 77.6 ± $$ \pm $$ 22.9ms) and ENCODE (71.0 ± $$ \pm $$ 17.7ms vs. 86.2 ± $$ \pm $$ 14.2ms) in 100 % $$ \% $$ of the simulated cases for a commercial 3T MRI system with b-values ranging from 500 to 3000 s/mm 2 $$ {}^2 $$ and in-plane spatial resolutions ranging from 1.0 to 3.0mm 2 $$ {}^2 $$ . Image distortion was estimated by intravoxel signal variance between diffusion encoding directions near the phantom edges and was significantly lower with Pre-ENCODE than with MONO (10.1 % $$ \% $$ vs. 22.7 % $$ \% $$ , p = 6 - 5 $$ p={6}^{-5} $$ ) and comparable to ENCODE (10.1 % $$ \% $$ vs. 10.4 % $$ \% $$ , p = 0 . 12 $$ p=0.12 $$ ). In vivo measurements of apparent diffusion coefficients were similar in global brain pixels (0.37 [0.28,1.45] × 1 0 - 3 $$ \times 1{0}^{-3} $$ mm 2 $$ {}^2 $$ /s vs. 0.38 [0.28,1.45] × 1 0 - 3 $$ \times 1{0}^{-3} $$ mm 2 $$ {}^2 $$ /s, p = 0 . 25 $$ p=0.25 $$ ) and increased in edge brain pixels (0.80 [0.17,1.49] × 1 0 - 3 $$ \times 1{0}^{-3} $$ mm 2 $$ {}^2 $$ /s vs. 0.70 [0.18,1.48] × 1 0 - 3 $$ \times 1{0}^{-3} $$ mm 2 $$ {}^2 $$ /s, p = 0 . 02 $$ p=0.02 $$ ) for MONO compared to Pre-ENCODE. CONCLUSION: Pre-ENCODE mitigated eddy current-induced image distortions for diffusion imaging with a shorter TE min $$ {}_{\mathrm{min}} $$ than MONO and ENCODE.

SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device.

Cardiovascular magnetic resonance (CMR) is a proven imaging modality for informing diagnosis and prognosis, guiding therapeutic decisions, and risk stratifying surgical intervention. Patients with a cardiac implantable electronic device (CIED) would be expected to derive particular benefit from CMR given high prevalence of cardiomyopathy and arrhythmia. While several guidelines have been published over the last 16 years, it is important to recognize that both the CIED and CMR technologies, as well as our knowledge in MR safety, have evolved rapidly during that period. Given increasing utilization of CIED over the past decades, there is an unmet need to establish a consensus statement that integrates latest evidence concerning MR safety and CIED and CMR technologies. While experienced centers currently perform CMR in CIED patients, broad availability of CMR in this population is lacking, partially due to limited availability of resources for programming devices and appropriate monitoring, but also related to knowledge gaps regarding the risk-benefit ratio of CMR in this growing population. To address the knowledge gaps, this SCMR Expert Consensus Statement integrates consensus guidelines, primary data, and opinions from experts across disparate fields towards the shared goal of informing evidenced-based decision-making regarding the risk-benefit ratio of CMR for patients with CIEDs.

Accelerated two-dimensional phase-contrast for cardiovascular MRI using deep learning-based reconstruction with complex difference estimation.

PURPOSE: To develop and validate a deep learning-based reconstruction framework for highly accelerated two-dimensional (2D) phase contrast (PC-MRI) data with accurate and precise quantitative measurements. METHODS: We propose a modified DL-ESPIRiT reconstruction framework for 2D PC-MRI, comprised of an unrolled neural network architecture with a Complex Difference estimation (CD-DL). CD-DL was trained on 155 fully sampled 2D PC-MRI pediatric clinical datasets. The fully sampled data ( n = 29 $$ n=29 $$ ) was retrospectively undersampled (6-11 × $$ \times $$ ) and reconstructed using CD-DL and a parallel imaging and compressed sensing method (PICS). Measurements of peak velocity and total flow were compared to determine the highest acceleration rate that provided accuracy and precision within ± 5 % $$ \pm 5\% $$ . Feasibility of CD-DL was demonstrated on prospectively undersampled datasets acquired in pediatric clinical patients ( n = 5 $$ n=5 $$ ) and compared to traditional parallel imaging (PI) and PICS. RESULTS: The retrospective evaluation showed that 9 × $$ \times $$ accelerated 2D PC-MRI images reconstructed with CD-DL provided accuracy and precision (bias, [95 % $$ \% $$ confidence intervals]) within ± 5 % $$ \pm 5\% $$ . CD-DL showed higher accuracy and precision compared to PICS for measurements of peak velocity (2.8 % $$ \% $$ [ - 2 . 9 $$ -2.9 $$ , 4.5] vs. 3.9 % $$ \% $$ [ - 11 . 0 $$ -11.0 $$ , 4.9]) and total flow (1.8 % $$ \% $$ [ - 3 . 9 $$ -3.9 $$ , 3.4] vs. 2.9 % $$ \% $$ [ - 7 . 1 $$ -7.1 $$ , 6.9]). The prospective feasibility study showed that CD-DL provided higher accuracy and precision than PICS for measurements of peak velocity and total flow. CONCLUSION: In a retrospective evaluation, CD-DL produced quantitative measurements of 2D PC-MRI peak velocity and total flow with ≤ 5 % $$ \le 5\% $$ error in both accuracy and precision for up to 9 × $$ \times $$ acceleration. Clinical feasibility was demonstrated using a prospective clinical deployment of our 8 × $$ \times $$ undersampled acquisition and CD-DL reconstruction in a cohort of pediatric patients.

