3D isotropic resolution diffusion-prepared magnitude-stabilized bSSFP imaging with high geometric fidelity at 1.5 Tesla.

INTRODUCTION: MRI has been increasingly used in radiation therapy to facilitate tumor and organ delineation and assess treatment response. Diffusion MRI can provide cellularity information and may enable functional-based treatment planning and adaptation. However, strong distortion associated with the conventional diffusion-weighted single-shot echo-planar imaging (DW-ssEPI) sequence is problematic for accurate target delineation. The goal of this work is to propose a 3D diffusion sequence with minimal distortion for radiation therapy applications. METHODS: A 3D diffusion-prepared magnitude-stabilized balanced steady-state free precession sequence (DP-MS-bSSFP) was developed. A 2D navigator was acquired during the linear catalyzation stage of the bSSFP readout to estimate the phase, which was then used in a plane-by-plane low-rank constrained reconstruction to correct the shot-to-shot k-space inconsistency. A diffusion phantom was scanned to evaluate and compare the geometric reliability and apparent diffusion coefficient (ADC) accuracy with the conventional DW-ssEPI. Eight landmarks were selected on each slice of the images to calculate the target registration error (TRE), which was used as a surrogate for geometric fidelity. The phantom was scanned under both 0℃ and room temperature. Brain scans were performed on five healthy volunteers. In the first volunteer, protocols of 1, 2, and 4 shots per Kz plane were compared. In vivo geometric fidelity and ADC accuracy were evaluated on the remaining four volunteers using the protocol of four shots per Kz plane. In the geometric fidelity study, 8-10 landmarks were picked on each slice to calculate the TRE. Regions of interest were placed on the white matter, the cerebellum, and the cerebrospinal fluid region to evaluate the ADC agreement between DW-ssEPI and DP-MS using the Bland-Altman plot. All scans were performed at 1.5 mm isotropic resolution to meet the high-resolution requirement of many radiotherapy applications. RESULTS: The DP-MS had drastically improved geometric accuracy compared with DW-ssEPI on the phantom. The mean TRE decreased from 2.09 mm to 0.70 mm. The percentage difference of the ADC values between the two diffusion sequences were less than 5.5% and 7% for the 0℃ and room temperature study, respectively. The DW-ssEPI had strong distortion and susceptibility-related artifacts at tissue air boundary, whereas distortion was minimal in DP-MS images. Overall, the mean/max TRE was over 2 mm/7 mm in the volunteers for DW-ssEPI, whereas less than 0.8 mm/2 mm for DP-MS. Good ADC agreement was observed for the white matter, the cerebellum, and the CSF based on the Bland-Altman plots. CONCLUSION: A 3D diffusion sequence was developed and validated. It provided high-resolution diffusion imaging with mean distortion less than 1 mm at 1.5 T, and is a promising imaging technique for treatment planning and adaptive radiotherapy.

MR image reconstruction using deep learning: evaluation of network structure and loss functions.

BACKGROUND: To review and evaluate approaches to convolutional neural network (CNN) reconstruction for accelerated cardiac MR imaging in the real clinical context. METHODS: Two CNN architectures, Unet and residual network (Resnet) were evaluated using quantitative and qualitative assessment by radiologist. Four different loss functions were also considered: pixel-wise (L1 and L2), patch-wise structural dissimilarity (Dssim) and feature-wise (perceptual loss). The networks were evaluated using retrospectively and prospectively under-sampled cardiac MR data. RESULTS: Based on our assessments, we find that Resnet and Unet achieve similar image quality but that former requires only 100,000 parameters compared to 1.3 million parameters for the latter. The perceptual loss function performed significantly better than L1, L2 or Dssim loss functions as determined by the radiologist scores. CONCLUSIONS: CNN image reconstruction using Resnet yields comparable image quality to Unet with 10X the number of parameters. This has implications for training with significantly lower data requirements. Network training using the perceptual loss function was found to better agree with radiologist scoring compared to L1, L2 or Dssim loss functions.

Respiratory motion-resolved, self-gated 4D-MRI using Rotating Cartesian K-space (ROCK): Initial clinical experience on an MRI-guided radiotherapy system.

PURPOSE: To optimize and evaluate the respiratory motion-resolved, self-gated 4D-MRI using Rotating Cartesian K-space (ROCK-4D-MRI) method in a 0.35 T MRI-guided radiotherapy (MRgRT) system. METHODS AND MATERIALS: The study included seven patients with abdominal tumors treated on the MRgRT system. ROCK-4D-MRI and 2D-CINE, was performed immediately after one of the treatment fractions. Motion quantification based on 4D-MRI was compared with those based on 2D-CINE. The image quality of 4D-MRI was evaluated against 4D-CT. The gross tumor volumes (GTV) were defined based on individual respiratory phases of both 4D-MRI and 4D-CT and compared for their variability over the respiratory cycle. RESULT: The motion measurements based on 4D-MRI matched well with 2D-CINE, with differences of 1.04 ±â€¯0.52 mm in the superior-inferior and 0.54 ±â€¯0.21 mm in the anterior-posterior directions. The image quality scores of 4D-MRI were significantly higher than 4D-CT, with better tumor contrast (3.29 ±â€¯0.76 vs. 1.86 ±â€¯0.90) and less motion artifacts (3.57 ±â€¯0.53 vs. 2.29 ±â€¯0.95). The GTVs were more consistent in 4D-MRI than in 4D-CT, with significantly smaller GTV variability (9.31 ±â€¯4.58% vs. 34.27 ±â€¯23.33%). CONCLUSION: Our study demonstrated the clinical feasibility of using the ROCK-4D-MRI to acquire high quality, respiratory motion-resolved 4D-MRI in a low-field MRgRT system. The 4D-MRI image could provide accurate dynamic information for radiotherapy treatment planning.

