Caloric Restriction and Weight Loss Are Primary Factors in the Early Tissue-Specific Metabolic Changes After Bariatric Surgery.

OBJECTIVE: To evaluate changes in insulin sensitivity, hormone secretion, and hepatic steatosis immediately after caloric restriction, vertical sleeve gastrectomy (VSG), and Roux-en-Y gastric bypass (RYGB). RESEARCH DESIGN AND METHODS: Obese subjects were assessed for 1) insulin sensitivity with hyperinsulinemic-euglycemic clamp with glucose tracer infusion, 2) adipokine concentrations with serum and subcutaneous adipose interstitial fluid sampling, and 3) hepatic fat content with MRI before and 7-10 days after VSG, RYGB, or supervised caloric restriction. RESULTS: Each group exhibited an ∼5% total body weight loss, accompanied by similar improvements in hepatic glucose production and hepatic, skeletal muscle, and adipose tissue insulin sensitivity. Leptin concentrations in plasma and adipose interstitial fluid were equally decreased, and reductions in hepatic fat were similar. CONCLUSIONS: The improvements in insulin sensitivity and adipokine secretion observed early after bariatric surgery are replicated by equivalent caloric restriction and weight loss.

Bedside detection of intracranial midline shift using portable magnetic resonance imaging.

Neuroimaging is crucial for assessing mass effect in brain-injured patients. Transport to an imaging suite, however, is challenging for critically ill patients. We evaluated the use of a low magnetic field, portable MRI (pMRI) for assessing midline shift (MLS). In this observational study, 0.064 T pMRI exams were performed on stroke patients admitted to the neuroscience intensive care unit at Yale New Haven Hospital. Dichotomous (present or absent) and continuous MLS measurements were obtained on pMRI exams and locally available and accessible standard-of-care imaging exams (CT or MRI). We evaluated the agreement between pMRI and standard-of-care measurements. Additionally, we assessed the relationship between pMRI-based MLS and functional outcome (modified Rankin Scale). A total of 102 patients were included in the final study (48 ischemic stroke; 54 intracranial hemorrhage). There was significant concordance between pMRI and standard-of-care measurements (dichotomous, κ = 0.87; continuous, ICC = 0.94). Low-field pMRI identified MLS with a sensitivity of 0.93 and specificity of 0.96. Moreover, pMRI MLS assessments predicted poor clinical outcome at discharge (dichotomous: adjusted OR 7.98, 95% CI 2.07-40.04, p = 0.005; continuous: adjusted OR 1.59, 95% CI 1.11-2.49, p = 0.021). Low-field pMRI may serve as a valuable bedside tool for detecting mass effect.

Portable, bedside, low-field magnetic resonance imaging for evaluation of intracerebral hemorrhage.

Radiological examination of the brain is a critical determinant of stroke care pathways. Accessible neuroimaging is essential to detect the presence of intracerebral hemorrhage (ICH). Conventional magnetic resonance imaging (MRI) operates at high magnetic field strength (1.5-3 T), which requires an access-controlled environment, rendering MRI often inaccessible. We demonstrate the use of a low-field MRI (0.064 T) for ICH evaluation. Patients were imaged using conventional neuroimaging (non-contrast computerized tomography (CT) or 1.5/3 T MRI) and portable MRI (pMRI) at Yale New Haven Hospital from July 2018 to November 2020. Two board-certified neuroradiologists evaluated a total of 144 pMRI examinations (56 ICH, 48 acute ischemic stroke, 40 healthy controls) and one ICH imaging core lab researcher reviewed the cases of disagreement. Raters correctly detected ICH in 45 of 56 cases (80.4% sensitivity, 95%CI: [0.68-0.90]). Blood-negative cases were correctly identified in 85 of 88 cases (96.6% specificity, 95%CI: [0.90-0.99]). Manually segmented hematoma volumes and ABC/2 estimated volumes on pMRI correlate with conventional imaging volumes (ICC = 0.955, p = 1.69e-30 and ICC = 0.875, p = 1.66e-8, respectively). Hematoma volumes measured on pMRI correlate with NIH stroke scale (NIHSS) and clinical outcome (mRS) at discharge for manual and ABC/2 volumes. Low-field pMRI may be useful in bringing advanced MRI technology to resource-limited settings.