Multishot Diffusion-Weighted MRI of the Breasts in the Supine vs. Prone Position.

BACKGROUND: Diffusion-weighted imaging (DWI) may allow for breast cancer screening MRI without a contrast injection. Multishot methods improve prone DWI of the breasts but face different challenges in the supine position. PURPOSE: To establish a multishot DWI (msDWI) protocol for supine breast MRI and to evaluate the performance of supine vs. prone msDWI. STUDY TYPE: Prospective. POPULATION: Protocol optimization: 10 healthy women (ages 22-56), supine vs. prone: 24 healthy women (ages 22-62) and five women (ages 29-61) with breast tumors. FIELD STRENGTH/SEQUENCE: 3-T, protocol optimization msDWI: free-breathing (FB) 2-shots, FB 4-shots, respiratory-triggered (RT) 2-shots, RT 4-shots, supine vs. prone: RT 4-shot msDWI, T2-weighted fast-spin echo. ASSESSMENT: Protocol optimization and supine vs. prone: three observers performed an image quality assessment of sharpness, aliasing, distortion (vs. T2), perceived SNR, and overall image quality (scale of 1-5). Apparent diffusion coefficients (ADCs) in fibroglandular tissue (FGT) and breast tumors were measured. STATISTICAL TESTS: Effect of study variables on dichotomized ratings (4/5 vs. 1/2/3) and FGT ADCs were assessed with mixed-effects logistic regression. Interobserver agreement utilized Gwet's agreement coefficient (AC). Lesion ADCs were assessed by Bland-Altman analysis and concordance correlation (ρc ). P value <0.05 was considered statistically significant. RESULTS: Protocol optimization: 4-shots significantly improved sharpness and distortion; RT significantly improved sharpness, aliasing, perceived SNR, and overall image quality. FGT ADCs were not significantly different between shots (P = 0.812), FB vs. RT (P = 0.591), or side (P = 0.574). Supine vs. prone: supine images were rated significantly higher for sharpness, aliasing, and overall image quality. FGT ADCs were significantly higher supine; lesion ADCs were highly correlated (ρc  = 0.92). DATA CONCLUSION: Based on image quality, supine msDWI outperformed prone msDWI. Lesion ADCs were highly correlated between the two positions, while FGT ADCs were higher in the supine position. EVIDENCE LEVEL: 2. TECHNICAL EFFICACY: Stage 1.

Myocardial mesostructure and mesofunction.

The complex and highly organized structural arrangement of some five billion cardiomyocytes directs the coordinated electrical activity and mechanical contraction of the human heart. The characteristic transmural change in cardiomyocyte orientation underlies base-to-apex shortening, circumferential shortening, and left ventricular torsion during contraction. Individual cardiomyocytes shorten ∼15% and increase in diameter ∼8%. Remarkably, however, the left ventricular wall thickens by up to 30-40%. To accommodate this, the myocardium must undergo significant structural rearrangement during contraction. At the mesoscale, collections of cardiomyocytes are organized into sheetlets, and sheetlet shear is the fundamental mechanism of rearrangement that produces wall thickening. Herein, we review the histological and physiological studies of myocardial mesostructure that have established the sheetlet shear model of wall thickening. Recent developments in tissue clearing techniques allow for imaging of whole hearts at the cellular scale, whereas magnetic resonance imaging (MRI) and computed tomography (CT) can image the myocardium at the mesoscale (100 µm to 1 mm) to resolve cardiomyocyte orientation and organization. Through histology, cardiac diffusion tensor imaging (DTI), and other modalities, mesostructural sheetlets have been confirmed in both animal and human hearts. Recent in vivo cardiac DTI methods have measured reorientation of sheetlets during the cardiac cycle. We also examine the role of pathological cardiac remodeling on sheetlet organization and reorientation, and the impact this has on ventricular function and dysfunction. We also review the unresolved mesostructural questions and challenges that may direct future work in the field.

Validation of cardiac diffusion tensor imaging sequences: A multicentre test-retest phantom study.