Accelerated 3D bSSFP imaging for treatment planning on an MRI-guided radiotherapy system.

PURPOSE: The purpose of this study was to introduce a compressed sensing and parallel imaging-combined technique to reduce the acquisition time of planning MRI for MR-guided radiotherapy (MRgRT) systems. METHODS AND MATERIALS: A variable-density Poisson-Disk (VDPD) undersampling acquisition along with compressed sensing reconstruction technique was developed and compared with the current planning MR protocol, which uses an optimized balanced steady-state free precession sequence with 7.5-fold (7.5×) acceleration achieved by GRAPPA and partial Fourier. The image quality of GRAPPA and VDPD with 7.5× and 15× acceleration was compared with fully sampled images on a phantom. Two volunteers were recruited to compare the in vivo imaging performance. Ten patients with abdominal tumors were scanned using the conventional GRAPPA 7.5× (25 s) and the proposed VDPD 15× (12.5 s) sequences. Three readers scored the two approaches in terms of the quality for organ and tumor delineation. The gross tumor volume (GTV) and two kidneys were contoured. Differences in centroid location and contour volumes, Dice coefficients, and mean distance-to-agreement (MDA) between contours draw on the two techniques were calculated. All studies were performed on a 0.35 T MRgRT system. RESULTS: In the phantom study, VDPD with 15× acceleration rate had lower noise level than GRAPPA with 7.5× acceleration. In both the phantom and volunteer study, noise amplification was apparent when the acceleration rate was increased from 7.5× to 15× in the GRAPPA acquisition, whereas it was minimally increased using the VDPD approach. In the patient study, no significant difference was found for the scoring and contouring statistics between the two techniques, whereas VDPD only took half the scan time as GRAPPA. Volume difference for the GTV and two kidneys between GRAPPA 7.5× and VDPD 15× was around 7.6%, 1.3%, and 2.8%, respectively; while the Dice index was approximately 0.85, 0.92, and 0.90, respectively. CONCLUSION: The proposed technique reduced the acquisition time by half and provided comparable or improved image quality than the standard planning MRI protocol.

Distortion-free diffusion MRI using an MRI-guided Tri-Cobalt 60 radiotherapy system: Sequence verification and preliminary clinical experience.

PURPOSE: Monitoring tumor response during the course of treatment and adaptively modifying treatment plan based on tumor biological feedback may represent a new paradigm for radiotherapy. Diffusion MRI has shown great promises in assessing and predicting tumor response to radiotherapy. However, the conventional diffusion-weighted single-shot echo-planar-imaging (DW-ssEPI) technique suffers from limited resolution, severe distortion, and possibly inaccurate ADC at low field strength. The purpose of this work was to develop a reliable, accurate and distortion-free diffusion MRI technique that is practicable for longitudinal tumor response evaluation and adaptive radiotherapy on a 0.35 T MRI-guided radiotherapy system. METHODS: A diffusion-prepared turbo spin echo readout (DP-TSE) sequence was developed and compared with the conventional diffusion-weighted single-shot echo-planar-imaging sequence on a 0.35 T MRI-guided radiotherapy system (ViewRay). A spatial integrity phantom was used to quantitate and compare the geometric accuracy of the two diffusion sequences for three orthogonal orientations. The apparent diffusion coefficient (ADC) accuracy was evaluated on a diffusion phantom under both 0 °C and room temperature to cover a diffusivity range between 0.40 × 10-3 and 2.10 × 10-3 mm2 /s. Ten room temperature measurements repeated on five different days were conducted to assess the ADC reproducibility of DP-TSE. Two glioblastoma (GBM) and six sarcoma patients were included to examine the in vivo feasibility. The target registration error (TRE) was calculated to quantitate the geometric accuracy where structural CT or MR images were co-registered to the diffusion images as references. ADC maps from DP-TSE and DW-ssEPI were calculated and compared. A tube phantom was placed next to patients not treated on ViewRay, and ADCs of this reference tube were also compared. RESULTS: The proposed DP-TSE passed the spatial integrity test (< 1 mm within 100 mm radius and < 2 mm within 175 mm radius) under the three orthogonal orientations. The detected errors were 0.474 ± 0.355 mm, 0.475 ± 0.287 mm, and 0.546 ± 0.336 mm in the axial, coronal, and sagittal plane. DW-ssEPI, however, failed the tests due to severe distortion and low signal intensity. Noise correction must be performed for the DW-ssEPI to avoid ADC quantitation errors, whereas it is optional for DP-TSE. At 0 °C, the two sequences provided accurate quantitation with < 3% variation with the reference. In the room temperature study, discrepancies between ADCs from DP-TSE and the reference were within 4%, but could be as high as 8% for DW-ssEPI after the noise correction. Excellent ADC reproducibility with a coefficient of variation < 5% was observed among the 10 measurements of DP-TSE, indicating desirable robustness for ADC-based tumor response assessment. In vivo TRE in DP-TSE was less than 1.6 mm overall, whereas it could be greater than 12 mm in DW-ssEPI. For GBM patients, the CSF and brain tissue ADCs from DP-TSE were within the ranges found in literature. ADC differences between the two techniques were within 8% among the six sarcoma patients. For the reference tube that had a relatively low diffusivity, the two diffusion sequences provided matched measurements. CONCLUSION: A diffusion technique with excellent geometric fidelity, accurate, and reproducible ADC measurement was demonstrated for longitudinal tumor response assessment using a low-field MRI-guided radiotherapy system.