Cold exposure induces dynamic, heterogeneous alterations in human brown adipose tissue lipid content.

Brown adipose tissue undergoes a dynamic, heterogeneous response to cold exposure that can include the simultaneous synthesis, uptake, and oxidation of fatty acids. The purpose of this work was to quantify these changes in brown adipose tissue lipid content (fat-signal fraction (FSF)) using fat-water magnetic resonance imaging during individualized cooling to 3 °C above a participant's shiver threshold. Eight healthy men completed familiarization, perception-based cooling, and MRI-cooling visits. FSF maps of the supraclavicular region were acquired in thermoneutrality and during cooling (59.5 ± 6.5 min). Brown adipose tissue regions of interest were defined, and voxels were grouped into FSF decades (0-10%, 10-20%…90-100%) according to their initial value. Brown adipose tissue contained a heterogeneous morphology of lipid content. Voxels with initial FSF values of 60-100% (P < 0.05) exhibited a significant decrease in FSF while a simultaneous increase in FSF occurred in voxels with initial FSF values of 0-30% (P < 0.05). These data suggest that in healthy young men, cold exposure elicits a dynamic and heterogeneous response in brown adipose tissue, with areas initially rich with lipid undergoing net lipid loss and areas of low initial lipid undergoing a net lipid accumulation.

MR fingerprinting with simultaneous T1, T2, and fat signal fraction estimation with integrated B0 correction reduces bias in water T1 and T2 estimates.

PURPOSE: MR fingerprinting (MRF) sequences permit efficient T1 and T2 estimation in cranial and extracranial regions, but these areas may include substantial fat signals that bias T1 and T2 estimates. MRI fat signal fraction estimation is also a topic of active research in itself, but may be complicated by B0 heterogeneity and blurring during spiral k-space acquisitions, which are commonly used for MRF. An MRF method is proposed that separates fat and water signals, estimates water T1 and T2, and accounts for B0 effects with spiral blurring correction, in a single sequence. THEORY AND METHODS: A k-space-based fat-water separation method is further extended to unbalanced steady-state free precession MRF with swept echo time. Repeated application of this k-space fat-water separation to demodulated forms of the measured data allows a B0 map and correction to be approximated. The method is compared with MRF without fat separation across a broad range of fat signal fractions (FSFs), water T1s and T2s, and under heterogeneous static fields in simulations, phantoms, and in vivo. RESULTS: The proposed method's FSF estimates had a concordance correlation coefficient of 0.990 with conventional measurements, and reduced biases in the T1 and T2 estimates due to fat signal relative to other MRF sequences by several hundred ms. The B0 correction improved the FSF, T1, and T2 estimation compared to those estimates without correction. CONCLUSION: The proposed method improves MRF water T1 and T2 estimation in the presence of fat and provides accurate FSF estimation with inline B0 correction.

Leptin Receptor Signaling in Sim1-Expressing Neurons Regulates Body Temperature and Adaptive Thermogenesis.