Cardiac diffusion tensor imaging (DTI) is an emerging technique for the in vivo characterisation of myocardial microstructure, and there is a growing need for its validation and standardisation. We sought to establish the accuracy, precision, repeatability and reproducibility of state-of-the-art pulse sequences for cardiac DTI among 10 centres internationally. Phantoms comprising 0%-20% polyvinylpyrrolidone (PVP) were scanned with DTI using a product pulsed gradient spin echo (PGSE; N = 10 sites) sequence, and a custom motion-compensated spin echo (SE; N = 5) or stimulated echo acquisition mode (STEAM; N = 5) sequence suitable for cardiac DTI in vivo. A second identical scan was performed 1-9 days later, and the data were analysed centrally. The average mean diffusivities (MDs) in 0% PVP were (1.124, 1.130, 1.113) x 10-3  mm2 /s for PGSE, SE and STEAM, respectively, and accurate to within 1.5% of reference data from the literature. The coefficients of variation in MDs across sites were 2.6%, 3.1% and 2.1% for PGSE, SE and STEAM, respectively, and were similar to previous studies using only PGSE. Reproducibility in MD was excellent, with mean differences in PGSE, SE and STEAM of (0.3 ± 2.3, 0.24 ± 0.95, 0.52 ± 0.58) x 10-5  mm2 /s (mean ± 1.96 SD). We show that custom sequences for cardiac DTI provide accurate, precise, repeatable and reproducible measurements. Further work in anisotropic and/or deforming phantoms is warranted.

Reproducibility of global and segmental myocardial strain using cine DENSE at 3 T: a multicenter cardiovascular magnetic resonance study in healthy subjects and patients with heart disease.

BACKGROUND: While multiple cardiovascular magnetic resonance (CMR) methods provide excellent reproducibility of global circumferential and global longitudinal strain, achieving highly reproducible segmental strain is more challenging. Previous single-center studies have demonstrated excellent reproducibility of displacement encoding with stimulated echoes (DENSE) segmental circumferential strain. The present study evaluated the reproducibility of DENSE for measurement of whole-slice or global circumferential (Ecc), longitudinal (Ell) and radial (Err) strain, torsion, and segmental Ecc at multiple centers. METHODS: Six centers participated and a total of 81 subjects were studied, including 60 healthy subjects and 21 patients with various types of heart disease. CMR utilized 3 T scanners, and cine DENSE images were acquired in three short-axis planes and in the four-chamber long-axis view. During one imaging session, each subject underwent two separate DENSE scans to assess inter-scan reproducibility. Each subject was taken out of the scanner and repositioned between the scans. Intra-user, inter-user-same-site, inter-user-different-site, and inter-user-Human-Deep-Learning (DL) comparisons assessed the reproducibility of different users analyzing the same data. Inter-scan comparisons assessed the reproducibility of DENSE from scan to scan. The reproducibility of whole-slice or global Ecc, Ell and Err, torsion, and segmental Ecc were quantified using Bland-Altman analysis, the coefficient of variation (CV), and the intraclass correlation coefficient (ICC). CV was considered excellent for CV ≤ 10%, good for 10% < CV ≤ 20%, fair for 20% < CV ≤ 40%, and poor for CV > 40. ICC values were considered excellent for ICC > 0.74, good for ICC 0.6 < ICC ≤ 0.74, fair for ICC 0.4 < ICC ≤ 0.59, poor for ICC < 0.4. RESULTS: Based on CV and ICC, segmental Ecc provided excellent intra-user, inter-user-same-site, inter-user-different-site, inter-user-Human-DL reproducibility and good-excellent inter-scan reproducibility. Whole-slice Ecc and global Ell provided excellent intra-user, inter-user-same-site, inter-user-different-site, inter-user-Human-DL and inter-scan reproducibility. The reproducibility of torsion was good-excellent for all comparisons. For whole-slice Err, CV was in the fair-good range, and ICC was in the good-excellent range. CONCLUSIONS: Multicenter data show that 3 T CMR DENSE provides highly reproducible whole-slice and segmental Ecc, global Ell, and torsion measurements in healthy subjects and heart disease patients.

Myofiber strain in healthy humans using DENSE and cDTI.

PURPOSE: Myofiber strain, Eff , is a mechanistically relevant metric of cardiac cell shortening and is expected to be spatially uniform in healthy populations, making it a prime candidate for the evaluation of local cardiomyocyte contractility. In this study, a new, efficient pipeline was proposed to combine microstructural cDTI and functional DENSE data in order to estimate Eff in vivo. METHODS: Thirty healthy volunteers were scanned with three long-axis (LA) and three short-axis (SA) DENSE slices using 2D displacement encoding and one SA slice of cDTI. The total acquisition time was 11 minutes ± 3 minutes across volunteers. The pipeline first generates 3D SA displacements from all DENSE slices which are then combined with cDTI data to generate a cine of myofiber orientations and compute Eff . The precision of the post-processing pipeline was assessed using a computational phantom study. Transmural myofiber strain was compared to circumferential strain, Ecc , in healthy volunteers using a Wilcoxon sign rank test. RESULTS: In vivo, computed Eff was found uniform transmurally compared to Ecc (-0.14[-0.15, -0.12] vs -0.18 [-0.20, -0.16], P < .001, -0.14 [-0.16, -0.12] vs -0.16 [-0.17, -0.13], P < .001 and -0.14 [-0.16, -0.12] vs Ecc_C = -0.14 [-0.15, -0.11], P = .002, Eff_C vs Ecc_C in the endo, mid, and epi layers, respectively). CONCLUSION: We demonstrate that it is possible to measure in vivo myofiber strain in a healthy human population in 10 minutes per subject. Myofiber strain was observed to be spatially uniform in healthy volunteers making it a potential biomarker for the evaluation of local cardiomyocyte contractility in assessing cardiovascular dysfunction.

