Fast 3D fMRI acquisition with high spatial resolutions over a reduced FOV.

PURPOSE: To develop and demonstrate a fast 3D fMRI acquisition technique with high spatial resolution over a reduced FOV, named k-t 3D reduced FOV imaging (3D-rFOVI). METHODS: Based on 3D gradient-echo EPI, k-t 3D-rFOVI used a 2D RF pulse to reduce the FOV in the in-plane phase-encoding direction, boosting spatial resolution without increasing echo train length. For image acceleration, full sampling was applied in the central k-space region along the through-slab direction (kz) for all time frames, while randomized undersampling was used in outer kz regions at different time frames. Images were acquired at 3T and reconstructed using a method based on partial separability. fMRI detection sensitivity of k-t 3D-rFOVI was quantitively analyzed with simulation data. Human visual fMRI experiments were performed to evaluate k-t 3D-rFOVI and compare it with a commercial multiband EPI sequence. RESULTS: The simulation data showed that k-t 3D-rFOVI can detect 100% of fMRI activations with an acceleration factor (R) of 2 and ˜80% with R = 6. In the human fMRI data acquired with 1.5-mm spatial resolution and 800-ms volume TR (TRvol), k-t 3D-rFOVI with R = 4 detected 46% more activated voxels in the visual cortex than the multiband EPI. Additional fMRI experiments showed that k-t 3D-rFOVI can achieve TRvol of 480 ms with R = 6, while reliably detecting visual activation. CONCLUSIONS: k-t 3D-rFOVI can simultaneously achieve a high spatial resolution (1.5-mm isotropically) and short TRvol (480-ms) at 3T. It offers a robust acquisition technique for fast fMRI studies over a focused brain volume.

Simultaneous perfusion, diffusion, T2 *, and T1 mapping with MR fingerprinting.

PURPOSE: Quantitative mapping of brain perfusion, diffusion, T2 *, and T1 has important applications in cerebrovascular diseases. At present, these sequences are performed separately. This study aims to develop a novel MRI technique to simultaneously estimate these parameters. METHODS: This sequence to measure perfusion, diffusion, T2 *, and T1 mapping with magnetic resonance fingerprinting (MRF) was based on a previously reported MRF-arterial spin labeling (ASL) sequence, but the acquisition module was modified to include different TEs and presence/absence of bipolar diffusion-weighting gradients. We compared parameters derived from the proposed method to those derived from reference methods (i.e., separate sequences of MRF-ASL, conventional spin-echo DWI, and T2 * mapping). Test-retest repeatability and initial clinical application in two patients with stroke were evaluated. RESULTS: The scan time of our proposed method was 24% shorter than the sum of the reference methods. Parametric maps obtained from the proposed method revealed excellent image quality. Their quantitative values were strongly correlated with those from reference methods and were generally in agreement with values reported in the literature. Repeatability assessment revealed that ADC, T2 *, T1 , and B1 + estimation was highly reliable, with voxelwise coefficient of variation (CoV) <5%. The CoV for arterial transit time and cerebral blood flow was 16% ± 3% and 25% ± 9%, respectively. The results from the two patients with stroke demonstrated that parametric maps derived from the proposed method can detect both ischemic and hemorrhagic stroke. CONCLUSION: The proposed method is a promising technique for multi-parametric mapping and has potential use in patients with stroke.

Multi-readout DWI with a reduced FOV for studying the coupling between diffusion and T 2 * relaxation in the prostate.

PURPOSE: To develop a DWI sequence with multiple readout echo-trains in a single shot (multi-readout DWI) over a reduced FOV, and to demonstrate its ability to achieve high data acquisition efficiency in the study of coupling between diffusion and relaxation in the human prostate. METHODS: The proposed multi-readout DWI sequence plays out multiple EPI readout echo-trains after a Stejskal-Tanner diffusion preparation module. Each EPI readout echo-train corresponded to a distinct effective TE. To maintain a high spatial resolution with a relatively short echo-train for each readout, a 2D RF pulse was used to limit the FOV. Experiments were performed on the prostate of six healthy subjects to acquire a set of images with three b values (0, 500, and 1000 s/mm2 ) and three TEs (63.0, 78.8, and 94.6 ms), producing three ADC maps at different TEs and three T 2 * $$ {T}_2^{\ast } $$ maps at different b values. RESULTS: Multi-readout DWI enabled a threefold acceleration without compromising the spatial resolution when compared with a conventional single-readout sequence. Images with three b values and three TEs were obtained in 3 min 40 s with an adequate SNR (≥ 26.9). The ADC values (1.45 ± 0.13, 1.52 ± 0.14, and 1.58 ± 0.15  µm 2 / ms $$ {\upmu \mathrm{m}}^2/\mathrm{ms} $$ ; P < 0.01) exhibited an increasing trend as TEs increased (63.0 ms, 78.8 ms, and 94.6 ms), whereas T 2 * $$ {T}_2^{\ast } $$ values (74.78 ± 13.21, 63.21 ± 7.84, and 56.61 ± 5.05 ms; P < 0.01) decreases as the b values increased (0, 500, and 1000 s/mm2 ). CONCLUSION: The multi-readout DWI sequence over a reduced FOV provides a time-efficient technique to study the coupling between diffusion and relaxation times.