Leptin signals to regulate food intake and energy expenditure under conditions of normative energy homeostasis. The central expression and function of leptin receptor B (LepRb) have been extensively studied during the past two decades; however, the mechanisms by which LepRb signaling dysregulation contributes to the pathophysiology of obesity remains unclear. The paraventricular nucleus of the hypothalamus (PVN) plays a crucial role in regulating energy balance as well as the neuroendocrine axes. The role of LepRb expression in the PVN in regard to the regulation of physiological function of leptin has been controversial. The single-minded homolog 1 gene (Sim1) is densely expressed in the PVN and in parts of the amygdala, making Sim1-Cre mice a useful model for examining molecular mechanisms regulating PVN function. In this study, we characterized the physiological role of LepRb in Sim1-expressing neurons using LepRb-floxed × Sim1-Cre mice. Sim1-specific LepRb-deficient mice were surprisingly hypophagic on regular chow but gained more weight upon exposure to a high-fat diet than did their control littermates. We show that Sim1-specific deletion of a single LepRb gene copy caused decreased surface and core body temperatures as well as decreased energy expenditure in ambient room temperatures in both female and male mice. Furthermore, cold-induced adaptive (nonshivering) thermogenesis is disrupted in homozygous knockout mice. A defective thermoregulatory response was associated with defective cold-induced upregulation of uncoupling protein 1 in brown adipose tissue and reduced serum T4. Our study provides novel functional evidence supporting LepRb signaling in Sim1 neurons in the regulation of body weight, core body temperature, and cold-induced adaptive thermogenesis.

Fat-Water Phantoms for Magnetic Resonance Imaging Validation: A Flexible and Scalable Protocol.

As new techniques are developed to image adipose tissue, methods to validate such protocols are becoming increasingly important. Phantoms, experimental replicas of a tissue or organ of interest, provide a low cost, flexible solution. However, without access to expensive and specialized equipment, constructing stable phantoms with high fat fractions (e.g., >50% fat fraction levels such as those seen in brown adipose tissue) can be difficult due to the hydrophobic nature of lipids. This work presents a detailed, low cost protocol for creating 5x 100 mL phantoms with fat fractions of 0%, 25%, 50%, 75%, and 100% using basic lab supplies (hotplate, beakers, etc.) and easily accessible components (distilled water, agar, water-soluble surfactant, sodium benzoate, gadolinium-diethylenetriaminepentacetate (DTPA) contrast agent, peanut oil, and oil-soluble surfactant). The protocol was designed to be flexible; it can be used to create phantoms with different fat fractions and a wide range of volumes. Phantoms created with this technique were evaluated in the feasibility study that compared the fat fraction values from fat-water magnetic resonance imaging to the target values in the constructed phantoms. This study yielded a concordance correlation coefficient of 0.998 (95% confidence interval: 0.972-1.00). In summary, these studies demonstrate the utility of fat phantoms for validating adipose tissue imaging techniques across a range of clinically relevant tissues and organs.

Phantom-based field maps for gradient nonlinearity correction in diffusion imaging.

Gradient coils in magnetic resonance imaging do not produce perfectly linear gradient fields. For diffusion imaging, the field nonlinearities cause the amplitude and direction of the applied diffusion gradients to vary over the field of view. This leads to site- and scan-specific systematic errors in estimated diffusion parameters such as diffusivity and anisotropy, reducing reliability especially in studies that take place over multiple sites. These errors can be substantially reduced if the actual scanner-specific gradient coil magnetic fields are known. The nonlinearity of the coil fields is measured by scanner manufacturers and used internally for geometric corrections, but obtaining and using the information for a specific scanner may be impractical for many sites that operate without special-purpose local engineering and research support. We have implemented an empirical field-mapping procedure using a large phantom combined with a solid harmonic approximation to the coil fields that is simple to perform and apply. Here we describe the accuracy and precision of the approach in reproducing manufacturer gold standard field maps and in reducing spatially varying errors in quantitative diffusion imaging for a specific scanner. Before correction, median B value error ranged from 33 - 41 relative to manufacturer specification at 100 mm from isocenter; correction reduced this to 0 - 4. On-axis spatial variation in the estimated mean diffusivity of an isotropic phantom was 2.2% - 4.1% within 60 mm of isocenter before correction, 0.5% - 1.6% after. Expected fractional anisotropy in the phantom was 0; highest estimated fractional anisotropy within 60 mm of isocenter was reduced from 0.024 to 0.012 in the phase encoding direction (48% reduction) and from 0.020 to 0.006 in the frequency encoding direction (72% reduction).

An Individualized, Perception-Based Protocol to Investigate Human Physiological Responses to Cooling.

