3.0 Tesla breast magnetic resonance imaging in patients with nipple discharge when mammography and ultrasound fail.

OBJECTIVES: To compare 3.0 Tesla breast magnetic resonance imaging (MRI) with galactography for detection of benign and malignant causes of nipple discharge in patients with negative mammography and ultrasound. METHODS: We prospectively evaluated 56 breasts of 50 consecutive patients with nipple discharge who had inconspicuous mammography and ultrasound, using 3.0 Tesla breast MRI with a dedicated 16-channel breast coil, and then compared the results with galactography. Histopathological diagnoses and follow-ups were used as reference standard. Lesion size estimated on MRI was compared with the size at histopathology. RESULTS: Sensitivity and specificity of MRI vs. galactography for detecting pathologic findings were 95.7 % vs. 85.7 % and 69.7 % vs. 33.3 %, respectively. For the supposed concrete pathology based on MRI findings, the specificity was 67.6 % and the sensitivity 77.3 % (PPV 60.7 %, NPV 82.1 %). Eight malignant lesions were detected (14.8 %). The estimated size at breast MRI showed excellent correlation with the size at histopathology (Pearson's correlation coefficient 0.95, p < 0.0001). CONCLUSIONS: MRI of the breast at 3.0 Tesla is an accurate imaging test and can replace galactography in the workup of nipple discharge in patients with inconspicuous mammography and ultrasound. KEY POINTS: • Breast MRI is an excellent diagnostic tool for patients with nipple discharge. • MRI of the breast reveals malignant lesions despite inconspicuous mammography and ultrasound. • MRI of the breast has greater sensitivity and specificity than galactography. • Excellent correlation of lesion size measured at MRI and histopathology was found.

Consideration of slice profiles in inversion recovery Look-Locker relaxation parameter mapping.

PURPOSE: To include the flip angle distribution caused by the slice profile into the model used for describing the relaxation curves observed in inversion recovery Look-Locker FLASH T1 mapping for a more accurate determination of the relaxation parameters. MATERIALS AND METHODS: For each inversion time, the flip angle dependent signal of the mono-exponential relaxation model is integrated across the slice profile. The resulting Consideration of Slice Profiles (CSP) relaxation curves are compared to the mono-exponential signal model in numerical simulations as well as in phantom and in-vivo experiments. RESULTS: All measured relaxation curves showed systematic deviations from a mono-exponential curve increasing with flip angle and T1 but decreasing with repetition time. Additionally, the accuracy of T1 was found to be largely dependent on the temporal coverage of the relaxation curve. All these systematic errors were largely reduced by the CSP model. CONCLUSION: The proposed CSP model represents a useful extension of the conventionally used mono-exponential relaxation model. Despite inherent model inaccuracies, the mono-exponential model was found to be sufficient for many T1 mapping situations. However, if only a poor temporal coverage of the relaxation process is achievable or a very precise modeling of the relaxation course is needed as in model-based techniques, the mono-exponential model leads to systematic errors and the CSP model should be used instead.

SElf-gated Non-Contrast-Enhanced FUnctional Lung imaging (SENCEFUL) using a quasi-random fast low-angle shot (FLASH) sequence and proton MRI.

Obtaining functional information on the human lung is of tremendous interest in the characterization of lung defects and pathologies. However, pulmonary ventilation and perfusion maps usually require contrast agents and the application of electrocardiogram (ECG) triggering and breath holds to generate datasets free of motion artifacts. This work demonstrates the possibility of obtaining highly resolved perfusion-weighted and ventilation-weighted images of the human lung using proton MRI and the SElf-gated Non-Contrast-Enhanced FUnctional Lung imaging (SENCEFUL) technique. The SENCEFUL technique utilizes a two-dimensional fast low-angle shot (FLASH) sequence with quasi-random sampling of phase-encoding (PE) steps for data acquisition. After every readout, a short additional acquisition of the non-phase-encoded direct current (DC) signal necessary for self-gating was added. By sorting the quasi-randomly acquired data according to respiratory and cardiac phase derived from the DC signal, datasets of representative respiratory and cardiac cycles could be accurately reconstructed. By application of the Fourier transform along the temporal dimension, functional maps (perfusion and ventilation) were obtained. These maps were compared with dynamic contrast-enhanced (DCE, perfusion) as well as standard Fourier decomposition (FD, ventilation) reference datasets. All datasets were additionally scored by two experienced radiologists to quantify image quality. In addition, one initial patient examination using SENCEFUL was performed. Functional images of healthy volunteers and a patient diagnosed with hypoplasia of the left pulmonary artery and left-sided pulmonary fibrosis were successfully obtained. Perfusion-weighted images corresponded well to DCE-MRI data; ventilation-weighted images offered a significantly better depiction of the lung periphery compared with standard FD. Furthermore, the SENCEFUL technique hints at a potential clinical relevance by successfully detecting a perfusion defect in the patient scan. It can be concluded that SENCEFUL enables highly resolved ventilation- and perfusion-weighted maps of the human lung to be obtained using proton MRI, and might be interesting for further clinical evaluation.