Right Ventricular Function and T1-Mapping in Boys With Duchenne Muscular Dystrophy.

BACKGROUND: Clinical management of boys with Duchenne muscular dystrophy (DMD) relies on in-depth understanding of cardiac involvement, but right ventricular (RV) structural and functional remodeling remains understudied. PURPOSE: To evaluate several analysis methods and identify the most reliable one to measure RV pre- and postcontrast T1 (RV-T1) and to characterize myocardial remodeling in the RV of boys with DMD. STUDY TYPE: Prospective. POPULATION: Boys with DMD (N = 27) and age-/sex-matched healthy controls (N = 17) from two sites. FIELD STRENGTH/SEQUENCE: 3.0 T using balanced steady state free precession, motion-corrected phase sensitive inversion recovery and modified Look-Locker inversion recovery sequences. ASSESSMENT: Biventricular mass (Mi), end-diastolic volume (EDVi) and ejection fraction (EF) assessment, tricuspid annular excursion (TAE), late gadolinium enhancement (LGE), pre- and postcontrast myocardial T1 maps. The RV-T1 reliability was assessed by three observers in four different RV regions of interest (ROI) using intraclass correlation (ICC). STATISTICAL TESTS: The Wilcoxon rank sum test was used to compare RV-T1 differences between DMD boys with negative LGE(-) or positive LGE(+) and healthy controls. Additionally, correlation of precontrast RV-T1 with functional measures was performed. A P-value <0.05 was considered statistically significant. RESULTS: A 1-pixel thick RV circumferential ROI proved most reliable (ICC > 0.91) for assessing RV-T1. Precontrast RV-T1 was significantly higher in boys with DMD compared to controls. Both LGE(-) and LGE(+) boys had significantly elevated precontrast RV-T1 compared to controls (1543 [1489-1597] msec and 1550 [1402-1699] msec vs. 1436 [1399-1473] msec, respectively). Compared to healthy controls, boys with DMD had preserved RVEF (51.8 [9.9]% vs. 54.2 [7.2]%, P = 0.31) and significantly reduced RVMi (29.8 [9.7] g vs. 48.0 [15.7] g), RVEDVi (69.8 [29.7] mL/m2 vs. 89.1 [21.9] mL/m2 ), and TAE (22.0 [3.2] cm vs. 26.0 [4.7] cm). Significant correlations were found between precontrast RV-T1 and RVEF (ß = -0.48%/msec) and between LV-T1 and LVEF (ß = -0.51%/msec). DATA CONCLUSION: Precontrast RV-T1 is elevated in boys with DMD compared to healthy controls and is negatively correlated with RVEF. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 2.

Fully-automated global and segmental strain analysis of DENSE cardiovascular magnetic resonance using deep learning for segmentation and phase unwrapping.

BACKGROUND: Cardiovascular magnetic resonance (CMR) cine displacement encoding with stimulated echoes (DENSE) measures heart motion by encoding myocardial displacement into the signal phase, facilitating high accuracy and reproducibility of global and segmental myocardial strain and providing benefits in clinical performance. While conventional methods for strain analysis of DENSE images are faster than those for myocardial tagging, they still require manual user assistance. The present study developed and evaluated deep learning methods for fully-automatic DENSE strain analysis. METHODS: Convolutional neural networks (CNNs) were developed and trained to (a) identify the left-ventricular (LV) epicardial and endocardial borders, (b) identify the anterior right-ventricular (RV)-LV insertion point, and (c) perform phase unwrapping. Subsequent conventional automatic steps were employed to compute strain. The networks were trained using 12,415 short-axis DENSE images from 45 healthy subjects and 19 heart disease patients and were tested using 10,510 images from 25 healthy subjects and 19 patients. Each individual CNN was evaluated, and the end-to-end fully-automatic deep learning pipeline was compared to conventional user-assisted DENSE analysis using linear correlation and Bland Altman analysis of circumferential strain. RESULTS: LV myocardial segmentation U-Nets achieved a DICE similarity coefficient of 0.87 ± 0.04, a Hausdorff distance of 2.7 ± 1.0 pixels, and a mean surface distance of 0.41 ± 0.29 pixels in comparison with manual LV myocardial segmentation by an expert. The anterior RV-LV insertion point was detected within 1.38 ± 0.9 pixels compared to manually annotated data. The phase-unwrapping U-Net had similar or lower mean squared error vs. ground-truth data compared to the conventional path-following method for images with typical signal-to-noise ratio (SNR) or low SNR (p < 0.05), respectively. Bland-Altman analyses showed biases of 0.00 ± 0.03 and limits of agreement of - 0.04 to 0.05 or better for deep learning-based fully-automatic global and segmental end-systolic circumferential strain vs. conventional user-assisted methods. CONCLUSIONS: Deep learning enables fully-automatic global and segmental circumferential strain analysis of DENSE CMR providing excellent agreement with conventional user-assisted methods. Deep learning-based automatic strain analysis may facilitate greater clinical use of DENSE for the quantification of global and segmental strain in patients with cardiac disease.