Cold exposure, a known stimulant of the thermogenic effects of brown adipose tissue (BAT), is the most widely used method to study BAT physiology in adult humans. Recently, individualized cooling has been recommended to standardize the physiological cold stress applied across participants, but critical experimental details remain unclear. The purpose of this work was to develop a detailed methodology for an individualized, perception-based protocol to investigate human physiological responses to cooling. Participants were wrapped in two water-circulating blankets and fitted with skin temperature probes to estimate BAT activity and peripheral vasoconstriction. We created a thermoesthesia graphical user interface (tGUI) to continuously record the subject's perception of cooling and shivering status during the cooling protocol. The protocol began with a 15 min thermoneutral phase followed by a series of 10 min cooling phases and concluded when sustained shivering (>1 min duration) occurred. Researchers used perception of cooling feedback (tGUI ratings) to manually adjust and personalize the water temperature at each cooling phase. Blanket water temperatures were recorded continuously during the protocol. Twelve volunteers (ages: 26.2 ± 1.4 years; 25% female) completed a feasibility study to evaluate the proposed protocol. Water temperature, perception of cooling, and shivering varied considerably across participants in response to cooling. Mean clavicle skin temperature, a surrogate measure of BAT activity, decreased (-0.99°C, 95% CI: -1.7 to -0.25°C, P = 0.16) after the cooling protocol, but an increase in supraclavicular skin temperature was observed in 4 participants. A strong positive correlation was also found between thermoesthesia and peripheral vasoconstriction (ρ = 0.84, P < 0.001). The proposed individualized, perception-based protocol therefore has potential to investigate the physiological responses to cold stress applied across populations with varying age, sex, body composition, and cold sensitivity characteristics.

Untangling the R2* contrast in multiple sclerosis: A combined MRI-histology study at 7.0 Tesla.

T2*-weighted multi-echo gradient-echo magnetic resonance imaging and its reciprocal R2* are used in brain imaging due to their sensitivity to iron content. In patients with multiple sclerosis who display pathological alterations in iron and myelin contents, the use of R2* may offer a unique way to untangle mechanisms of disease. Coronal slices from 8 brains of deceased multiple sclerosis patients were imaged using a whole-body 7.0 Tesla MRI scanner. The scanning protocol included three-dimensional (3D) T2*-w multi-echo gradient-echo and 2D T2-w turbo spin echo (TSE) sequences. Histopathological analyses of myelin and iron content were done using Luxol fast blue and proteolipid myelin staining and 3,3'-diaminobenzidine tetrahydrochloride enhanced Turnbull blue staining. Quantification of R2*, myelin and iron intensity were obtained. Variations in R2* were found to be affected differently by myelin and iron content in different regions of multiple sclerosis brains. The data shall inform clinical investigators in addressing the role of T2*/R2* variations as a biomarker of tissue integrity in brains of MS patients, in vivo.

Ghost reduction in echo-planar imaging by joint reconstruction of images and line-to-line delays and phase errors.

PURPOSE: To correct line-to-line delays and phase errors in echo-planar imaging (EPI). THEORY AND METHODS: EPI-trajectory auto-corrected image reconstruction (EPI-TrACR) is an iterative maximum-likelihood technique that exploits data redundancy provided by multiple receive coils between nearby lines of k-space to determine and correct line-to-line trajectory delays and phase errors that cause ghosting artifacts. EPI-TrACR was efficiently implemented using a segmented FFT and was applied to in vivo brain data acquired at 7 T across acceleration (1×-4×) and multishot factors (1-4 shots), and in a time series. RESULTS: EPI-TrACR reduced ghosting across all acceleration factors and multishot factors, compared to conventional calibrated reconstructions and the PAGE method. It also achieved consistently lower ghosting in the time series. Averaged over all cases, EPI-TrACR reduced root-mean-square ghosted signal outside the brain by 27% compared to calibrated reconstruction, and by 40% compared to PAGE. CONCLUSION: EPI-TrACR automatically corrects line-to-line delays and phase errors in multishot, accelerated, and dynamic EPI. While the method benefits from additional calibration data for initialization, it was not a requirement for most reconstructions. Magn Reson Med 79:3114-3121, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Dynamic Imaging of the Eye, Optic Nerve, and Extraocular Muscles With Golden Angle Radial MRI.