4D MUSIC CMR: value-based imaging of neonates and infants with congenital heart disease.

BACKGROUND: 4D Multiphase Steady State Imaging with Contrast (MUSIC) acquires high-resolution volumetric images of the beating heart during uninterrupted ventilation. We aim to evaluate the diagnostic performance and clinical impact of 4D MUSIC in a cohort of neonates and infants with congenital heart disease (CHD). METHODS: Forty consecutive neonates and infants with CHD (age range 2 days to 2 years, weight 1 to 13 kg) underwent 3.0 T CMR with ferumoxytol enhancement (FE) at a single institution. Independently, two readers graded the diagnostic image quality of intra-cardiac structures and related vascular segments on FE-MUSIC and breath held FE-CMRA images using a four-point scale. Correlation of the CMR findings with surgery and other imaging modalities was performed in all patients. Clinical impact was evaluated in consensus with referring surgeons and cardiologists. One point was given for each of five key outcome measures: 1) change in overall management, 2) change in surgical approach, 3) reduction in the need for diagnostic catheterization, 4) improved assessment of risk-to-benefit for planned intervention and discussion with parents, 5) accurate pre-procedural roadmap. RESULTS: All FE-CMR studies were completed successfully, safely and without adverse events. On a four-point scale, the average FE-MUSIC image quality scores were >3.5 for intra-cardiac structures and >3.0 for coronary arteries. Intra-cardiac morphology and vascular anatomy were well visualized with good interobserver agreement (r = 0.46). Correspondence between the findings on MUSIC, surgery, correlative imaging and autopsy was excellent. The average clinical impact score was 4.2 ± 0.9. In five patients with discordant findings on echo/MUSIC (n = 5) and catheter angiography/MUSIC (n = 1), findings on FE-MUSIC were shown to be accurate at autopsy (n = 1) and surgery (n = 4). The decision to undertake biventricular vs univentricular repair was amended in 2 patients based on FE-MUSIC findings. Plans for surgical approaches which would have involved circulatory arrest were amended in two of 28 surgical cases. In all 28 cases requiring procedural intervention, FE-MUSIC provided accurate dynamic 3D roadmaps and more confident risk-to-benefit assessments for proposed interventions. CONCLUSIONS: FE-MUSIC CMR has high clinical impact by providing accurate, high quality, simple and safe dynamic 3D imaging of cardiac and vascular anatomy in neonates and infants with CHD. The findings influenced patient management in a positive manner.

Rapid quantitative T2 mapping of the prostate using three-dimensional dual echo steady state MRI at 3T.

PURPOSE: To develop and evaluate a rapid three-dimensional (3D) quantitative T2 mapping method for prostate cancer imaging using dual echo steady state (DESS) MRI at 3T. METHODS: In simulations, DESS-T2 mapping in the presence of T1 and B1+ variations was evaluated. In a phantom and in healthy volunteers (n = 4), 3D DESS-T2 mapping was compared with a two-dimensional turbo spin echo (TSE) approach. In volunteers and a pilot patient study (n = 29), quantitative T2 in normal prostate anatomical zones and in suspected cancerous lesions was evaluated. RESULTS: The simulated bias for DESS-T2 was < 2% (5%) for typically observed T1 ( B1+) variations. In phantoms and in vivo, high correlation of DESS-T2 and TSE-T2 (r2 = 0.98 and 0.88, P < 0.001) was found. DESS-T2 in the normal peripheral zone and transition zone was 115 ± 26 ms and 64 ± 7 ms, respectively, in healthy volunteers and 129 ± 39 ms and 83 ± 12 ms, respectively, in patients. In suspected cancerous lesions, DESS-T2 was 72 ± 14 ms, which was significantly decreased from the normal peripheral zone (P < 0.001) but not from the transition zone. CONCLUSION: Rapid 3D T2 mapping in the entire prostate can be performed in 1 min using DESS MRI. Magn Reson Med 76:1720-1729, 2016. © 2016 International Society for Magnetic Resonance in Medicine.