A gradient optimization toolbox for general purpose time-optimal MRI gradient waveform design.

PURPOSE: To introduce and demonstrate a software library for time-optimal gradient waveform optimization with a wide range of applications. The software enables direct on-the-fly gradient waveform design on the scanner hardware for multiple vendors. METHODS: The open-source gradient optimization (GrOpt) toolbox was implemented in C with both Matlab and Python wrappers. The toolbox enables gradient waveforms to be generated based on a set of constraints that define the features and encodings for a given acquisition. The GrOpt optimization routine is based on the alternating direction method of multipliers (ADMM). Additional constraints enable error corrections to be added, or patient comfort and safety to be adressed. A range of applications and compute speed metrics are analyzed. Finally, the method is implemented and tested on scanners from different vendors. RESULTS: Time-optimal gradient waveforms for different pulse sequences and the constraints that define them are shown. Additionally, the ability to add, arbitrary motion (gradient moment) compensation or limit peripheral nerve stimulation is demonstrated. There exists a trade-off between computation time and gradient raster time, but it was observed that acceptable gradient waveforms could be generated in 1-40 ms. Gradient waveforms generated and run on the different scanners were functionally equivalent, and the images were comparable. CONCLUSIONS: GrOpt is an open source toolbox that enables on-the-fly optimization of gradient waveform design, subject to a set of defined constraints. GrOpt was presented for a range of imaging applications, analyzed in terms of computational complexity, and implemented to run on the scanner for a multi-vendor demonstration.

Optimization methods for magnetic resonance imaging gradient waveform design.

The development and implementation of novel MRI pulse sequences remains challenging and laborious. Gradient waveforms are typically designed using a combination of analytical and ad hoc methods to construct each gradient waveform axis independently. This strategy makes coding the pulse sequence complicated, in addition to being time inefficient. As a consequence, nearly all commercial MRI pulse sequences fail to maximize use of the available gradient hardware or efficiently mitigate physiological effects. This results in expensive MRI systems that underperform relative to their inherent hardware capabilities. To address this problem, a software solution is proposed that incorporates numerical optimization methods into MRI pulse sequence programming. Examples are shown for rotational variant vs. invariant waveform designs, acceleration nulled velocity encoding gradients, and mitigation of peripheral nerve stimulation for diffusion encoding. The application of optimization methods to MRI pulse sequence design incorporates gradient hardware limits and the prescribed MRI protocol parameters (e.g. field-of-view, resolution, gradient moments, and/or b-value) to simultaneously construct time-optimal gradient waveforms. In many cases, the resulting constrained gradient waveform design problem is convex and can be solved on-the-fly on the MRI scanner. The result is a set of multi-axis time-optimal gradient waveforms that satisfy the design constraints, thereby increasing SNR-efficiency. These optimization methods can also be used to mitigate imaging artifacts (e.g. eddy currents) or account for peripheral nerve stimulation. The result of the optimization method is to enable easier pulse sequence gradient waveform design and permit on-the-fly implementation for a range of MRI pulse sequences.

Evaluation of a Workflow to Define Low Specific Absorption Rate MRI Protocols for Patients With Active Implantable Medical Devices.