Acquisition-weighted chemical shift imaging improves SLOOP quantification of human cardiac phosphorus metabolites.

PURPOSE: Phosphorous metabolite ratios in human myocardium were determined by a combination of acquisition weighted CSI and a SLOOP evaluation and the results were compared to corresponding SLOOP experiments using standard CSI. MATERIALS AND METHODS: 10 healthy subjects were examined at 1.5 T using both standard CSI and acquisition weighted CSI. Both experiments were performed with a similar acquisition time and the same spatial resolution. The PCr/ATP ratio was determined and the localization properties of both experiments were compared. RESULTS: The PCr/ATP ratio of 2.2±0.4 found for the experiment using acquisition weighted CSI was almost identical to the value of 2.0±0.4 for standard CSI. The sensitivity and the localization properties improved in all subjects using SLOOP evaluation of the acquisition weighted sampling in comparison to the standard CSI acquisition with an average of 3% and 18%, respectively. CONCLUSION: The employment of acquisition weighting allows for a further improvement of the (31)P SLOOP spectroscopy of the human heart.

Reproducibility of manual and semi-automated late enhancement quantification in patients with Fabry disease.

BACKGROUND: Late enhancement (LE) imaging is increasingly used for diagnosis of non-ischemic cardiomyopathy. However, the mostly patchy appearance of LE in this context may reduce the reproducibility of LE measurement. PURPOSE: To report intra- and inter-observer variabilities of LE measurements in Fabry disease using manual and semi-automated quantification. MATERIAL AND METHODS: Twenty MRI data-sets of male patients aged 44 ± 7 years were analyzed twice (interval 12 months) by one observer and additionally once by a second observer. Left ventricular (LV) parameters were determined using cine MRI. Gradient-echo LE images were analyzed by manual planimetry and by a semi-automatic prototype software. Variabilities were determined by Bland-Altman analyses and additionally intra-class correlation coefficient (ICC) values were calculated to survey intra- and inter-observer reproducibility. RESULTS: The amount of LE was 5.2 ± 5.1 mL or 2.8 ± 2.6 % of LV mass (observer 2). LE was detected predominantly intramurally in a patchy pattern. All patients had LE restricted to the basal infero-lateral parts of the LV. The extent of LE correlated to LV mass (207 ± 70 g, P < 0.05, r = 0.6). The intra- and inter-observer variabilities were -0.6 to 1.0 mL and -0.7 to 1.6 mL, respectively (95% confidence intervals). ICC values were 0.981-0.999. The semi-automatic software allowed quantification of LE areas in all patients. The comparison of LE amount determined by semi-automatic software versus manual planimetry yielded an intra-observer variability ranging from -1.9 to 2.3 mL. CONCLUSION: Semi-automatic planimetry of patchy LE in patients with Fabry disease is feasible. The determined intra- and inter-observer variabilities for manual and semi-automatic planimetry were in the range of 20-40% of LE amount with high ICC values.

Accelerated radial Fourier-velocity encoding using compressed sensing.

