Quantitative Susceptibility Mapping for Characterization of Intraplaque Hemorrhage and Calcification in Carotid Atherosclerotic Disease.

BACKGROUND: Carotid artery intraplaque hemorrhage (IPH), an unstable component of atherosclerosis, is associated with an increased risk of stroke. PURPOSE: To investigate quantitative susceptibility mapping (QSM) as a tool for the evaluation of IPH and calcification in vivo. STUDY TYPE: Prospective. POPULATION: Ten healthy volunteers and 15 patients. FIELD STRENGTH/SEQUENCE: 3.0T Susceptibility-weighted imaging (SWI), magnetization-prepared rapid acquisition with gradient echo (MP-RAGE), T1 -weighted sampling perfection with application of optimized contrasts using different flip angle evolution (T1 -SPACE), T2 -weighted turbo spin-echo (T2 WI), and time-of-flight (TOF) sequences. ASSESSMENT: The vessel wall area of the carotid artery was measured with QSM and compared with T1 -SPACE on healthy volunteers. Four radiologists, blinded to clinical history and patient identity, determined the presence and area of IPH on MP-RAGE and QSM, as well as the area of calcification on T1 -SPACE and QSM. STATISTICAL TESTS: Bland-Altman analysis, Pearson correlation coefficients, linear regression analyses were performed to evaluate the concordance of area measurements. Cohen's kappa (κ) was analyzed to determine the agreement between IPH detections. The paired t-test was used to compare the group differences. RESULTS: In 423 matched slices, 20.1% (85/423) and 19.6% (83/423) were detected to have IPH on MP-RAGE and QSM, respectively. IPH detection by QSM and MP-RAGE showed good agreement (κ = 0.822, P < 0.001) between the two methods. There was no significant difference in IPH area measurements between QSM and MP-RAGE (7.28 mm2 ± 6.41 vs. 7.16 mm2 ± 5.99, P = 0.575). There was no significant difference in calcification area measurement between QSM and T1 -SPACE (3.51 mm2 ± 1.78 vs. 3.41 mm2 ± 2.02, P = 0.783). DATA CONCLUSION: QSM is a novel imaging tool for the identification of IPH in patients with carotid atherosclerosis and enables differentiation of IPH and calcification. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 1 J. Magn. Reson. Imaging 2020;52:534-541.

Quantifying iron content in magnetic resonance imaging.

Measuring iron content has practical clinical indications in the study of diseases such as Parkinson's disease, Huntington's disease, ferritinopathies and multiple sclerosis as well as in the quantification of iron content in microbleeds and oxygen saturation in veins. In this work, we review the basic concepts behind imaging iron using T2, T2*, T2', phase and quantitative susceptibility mapping in the human brain, liver and heart, followed by the applications of in vivo iron quantification in neurodegenerative diseases, iron tagged cells and ultra-small superparamagnetic iron oxide (USPIO) nanoparticles.

Cerebral microbleed detection using Susceptibility Weighted Imaging and deep learning.

Detecting cerebral microbleeds (CMBs) is important in diagnosing a variety of diseases including dementia, stroke and traumatic brain injury. However, manual detection of CMBs can be time-consuming and prone to errors, whereas the current automatic algorithms for CMB detection are usually limited by large number of false positives. In this study, we present a two-stage CMB detection framework which contains a candidate detection stage based on a 3D fast radial symmetry transform of the composite images from Susceptibility Weighted Imaging (SWI), and a false positive reduction stage based on deep residual neural networks using both the SWI and the high-pass filtered phase images. While the SWI images provide exquisite sensitivity to the presence of blood products, the high-pass filtered phase images enable the differentiation of diamagnetic calcifications from paramagnetic microbleeds. The deep learning model was trained using 154 data sets, and the best models were selected using 25 validation data sets. Finally, the models were tested using 41 cases, including 13 hemodialysis cases, 9 traumatic brain injury cases, 9 stroke cases and 10 healthy controls. Using 3D SWI and high-pass filtered phase images as input, the best model led to a sensitivity of 95.8%, a precision of 70.9%, and 1.6 false positives per case. This model achieved similar performance to the most experienced human rater and outperformed recently reported CMB detection methods. This study demonstrates the potential of applying deep learning techniques to medical imaging for improving efficiency and accuracy in diagnosis.