BACKGROUND: MRI exams for patients with MR-conditional active implantable medical devices (AIMDs) are contraindicated unless specific conditions are met. This limits the maximum specific absorption rate (SAR, W/kg). Currently, there is no general framework to guide meeting a lower SAR limit. PURPOSE: To design and evaluate a workflow for modifying MRI protocols to whole-body SAR (WB-SAR ≤0.1 W/kg) and local-head SAR (LH-SAR ≤0.3 W/kg) limits while mitigating the impact on image quality and exam time. STUDY TYPE: Prospective. POPULATION: Twenty healthy volunteers on head (n = 5), C-spine (n = 5), T-spine (n = 5), and L-spine (n = 5) with IRB consent. ASSESSMENT: Vendor-provided head, C-spine, T-spine, and L-spine protocols (SARRT ) were modified to meet both low SAR targets (SARLOW ) using the proposed workflow. in vitro SNR and CNR were evaluated with a T1 -T2 phantom. in vivo image quality and clinical acceptability were scored using a 5-point Likert scale for two blinded readers. FIELD STRENGTH/SEQUENCES: 1.5T/spin-echoes, gradient-echoes. STATISTICAL ANALYSIS: In vitro SNR and CNR values were evaluated with a repeated measures general linear model. in vivo image quality and clinical acceptability were evaluated using a generalized estimating equation analysis (GEE). The two reader's level of agreement was analyzed using Cohen's kappa statistical analysis. RESULTS: Using the workflow, SAR limits were met. LH-SAR: 0.12 ± 0.02 W/kg, median (SD) values for LH-SAR were 0.12 (0.02) W/kg and WB-SAR: 0.09 (0.01) W/kg. Examination time did not increase ≤2x the initial time. SARRT SNR values were higher and significantly different than SARLOW (P < 0.05). However, no significant difference was observed between the CNR values (value = 0.21). Median (IQR) CNR values were 14.2 (25.0) vs. 15.1 (9.2) for head, 12.1 (16.9) vs. 25.3 (14.2) for C-spine, 81.6 (70.1) vs. 71.0 (26.6) for T-spine, and 51.4 (52.6) vs. 37.7 (27.3) for L-spine. Image quality scores were not significantly different between SARRT and SARLOW (median [SD] scores were 4.0 [0.01] vs. 4.3 [0.2], P > 0.05). DATA CONCLUSION: The proposed workflow provides guidance for modifying routine MRI exams to achieve low SAR limits. This can benefit patients referred for an MRI exam with low SAR MR-conditional AIMDs. LEVEL OF EVIDENCE: 1 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;52:91-102.

Prostate diffusion MRI with minimal echo time using eddy current nulled convex optimized diffusion encoding.

BACKGROUND: Prostate diffusion-weighted imaging (DWI) using monopolar encoding is sensitive to eddy-current-induced distortion artifacts. Twice-refocused bipolar encoding suppresses eddy current artifacts, but increases echo time (TE), leading to lower signal-to-noise ratio (SNR). Optimization of the diffusion encoding might improve prostate DWI. PURPOSE: To evaluate eddy current nulled convex optimized diffusion encoding (ENCODE) for prostate DWI with minimal TE. STUDY TYPE: Prospective cohort study. POPULATION: A diffusion phantom, an ex vivo prostate specimen, 10 healthy male subjects (27 ± 3 years old), and five prostate cancer patients (62 ± 7 years old). FIELD STRENGTH/SEQUENCE: 3T; single-shot spin-echo echoplanar DWI. ASSESSMENT: Eddy-current artifacts, TE, SNR, apparent diffusion coefficient (ADC), and image quality scores from three independent readers were compared between monopolar, bipolar, and ENCODE prostate DWI for standard-resolution (1.6 × 1.6 mm2 , partial Fourier factor [pF] = 6/8) and higher-resolution protocols (1.6 × 1.6 mm2 , pF = off; 1.0 × 1.0 mm2 , pF = 6/8). STATISTICAL TESTING: SNR and ADC differences between techniques were tested with Kruskal-Wallis and Wilcoxon signed-rank tests (P < 0.05 considered significant). RESULTS: Eddy current suppression with ENCODE was comparable to bipolar encoding (mean coefficient of variation across three diffusion directions of 9.4% and 9%). For a standard-resolution protocol, ENCODE achieved similar TE as monopolar and reduced TE by 14 msec compared to bipolar, resulting in 27% and 29% higher mean SNR in prostate transition zone (TZ) and peripheral zone (PZ) (P < 0.05) compared to bipolar, respectively. For higher-resolution protocols, ENCODE achieved the shortest TE (67 msec), with 17-21% and 58-70% higher mean SNR compared to monopolar (TE = 77 msec) and bipolar (TE = 102 msec) in PZ and TZ (P < 0.05). No significant differences were found in mean TZ (P = 0.91) and PZ ADC (P = 0.94) between the three techniques. ENCODE achieved similar or higher image quality scores than bipolar DWI in patients, with mean intraclass correlation coefficient of 0.77 for overall quality between three independent readers. DATA CONCLUSION: ENCODE minimizes TE (improves SNR) and reduces eddy-current distortion for prostate DWI compared to monopolar and bipolar encoding. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2020;51:1526-1539.

Motion-Induced Signal Loss in In Vivo Cardiac Diffusion-Weighted Imaging.

LEVEL OF EVIDENCE: 5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:319-320.

4D Flow MR Imaging to Improve Microwave Ablation Prediction Models: A Feasibility Study in an In Vivo Porcine Liver.