Time-dependent diffusion MRI using multiple stimulated echoes.

PURPOSE: To develop a time-efficient pulse sequence that acquires multiple diffusion-weighted images with distinct diffusion times in a single shot by using multiple stimulated echoes (mSTE) with variable flip angles (VFA). METHODS: The proposed diffusion-weighted mSTE with VFA (DW-mSTE-VFA) sequence begins with two 90° RF pulses that straddle a diffusion gradient lobe (GD ) to excite and restore one half of the magnetization into the longitudinal axis. The restored longitudinal magnetization was successively re-excited by a series of RF pulses with VFA, each followed by another GD , to generate a set of stimulated echoes. Each of the multiple stimulated echoes was acquired with an EPI echo train. As such, the train of multiple stimulated echoes produced a set of diffusion-weighted images with varying diffusion times in a single shot. This technique was experimentally demonstrated on a diffusion phantom, a fruit, and healthy human brain and prostate at 3 T. RESULTS: In the phantom experiment, the mean ADC measured at different diffusion times using DW-mSTE-VFA were highly consistent (r = 0.999) with those from a commercial spin-echo diffusion-weighted EPI sequence. In the fruit and brain experiments, DW-mSTE-VFA exhibited similar diffusion-time dependence to a standard diffusion-weighted stimulated echo sequence. The ADC showed significant time dependence in the human brain (p = 0.003 in both white matter and gray matter) and prostate tissues (p = 0.003 in both peripheral zone and central gland). CONCLUSION: DW-mSTE-VFA offers a time-efficient tool for investigating the diffusion-time dependency in diffusion MRI studies.

Comparison of uniform-density, variable-density, and dual-density spiral samplings for multi-shot DWI.

PURPOSE: To compare the performances of uniform-density spiral (UDS), variable-density spiral (VDS), and dual-density spiral (DDS) samplings in multi-shot diffusion imaging, and determine a sampling strategy that balances reliability of shot navigator and overall DWI image quality. THEORY AND METHODS: UDS, VDS, and DDS trajectories were implemented to achieve four-shot diffusion-weighted spiral imaging. First, the static B0 off-resonance effects in UDS, VDS, and DDS acquisitions were analyzed based on a signal model. Then, in vivo experiments were performed to verify the theoretical analyses, and fractional anisotropy (FA) fitting residuals were used to quantitatively assess the quality of spiral diffusion data for tensor estimation. Finally, the SNR performances and g-factor behavior of the three spiral samplings were evaluated using a Monte Carlo-based pseudo multiple replica method. RESULTS: Among the three spiral trajectories with the same readout duration, UDS sampling exhibited the least off-resonance artifacts. This was most evident when the static B0 off-resonance effect was severe. The UDS diffusion images had higher anatomical fidelity and lower FA fitting residuals than the other two counterparts. Furthermore, the four-shot UDS acquisition achieved the best SNR performance in diffusion imaging with 12.11% and 40.85% improvements over the VDS and DDS acquisitions with the same readout duration, respectively. CONCLUSION: UDS sampling is an efficient spiral acquisition scheme for high-resolution diffusion imaging with reliable navigator information. It provides superior off-resonance performance and SNR efficiency over the VDS and DDS samplings for the tested scenarios.

Three-dimensional echo-shifted EPI with simultaneous blip-up and blip-down acquisitions for correcting geometric distortion.

