Correction of proton resonance frequency shift temperature maps for magnetic field disturbances caused by breathing.

Respiratory induced resonance offset (RIRO) is a periodic disturbance of a magnetic field due to breathing. Such disturbance handicaps the accuracy of the proton resonance frequency shift (PRFS) method of MRI temperature mapping in anatomies situated nearby the lungs and chest wall. In this work, we propose a method capable of minimizing errors caused by RIRO in PRFS temperature maps. In this method, a set of baseline images characterizing RIRO at a variety of respiratory cycle instants is acquired before the thermal treatment starts. During the treatment, the temperature evolution is found from two successive images. Then, the calculated temperature changes are corrected for the additional contribution caused by RIRO using the pre-treatment baseline images acquired at the identical instances of the respiratory cycle. Our method is shown to improve the accuracy and stability of PRFS temperature maps in the presence of RIRO and inter-scan motion in phantom and volunteers' breathing experiments. Our method is also shown to be applicable to anatomies moving during breathing if a proper registration procedure is applied.

MRI temperature mapping during thermal balloon angioplasty.

Knowledge on the thermal dose delivered during thermal balloon angioplasty (TBA) is desirable to understand why TBA's outcome varies widely among patients and why it is subject to high restenosis rates. In its conventional implementation, TBA involves injection of a heated medium into a balloon positioned within a stenotic blood vessel. The medium injection causes flow, motion and susceptibility-redistribution artefacts that are devastating to the proton resonance frequency shift (PRFS) technique of MRI temperature mapping. Here, we propose to separate in time medium injection and heating by first inflating a balloon with a medium at an initial temperature, and then by heating the medium up using laser light. The separation is shown to eliminate all the mentioned artefacts and to enable real-time MRI temperature mapping using the PRFS technique. Accurate and reliable temperature maps were acquired in a TBA balloon itself and in the surrounding phantom tissue during heat application.

Magnetic resonance imaging of the left atrial appendage post pulmonary vein isolation: Implications for percutaneous left atrial appendage occlusion.

BACKGROUND: There is increasing interest in performing left atrial appendage (LAA) occlusion at the time of atrial fibrillation (AF) ablation procedures. However, to date there has been no description of the acute changes to the LAA immediately following pulmonary vein (PV) isolation and additional left atrium (LA) substrate modification. This study assessed changes in the size and tissue characteristics of the LAA ostium in patients undergoing PV isolation. METHODS: This series included 8 patients who underwent cardiovascular magnetic resonance evaluation of the LA with delayed enhancement magnetic resonance imaging and contrast enhanced 3-D magnetic resonance angiography pre-, within 48 h of, and 3 months post ablation. Two independent cardiac radiologists evaluated the ostial LAA diameters and area at each time point in addition to the presence of gadolinium enhancement. RESULTS: Compared to pre-ablation values, the respective median differences in oblique diameters and LAA area were +1.8 mm, +1.7 mm, and +0.6 cm(2) immediately post ablation (all NS) and -2.7 mm, -2.3 mm, and -0.5 cm(2) at 3 months (all NS). No delayed enhancement was detected in the LAA post ablation. CONCLUSION: No significant change to LAA diameter, area, or tissue characteristics was noted after PV isolation. While these findings suggest the safety and feasibility of concomitant PV isolation and LAA device occlusion, the variability in the degree and direction of change of the LAA measurements highlights the need for further study.

Visualization of thermal ablation lesions using cumulative dynamic contrast enhancement MRI.

A novel robust and user friendly method for post-processing dynamic contrast enhanced (DCE) MRI data is presented, which provides reliable real-time delineation of the borders of thermal ablation lesions on low SNR images shortly after contrast agent injection without any model-based curve fitting. Some simple descriptors of the DCE process are calculated in a time efficient recursive manner and combined into a single image reflecting both current and previous enhancement states of each pixel, which allows robust discrimination between tissue areas with different perfusion properties. The resulting cumulative DCE (CDCE) images are shown to exhibit a strong correlation with histopathology and late gadolinium enhancement representations of the thermal damage in soft tissue. It is shown that the outer border of the non-perfused ablation lesion core on CDCE MRI corresponds to the histopathological lesion border. The described method has a potential not only to facilitate thermal ablation outcome assessment, but also to improve detection of infiltrative tumours and reduce the administered contrast agent dose in any DCE scans.

Practical aspects of MR imaging in the presence of conductive guide wires.

Various aspects of RF-induced heating of guide wires during their MRI guidance have been investigated in the past. However, the previous works focused on inducing tip heating in either fully immersed or tip-immersed (and otherwise free) wires of impractical lengths in small phantoms. This study simulates real clinical conditions using a product guide wire and a same-length conductive wire partially inserted into a torso-size phantom filled with saline solution. The purpose was to identify potential safety concerns relevant to real clinical applications, as opposed to identifying the worst-case heating scenario. Significant heating occurred at the insertion point, independent of tip heating, with a strong correlation with excitation frequency-dependent imaging parameters. Heat transfer through the wire was also demonstrated to be a safety concern. From these experiments, we have been able to demonstrate additional impacting factors that increase the complexity of safety considerations for the use of conductive guide wires during MR imaging. Safety under a particular set of conditions does not imply safety in all possible conditions that can be encountered during real MRI-guided interventions.

Correction of proton resonance frequency shift temperature maps for magnetic field disturbances using fat signal.

PURPOSE: To improve the immunity of the proton resonance frequency shift (PRFS) method of MRI temperature mapping against magnetic field disturbances. Since PRFS is a phase-sensitive method, it misinterprets magnetic field disturbances as artifact temperature changes. If not corrected, the resulting temperature artifacts can completely obscure the true temperature estimation, especially if the temperature elevations are small. MATERIALS AND METHODS: Since the fat protons experience the same magnetic field disturbances as the water protons, but no temperature-related frequency shift, the fat signal has been used for correcting PRFS temperature maps for the disturbances. A simple correction method is proposed that has either better compensation capability than the phase correction methods previously reported or higher spatial and temporal resolution than the spectroscopic correction methods previously reported. The evaluated method is based on the utilization of several gradient and spin echoes acquired within one repetition interval with water- and fat-selective scans. RESULTS: In a series of phantom experiments, the improved method is shown to enable the reconstruction of accurate temperature maps in spite of interscan motion, suboptimal fat-water separation, and a wide range of magnetic field disturbances. CONCLUSION: Our approach can be used for the guidance of thermal therapies involving tissues containing fat or surrounded by fat.