A body-sized phantom for evaluation of diffusion-weighted MRI data using conventional, readout-segmented, and zoomed echo-planar sequences.

BACKGROUND: Abdominal diffusion-weighted imaging (DWI) has been rapidly increasing during the last few years. For the evaluation of new DWI techniques, the development of suitable phantoms and quality assurance methods is important. PURPOSE: To construct a body-diameter phantom for abdominal DWI and study the impact of different acquisition options on image quality. MATERIAL AND METHODS: A phantom with a diameter of 31 cm and a volume of 26 L was constructed, containing four samples representing a clinically relevant range of apparent diffusion coefficient (ADC) values. Measurements were carried out on 1.5T and 3.0T MRI systems using conventional echo-planar imaging (EPI), readout-segmented EPI, and zoomed EPI (3.0T) sequences. The effects of parallel imaging, coil intensity normalization, and patient-specific B1 shim (3.0T) were also examined. ADC values and signal-to-noise ratios of the samples were measured, and the level of artifacts was visually evaluated. RESULTS: The agreement of ADC values between different acquisition options was generally good, but higher values (by 0.07 × 10(-3) mm(2)/s on the average) with readout-segmented EPI as well as ADC variations of approximately 0.1 × 10(-3) mm(2)/s in slice direction were observed. The image artifacts were reduced by using patient-specific B1 shim, readout-segmented EPI, or zoomed EPI. CONCLUSION: The body-sized phantom demonstrated well the expected image artifacts in DWI with large field of view. The use of patient-specific B1 shim, readout-segmented EPI, or zoomed EPI improved image quality of DWI in this study.

Cardiac MRI in patients with cardiac pacemakers: practical methods for reducing susceptibility artifacts and optimizing image quality.

BACKGROUND: Magnetic resonance imaging (MRI) of pacemaker patients has become available despite of previous contraindications. However, pacing systems containing ferromagnetic material may hamper the diagnostic quality of cardiac MR (CMR) images. PURPOSE: To study methods for reducing susceptibility-based artifacts in CMR examinations of pacemaker patients. MATERIAL AND METHODS: Altogether 16 patients were scanned with 1.5T MRI scanner using cine balanced steady-state free-precession (bSSFP) and spoiled gradient echo (SPGR) sequences. The use of frequency-scout was also evaluated. For myocardial late gadolinium-enhanced (LGE) imaging, SPGR or bSSFP readout inversion-recovery prepared gradient echo sequences were used with and without phase-sensitive inversion-recovery (PSIR). Two radiologists subjectively compared the image quality (IQ) and the ranges of susceptibility artifacts were evaluated objectively. RESULTS: The IQ proved adequate for diagnosing each patient, although in a few patients with a left-side implanted generator, artifacts hampered IQ in the anterior and anteroseptal segments of the myocardium in bSSFP cine and LGE sequences. In bSSFP cine, the use of frequency-scout could often transfer the banding artifacts away from the left ventricular myocardium. In LGE imaging, the artifacts were more pronounced in IR-bSSFP and PSIR than in IR-SPGR sequences. The ranges of generator-based artifacts were greater in bSSFP (10-12 cm) than in SPGR (6 cm) sequences due to banding artifacts. CONCLUSION: The artifacts caused by pacemakers typically did not compromise the diagnostic IQ. The use of frequency-scout prior to bSSFP cine or the use of SPGR-based sequences could also improve IQ.

Data quality in fMRI and simultaneous EEG-fMRI.

OBJECT: To evaluate functional magnetic resonance imaging (fMRI) and simultaneous electroencephalography (EEG)-fMRI data quality in an organization using several magnetic resonance imaging (MRI) systems. MATERIALS AND METHODS: Functional magnetic resonance imaging measurements were carried out twice with a uniform gel phantom on five different MRI systems with field strengths of 1.5 and 3.0 T. Several image quality parameters were measured with automatic analysis software. For simultaneous EEG-fMRI, data quality was evaluated on 3.0 T systems, and the phantom results were compared to data on human volunteers. RESULTS: The fMRI quality parameters measured with different MRI systems were on an acceptable level. The presence of the EEG equipment caused superficial artifacts on the phantom image. The typical artifact depth was 15 mm, and no artifacts were observed in the brain area in the images of volunteers. Average signal-to-noise ratio (SNR) reduction in the phantom measurements was 15 %, a reduction of SNR similar to that observed in the human data. We also detected minor changes in the noise of the EEG signal during the phantom measurement. CONCLUSION: The phantom proved valuable in the successful evaluation of the data quality of fMRI and EEG-fMRI. The results fell within acceptable limits. This study demonstrated a repeatable method to measure and follow up on the data quality of simultaneous EEG-fMRI.