Increased iron deposition of deep cerebral gray matter structures in hemodialysis patients: A longitudinal study using quantitative susceptibility mapping.

BACKGROUND: The cerebral iron overload in hemodialysis patients has been reported in a previous study, in which the evaluation of the changes in iron content could be affected by the cross-sectional analysis. PURPOSE: To investigate the longitudinal changes of iron deposition in hemodialysis patients using quantitative susceptibility mapping (QSM) and correlate these findings with the longitudinal changes of neurocognitive function and clinical factors. STUDY TYPE: Prospective; longitudinal. POPULATION: In all, 34 patients and 30 healthy controls (HCs); the mean follow-up interval was 22 ± 7 months. FIELD STRENGTH/SEQUENCE: 3.0T, susceptibility-weighted imaging (SWI). ASSESSMENT: QSM reconstructed from original phase data of SWI was used to measure the susceptibility of gray matter structures including bilateral caudate nucleus (CN), globus pallidus (GP), putmen (PUT), red nucleus (RN), substantia nigra (SN), dentate nucleus (DN), thalamus (THA), pulvinar of thalamus (PT). The Mini-Mental State Examination (MMSE) test and clinical factors were recorded. STATISTICAL TESTING: Analysis of covariance adjusting for age and gender as covariates or a paired t-test for the differences in susceptibility, MMSE scores, and clinical factors among baseline, follow-up patients, and HCs. Correlation and stepwise regression analysis for the relationship between susceptibility, MMSE scores, and clinical factors. RESULTS: The susceptibility of bilateral CN, GP, PUT, RN, SN, DN, THA, PT in follow-up patients was significantly higher than that in baseline between patients and HCs except for left THA (all P < 0.05; Bonferroni corrected). MMSE scores significantly negatively correlated with the susceptibility of bilateral CN, PUT, and RRN in the baseline examination and bilateral CN, PUT, RN, and DN in the follow-up examination (all P < 0.05; false discovery rate [FDR] corrected). The follow-up interval, creatinine, phosphorus, and calcium were independent factors for the increased susceptibility of some nuclei (all P < 0.05). DATA CONCLUSION: The iron deposition of gray matter nuclei in hemodialysis patients increased over roughly a 2-year period and may be a risk factor for neurocognitive impairment. Creatinine and abnormal calcium-phosphorus metabolism were independent risk factors for abnormal iron deposition. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:786-799.

Susceptibility weighted imaging and quantitative susceptibility mapping of the cerebral vasculature using ferumoxytol.

PURPOSE: To demonstrate the potential of imaging cerebral arteries and veins with ferumoxytol using susceptibility weighted imaging (SWI) and quantitative susceptibility mapping (QSM). MATERIALS AND METHODS: The relationships between ferumoxytol concentration and the apparent susceptibility at 1.5T, 3T, and 7T were determined using phantom data; the ability of visualizing subvoxel vessels was evaluated using simulations; and the feasibility of using ferumoxytol to enhance the visibility of small vessels was confirmed in three healthy volunteers at 7T(with doses 1 mg/kg to 4 mg/kg). The visualization of the lenticulostriate arteries and the medullary veins was assessed by two raters and the contrast-to-noise ratios (CNRs) of these vessels were measured. RESULTS: The relationship between ferumoxytol concentration and susceptibility was linear with a slope 13.3 ± 0.2 ppm·mg-1 ·mL at 7T. Simulations showed that SWI data with an increased dose of ferumoxytol, higher echo time (TE), and higher imaging resolution improved the detection of smaller vessels. With 4 mg/kg ferumoxytol, voxel aspect ratio = 1:8, TE = 10 ms, the diameter of the smallest detectable artery was approximately 50µm. The rating score for arteries was improved from 1.5 ± 0.5 (precontrast) to 3.0 ± 0.0 (post-4 mg/kg) in the in vivo data and the apparent susceptibilities of the arteries (0.65 ± 0.02 ppm at 4 mg/kg) agreed well with the expected susceptibility (0.71 ± 0.05 ppm). CONCLUSION: The CNR for cerebral vessels with ferumoxytol can be enhanced using SWI, and the apparent susceptibilities of the arteries can be reliably quantified using QSM. This approach improves the imaging of the entire vascular system outside the capillaries and may be valuable for a variety of neurodegenerative diseases which involve the microvasculature. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:621-633.