PURPOSE: EPI with blip-up/down acquisition (BUDA) can provide high-quality images with minimal distortions by using two readout trains with opposing phase-encoding gradients. Because of the need for two separate acquisitions, BUDA doubles the scan time and degrades the temporal resolution when compared to single-shot EPI, presenting a major challenge for many applications, particularly fMRI. This study aims at overcoming this challenge by developing an echo-shifted EPI BUDA (esEPI-BUDA) technique to acquire both blip-up and blip-down datasets in a single shot. METHODS: A 3D esEPI-BUDA pulse sequence was designed by using an echo-shifting strategy to produce two EPI readout trains. These readout trains produced a pair of k-space datasets whose k-space trajectories were interleaved with opposite phase-encoding gradient directions. The two k-space datasets were separately reconstructed using a 3D SENSE algorithm, from which time-resolved B0 -field maps were derived using TOPUP in FSL and then input into a forward model of joint parallel imaging reconstruction to correct for geometric distortion. In addition, Hankel structured low-rank constraint was incorporated into the reconstruction framework to improve image quality by mitigating the phase errors between the two interleaved k-space datasets. RESULTS: The 3D esEPI-BUDA technique was demonstrated in a phantom and an fMRI study on healthy human subjects. Geometric distortions were effectively corrected in both phantom and human brain images. In the fMRI study, the visual activation volumes and their BOLD responses were comparable to those from conventional 3D echo-planar images. CONCLUSION: The improved imaging efficiency and dynamic distortion correction capability afforded by 3D esEPI-BUDA are expected to benefit many EPI applications.

The Relationship Between Sleep and Brain Function in Older Adults With Chronic Kidney Disease and Self-Identified Cognitive Impairment.

Older adults with chronic kidney disease (CKD) are at risk for cognitive impairment and sleep disturbances. The purpose of the current study was to investigate the relationship between sleep and brain structure/function in older adults with CKD and self-identified cognitive impairment. The sample (N = 37) had a mean age of 68 years (SD = 4.9 years), estimated glomerular filtration rate of 43.7 mL/min/1.73m2 (SD = 10.98), median sleep time of 7.4 hours, and was 70% female. Sleeping <7.4 hours, compared to ≥7.4 hours, was associated with better attention/information processing (ß = 11.46, 95% confidence interval [CI] [3.85, 19.06]) and better learning/memory (ß = 2.06, 95% CI [0.37, 3.75]). Better sleep efficiency was associated with better global cerebral blood flow (ß = 3.30, 95% CI [0.65, 5.95]). Longer awake length after sleep onset was associated with worse fractional anisotropy of the cingulum (ß = -0.01, 95% CI [-0.02, -0.003]). Sleep duration and continuity may be related to brain function in older adults with CKD and self-identified cognitive impairment. [Journal of Gerontological Nursing, 49(7), 31-39.].

Gradient-echo-train-based sub-millisecond periodic event encoded dynamic imaging with random (k, t)-space undersampling: k-t get-SPEEDI.

PURPOSE: The gradient-echo-train-based Sub-millisecond Periodic Event Encoded Dynamic Imaging (get-SPEEDI) technique provides ultrahigh temporal resolutions (∼0.6 ms) for detecting rapid physiological activities, but its practical adoption can be hampered by long scan times. This study aimed at developing a more efficient variant of get-SPEEDI for reducing the scan time without degrading temporal resolution or image quality. METHODS: The proposed pulse sequence, named k-t get-SPEEDI, accelerated get-SPEEDI acquisition by undersampling the k-space phase-encoding lines semi-randomly. At each time frame, k-space was fully sampled in the central region whereas randomly undersampled in the outer regions. A time-series of images was reconstructed using an algorithm based on the joint partial separability and sparsity constraints. To demonstrate the performance of k-t get-SPEEDI, images of human aortic valve opening and closing were acquired with 0.6-ms temporal resolution and compared with those from conventional get-SPEEDI. RESULTS: k-t get-SPEEDI achieved a 2-fold scan time reduction over the conventional get-SPEEDI (from ∼6 to ∼3 min), while achieving comparable SNRs and contrast-to-noise ratio (CNRs) for visualizing the dynamic process of aortic valve: SNR/CNR ≈$$ \approx $$ 70/38 vs. 73/39 in the k-t and conventional get-SPEEDI scans, respectively. The time courses of aortic valve area also matched well between these two sequences with a correlation coefficient of 0.86. CONCLUSIONS: The k-t get-SPEEDI pulse sequence was able to half the scan time without compromising the image quality and ultrahigh temporal resolution. Additional scan time reduction may also be possible, facilitating in vivo adoptions of SPEEDI techniques.

Three-dimensional reduced field-of-view imaging (3D-rFOVI).