PURPOSE: Phase Contrast Magnetic Resonance Imaging (MRI) is a tool for non-invasive determination of flow velocities inside blood vessels. Because Phase Contrast MRI only measures a single mean velocity per voxel, it is only applicable to vessels significantly larger than the voxel size. In contrast, Fourier Velocity Encoding measures the entire velocity distribution inside a voxel, but requires a much longer acquisition time. For accurate diagnosis of stenosis in vessels on the scale of spatial resolution, it is important to know the velocity distribution of a voxel. Our aim was to determine velocity distributions with accelerated Fourier Velocity Encoding in an acquisition time required for a conventional Phase Contrast image. MATERIALS AND METHODS: We imaged the femoral artery of healthy volunteers with ECG-triggered, radial CINE acquisition. Data acquisition was accelerated by undersampling, while missing data were reconstructed by Compressed Sensing. Velocity spectra of the vessel were evaluated by high resolution Phase Contrast images and compared to spectra from fully sampled and undersampled Fourier Velocity Encoding. By means of undersampling, it was possible to reduce the scan time for Fourier Velocity Encoding to the duration required for a conventional Phase Contrast image. RESULTS: Acquisition time for a fully sampled data set with 12 different Velocity Encodings was 40 min. By applying a 12.6-fold retrospective undersampling, a data set was generated equal to 3:10 min acquisition time, which is similar to a conventional Phase Contrast measurement. Velocity spectra from fully sampled and undersampled Fourier Velocity Encoded images are in good agreement and show the same maximum velocities as compared to velocity maps from Phase Contrast measurements. CONCLUSION: Compressed Sensing proved to reliably reconstruct Fourier Velocity Encoded data. Our results indicate that Fourier Velocity Encoding allows an accurate determination of the velocity distribution in vessels in the order of the voxel size. Thus, compared to normal Phase Contrast measurements delivering only mean velocities, no additional scan time is necessary to retrieve meaningful velocity spectra in small vessels.

Phase-labeled reference EPI for frequency-segmented inhomogeneity corrections (PREFICS).

PURPOSE: To develop a method to correct for geometric distortions in non-Cartesian echo planar imaging using data acquired in a fast prescan. METHODS: Echo planar images were obtained using a non-Cartesian density weighted k-space trajectory. In contrast to linear Cartesian acquisition, distortions arising in non-Cartesian acquisitions can only be corrected using conjugate phase-based methods. Up to now these methods require a time consuming field map acquisition in undistorted coordinates. In this work, a phase-labeled reference EPI scan was performed in a very short time, yielding a displacement map in distorted coordinates. Subsequently, this map was applied to itself and thus transformed into undistorted coordinates. The echo planar images were then corrected with a frequency-segmented conjugate phase method. The results were compared with corrections based on a multi-echo reference field map acquired in undistorted coordinates. RESULTS: Uncorrected density weighted EPI exhibited geometric distortions and severe ringing artifacts. These distortions could be successfully corrected using the novel method. The quality was comparable to corrections based on the multi-echo reference field map. The novel method shortens the field map acquisition duration by a factor of 64. CONCLUSION: The method presented allows correcting non-Cartesian EPI from a reference scan consisting of only two phase-labeled echo planar images.

High resolution myocardial first-pass perfusion imaging with extended anatomic coverage.

PURPOSE: To evaluate and to compare Parallel Imaging and Compressed Sensing acquisition and reconstruction frameworks based on simultaneous multislice excitation for high resolution contrast-enhanced myocardial first-pass perfusion imaging with extended anatomic coverage. MATERIALS AND METHODS: The simultaneous multislice imaging technique MS-CAIPIRINHA facilitates imaging with significantly extended anatomic coverage. For additional resolution improvement, equidistant or random undersampling schemes, associated with corresponding reconstruction frameworks, namely Parallel Imaging and Compressed Sensing can be used. By means of simulations and in vivo measurements, the two approaches were compared in terms of reconstruction accuracy. Comprehensive quality metrics were used, identifying statistical and systematic reconstruction errors. RESULTS: The quality measures applied allow for an objective comparison of the frameworks. Both approaches provide good reconstruction accuracy. While low to moderate noise enhancement is observed for the Parallel Imaging approach, the Compressed Sensing framework is subject to systematic errors and reconstruction induced spatiotemporal blurring. CONCLUSION: Both techniques allow for perfusion measurements with a resolution of 2.0 × 2.0 mm(2) and coverage of six slices every heartbeat. Being not affected by systematic deviations, the Parallel Imaging approach is considered to be superior for clinical studies.