PURPOSE: To characterize the effect of hepatic vessel flow using 4-dimensional (4D) flow magnetic resonance (MR) imaging and correlate their effect on microwave ablation volumes in an in vivo non-cirrhotic porcine liver model. MATERIALS AND METHODS: Microwave ablation antennas were placed under ultrasound guidance in each liver lobe of swine (n = 3 in each animal) for a total of 9 ablations. Pre- and post-ablation 4D flow MR imaging was acquired to quantify flow changes in the hepatic vasculature. Flow measurements, along with encompassed vessel size and vessel-antenna spacing, were then correlated with final ablation volume from segmented MR images. RESULTS: The linear regression model demonstrated that the preablation measurement of encompassed hepatic vein size (ß = -0.80 ± 0.25, 95% confidence interval [CI] -1.15 to -0.22; P = .02) was significantly correlated to final ablation zone volume. The addition of hepatic vein flow rate found via 4D flow MRI (ß = -0.83 ± 0.65, 95% CI -2.50 to 0.84; P = .26), and distance from antenna to hepatic vein (ß = 0.26 ± 0.26, 95% CI -0.40 to 0.92; P = .36) improved the model accuracy but not significantly so (multivariate adjusted R2 = 0.70 vs univariate (vessel size) adjusted R2 = 0.63, P = .24). CONCLUSIONS: Hepatic vein size in an encompassed ablation zone was found to be significantly correlated with final ablation zone volume. Although the univariate 4D flow MR imaging-acquired measurements alone were not found to be statistically significant, its addition to hepatic vein size improved the accuracy of the ablation volume regression model. Pre-ablation 4D flow MR imaging of the liver may assist in prospectively optimizing thermal ablation treatment.

T1-Mapping and extracellular volume estimates in pediatric subjects with Duchenne muscular dystrophy and healthy controls at 3T.

BACKGROUND: Cardiovascular disease is the leading cause of death in patients with Duchenne muscular dystrophy (DMD)-a fatal X-linked genetic disorder. Late gadolinium enhancement (LGE) imaging is the current gold standard for detecting myocardial tissue remodeling, but it is often a late finding. Current research aims to investigate cardiovascular magnetic resonance (CMR) biomarkers, including native (pre-contrast) T1 and extracellular volume (ECV) to evaluate the early on-set of microstructural remodeling and to grade disease severity. To date, native T1 measurements in DMD have been reported predominantly at 1.5T. This study uses 3T CMR: (1) to characterize global and regional myocardial pre-contrast T1 differences between healthy controls and LGE + and LGE- boys with DMD; and (2) to report global and regional myocardial post-contrast T1 values and myocardial ECV estimates in boys with DMD, and (3) to identify left ventricular (LV) T1-mapping biomarkers capable of distinguishing between healthy controls and boys with DMD and detecting LGE status in DMD. METHODS: Boys with DMD (N = 28, 13.2 ± 3.1 years) and healthy age-matched boys (N = 20, 13.4 ± 3.1 years) were prospectively enrolled and underwent a 3T CMR exam including standard functional imaging and T1 mapping using a modified Look-Locker inversion recovery (MOLLI) sequence. Pre-contrast T1 mapping was performed on all boys, but contrast was administered only to boys with DMD for post-contrast T1 and ECV mapping. Global and segmental myocardial regions of interest were contoured on mid LV T1 and ECV maps. ROI measurements were compared for pre-contrast myocardial T1 between boys with DMD and healthy controls, and for post-contrast myocardial T1 and ECV between LGE + and LGE- boys with DMD using a Wilcoxon rank-sum test. Results are reported as median and interquartile range (IQR). p-Values < 0.05 were considered significant. Receiver Operating Characteristic analysis was used to evaluate a binomial logistic classifier incorporating T1 mapping and LV function parameters in the tasks of distinguishing between healthy controls and boys with DMD, and detecting LGE status in DMD. The area under the curve is reported. RESULTS: Boys with DMD had significantly increased global native T1 [1332 (60) ms vs. 1289 (56) ms; p = 0.004] and increased within-slice standard deviation (SD) [100 (57) ms vs. 74 (27) ms; p = 0.001] compared to healthy controls. LGE- boys with DMD also demonstrated significantly increased lateral wall native T1 [1322 (68) ms vs. 1277 (58) ms; p = 0.001] compared to healthy controls. LGE + boys with DMD had decreased global myocardial post-contrast T1 [565 (113) ms vs 635 (126) ms; p = 0.04] and increased global myocardial ECV [32 (8) % vs. 28 (4) %; p = 0.02] compared to LGE- boys. In all classification tasks, T1-mapping biomarkers outperformed a conventional biomarker, LV ejection fraction. ECV was the best performing biomarker in the task of predicting LGE status (AUC = 0.95). CONCLUSIONS: Boys with DMD exhibit elevated native T1 compared to healthy, sex- and age-matched controls, even in the absence of LGE. Post-contrast T1 and ECV estimates from 3T CMR are also reported here for pediatric patients with DMD for the first time and can distinguish between LGE + from LGE- boys. In all classification tasks, T1-mapping biomarkers outperform a conventional biomarker, LVEF.

It's the little things: On the complexity of planar electrode heating in MRI.