Reduced deep regional cerebral venous oxygen saturation in hemodialysis patients using quantitative susceptibility mapping.

Cerebral venous oxygen saturation (SvO2) is an important indicator of brain function. There was debate about lower cerebral oxygen metabolism in hemodialysis patients and there were no reports about the changes of deep regional cerebral SvO2 in hemodialysis patients. In this study, we aim to explore the deep regional cerebral SvO2 from straight sinus using quantitative susceptibility mapping (QSM) and the correlation with clinical risk factors and neuropsychiatric testing. 52 hemodialysis patients and 54 age-and gender-matched healthy controls were enrolled. QSM reconstructed from original phase data of 3.0 T susceptibility-weighted imaging was used to measure the susceptibility of straight sinus. The susceptibility was used to calculate the deep regional cerebral SvO2 and compare with healthy individuals. Correlation analysis was performed to investigate the correlation between deep regional cerebral SvO2, clinical risk factors and neuropsychiatric testing. The deep regional cerebral SvO2 of hemodialysis patients (72.5 ± 3.7%) was significantly lower than healthy controls (76.0 ± 2.1%) (P < 0.001). There was no significant difference in the measured volume of interests of straight sinus between hemodialysis patients (250.92 ± 46.65) and healthy controls (249.68 ± 49.68) (P = 0.859). There were no significant correlations between the measured susceptibility and volume of interests in hemodialysis patients (P = 0.204) and healthy controls (P = 0.562), respectively. Hematocrit (r = 0.480, P < 0.001, FDR corrected), hemoglobin (r = 0.440, P < 0.001, FDR corrected), red blood cell (r = 0.446, P = 0.003, FDR corrected), dialysis duration (r = 0.505, P = 0.002, FDR corrected) and parathyroid hormone (r = -0.451, P = 0.007, FDR corrected) were risk factors for decreased deep regional cerebral SvO2 in patients. The Mini-Mental State Examination (MMSE) scores of hemodialysis patients were significantly lower than healthy controls (P < 0.001). However, the deep regional cerebral SvO2 did not correlate with MMSE scores (P = 0.630). In summary, the decreased deep regional cerebral SvO2 occurred in hemodialysis patients and dialysis duration, parathyroid hormone, hematocrit, hemoglobin and red blood cell may be clinical risk factors.

Determination of detection sensitivity for cerebral microbleeds using susceptibility-weighted imaging.

Cerebral microbleeds (CMBs) are small brain hemorrhages caused by the break down or structural abnormalities of small vessels of the brain. Owing to the paramagnetic properties of blood degradation products, CMBs can be detected in vivo using susceptibility-weighted imaging (SWI). SWI can be used not only to detect iron changes and CMBs, but also to differentiate them from calcifications, both of which may be important MR-based biomarkers for neurodegenerative diseases. Moreover, SWI can be used to quantify the iron in CMBs. SWI and gradient echo (GE) imaging are the two most common methods for the detection of iron deposition and CMBs. This study provides a comprehensive analysis of the number of voxels detected in the presence of a CMB on GE magnitude, phase and SWI composite images as a function of resolution, signal-to-noise ratio (SNR), TE, field strength and susceptibility using in silico experiments. Susceptibility maps were used to quantify the bias in the effective susceptibility value and to determine the optimal TE for CMB quantification. We observed a non-linear trend with susceptibility for CMB detection from the magnitude images, but a linear trend with susceptibility for CMB detection from the phase and SWI composite images. The optimal TE values for CMB quantification were found to be 3 ms at 7 T, 7 ms at 3 T and 14 ms at 1.5 T for a CMB of one voxel in diameter with an SNR of 20: 1. The simulations of signal loss and detectability were used to generate theoretical formulae for predictions. Copyright © 2016 John Wiley & Sons, Ltd.