Purpose: The eye and its accessory structures, the optic nerve and the extraocular muscles, form a complex dynamic system. In vivo magnetic resonance imaging (MRI) of this system in motion can have substantial benefits in understanding oculomotor functioning in health and disease, but has been restricted to date to imaging of static gazes only. The purpose of this work was to develop a technique to image the eye and its accessory visual structures in motion. Methods: Dynamic imaging of the eye was developed on a 3-Tesla MRI scanner, based on a golden angle radial sequence that allows freely selectable frame-rate and temporal-span image reconstructions from the same acquired data set. Retrospective image reconstructions at a chosen frame rate of 57 ms per image yielded high-quality in vivo movies of various eye motion tasks performed in the scanner. Motion analysis was performed for a left-right version task where motion paths, lengths, and strains/globe angle of the medial and lateral extraocular muscles and the optic nerves were estimated. Results: Offline image reconstructions resulted in dynamic images of bilateral visual structures of healthy adults in only ∼15-s imaging time. Qualitative and quantitative analyses of the motion enabled estimation of trajectories, lengths, and strains on the optic nerves and extraocular muscles at very high frame rates of ∼18 frames/s. Conclusions: This work presents an MRI technique that enables high-frame-rate dynamic imaging of the eyes and orbital structures. The presented sequence has the potential to be used in furthering the understanding of oculomotor mechanics in vivo, both in health and disease.

Stability of Gradient Field Corrections for Quantitative Diffusion MRI.

In magnetic resonance diffusion imaging, gradient nonlinearity causes significant bias in the estimation of quantitative diffusion parameters such as diffusivity, anisotropy, and diffusion direction in areas away from the magnet isocenter. This bias can be substantially reduced if the scanner- and coil-specific gradient field nonlinearities are known. Using a set of field map calibration scans on a large (29 cm diameter) phantom combined with a solid harmonic approximation of the gradient fields, we predicted the obtained b-values and applied gradient directions throughout a typical field of view for brain imaging for a typical 32-direction diffusion imaging sequence. We measured the stability of these predictions over time. At 80 mm from scanner isocenter, predicted b-value was 1-6% different than intended due to gradient nonlinearity, and predicted gradient directions were in error by up to 1 degree. Over the course of one month the change in these quantities due to calibration-related factors such as scanner drift and variation in phantom placement was <0.5% for b-values, and <0.5 degrees for angular deviation. The proposed calibration procedure allows the estimation of gradient nonlinearity to correct b-values and gradient directions ahead of advanced diffusion image processing for high angular resolution data, and requires only a five-minute phantom scan that can be included in a weekly or monthly quality assurance protocol.

Multi-frequency interpolation in spiral magnetic resonance fingerprinting for correction of off-resonance blurring.

Magnetic resonance fingerprinting (MRF) pulse sequences often employ spiral trajectories for data readout. Spiral k-space acquisitions are vulnerable to blurring in the spatial domain in the presence of static field off-resonance. This work describes a blurring correction algorithm for use in spiral MRF and demonstrates its effectiveness in phantom and in vivo experiments. Results show that image quality of T1 and T2 parametric maps is improved by application of this correction. This MRF correction has negligible effect on the concordance correlation coefficient and improves coefficient of variation in regions of off-resonance relative to uncorrected measurements.

Incorporating dixon multi-echo fat water separation for novel quantitative magnetization transfer of the human optic nerve in vivo.