Boosting BOLD fMRI by K-space density weighted echo planar imaging.

Functional magnetic resonance imaging (fMRI) has become a powerful and influential method to non-invasively study neuronal brain activity. For this purpose, the blood oxygenation level-dependent (BOLD) effect is most widely used. T2* weighted echo planar imaging (EPI) is BOLD sensitive and the prevailing fMRI acquisition technique. Here, we present an alternative to its standard Cartesian recordings, i.e. k-space density weighted EPI, which is expected to increase the signal-to-noise ratio in fMRI data. Based on in vitro and in vivo pilot measurements, we show that fMRI by k-space density weighted EPI is feasible and that this new acquisition technique in fact boosted spatial and temporal SNR as well as the detection of local fMRI activations. Spatial resolution, spatial response function and echo time were identical for density weighted and conventional Cartesian EPI. The signal-to-noise ratio gain of density weighting can improve activation detection and has the potential to further increase the sensitivity of fMRI investigations.

Model-based Acceleration of Parameter mapping (MAP) for saturation prepared radially acquired data.

A reconstruction technique called Model-based Acceleration of Parameter mapping (MAP) is presented allowing for quantification of longitudinal relaxation time and proton density from radial single-shot measurements after saturation recovery magnetization preparation. Using a mono-exponential model in image space, an iterative fitting algorithm is used to reconstruct one well resolved and consistent image for each of the projections acquired during the saturation recovery relaxation process. The functionality of the algorithm is examined in numerical simulations, phantom experiments, and in-vivo studies. MAP reconstructions of single-shot acquisitions feature the same image quality and resolution as fully sampled reference images in phantom and in-vivo studies. The longitudinal relaxation times obtained from the MAP reconstructions are in very good agreement with the reference values in numerical simulations as well as phantom and in-vivo measurements. Compared to available contrast manipulation techniques, no averaging of projections acquired at different time points of the relaxation process is required in MAP imaging. The proposed technique offers new ways of extracting quantitative information from single-shot measurements acquired after magnetization preparation. The reconstruction simultaneously yields images with high spatiotemporal resolution fully consistent with the acquired data as well as maps of the effective longitudinal relaxation parameter and the relative proton density.

Density weighted turbo spin echo imaging.

PURPOSE: To optimize the spatial response function (SRF) while maintaining optimal signal to noise ratio (SNR) in T2 weighted turbo spin echo (TSE) imaging by prospective density weighting. MATERIALS AND METHODS: Density weighting optimizes the SRF by sampling the k-space with variable density without the need of retrospective filtering, which would typically result in nonoptimal SNR. For TSE, the T2 decay needs to be considered when calculating an optimized sampling pattern. Simulations were carried out and T2 weighted in vivo TSE measurements were performed on a 3 Tesla MRI system. To evaluate the SNR, reversed centric density weighted and retrospectively filtered Cartesian acquisitions with identical measurement parameters and SRFs were compared with TE(eff) = 90 ms and a density weighted k-space sampling optimized to yield a Kaiser function for SRF side lobe suppression for white matter. RESULTS: Density weighting of a reversed centric reordering scheme resulted in an SNR increase of (43 ± 13)% compared with the Cartesian acquisition with retrospective filtering while maintaining comparable contrast behavior. CONCLUSION: Density weighting is applicable to TSE imaging and results in significantly increased SNR. The gain can be used to shorten the measurement time, which suggests applying density weighting in both time and SNR constrained MRI.

Percutaneous image-guided implantation of totally implantable venous access ports in the forearm or the chest? A patients' point of view.