Safety in simultaneous EEG-fMRI at 3 T: temperature measurements.

BACKGROUND: In simultaneous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI), safety of the EEG equipment is ensured by the manufacturer only for localizers and fMRI sequences. To conduct a clinically feasible simultaneous EEG-fMRI study, other sequences, e.g. anatomical and B0-correction sequences, have to be acquired in the same imaging session. PURPOSE: To measure the temperature increase of the electrodes in different size EEG caps in a phantom and volunteers during magnetic resonance imaging (MRI) sequences typically used in clinical studies. MATERIAL AND METHODS: A phantom with EEG caps of size 52, 56, and 60 was imaged using several sequences in two 3 T MRI scanners to determine the maximum and average temperature increases in the electrodes. Additionally, three volunteer studies were performed for the EEG caps of sizes 56 and 60. The sequences were gradient echo based echo planar imaging sequence, T2-weighted turbo spin echo (T2-TSE), spin echo multiecho for B0-correction, diffusion tensor imaging and T1-weighted 3D sequences. RESULTS: In phantom studies the maximum temperature increase was 4.1℃ with a mean of 1.2 ± 1.1℃. In volunteer studies, the maximum temperature measured was 35.6℃ and the maximum temperature rise was 2.1℃ with a mean of 0.9 ± 0.7℃. Both were observed with a T2-TSE sequence. CONCLUSION: The temperature of the electrodes did not exceed the limits set by the IEC 60601-1 standard (43℃) or manufacturer (45℃), thus indicating a safe EEG-fMRI protocol in this respect.

Convolutional neural networks for detection of transthyretin amyloidosis in 2D scintigraphy images.

BACKGROUND: Transthyretin amyloidosis (ATTR) is a progressive disease which can be diagnosed non-invasively using bone avid [99mTc]-labeled radiotracers. Thus, ATTR is also an occasional incidental finding on bone scintigraphy. In this study, we trained convolutional neural networks (CNN) to automatically detect and classify ATTR from scintigraphy images. The study population consisted of 1334 patients who underwent [99mTc]-labeled hydroxymethylene diphosphonate (HMDP) scintigraphy and were visually graded using Perugini grades (grades 0-3). A total of 47 patients had visual grade ≥ 2 which was considered positive for ATTR. Two custom-made CNN architectures were trained to discriminate between the four Perugini grades of cardiac uptake. The classification performance was compared to four state-of-the-art CNN models. RESULTS: Our CNN models performed better than, or equally well as, the state-of-the-art models in detection and classification of cardiac uptake. Both models achieved area under the curve (AUC) ≥ 0.85 in the four-class Perugini grade classification. Accuracy was good in detection of negative vs. positive ATTR patients (grade < 2 vs grade ≥ 2, AUC > 0.88) and high-grade cardiac uptake vs. other patients (grade < 3 vs. grade 3, AUC = 0.94). Maximum activation maps demonstrated that the automated deep learning models were focused on detecting the myocardium and not extracardiac features. CONCLUSION: Automated convolutional neural networks can accurately detect and classify different grades of cardiac uptake on bone scintigraphy. The CNN models are focused on clinically relevant image features. Automated screening of bone scintigraphy images using CNN could improve the early diagnosis of ATTR.

MRI quality assurance using the ACR phantom in a multi-unit imaging center.