PURPOSE: This study aimed at developing a 3D reduced field-of-view imaging (3D-rFOVI) technique using a 2D radiofrequency (RF) pulse, and demonstrating its ability to achieve isotropic high spatial resolution and reduced image distortion in echo planar imaging (EPI). METHODS: The proposed 3D-rFOVI technique takes advantage of a 2D RF pulse to excite a slab along the conventional slice-selection direction (i.e., z-direction) while limiting the spatial extent along the phase-encoded direction (i.e., y-direction) within the slab. The slab is phase-encoded in both through-slab and in-slab phase-encoded directions. The 3D-rFOVI technique was implemented at 3T in gradient-echo and spin-echo EPI pulse sequences for functional MRI (fMRI) and diffusion-weighted imaging (DWI), respectively. 3D-rFOVI experiments were performed on a phantom and human brain to illustrate image distortion reduction, as well as isotropic high spatial resolution, in comparison with 3D full-FOV imaging. RESULTS: In both the phantom and the human brain, image voxel dislocation was substantially reduced by 3D-rFOVI when compared with full-FOV imaging. In the fMRI experiment with visual stimulation, 3D isotropic spatial resolution of (2 × 2 × 2 mm3 ) was achieved with an adequate signal-to-noise ratio (81.5) and blood oxygen level-dependent (BOLD) contrast (2.5%). In the DWI experiment, diffusion-weighted brain images with an isotropic resolution of (1 × 1 × 1 mm3 ) was obtained without appreciable image distortion. CONCLUSION: This study indicates that 3D-rFOVI is a viable approach to 3D neuroimaging over a zoomed region.

In-plane simultaneous multisegment imaging using a 2D RF pulse.

PURPOSE: To develop an in-plane simultaneous multisegment (IP-SMS) imaging technique using a 2D-RF pulse and to demonstrate its ability to achieve high spatial resolution in EPI while reducing image distortion. METHODS: The proposed IP-SMS technique takes advantage of periodic replicates of the excitation profile of a 2D-RF pulse to simultaneously excite multiple segments within a slice. These segments were acquired over a reduced FOV and separated using a joint GRAPPA reconstruction by leveraging virtual coils that combined the physical coil sensitivity and 2D-RF pulse spatial response. Two excitations were used with complementary spatial response profiles to adequately cover a full FOV, producing a full-FOV image that had the benefits of reduced FOV with high spatial resolution and reduced distortion. The IP-SMS technique was implemented in a diffusion-weighted single-shot EPI sequence. Experimental demonstrations were performed on a phantom and healthy human brain. RESULTS: In the phantom experiment, IP-SMS enabled a four-fold acceleration using an eight-channel coil without causing residual aliasing artifacts. In the human brain experiment, diffusion-weighted images with high in-plane resolution (1 × 1 mm2 ) and substantially reduced image distortion were obtained in all imaging planes in comparison with a commercial diffusion-weighted EPI sequence. The capability of IP-SMS for contiguous whole-brain coverage was also demonstrated. CONCLUSION: The proposed IP-SMS technique can realize the benefits of reduced-FOV imaging while achieving a full-FOV coverage with good image quality and time efficiency.

Evaluation of a fractional-order calculus diffusion model and bi-parametric VI-RADS for staging and grading bladder urothelial carcinoma.

OBJECTIVES: To evaluate the feasibility of high b-value diffusion-weighted imaging (DWI) for distinguishing non-muscle-invasive bladder cancer (NMIBC) from muscle-invasive bladder cancer (MIBC) and low- from high-grade bladder urothelial carcinoma using a fractional-order calculus (FROC) model as well as a combination of FROC DWI and bi-parametric Vesical Imaging-Reporting and Data System (VI-RADS). METHODS: Fifty-eight participants with bladder urothelial carcinoma were included in this IRB-approved prospective study. Diffusion-weighted images, acquired with 16 b-values (0-3600 s/mm2), were analyzed using the FROC model. Three FROC parameters, D, ß, and µ, were used for delineating NMIBC from MIBC and for tumor grading. A receiver operating characteristic (ROC) analysis was performed based on the individual FROC parameters and their combinations, followed by comparisons with apparent diffusion coefficient (ADC) and bi-parametric VI-RADS based on T2-weighted images and DWI. RESULTS: D and µ were significantly lower in the MIBC group than in the NMIBC group (p = 0.001 for each), and D, ß, and µ all exhibited significantly lower values in the high- than in the low-grade tumors (p ≤ 0.011). The combination of D, ß, and µ produced the highest specificity (85%), accuracy (78%), and the area under the ROC curve (AUC, 0.782) for distinguishing NMIBC and MIBC, and the best sensitivity (89%), specificity (86%), accuracy (88%), and AUC (0.892) for tumor grading, all of which outperformed the ADC. The combination of FROC parameters with bi-parametric VI-RADS improved the AUC from 0.859 to 0.931. CONCLUSIONS: High b-value DWI with a FROC model is useful in distinguishing NMIBC from MIBC and grading bladder tumors. KEY POINTS: • Diffusion parameters derived from a FROC diffusion model may differentiate NMIBC from MIBC and low- from high-grade bladder urothelial carcinomas. • Under the condition of a moderate sample size, higher AUCs were achieved by the FROC parameters D (0.842) and µ (0.857) than ADC (0.804) for bladder tumor grading with p ≤ 0.046. • The combination of the three diffusion parameters from the FROC model can improve the specificity over ADC (85% versus 67%, p = 0.031) for distinguishing NMIBC and MIBC and enhance the performance of bi-parametric VI-RADS.