PURPOSE: This study aimed to compare patients' satisfaction and impact on daily life after implantation of totally implantable venous access ports (TIVAP) in the forearm and the chest. METHODS: In this prospective study, 50 patients (mean age, 55.8 ± 15.4 years) received three questionnaires on days 1, 30, and 90 after implantation in the forearm (n = 25) or the chest (n = 25). Knowledge concerning device function, comfort perception, and impact of TIVAP on daily activities were evaluated. Ratings were dichotomized depending on whether statements were agreed with or contradicted. Fisher's exact test was used to determine differences between the forearm port (FP) and chest port (CP) groups. RESULTS: There was no significant difference between the two groups with regard to unpleasant feelings (p = 0.09) and discomfort while puncturing (p = 0.06). Main fears in both groups were dysfunction and infection. The possibility of high-pressure injections via the TIVAP was rated important in both groups. More CP patients feared dislocation of their TIVAP during sleep (p < 0.05). CP patients experienced more negative perceptions while driving a car and wearing brassieres (p < 0.05) than FP patients. All patients would recommend their device. CONCLUSIONS: During certain activities, the FP device seems to be favorable, since it causes less discomfort than the CP.

Small-bowel MRI in children and young adults with Crohn disease: retrospective head-to-head comparison of contrast-enhanced and diffusion-weighted MRI.

BACKGROUND: Small-bowel MRI based on contrast-enhanced T1-weighted sequences has been challenged by diffusion-weighted imaging (DWI) for detection of inflammatory bowel lesions and complications in patients with Crohn disease. OBJECTIVE: To evaluate free-breathing DWI, as compared to contrast-enhanced MRI, in children, adolescents and young adults with Crohn disease. MATERIALS AND METHODS: This retrospective study included 33 children and young adults with Crohn disease ages 17 ± 3 years (mean ± standard deviation) and 27 matched controls who underwent small-bowel MRI with contrast-enhanced T1-weighted sequences and DWI at 1.5 T. The detectability of Crohn manifestations was determined. Concurrent colonoscopy as reference was available in two-thirds of the children with Crohn disease. RESULTS: DWI and contrast-enhanced MRI correctly identified 32 and 31 patients, respectively. All 22 small-bowel lesions and all Crohn complications were detected. False-positive findings (two on DWI, one on contrast-enhanced MRI), compared to colonoscopy, were a result of large-bowel lumen collapse. Inflammatory wall thickening was comparable on DWI and contrast-enhanced MRI. DWI was superior to contrast-enhanced MRI for detection of lesions in 27% of the assessed bowel segments and equal to contrast-enhanced MRI in 71% of segments. CONCLUSION: DWI facilitates fast, accurate and comprehensive workup in Crohn disease without the need for intravenous administration of contrast medium. Contrast-enhanced MRI is superior in terms of spatial resolution and multiplanar acquisition.

Diffusion-weighted MRI for detection and differentiation of musculoskeletal tumorous and tumor-like lesions in pediatric patients.

BACKGROUND: MRI is the diagnostic mainstay for detection and differentiation of musculoskeletal tumors. However, a projection regarding the biological dignity of lesions based on standard MRI sequences remains difficult and uncertain. This study was undertaken to analyse whether diffusion-weighted MRI (DWI) can distinguish between benign and malignant musculoskeletal tumorous and tumor-like lesions in pediatric patients. METHODS: MR examinations of 44 consecutive pediatric patients (26 girls, mean age 11±6 years) including standard sequences and DWI (b=50/800 s/mm(2)) at 1.5 or 3 Tesla were retrospectively evaluated. The study group contained 10 patients with non-treated malignant tumors and 34 patients with benign lesions. Size, relative signal intensity and apparent diffusion coefficient (ADC, unit ×10(-3) mm(2)/s) were determined in one lesion per patient. RESULTS: Mean ADC was 0.78±0.45×10(-3) mm(2)/s in patients with malignant tumors and 1.71±0.75 ×10(-3) mm(2)/s in patients with benign lesions (P<0.001). Relative operating characteristics (ROC) analysis showed a sensitivity of 90% and a specificity of 91% for malignancy, based on an ADC cut-off value of ≤1.03. On logistic regression, mean ADC and lesion size accounted for 62% of variability in benign vs. malignant tumors. For malignant tumors, the signal intensity ratio was higher on DWI than on T1w post-contrast images (P<0.002). Two cases of local tumor recurrence were diagnosed by DWI only. CONCLUSIONS: DWI shows promising results for determination of biological dignity in musculoskeletal tumors. Mean ADC ≤1.03×10(-3) mm(2)/s is a strong indicator of malignancy at the first diagnosis. The use of DWI for early diagnosis of tumor recurrence in comparison with standard MRI sequences should be evaluated in prospective studies.