Susceptibility-weighted imaging: current status and future directions.

Susceptibility-weighted imaging (SWI) is a method that uses the intrinsic nature of local magnetic fields to enhance image contrast in order to improve the visibility of various susceptibility sources and to facilitate diagnostic interpretation. It is also the precursor to the concept of the use of phase for quantitative susceptibility mapping (QSM). Nowadays, SWI has become a widely used clinical tool to image deoxyhemoglobin in veins, iron deposition in the brain, hemorrhages, microbleeds and calcification. In this article, we review the basics of SWI, including data acquisition, data reconstruction and post-processing. In particular, the source of cusp artifacts in phase images is investigated in detail and an improved multi-channel phase data combination algorithm is provided. In addition, we show a few clinical applications of SWI for the imaging of stroke, traumatic brain injury, carotid vessel wall, siderotic nodules in cirrhotic liver, prostate cancer, prostatic calcification, spinal cord injury and intervertebral disc degeneration. As the clinical applications of SWI continue to expand both in and outside the brain, the improvement of SWI in conjunction with QSM is an important future direction of this technology. Copyright © 2016 John Wiley & Sons, Ltd.

A fully flow-compensated multiecho susceptibility-weighted imaging sequence: The effects of acceleration and background field on flow compensation.

PURPOSE: To present a fully flow-compensated multiecho gradient echo sequence that can be used for MR angiography (MRA), susceptibility weighted imaging (SWI), and quantitative susceptibility mapping (QSM) and to study the effects of flow acceleration and background field gradients on flow compensation. METHODS: The quality of flow compensation was evaluated using the data from eight volunteers. The effects of flow acceleration were studied by changing the polarities of the readout gradients in two consecutive scans. The background field was used to estimate the phase errors of flow compensation in the presence of field inhomogeneities. SWI and QSM data were generated with confounding arterial phase removed. T2 * maps were obtained from the multiecho data to estimate T2 * of arterial blood. RESULTS: Reasonable flow compensation was achieved. Nevertheless, background field gradients and acceleration-induced phase errors were found to be as large as π/2 and π/3, respectively, both in agreement with theory. T2 * was measured as 82 ± 4 ms and 74 ± 9 ms for arteries inside and outside the brain, respectively, at 3T. CONCLUSION: High-quality MRA, SWI, and QSM data can be obtained simultaneously. Masking out the arteries to remove the phase due to flow acceleration and background field gradients improves the quality of both SWI and QSM data. Magn Reson Med 76:478-489, 2016. © 2015 Wiley Periodicals, Inc.

A quantitative study of susceptibility and additional frequency shift of three common materials in MRI.

PURPOSE: This work quantifies magnetic susceptibilities and additional frequency shifts derived from different samples. METHODS: Twenty samples inside long straws were imaged with a multiecho susceptibility weighted imaging and analyzed with two approaches for comparisons. One approach applied our complex image summation around a spherical or cylindrical object method to phase distributions outside straws. The other approach utilized phase values inside each straw from two orientations. Both methods quantified susceptibilities of each sample at each echo time. The R2* value of each sample was measured too. Uncertainty of each measurement was also estimated. RESULTS: Quantified susceptibilities from complex image summation around a spherical or cylindrical object are consistent within uncertainties between different echo times. However, this is not the case for the other method. Nonetheless, most quantified susceptibilities are consistent between these two methods. Phase values due to additional frequency shifts in some of ferritin and nanoparticle samples have been identified. Only R2* values quantified from low concentration nanoparticle samples agree with the predictions from the static dephasing theory. CONCLUSION: This work suggests that using the sample sizes and phase values only outside samples can correctly quantify the susceptibilities of those samples. With the presence of a possible additional frequency shift inside a material, it will not be suitable to obtain susceptibility maps without taking that into account. Magn Reson Med 76:1263-1269, 2016. © 2015 Wiley Periodicals, Inc.