BACKGROUND: Magnetic resonance imaging (MRI) instrumentation is vulnerable to technical and image quality problems, and quality assurance is essential. In the studied regional imaging center the long-term quality assurance has been based on MagNET phantom measurements. American College of Radiology (ACR) has an accreditation program including a standardized image quality measurement protocol and phantom. The ACR protocol includes recommended acceptance criteria for clinical sequences and thus provides possibility to assess the clinical relevance of quality assurance. The purpose of this study was to test the ACR MRI phantom in quality assurance of a multi-unit imaging center. MATERIAL AND METHODS: The imaging center operates 11 MRI systems of three major manufacturers with field strengths of 3.0 T, 1.5 T and 1.0 T. Images of the ACR phantom were acquired using a head coil following the ACR scanning instructions. Both ACR T1- and T2-weighted sequences as well as T1- and T2-weighted brain sequences in clinical use at each site were acquired. Measurements were performed twice. The images were analyzed and the results were compared with the ACR acceptance levels. RESULTS: The acquisition procedure with the ACR phantom was faster than with the MagNET phantoms. On the first and second measurement rounds 91% and 73% of the systems passed the ACR test. Measured slice thickness accuracies were not within the acceptance limits in site T2 sequences. Differences in the high contrast spatial resolution between the ACR and the site sequences were observed. In 3.0 T systems the image intensity uniformity was slightly lower than the ACR acceptance limit. CONCLUSION: The ACR method was feasible in quality assurance of a multi-unit imaging center and the ACR protocol could replace the MagNET phantom tests. An automatic analysis of the images will further improve cost-effectiveness and objectiveness of the ACR protocol.

Reproducibility of phantom-based quality assurance parameters in real-time ultrasound imaging.

BACKGROUND: In a large radiological center, the ultrasound (US) quality assurance (QA) program involves several professionals. Although the operator and the parameters utilized can contribute to the results, the selected QA parameters should still reflect the quality of the US scanner, not the measuring process. PURPOSE: To evaluate the reproducibility of recommended phantom-based US QA parameters in a realistic environment. MATERIAL AND METHODS: Six sonographers measured six high-end US scanners with 20 transducers using a general purpose phantom. Every transducer was measured altogether seven times, using one frequency per transducer. The QA parameters studied were homogeneity, visualization depth, vertical and horizontal distance measurements, axial and lateral resolution, and the correct visibility of anechoic and high-contrast masses. The evaluation of the homogeneity was based on visual observations. Inter-observer interquartile ranges were computed for the grading of the masses. For the other QA parameters, the mean inter- and intra-observer coefficients of variation (CoV) were calculated. In addition, the symmetry of the reverberations when imaging air with a clean transducer was checked. RESULTS: The mean inter-observer CoVs were: visualization depth 11 ± 4%, vertical distance 1.7 ± 0.4%, horizontal distance 1.4 ± 0.6%, axial resolution 22 ± 7%, and lateral resolution 16 ± 8%. The mean intra-observer values were about half of these values with similar standard deviations. The visual evaluation of the homogeneity and the symmetry of the reverberations produced false-positive findings in 5% of the cases, but were found useful in detecting a defective transducer. The grading of the masses had mean interquartile ranges of 20-30% of the grading scale. CONCLUSION: The inter-observer variability in measuring phantom-based QA parameters can be relatively high. This should be considered when implementing a phantom-based QA protocol and evaluating the results.

Preoperative hepatic 3D models: virtual liver resection using three-dimensional imaging technique.

Emerging new techniques for liver resections set new requirements for the preoperative imaging and planning. Open surgery is a three-dimensional procedure and planning of the resection line may be difficult when basing on conventional two-dimensional CTs or MRIs, although all the information is there. With multidetector-row CT (MDCT), thin slices can be obtained with excellent temporal resolution, and precise three-dimensional (3D) models can be created. We regard 3D imaging technique useful in most liver resections. It improves the surgeon's knowledge of liver anatomy and makes even more complicated liver resections safe. Better knowledge of three-dimensional appearances of liver structures may further improve the results of curative liver surgery. However, before becoming a routine clinical procedure, research and development are still needed. Also, careful testing and evaluation of the methods have to be performed. In the future, 3D models will probably play an important role in the preoperative planning of liver resections.

A review of cardiac image registration methods.

In this paper, the current status of cardiac image registration methods is reviewed. The combination of information from multiple cardiac image modalities, such as magnetic resonance imaging, computed tomography, positron emission tomography, single-photon emission computed tomography, and ultrasound, is of increasing interest in the medical community for physiologic understanding and diagnostic purposes. Registration of cardiac images is a more complex problem than brain image registration because the heart is a nonrigid moving organ inside a moving body. Moreover, as compared to the registration of brain images, the heart exhibits much fewer accurate anatomical landmarks. In a clinical context, physicians often mentally integrate image information from different modalities. Automatic registration, based on computer programs, might, however, offer better accuracy and repeatability and save time.

A 3-D model-based registration approach for the PET, MR and MCG cardiac data fusion.