Diffusion-weighted MRI of bone marrow oedema, soft tissue oedema and synovitis in paediatric patients: feasibility and initial experience.

BACKGROUND: MRI has become the mainstay of diagnostic imaging in paediatric rheumatology for lesion detection, differential diagnosis and therapy surveillance. MR imaging of synovitis, in particular, is indispensable for early diagnosis and follow-up in arthritis patients. We used diffusion-weighted MRI (DWI) as a new imaging modality in comparison to standard MRI sequences to study bone marrow oedema, soft-tissue oedema and synovitis in paediatric patients. METHODS: A total of 52 patients (mean age 11 ± 5 years) with bone marrow oedema (n = 31), soft-tissue oedema (n = 20) and synovitis (n = 15) were examined with transversal diffusion-weighted single-shot echoplanar imaging in addition to standard MR sequences (T2W TIRM, T1W pre- and post-contrast). Diffusion-weighted images were used for lesion detection and apparent diffusion coefficient (ADC, unit × 10-3 mm2/s) values were measured with ROI technique on ADC maps. RESULTS: In 50 of 52 patients, DWI delineated the lesion of interest corresponding to pathological signal increase on standard sequences. Mean ADC was 1.60 ± 0.14 (range 1.38 - 1.99) in osseous lesions, 1.72 ± 0.31 (range 1.43 - 2.56) in soft tissue oedema and 2.82 ± 0.24 (range 2.47 - 3.18) for joint effusion (ANOVA p < 0.001). No significant difference in mean ADC was seen for inflammatory vs. non-inflammatory lesions. Relative signal intensity of oedema was similar for DWI and T2W TIRM. DWI visualised synovial restricted diffusion with a mean ADC of 2.12 ± 0.45 in 12 of 15 patients with synovitis. CONCLUSIONS: Diffusion-weighted MRI reliably visualises osseous and soft tissue oedema, as compared to standard sequences. DWI of synovitis is feasible in large joints and presents a novel approach to contrast-free imaging of synovitis. Whole-body DWI for chronic non-bacterial osteomyelitis should be evaluated in future studies.

Diffusion-weighted MRI of abscess formations in children and young adults.

BACKGROUND: Diffusion-weighted MRI (DWI) is helpful for detection of brain abscess and pelvic abscess in adults. In the present study, we evaluated the diagnostic performance of DWI in children and young adults with abdominal and soft tissue abscess formations. METHODS: Seventeen patients (11 females, aged 13 ± 6 years) with suspected abdominal or soft-tissue abscess underwent routine MRI including free-breathing DWI and contrast-enhanced T1w imaging. Seventeen random age-matched patients with non-purulent abdominal fluid collections served as controls. Mean apparent diffusion coefficent (ADC) was measured for abscess, muscle, liver, spleen and kidney tissue as well as for cerebrospinal fluid, urine and free abdominal fluid. RESULTS: All fluid collections were identified on diffusion-weighted images. Thirteen of 14 confirmed abscess formations showed an ADC < 1.0 × 10(-3) mm(2)/s with a mean value of 0.80 ± 0.38 mm(2)/s. One tuberculous soft-tissue abscess had a higher ADC of 1.85 × 10(-3) mm(2)/s. Ring enhancement on T1w imaging was seen in three non-purulent fluid collections. There were no false-positive findings in the control group. CONCLUSIONS: Diffusion-weighted MRI is highly sensitive for abscess and may add specificity to contrast-enhanced T1w imaging of ring-enhancing fluid collections. DWI with free-breathing rapid image acquisition and without the need of intravenous contrast application constitutes a particularly useful choice in pediatric imaging.

Acute thromboembolic occlusion of the superior mesenteric artery following covered stent occlusion in the superior mesenteric artery: endovascular therapy using mechanical rotational thrombectomy.