Assessing global and regional iron content in deep gray matter as a function of age using susceptibility mapping.

PURPOSE: To investigate the correlation of non-heme iron content in deep gray matter nuclei as a function of age using quantitative susceptibility mapping (QSM) from both whole-structural and regional perspectives. MATERIALS AND METHODS: We studied a group of 174 normal subjects ranging from 20 to 69 years old and measured the magnetic susceptibility of seven subcortical gray matter nuclei. SWI (susceptibility-weighted imaging) phase images were used to generate the susceptibility maps, which were acquired on a 1.5T scanner. The 3D whole-structural measurements were used to determine age-related thresholds, which were applied to calculate the local iron deposition (RII: portion of the structure that contains iron concentration larger than the structure threshold). Age-susceptibility correlation was reported for each measured structure for both the whole-region and two-region (low iron and high iron content regions) analysis. RESULTS: For the local high iron content region, a strong age-susceptibility correlation was found in the caudate nucleus (CN,R = 0.9), putamen (PUT,R = 0.9), red nucleus (RN,R = 0.8), globus pallidus (GP,R = 0.7), substantia nigra (SN,R = 0.5), and pulvinar thalamus (PT,R = 0.5); for the global iron content, a strong age-susceptibility correlation was found in CN(R = 0.6), PUT(R = 0.7), and RN(R = 0.6). Overall, for each structure analyzed in this study, regional analysis showed higher correlation coefficient and higher slope comparing to the whole-region analysis. Further, we found the quantitative conversion factor between magnetic susceptibility and iron concentration to be 1.03 ± 0.03 ppb per µg iron/g wet tissue. CONCLUSION: We conclude that the age-susceptibility correlation can serve as a quantitative magnetic susceptibility baseline as a function of age for monitoring abnormal global and regional iron deposition. A regional analysis has shown a tighter age related behavior, providing a reliable and sensitive reference for what can be considered normal iron content for studies of neurodegenerative diseases. J. Magn. Reson. Imaging 2016;44:59-71.

Susceptibility mapping of air, bone, and calcium in the head.

PURPOSE: To demonstrate the mapping of structures with high susceptibility values, such as the sinuses, bones and teeth, using short echo times. METHODS: Four in vivo datasets were collected with a gradient-echo sequence (TE1 = 2.5 ms, TE2 = 5 ms and TE3 = 7.5 ms). Complex division was performed to remove the phase offset term and generate the phase at TE = 2.5 ms. Susceptibility maps were generated from unwrapped phase images, using a geometry-constrained iterative algorithm, by preserving phase information in the extracerebral tissues. The susceptibility results were improved by updating the missing phase information inside structures with no signal using the predicted phase at each iteration step. Simulated phase images of a three-dimensional brain model and tooth phantom were used to validate the proposed method. RESULTS: Improved susceptibility maps were obtained once the phase information in the extracerebral tissue region was incorporated, for both the model and in vivo data. For in vivo data, the average susceptibilities of air (sphenoid sinus), bone and calcium (teeth) were found to be (in ppm): Δχ(sinus-tissue) = +9.2 ± 1.3, Δχ(bone-tissue) = -2.1 ± 0.6 and Δχ(teeth-tissue) = -3.3 ± 1.2, respectively. CONCLUSION: High susceptibility structures with little or no signal can be imaged using quantitative susceptibility mapping and can be used to improve background field removal.

Quantitative measurements of brain iron deposition in cirrhotic patients using susceptibility mapping.