Exercise Training and Cognitive Function in Kidney Disease: Protocol for a Pilot Randomized Controlled Trial.

BACKGROUND: Chronic kidney disease (CKD) is extremely common in older adults and is associated with cognitive impairment. It is hypothesized that accelerated cognitive decline in CKD results from a vascular dysfunction-induced reduction in the integrity of the brain white matter. OBJECTIVE: The aim of this study was to describe the protocol for a study to evaluate whether exercise training provides a cerebroprotective effect by improving cerebrovascular health. METHODS: This is a randomized controlled trial investigating feasibility and effect size. RESULTS: Participants will be randomized to either a 24-week, home-based, walking program or a usual care group. Participants will undergo evaluation of cognitive function, brain structure via magnetic reasoning imaging, physical function, physical activity, and vascular function. The primary outcome is change in cognitive function. DISCUSSION: The findings of this study will help determine whether exercise training influences cognitive function during a therapeutic window in the disease process of cognitive impairment in older adults with CKD. CONCLUSION: This protocol describes a study to evaluate cognition and brain structure following a home-based exercise program to an at-risk population.

Magnetic resonance imaging with submillisecond temporal resolution.

PURPOSE: To demonstrate an MRI technique-Submillisecond Periodic Event Encoded Dynamic Imaging (SPEEDI)-for capturing cyclic dynamic events with submillisecond temporal resolution. METHODS: The SPEEDI technique is based on an FID or an echo signal in which each time point in the signal is used to sample a distinct k-space raster, followed by repeated FIDs or echoes to produce the remaining k-space data in each k-space raster. All acquisitions are synchronized with a cyclic event, resulting in a set of time-resolved images of the cyclic event with a temporal resolution determined by the dwell time. In SPEEDI, spatial encoding is accomplished by phase encoding. The SPEEDI technique was demonstrated in two experiments at 3 T to (1) visualize fast-changing electric currents that mimicked the waveform of an action potential, and (2) characterize rapidly decaying eddy currents in an MRI system, with a temporal resolution of 0.2 ms and 0.4 ms, respectively. In both experiments, compressed sensing was incorporated to reduce the scan times. Phase difference maps related to the dynamics of electric currents or eddy currents were then obtained. RESULTS: In the first experiment, time-resolved phase maps resulting from the action potential-mimicking current waveform were successfully obtained and agreed well with theoretical calculations (normalized RMS error = 0.07). In the second experiment, spatially resolved eddy current phase maps revealed time constants (27.1 ± 0.2 ms, 41.1 ± 3.5 ms, and 34.8 ± 0.7 ms) that matched well with those obtained from an established method using point sources (26.4 ms, 41.2 ms and 34.8 ms). For both experiments, phase maps from fully sampled and compressed-sensing-accelerated k-space data exhibited a high structural similarity (> 0.8) despite a two-fold to three-fold acceleration. CONCLUSIONS: We have illustrated that SPEEDI can provide submillisecond temporal resolution. This capability will likely lead to future exploration of ultrafast, cyclic biomedical processes using MRI.

MRI with sub-millisecond temporal resolution over a reduced field of view.