Acute thromboembolic occlusion of the superior mesenteric artery is a rare and often fatal condition in which surgery represents the golden standard in therapy. We present a case in which a patient was treated with covered stent implantation for acute bleeding from the superior mesenteric artery following pancreatic resection, radiation, and embolization of a hepatic artery pseudoaneurysm. Some weeks later clinical signs were suggestive of acute thromboembolic occlusion of the superior mesenteric artery and digital subtraction angiography showed occlusion of the previously implanted covered stents. The patient was successfully treated transfemorally with percutaneous mechanical instent thrombectomy using a 6F Rotarex® catheter. We conclude that in selected cases percutaneous mechanical thrombectomy may represent a minimally-invasive alternative to open surgical thrombectomy for treatment of acute thromboembolic occlusion of the superior mesenteric artery.

Interplatform reproducibility of CT coronary calcium scoring software.

PURPOSE: To investigate whether coronary artery calcium (CAC) scoring performed on three different workstations generates comparable and thus vendor-independent results. MATERIALS AND METHODS: Institutional review board and Federal Office for Radiation Protection approval were received, as was each patient's written informed consent. Fifty-nine patients (37 men, 22 women; mean age, 57 years±3 [standard deviation]) underwent CAC scoring with use of 64-section multidetector computed tomography (CT) with retrospective electrocardiographic gating (one examination per patient). Data sets were created at 10% increments of the R-R interval from 40%-80%. Two experienced observers in consensus calculated Agatston and volume scores for all data sets by using the calcium scoring software of three different workstations. Comparative analysis of CAC scores between the workstations was performed by using regression analysis, Spearman rank correlation (rs), and the Kruskal-Wallis test. RESULTS: Each workstation produced different absolute numeric results for Agatston and volume scores. However, statistical analysis revealed excellent correlation between the workstations, with highest correlation at 60% of the R-R interval (minimal rs=0.998; maximal rs=0.999) for both scoring methods. No significant differences were detected for Agatston and volume score results between the software platforms. At analysis of individual reconstruction intervals, each workstation demonstrated the same score variability, with the consequence that 12 of 59 patients were assigned to divergent cardiac risk groups by using at least one of the workstations. CONCLUSION: While mere numeric values might be different, commercially available software platforms produce comparable CAC scoring results, which suggests a vendor-independence of the method; however, none of the analyzed software platforms appears to provide a distinct advantage for risk stratification, as the variability of CAC scores depending on the reconstruction interval persists across platforms.

Resolution evaluation of MR images reconstructed by iterative thresholding algorithms for compressed sensing.

PURPOSE: Magnetic resonance imaging systems usually feature linear and shift-invariant (stationary) transform characteristics. The point spread function or equivalently the modulation transfer function may thus be used for an objective quality assessment of imaging modalities. The recently introduced theory of compressed sensing, however, incorporates nonlinear and nonstationary reconstruction algorithms into the magnetic resonance imaging process which prohibits the usage of the classical point spread function and therefore the according evaluation. METHODS: In this work, a local point spread function concept was applied to assess the quality of magnetic resonance images which were reconstructed by an iterative soft thresholding algorithm for compressed sensing. The width of the main lobe of the local point spread function was used to perform studies on the spatial and temporal resolution properties of both numerical phantom and in vivo images. The impact of k-space sampling patterns as well as additional sparsifying transforms on the local spatial image resolution was investigated. In addition, the local temporal resolution of image series, which were reconstructed by exploiting spatiotemporal sparsity, was determined. Finally, the dependency of the local resolution on the thresholding parameter of the algorithm was examined. RESULTS: The sampling patterns as well as the additional sparsifying transform showed a distinct impact on the local image resolution of the phantom image. The reconstructions, which were using x-f-space as a sparse transform domain showed slight temporal blurring for dynamic parts of the imaged object. The local image resolution had a dependence on the thresholding parameter, which allowed for optimizing the reconstruction. CONCLUSIONS: Local point spread functions enable the evaluation of the local spatial and temporal resolution of images reconstructed with the nonlinear and nonstationary iterative soft thresholding algorithm. By determining the influence of thresholding parameter and sampling pattern chosen on this model-based reconstruction, the method allows selecting appropriate acquisition parameters and thus improving the results.