Neurological disorders are increasingly analysed and treated with implantable electrodes, and patients with such electrodes are studied with MRI despite the risk of radio-frequency (RF) induced heating during the MRI exam. Recent clinical research suggests that electrodes with smaller diameters of the electrical interface between implant and tissue are beneficial; however, the influence of this electrode contact diameter on RF-induced heating has not been investigated. In this work, electrode contact diameters between 0.3 and 4 mm of implantable electrodes appropriate for stimulation and electrocorticography were evaluated in a 1.5 T MRI system. In situ temperature measurements adapted from the ASTM standard test method were performed and complemented by simulations of the specific absorption rate (SAR) to assess local SAR values, temperature increase and the distribution of dissipated power. Measurements showed temperature changes between 0.8 K and 53 K for different electrode contact diameters, which is well above the legal limit of 1 K. Systematic errors in the temperature measurements are to be expected, as the temperature sensors may disturb the heating pattern near small electrodes. Compared to large electrodes, simulations suggest that small electrodes are subject to less dissipated power, but more localized power density. Thus, smaller electrodes might be classified as safe in current certification procedures but may be more likely to burn adjacent tissue. To assess these local heating phenomena, smaller temperature sensors or new non-invasive temperature sensing methods are needed.

Effect of flow-encoding strength on intravoxel incoherent motion in the liver.

PURPOSE: To study the impact of variable flow-encoding strength on intravoxel incoherent motion (IVIM) liver imaging of diffusion and perfusion. THEORY: Signal attenuation in DWI arises from (1) intravoxel microvascular blood flow, which depends on the flow-encoding strength α (first gradient moment) of the diffusion-encoding waveform, and (2) intravoxel spin diffusion, which depends on the b-value of the diffusion-encoding gradient waveforms α and b-value. Both are linked to the diffusion-encoding gradient waveform and conventionally are not independently controlled. METHODS: In this work a convex optimization framework was used to generate gradient waveforms with independent α and b-value. Thirty-six unique α and b-value sample points from 5 different gradient waveforms were used to reconstruct perfusion fraction (f), coefficient of diffusion (D), and blood velocity standard deviation (Vb ) maps using a recently proposed IVIM model. Faster acquisition strategies were evaluated with 1000 random subsampling strategies of 16, 8, and 4 α and b-value. Among the subsampled reconstructions, the sampling schemes that minimized the difference with the fully sampled reconstruction were reported. RESULTS: Healthy volunteers (N = 9) were imaged on a 3T scanner. Liver perfusion and diffusion estimates using the fully sampled IVIM method were f = 0.19 ± 0.06, D = 1.15 ± 0.15 × 10-3 mm2 /s, and Vb = 5.22 ± 3.86 mm/s. No statistical differences were found between the fully sampled and 2-times undersampled reconstruction (f = 0.2 ± 0.07, D = 1.19 ± 0.15 × 10-3 mm2 /s, Vb = 5.79 ± 3.43 mm/s); 4-times undersampled (f = 0.2 ± 0.06, D = 1.15 ± 0.17 × 10-3 mm2 /s, Vb = 4.66 ± 3.61 mm/s), or 8-times undersampled ( f = 0.2 ± 0.06, D = 1.23 ± 0.22 × 10-3 mm2 /s, Vb = 4.99 ± 3.82 mm/s) approaches. CONCLUSION: We demonstrate the IVIM signal's dependence on the b-value, the diffusion-encoding time and the flow-encoding strength and observe in vivo the ballistic regime signature of microperfusion in the liver. This work also demonstrates that using an IVIM model and sampling scheme matched to the ballistic regime, pixel-wise IVIM parameter maps are possible when sampling as few as 4 IVIM signals.

Time-optimized 4D phase contrast MRI with real-time convex optimization of gradient waveforms and fast excitation methods.

PURPOSE: To shorten 4D flow acquisitions by shortening TRs with fast RF pulses and gradient waveforms. Real-time convex optimization is used to generate these gradients waveforms on the scanner. THEORY AND METHODS: RF and slab-select waveforms were shortened with a minimum phase SLR excitation and the time-optimal variable-rate selective excitation method. Real-time convex optimization was used to shorten bipolar and spoiler gradients by finding the shortest gradient waveforms that satisfied constraints on scan parameters, gradient hardware, M0 , M1 , and peripheral nerve stimulation. Waveforms were calculated and TE and/or TR values were compared for a range of scan parameters and compared to a conventional 4D flow sequence. The method was tested in flow phantoms, and in the aorta and neurovasculature of volunteers (N = 10). Additionally, eddy current error was measured in a large phantom. RESULTS: TEs and TRs were shortened by 21-32% and 20-34%, respectively, compared to the conventional sequence over a range of scan parameters. Bland-Altman analysis of 2 flow phantom configurations showed flow rate bias of 0.3 mL/s and limits of agreement (LOA) of [-6.9, 7.5] mL/s for a cardiac phantom and a bias of -0.1 mL/s with LOA = [-0.4, 0.2] mL/s for a neuro phantom. Similar agreement was also seen for flow measurements in volunteers (bias = -1.0 and -0.1 mL/s, LOA = [-34.9, 33.0] and [-0.7, 0.6] mL/s). Measured eddy currents were 39% larger with the CVX + mpVERSE method. CONCLUSION: The real-time optimized 4D flow gradients and fast slab-selection excitation methods produced up to 34% faster TRs with excellent flow measurement agreement compared to a conventional 4D flow sequence.