BACKGROUND: Susceptibility-weighted imaging (SWI) has been used to detect micro-bleeds and iron deposits in the brain. However, no reports have been published on the application of SWI in studying iron changes in the brain of cirrhotic patients. PURPOSE: To compare the susceptibility of different brain structures in cirrhotic patients with that in healthy controls and to evaluate susceptibility as a potential biomarker and correlate the measured susceptibility and cadaveric brain iron concentration for a variety of brain structures. MATERIAL AND METHODS: Forty-three cirrhotic patients (27 men, 16 women; mean age, 50 ± 9 years) and 34 age- and sex-matched healthy controls (22 men, 12 women; mean age, 47 ± 7 years) were included in this retrospective study. Susceptibility was measured in the frontal white matter, basal ganglia, midbrain, and dentate nucleus and compared with results gathered from two postmortem brain studies. Correlation between susceptibility and clinical biomarkers and neuropsychiatric tests scores was calculated. RESULTS: In cirrhotic patients, the susceptibility of left frontal white matter, bilateral caudate head, and right substantia nigra was higher than that in healthy controls (P < 0.05). There was a positive correlation between susceptibility and iron concentration from one postmortem brain study (r = 0.835, P = 0.01) in eight deep grey matter structures and another in five brain structures (r = 0.900, P = 0.03). The susceptibility of right caudate head (r = 0.402) and left caudate head (r = 0.408) correlated with neuropsychological test scores (both P < 0.05). CONCLUSION: Abnormal iron deposits occur in cirrhotic patients and abnormal susceptibility of some brain regions appears to reflect neurocognitive changes.

Improved MR venography using quantitative susceptibility-weighted imaging.

PURPOSE: To remove the geometry dependence of phase-based susceptibility weighting masks in susceptibility-weighted imaging (SWI) and to improve the visualization of the veins and microbleeds. MATERIALS AND METHODS: True SWI (tSWI) was generated using susceptibility-based masks. Simulations were used to evaluate the influence of the characteristic parameters defining the mask. In vivo data from three healthy adult human volunteers were used to compare the contrast-to-noise-ratios (CNRs) of the right septal vein and the left internal cerebral vein as measured from both tSWI and SWI data. A traumatic brain injury (TBI) patient dataset was used to illustrate qualitatively the proper visualization of microbleeds using tSWI. RESULTS: Compared with conventional SWI, tSWI improved the CNR of the two selected veins by a factor of greater than three for datasets with isotropic resolution and greater than 30% for datasets with anisotropic resolution. Veins with different orientations can be properly enhanced in tSWI. Furthermore, the blooming artifact due to the strong dipolar phase of microbleeds in conventional SWI was reduced in tSWI for the TBI case. CONCLUSION: The use of tSWI overcomes the geometric limitations of using phase and provides better visualization of the venous system, especially for data collected with isotropic resolution.

Measuring iron in the brain using quantitative susceptibility mapping and X-ray fluorescence imaging.

Measuring iron content in the brain has important implications for a number of neurodegenerative diseases. Quantitative susceptibility mapping (QSM), derived from magnetic resonance images, has been used to measure total iron content in vivo and in post mortem brain. In this paper, we show how magnetic susceptibility from QSM correlates with total iron content measured by X-ray fluorescence (XRF) imaging and by inductively coupled plasma mass spectrometry (ICPMS). The relationship between susceptibility and ferritin iron was estimated at 1.10±0.08 ppb susceptibility per µg iron/g wet tissue, similar to that of iron in fixed (frozen/thawed) cadaveric brain and previously published data from unfixed brains. We conclude that magnetic susceptibility can provide a direct and reliable quantitative measurement of iron content and that it can be used clinically at least in regions with high iron content.

Quantitative susceptibility mapping of small objects using volume constraints.

Microbleeds have been implicated to play a role in many neurovascular and neurodegenerative diseases. The diameter of each microbleed has been used previously as a possible quantitative measure for grading microbleeds. We propose that magnetic susceptibility provides a new quantitative measure of extravasated blood. Recently, a Fourier-based method has been used that allows susceptibility quantification from phase images for any arbitrarily shaped structures. However, when very small objects, such as microbleeds, are considered, the accuracy of this susceptibility mapping method still remains to be evaluated. In this article, air bubbles and glass beads are taken as microbleed surrogates to evaluate the quantitative accuracy of the susceptibility mapping method. We show that when an object occupies only a few voxels, an estimate of the true volume of the object is necessary for accurate susceptibility quantification. Remnant errors in the quantified susceptibilities and their sources are evaluated. We show that quantifying magnetic moment, rather than the susceptibility of these small structures, may be a better and more robust alternative.