PURPOSE: The optic nerve (ON) represents the sole pathway between the eyes and brain; consequently, diseases of the ON can have dramatic effects on vision. However, quantitative magnetization transfer (qMT) applications in the ON have been limited to ex vivo studies, in part because of the fatty connective tissue that surrounds the ON, confounding the magnetization transfer (MT) experiment. Therefore, the aim of this study was to implement a multi-echo Dixon fat-water separation approach to remove the fat component from MT images. METHODS: MT measurements were taken in a single slice of the ON and frontal lobe using a three-echo Dixon readout, and the water and out-of-phase images were applied to a two-pool model in ON tissue and brain white matter to evaluate the effectiveness of using Dixon fat-water separation to remove fatty tissue from MT images. RESULTS: White matter data showed no significant differences between image types; however, there was a significant increase (p < 0.05) in variation in the out-of-phase images in the ON relative to the water images. CONCLUSIONS: The results of this study demonstrate that Dixon fat-water separation can be robustly used for accurate MT quantification of anatomies susceptible to partial volume effects resulting from fat. Magn Reson Med 77:707-716, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Multisite, multivendor validation of the accuracy and reproducibility of proton-density fat-fraction quantification at 1.5T and 3T using a fat-water phantom.

PURPOSE: To evaluate the accuracy and reproducibility of quantitative chemical shift-encoded (CSE) MRI to quantify proton-density fat-fraction (PDFF) in a fat-water phantom across sites, vendors, field strengths, and protocols. METHODS: Six sites (Philips, Siemens, and GE Healthcare) participated in this study. A phantom containing multiple vials with various oil/water suspensions (PDFF:0%-100%) was built, shipped to each site, and scanned at 1.5T and 3T using two CSE protocols per field strength. Confounder-corrected PDFF maps were reconstructed using a common algorithm. To assess accuracy, PDFF bias and linear regression with the known PDFF were calculated. To assess reproducibility, measurements were compared across sites, vendors, field strengths, and protocols using analysis of covariance (ANCOVA), Bland-Altman analysis, and the intraclass correlation coefficient (ICC). RESULTS: PDFF measurements revealed an overall absolute bias (across sites, field strengths, and protocols) of 0.22% (95% confidence interval, 0.07%-0.38%) and R2 > 0.995 relative to the known PDFF at each site, field strength, and protocol, with a slope between 0.96 and 1.02 and an intercept between -0.56% and 1.13%. ANCOVA did not reveal effects of field strength (P = 0.36) or protocol (P = 0.19). There was a significant effect of vendor (F = 25.13, P = 1.07 × 10-10 ) with a bias of -0.37% (Philips) and -1.22% (Siemens) relative to GE Healthcare. The overall ICC was 0.999. CONCLUSION: CSE-based fat quantification is accurate and reproducible across sites, vendors, field strengths, and protocols. Magn Reson Med 77:1516-1524, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Fat-water MRI of a diet-induced obesity mouse model at 15.2T.

Quantitative fat-water MRI (FWMRI) methods provide valuable information about the distribution, volume, and composition of adipose tissue (AT). Ultra high field FWMRI of animal models may have the potential to provide insights into the progression of obesity and its comorbidities. Here, we present quantitative FWMRI with all known confounder corrections on a 15.2T preclinical scanner for noninvasive in vivo monitoring of an established diet-induced obesity mouse model. Male C57BL/6J mice were placed on a low-fat (LFD) or a high-fat diet (HFD). Three-dimensional (3-D) multiple gradient echo MRI at 15.2T was performed at baseline, 4, 8, 12, and 16 weeks after diet onset. A 3-D fat-water separation algorithm and additional processing were used to generate proton-density fat fraction (PDFF), local magnetic field offset, and [Formula: see text] maps. We examined these parameters in perirenal AT ROIs from LFD and HFD mice. The data suggest that PDFF, local field offset, and [Formula: see text] have different time course behaviors between LFD and HFD mice over 16 weeks. This work suggests FWMRI at 15.2T may be a useful tool for longitudinal studies of adiposity due to the advantages of ultra high field although further investigation is needed to understand the observed time course behavior.

Characterizing active and inactive brown adipose tissue in adult humans using PET-CT and MR imaging.