PURPOSE: To demonstrate an MRI pulse sequence-Sub-millisecond Periodic Event Encoded Dynamic Imaging with a reduced field of view (or rFOV-SPEEDI)-for decreasing the scan times while achieving sub-millisecond temporal resolution. METHODS: rFOV-SPEEDI was based on a variation of SPEEDI, known as get-SPEEDI, which used each echo in an echo-train to sample a distinct k-space raster by synchronizing with a cyclic event. This can produce a set of time-resolved images of the cyclic event with a temporal resolution determined by the echo spacing (typically < 1 ms). rFOV-SPEEDI incorporated a 2D radiofrequency (RF) pulse into get-SPEEDI to limit the field of view (FOV), leading to reduction in phase-encoding steps and subsequently decreased scan times without compromising the spatial resolution. Two experiments were performed at 3T to illustrate rFOV-SPEEDI's capability of capturing fast-changing electric currents in a phantom and the rapid opening and closing of aortic valve in human subjects over reduced FOVs. The results were compared with those from full FOV get-SPEEDI. RESULTS: In the first experiment, the rapidly varying currents (50-200 Hz) were successfully captured with a temporal resolution of 0.8 ms, and agreed well with the applied currents. In the second experiment, the rapid opening and closing processes of aortic valve were clearly visualized with a temporal resolution of 0.6 ms over a reduced FOV (12 × 12 cm2 ). In both experiments, the acquisition times of rFOV-SPEEDI were decreased by 33%-50% relative to full FOV get-SPEEDI acquisitions and the spatial resolution was maintained. CONCLUSION: Reducing the FOV is a viable approach to shortening the scan times in SPEEDI, which is expected to help stimulate SPEEDI applications for studying ultrafast, cyclic physiological and biophysical processes over a focal region.

Quartile histogram assessment of glioma malignancy using high b-value diffusion MRI with a continuous-time random-walk model.

The purpose of this study is to investigate the feasibility of using a continuous-time random-walk (CTRW) diffusion model, together with a quartile histogram analysis, for assessing glioma malignancy by probing tissue heterogeneity as well as cellularity. In this prospective study, 91 patients (40 females, 51 males) with histopathologically proven gliomas underwent MRI at 3 T. The cohort included 42 grade II (GrII), 19 grade III (GrIII) and 29 grade IV (GrIV) gliomas. Echo-planar diffusion-weighted imaging was conducted using 17 b-values (0-4000 s/mm2 ). Three CTRW model parameters, including an anomalous diffusion coefficient Dm , and two parameters related to temporal and spatial diffusion heterogeneity α and ß, respectively, were obtained. The mean parameter values within the tumor regions of interest (ROIs) were computed by utilizing the first quartile of the histograms as well as the full ROI for comparison. A Bonferroni-Holm-corrected Mann-Whitney U-test was used for the group comparisons. Individual and combinations of the CTRW parameters were evaluated for the characterization of gliomas with a receiver operating characteristic analysis. All first-quartile mean CTRW parameters yielded significant differences (p-values < 0.05) between pair-wise comparisons of GrII (Dm : 1.14 ± 0.37 µm2 /ms; α: 0.904 ± 0.03, ß: 0.913 ± 0.06), GrIII (Dm : 0.88 ± 0.21 µm2 /ms; α: 0.888 ± 0.01, ß: 0.857 ± 0.06) and GrIV gliomas (Dm : 0.73 ± 0.22 µm2 /ms; α: 0.878 ± 0.01; ß: 0.791 ± 0.07). The highest sensitivity, specificity, accuracy and area-under-the-curve of using the combinations of the first-quartile parameters were 84.2%, 78.5%, 75.4% and 0.76 for GrII and GrIII classification; 86.2%, 89.4%, 75% and 0.76 for GrIII and GrIV classification; and 86.2%, 85.7%, 84.5% and 0.90 for GrII and GrIV classification, respectively. Quartile-based analysis produced higher accuracy and area-under-the-curve than the full ROI-based analysis in all classifications. The CTRW diffusion model, together with a quartile-based histogram analysis, offers a new way for probing tumor structural heterogeneity at a subvoxel level, and has potential for in vivo assessment of glioma malignancy to complement histopathology.

New imaging features of tuberous sclerosis complex: A 7 T MRI study.