Parental neglect and short-form video application addiction in Chinese adolescents: The mediating role of alexithymia and the moderating role of refusal self-efficacy.

BACKGROUND: The phenomenon of short-form video application addiction among Chinese adolescents is noteworthy. More research has focused on the influencing factors of internet addiction, but research on specifically exploring the antecedents and influencing mechanisms of short-form video application addiction (a subcategory of internet addiction) among adolescents is insufficient. OBJECTIVES: This study aimed to investigate the relation between parental neglect and short-form video application addiction among Chinese adolescents and examine the mediating effect of alexithymia and the moderating role of refusal self-efficacy. METHODS: A total of 1203 Chinese adolescents were assigned to complete scales regarding parental neglect, alexithymia, refusal self-efficacy and short-form video application addiction. RESULTS: Parental neglect was positively related to short-form video application addiction among Chinese adolescents, and alexithymia mediated this link. Furthermore, refusal self-efficacy moderated the direct connection between parental neglect and short-form video application addiction. Specifically, the link between parental neglect and short-form video application addiction became weaker as adolescents' refusal self-efficacy increased. CONCLUSION: The experiences of parental neglect are closely related to higher levels of short-form video application addiction among Chinese adolescents. Parental neglect is associated with higher level of short-form video application addiction through stronger alexithymia, and the relationship between parental neglect and short-form video application addiction is attenuated when adolescents have high refusal self-efficacy.

Utility of quantitative susceptibility mapping and diffusion kurtosis imaging in the diagnosis of early Parkinson's disease.

OBJECTIVE: To investigate the utility of quantitative susceptibility mapping (QSM) and diffusion kurtosis imaging (DKI) as complementary tools in characterizing pathological changes in the deep grey nuclei in early Parkinson's disease (PD) and their clinical correlates to aid in diagnosis of PD. METHOD: Patients with a diagnosis of PD made within a year and age-matched healthy controls were recruited. All participants underwent clinical evaluation using the Unified Parkinson's Disease Rating Scale (MDS-UPDRS III) and Hoehn & Yahr stage (H&Y), and brain 3 T MRI including QSM and DKI. Regions-of-interest (ROIs) in the caudate nucleus, putamen, globus pallidus, and medial and lateral substantia nigra (SN) were manually drawn to compare the mean susceptibility (representing iron deposition) and DKI indices (representing restricted water diffusion) between PD patients and healthy controls and in correlation with MDS-UPDRS III and H&Y, focusing on susceptibility value, mean diffusivity (MD) and mean kurtosis (MK). RESULTS: There were forty-seven PD patients (aged 68.7 years, 51% male, disease duration 0.78 years) and 16 healthy controls (aged 67.4 years, 63% male). Susceptibility value was increased in PD in all ROIs except the caudate, and was significantly different after multiple comparison correction in the putamen (PD: 64.75 ppb, HC: 44.61 ppb, p = 0.004). MD was significantly higher in PD in the lateral SN, putamen and caudate, the regions with the lowest susceptibility value. In PD patients, we found significant association between the MDS-UPDRS III score and susceptibility value in the putamen after correcting for age and sex (ß = 0.21, p = 0.003). A composite DKI-QSM diagnostic marker based on these findings successfully differentiated the groups (p < 0.0001) and had "good" classification performance (AUC = 0.88). CONCLUSIONS: QSM and DKI are complementary tools allowing a better understanding of the complex contribution of iron deposition and microstructural changes in the pathophysiology of PD.

Multi-Echo Quantitative Susceptibility Mapping for Strategically Acquired Gradient Echo (STAGE) Imaging.