Activated brown adipose tissue (BAT) plays an important role in thermogenesis and whole body metabolism in mammals. Positron emission tomography (PET)-computed tomography (CT) imaging has identified depots of BAT in adult humans, igniting scientific interest. The purpose of this study is to characterize both active and inactive supraclavicular BAT in adults and compare the values to those of subcutaneous white adipose tissue (WAT). We obtained [(18)F]fluorodeoxyglucose ([(18)F]FDG) PET-CT and magnetic resonance imaging (MRI) scans of 25 healthy adults. Unlike [(18)F]FDG PET, which can detect only active BAT, MRI is capable of detecting both active and inactive BAT. The MRI-derived fat signal fraction (FSF) of active BAT was significantly lower than that of inactive BAT (means ± SD; 60.2 ± 7.6 vs. 62.4 ± 6.8%, respectively). This change in tissue morphology was also reflected as a significant increase in Hounsfield units (HU; -69.4 ± 11.5 vs. -74.5 ± 9.7 HU, respectively). Additionally, the CT HU, MRI FSF, and MRI R2* values are significantly different between BAT and WAT, regardless of the activation status of BAT. To the best of our knowledge, this is the first study to quantify PET-CT and MRI FSF measurements and utilize a semiautomated algorithm to identify inactive and active BAT in the same adult subjects. Our findings support the use of these metrics to characterize and distinguish between BAT and WAT and lay the foundation for future MRI analysis with the hope that some day MRI-based delineation of BAT can stand on its own.

Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease.

Quantitative magnetic resonance imaging (qMRI) describes the development and use of MRI to quantify physical, chemical, and/or biological properties of living systems. Neuromuscular diseases often exhibit a temporally varying, spatially heterogeneous, and multi-faceted pathology. The goal of this protocol is to characterize this pathology using qMRI methods. The MRI acquisition protocol begins with localizer images (used to locate the position of the body and tissue of interest within the MRI system), quality control measurements of relevant magnetic field distributions, and structural imaging for general anatomical characterization. The qMRI portion of the protocol includes measurements of the longitudinal and transverse relaxation time constants (T1 and T2, respectively). Also acquired are diffusion-tensor MRI data, in which water diffusivity is measured and used to infer pathological processes such as edema. Quantitative magnetization transfer imaging is used to characterize the relative tissue content of macromolecular and free water protons. Lastly, fat-water MRI methods are used to characterize fibro-adipose tissue replacement of muscle. In addition to describing the data acquisition and analysis procedures, this paper also discusses the potential problems associated with these methods, the analysis and interpretation of the data, MRI safety, and strategies for artifact reduction and protocol optimization.

Whole-body continuously moving table fat-water MRI with dynamic B0 shimming at 3 Tesla.

PURPOSE: The purpose of this work was to develop a rapid and robust whole-body fat-water MRI (FWMRI) method using a continuously moving table (CMT) with dynamic field corrections at 3 Tesla. METHODS: CMT FWMRI was developed at 3 Tesla with a multiecho golden angle (GA) radial trajectory and dynamic B0 field shimming. Whole-body imaging was performed with 4 echoes and superior-inferior coverage of 1.8 meters without shims in 90 s. 716 axial images were reconstructed with GA profile binning followed by B0 field map generation using fast three-point seeded region growing fat-water separation and slice-specific 0(th) and 1(st) order shim calculation. Slice-specific shims were applied dynamically in a repeated CMT FWMRI scan in the same session. The resulting images were evaluated for field homogeneity improvements and quality of fat-water separation with a whole-image energy optimized algorithm. RESULTS: GA sampling allowed high quality whole-body FWMRI from multiecho CMT data. Dynamic B0 shimming greatly improved field homogeneity in the body and produced high quality water and fat only images as well as fat signal fraction and R2 * relaxivity maps. CONCLUSION: A rapid and robust technique for whole-body fat-water quantification has been developed with CMT MRI with dynamic B0 field correction. Magn Reson Med 76:183-190, 2016. © 2015 Wiley Periodicals, Inc.