Few in vivo studies have focused on the perivenous association of tubers and iron deposition in the deep gray nuclei in patients with tuberous sclerosis complex (TSC). We investigated this possible relationship in TSC patients using susceptibility weighted imaging (SWI) at 7 T. SWI with high spatial resolution and enhanced sensitivity was performed on 11 TSC patients in comparison with 15 age- and sex-matched healthy controls. The relationship between tubers and veins was evaluated. In addition, the phase images of SWI were processed to produce local field shift (LFS) maps to quantify iron deposition. The mean LFS in the deep gray nuclei was compared between the TSC patients and healthy controls using a covariance analysis. Venous involvement was observed in 211 of the 231 (91.3%) cortical tubers on SWI. The slender tubers often oriented around the long axis of penetrating veins, possibly because cortical tubers typically developed and/or migrated along venous vasculatures. A significant difference in LFS of the thalamus was detected between the TSC patients and healthy controls (3.36 ± 0.50 versus 3.01 ± 0.39, p < 0.01). The new in vivo imaging features observed at 7 T provide valuable insights into the possible venous association of TSC lesions and iron accumulation in the deep gray nuclei. Our results may lead to a better understanding of the pathological changes involved in TSC under in vivo conditions.

Condensation Artifact.

During the ongoing COVID-19 pandemic, an artifact with hyperintense signal was observed on the brain images of a number of patients or research subjects, particularly those with heavy body weight and/or increased respiratory rate. The artifact was primarily seen on 3D or 2D sagittal or coronal T2-weighted images, although it occasionally also appeared in the axial plane. It manifested as a bright spot or a cluster of bright spots at similar locations, superior or lateral superior to the skull. This artifact was found to be caused by condensed water droplet(s) in the head coil as a consequence of the altered moisture flow pattern associated with each exhalation due to the mask on the patient. We call this artifact condensation artifact. Several strategies have been proposed to prevent or resolve the artifact. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 1.

Visualization of Human Aortic Valve Dynamics Using Magnetic Resonance Imaging with Sub-Millisecond Temporal Resolution.

BACKGROUND: Visualization of aortic valve dynamics is important in diagnosing valvular diseases but is challenging to perform with magnetic resonance imaging (MRI) due to the limited temporal resolution. PURPOSE: To develop an MRI technique with sub-millisecond temporal resolution and demonstrate its application in visualizing rapid aortic valve opening and closing in human subjects in comparison with echocardiography and conventional MRI techniques. STUDY TYPE: Prospective. POPULATION: Twelve healthy subjects. FIELD STRENGTH/SEQUENCE: 3 T; gradient-echo-train-based sub-millisecond periodic event encoded imaging (get-SPEEDI) and balanced steady-state free precession (bSSFP). ASSESSMENT: Images were acquired using get-SPEEDI with a temporal resolution of 0.6 msec. get-SPEEDI was triggered by an electrocardiogram so that each echo in the gradient echo train corresponded to an image at a specific time point, providing a time-resolved characterization of aortic valve dynamics. For comparison, bSSFP was also employed with 12 msec and 24 msec temporal resolutions, respectively. The durations of the aortic valve rapid opening (Tro ), rapid closing (Trc ), and the maximal aortic valve area (AVA) normalized to height were measured with all three temporal resolutions. M-mode echocardiograms with a temporal resolution of 0.8 msec were obtained for further comparison. STATISTICAL TEST: Parameters were compared between the three sequences, together with the echocardiography results, with a Mann-Whitney U test. RESULTS: Significantly shorter Tro (mean ± SD: 27.5 ± 6.7 msec) and Trc (43.8 ± 11.6 msec) and larger maximal AVA/height (2.01 ± 0.29 cm2 /m) were measured with get-SPEEDI compared to either bSSFP sequence (Tro of 56.3 ± 18.8 and 63.8 ± 20.2 msec; Trc of 68.2 ± 16.6 and 72.8 ± 18.2 msec; maximal AVA/height of 1.63 ± 0.28 and 1.65 ± 0.32 cm2 /m for 12 msec and 24 msec temporal resolutions, respectively, P < 0.05). In addition, the get-SPEEDI results were more consistent with those measured using echocardiography, especially for Tro (29.0 ± 4.1 msec, P = 0.79) and Trc (41.6 ± 4.3 msec, P = 0.16). DATA CONCLUSION: get-SPEEDI allows for visualization of human aortic valve dynamics and provided values closer to those measured using echocardiography than the bSSFP sequences. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 1.

In vivo assessment of Lauren classification for gastric adenocarcinoma using diffusion MRI with a fractional order calculus model.