PURPOSE: To develop a method to reconstruct quantitative susceptibility mapping (QSM) from multi-echo, multi-flip angle data collected using strategically acquired gradient echo (STAGE) imaging. METHODS: The proposed QSM reconstruction algorithm, referred to as "structurally constrained Susceptibility Weighted Imaging and Mapping" scSWIM, performs an ℓ 1 and ℓ 2 regularization-based reconstruction in a single step. The unique contrast of the T1 weighted enhanced (T1WE) image derived from STAGE imaging was used to extract reliable geometry constraints to protect the basal ganglia from over-smoothing. The multi-echo multi-flip angle data were used for improving the contrast-to-noise ratio in QSM through a weighted averaging scheme. The measured susceptibility values from scSWIM for both simulated and in vivo data were compared to the: original susceptibility model (for simulated data only), the multi orientation COSMOS (for in vivo data only), truncated k-space division (TKD), iterative susceptibility weighted imaging and mapping (iSWIM), and morphology enabled dipole inversion (MEDI) algorithms. Goodness of fit was quantified by measuring the root mean squared error (RMSE) and structural similarity index (SSIM). Additionally, scSWIM was assessed in ten healthy subjects. RESULTS: The unique contrast and tissue boundaries from T1WE and iSWIM enable the accurate definition of edges of high susceptibility regions. For the simulated brain model without the addition of microbleeds and calcium, the RMSE was best at 5.21ppb for scSWIM and 8.74ppb for MEDI thanks to the reduced streaking artifacts. However, by adding the microbleeds and calcium, MEDI's performance dropped to 47.53ppb while scSWIM performance remained the same. The SSIM was highest for scSWIM (0.90) and then MEDI (0.80). The deviation from the expected susceptibility in deep gray matter structures for simulated data relative to the model (and for the in vivo data relative to COSMOS) as measured by the slope was lowest for scSWIM + 1%(-1%); MEDI + 2%(-11%) and then iSWIM -5%(-10%). Finally, scSWIM measurements in the basal ganglia of healthy subjects were in agreement with literature. CONCLUSION: This study shows that using a data fidelity term and structural constraints results in reduced noise and streaking artifacts while preserving structural details. Furthermore, the use of STAGE imaging with multi-echo and multi-flip data helps to improve the signal-to-noise ratio in QSM data and yields less artifacts.

STrategically Acquired Gradient Echo (STAGE) imaging, part III: Technical advances and clinical applications of a rapid multi-contrast multi-parametric brain imaging method.

One major thrust in radiology today is image standardization with a focus on rapidly acquired quantitative multi-contrast information. This is critical for multi-center trials, for the collection of big data and for the use of artificial intelligence in evaluating the data. Strategically acquired gradient echo (STAGE) imaging is one such method that can provide 8 qualitative and 7 quantitative pieces of information in 5 min or less at 3 T. STAGE provides qualitative images in the form of proton density weighted images, T1 weighted images, T2* weighted images and simulated double inversion recovery (DIR) images. STAGE also provides quantitative data in the form of proton spin density, T1, T2* and susceptibility maps as well as segmentation of white matter, gray matter and cerebrospinal fluid. STAGE uses vendors' product gradient echo sequences. It can be applied from 0.35 T to 7 T across all manufacturers producing similar results in contrast and quantification of the data. In this paper, we discuss the strengths and weaknesses of STAGE, demonstrate its contrast-to-noise (CNR) behavior relative to a large clinical data set and introduce a few new image contrasts derived from STAGE, including DIR images and a new concept referred to as true susceptibility weighted imaging (tSWI) linked to fluid attenuated inversion recovery (FLAIR) or tSWI-FLAIR for the evaluation of multiple sclerosis lesions. The robustness of STAGE T1 mapping was tested using the NIST/NIH phantom, while the reproducibility was tested by scanning a given individual ten times in one session and the same subject scanned once a week over a 12-week period. Assessment of the CNR for the enhanced T1W image (T1WE) showed a significantly better contrast between gray matter and white matter than conventional T1W images in both patients with Parkinson's disease and healthy controls. We also present some clinical cases using STAGE imaging in patients with stroke, metastasis, multiple sclerosis and a fetus with ventriculomegaly. Overall, STAGE is a comprehensive protocol that provides the clinician with numerous qualitative and quantitative images.