In this paper, a new approach is presented for the assessment of a 3-D anatomical and functional model of the heart including structural information from magnetic resonance imaging (MRI) and functional information from positron emission tomography (PET) and magnetocardiography (MCG). The method uses model-based co-registration of MR and PET images and marker-based registration for MRI and MCG. Model-based segmentation of MR anatomical images results in an individualized 3-D biventricular model of the heart including functional parameters from PET and MCG in an easily interpretable 3-D form.

MRI with cardiac pacing devices - safety in clinical practice.

OBJECTIVES: The aim of this study was to introduce a single centre "real life" experience of performing MRI examinations in clinical practice on patients with cardiac pacemaker systems. Additionally, we aimed to evaluate the safety of using a dedicated safety protocol for these patients. MATERIALS AND METHODS: We used a 1.5T MRI scanner to conduct 68 MRI scans of different body regions in patients with pacing systems. Of the cardiac devices, 32% were MR-conditional, whereas the remaining 68% were MR-unsafe. We recorded the functional parameters of the devices prior, immediately after, and approximately one month after the MRI scanning, and compared the device parameters to the baseline values. RESULTS: All MRI examinations were completed safely, and each device could be interrogated normally following the MRI. We observed no changes in the programmed parameters of the devices. For most of the participants, the distributions of the immediate and one-month changes in the device parameters were within 20% of the baseline values, although some changes approached clinically important thresholds. Furthermore, we observed no differences in the variable changes between MR-conditional and MR-unsafe pacing systems, or between scans of the thorax area and other scanned areas. CONCLUSION: MRI in patients with MR-conditional pacing systems and selected MR-unsafe systems could be performed safely under strict conditions in this study.

Phantom-based quality assurance measurements in B-mode ultrasound.

BACKGROUND: Recommended phantom-based quality assurance measurements in B-mode ultrasound (US) may be tedious. For the purpose of cost-effective US quality assurance it is important to evaluate measurements that effectively reflect the quality of US scanner. PURPOSE: To find out which recommended phantom-based quality assurance measurements are effective in detecting dead or weak transducer elements or channels in US scanners when visual image analysis and manual measurements are used. MATERIAL AND METHODS: Altogether 66 transducers from 33 US scanners were measured using a general purpose phantom and a transducer tester. The measurements were divided into two groups. Group I consisted of phantom-based uniformity measurement, imaging the air with a clean transducer (air image) and measuring the transducer with the transducer tester, and group II of phantom-based measurements of depth of penetration, beam profile, near field, axial and lateral resolution, and vertical and horizontal distance accuracy. The group II measurements were compared to group I measurements. RESULTS: With group I measurements, the results with 20% of the transducers were found defective. With 35% of the transducers the results were considered defective in group II measurements. Concurrent flaws in both groups were found with 11% of the transducers. CONCLUSION: Phantom-based measurements of depth of penetration, beam profile, near field, axial and lateral resolution, and vertical and horizontal distance accuracy did not consistently detect dead or weak transducer elements or channels in US scanners.

Quality assurance in diagnostic ultrasound.

OBJECTIVE: To setup a practical ultrasound quality assurance protocol in a large radiological center, results from transducer tests, phantom measurements and visual checks for physical faults were compared. MATERIALS AND METHODS: Altogether 151 transducers from 54 ultrasound scanners, from seven different manufacturers, were tested with a Sonora FirstCall aPerio™ system (Sonora Medical Systems, Inc., Longmont, CO, USA) to detect non-functional elements. Phantom measurements using a CIRS General Purpose Phantom Model 040 (CIRS Tissue Simulation and Phantom Technology, VA, USA) were available for 135 transducers. The transducers and scanners were also checked visually for physical faults. The percentages of defective findings in these tests were computed. RESULTS: Defective results in the FirstCall tests were found in 17% of the 151 transducers, and in 16% of the 135 transducers. Defective image quality resulted with 15% of the transducers, and 25% of the transducers had a physical flaw. In 16% of the scanners, a physical fault elsewhere than in the transducer was found. Seven percent of the transducers had a concurrent defective result both in the FirstCall test and in the phantom measurements, 8% in the FirstCall test and in the visual check, 4% in the phantom measurements and in the visual check, and 2% in all three tests. CONCLUSION: The tested methods produced partly complementary results and seemed all to be necessary. Thus a quality assurance protocol is forced to be rather labored, and therefore the benefits and costs must be closely followed.