OBJECTIVES: To evaluate the performance of a fractional order calculus (FROC) diffusion model for imaging-based assessment of Lauren classification in gastric adenocarcinoma. METHODS: In this study, 43 patients (15 females, 28 males) with gastric adenocarcinoma underwent MRI at 1.5 T. According to pathology-based Lauren classification, 10 patients had diffuse-type, 20 had intestinal-type, and 13 had mixed-type lesions. The diffuse and mixed types were combined as diffuse-and-mixed type to be differentiated from the intestinal type using diffusion MRI. Diffusion-weighted images were acquired by using eleven b-values (0-2000 s/mm2). Three FROC model parameters comprising diffusion coefficient D, intravoxel diffusion heterogeneity ß, and a microstructural quantity µ, together with a conventional apparent diffusion coefficient (ADC), were estimated. The mean parameter values in the tumour were computed by using a percentile histogram analysis. Individual or linear combinations of the mean parameters in the tumour were used to differentiate the diffuse-and-mixed type from the intestinal type using descriptive statistics and receiver operating characteristic (ROC) analyses. RESULTS: Significant differences were observed between diffuse-and-mixed-type and intestinal-type lesions in D (0.99 ± 0.20 µm2/ms vs. 1.11 ± 0.23 µm2/ms; p = 0.036), ß (0.37 ± 0.08 vs. 0.43 ± 0.11; p = 0.043), µ (7.92 ± 2.79 µm vs. 9.87 ± 1.52 µm; p = 0.038), and ADC (0.81 ± 0.34 µm2/ms vs. 0.96 ± 0.19 µm2/ms; p = 0.033). Among the individual parameters, µ produced the largest area under the ROC curve (0.739). The combinations of (D, ß, µ) and (ß and µ) produced the best overall performance with a sensitivity of 0.739, specificity of 0.750, accuracy of 0.744, and area under the curve of 0.793 (95% confidence interval: 0.657-0.929). CONCLUSION: Diffusion MRI with the FROC model holds promise for non-invasive assessment of Lauren classification for gastric adenocarcinoma. KEY POINTS: • High b-value diffusion MRI with a FROC model that is sensitive to tissue microstructures can differentiate the diffuse-and-mixed type from intestinal type of gastric adenocarcinoma. • The combination of FROC parameters produced the best result for distinguishing the diffuse-and-mixed type from the intestinal type with an area under the receiver operating characteristic curve of 0.793. • The FROC model parameters, individually or conjointly, hold promise for repeated, non-invasive evaluations of gastric adenocarcinoma at various time points throughout disease progression or regression to complement conventional Lauren classification.

Intravoxel Incoherent Motion Diffusion-weighted MRI of Infiltrated Marrow for Predicting Overall Survival in Newly Diagnosed Acute Myeloid Leukemia.

Background Acute myeloid leukemia (AML) features relatively low overall survival (OS). Intravoxel incoherent motion (IVIM) diffusion-weighted MRI separates tissue microcapillary perfusion and diffusivity and may have potential for helping to assess prognosis in infiltrated marrow disease apart from solid tumor. Thus, a study of overall survival would contribute to clarifying the value of IVIM for assessing long-term prognosis in AML. Purpose To determine whether the IVIM-derived parameters of infiltrated bone marrow may be associated with OS in newly diagnosed AML. Materials and Methods This prospective study enrolled participants with newly diagnosed AML between July 2014 to March 2016 consecutively. Participants underwent MRI of the lumbar spine by using an IVIM sequence. Participant clinical characteristics and OS were collected. The median of follow-up period was 20 months (range, 1-56 months). The IVIM parameters (pseudoperfusion fraction, f; diffusion coefficient, D; and pseudodiffusion coefficient, D*) were obtained. A nonparametric log-rank test was used to identify the threshold of IVIM parameters for OS. Univariable Kaplan-Meier and multivariable Cox proportional hazards regression analyses were performed to investigate prognostic significance of possible indicators. Results Fifty-three participants (mean age, 42 years ± 17; 30 men) were evaluated. Nonparametric log-rank test results showed that the thresholds of f and D values for OS were 31.0% and 0.2 × 10-3 mm2/sec, respectively. Univariable analyses indicated that high f value (>31.0%) and low D value (≤0.2 × 10-3 mm2/sec) were associated with shorter OS (P = .003 and .01, respectively). An f value greater than 31.0% (hazard ratio, 2.4; 95% confidence interval: 1.0, 5.6; P = .046) was associated with OS, independent of clinical confounders (age, karyotype, and white blood cell counts) in a multivariable analysis. Conclusion Pseudoperfusion fraction and diffusion coefficient from intravoxel incoherent motion diffusion-weighted MRI may be viable prognosis predictors of newly diagnosed acute myeloid leukemia. © RSNA, 2020.