Simultaneous 18-FDG PET and MR imaging in lower extremity arterial disease.

Background: Simultaneous positron emission tomography (PET) and magnetic resonance imaging (MRI) is a novel hybrid imaging method integrating the advances of morphological tissue characterization of MRI with the pathophysiological insights of PET applications. Aim: This study evaluated the use of simultaneous 18-FDG PET/MR imaging for characterizing atherosclerotic lesions in lower extremity arterial disease (LEAD). Methods: Eight patients with symptomatic stenoses of the superficial femoral artery (SFA) under simultaneous acquisition of 18-FDG PET and contrast-enhanced MRI using an integrated whole-body PET/MRI scanner. Invasive plaque characterization of the SFA was performed by intravascular imaging using optical coherence tomography. Histological analysis of plaque specimens was performed after directional atherectomy. Results: MRI showed contrast enhancement at the site of arterial stenosis, as assessed on T2-w and T1-w images, compared to a control area of the contralateral SFA (0.38 ± 0.15 cm vs. 0.23 ± 0.11 cm; 1.77 ± 0.19 vs. 1.57 ± 0.15; p-value <0.05). On PET imaging, uptake of 18F-FDG (target-to-background ratio TBR > 1) at the level of symptomatic stenosis was observed in all but one patient. Contrast medium-induced MR signal enhancement was detected in all plaques, whereas FDG uptake in PET imaging was increased in lesions with active fibroatheroma and reduced in fibrocalcified lesions. Conclusion: In this multimodal imaging study, we report the feasibility and challenges of simultaneous PET/MR imaging of LEAD, which might offer new perspectives for risk estimation.

Correlation between whole skeleton dual energy CT calcium-subtracted attenuation and bone marrow infiltration in multiple myeloma.

OBJECTIVES: Objective evaluation of the extent of skeletal marrow involvement in multiple myeloma remains a clinical gap for CT. We aimed to develop a quantitative segmentation pipeline for dual energy CT and to assess whether quantified whole skeleton calcium-subtracted attenuation values correlate with biopsy-derived bone marrow infiltration in multiple myeloma. METHODS: Consecutive prospective patients with suspected/established myeloma underwent dual source CT from the skull vertex to proximal tibia. Whole skeleton segmentation was performed for 120 kVp-equivalent images as follows: following Hounsfield unit (HU) thresholding, a Chan-Vese morphological operation was implemented to generate a whole skeleton segmentation mask. This mask was then applied to corresponding whole skeleton material decomposition calcium-subtracted maps, generating whole skeleton HU values. Associations with biopsy-derived bone marrow plasma cell infiltration percentage were assessed with Spearman's rank correlation; significance was at 5%. RESULTS: 21 patients (12 females; median (IQR) 67 (61, 73) years) were included; 16 patients had osteolytic bone lesions; 15 patients underwent bone marrow biopsy. Segmentation and quantification were feasible in all patients. Median (IQR) of the average skeletal calcium-subtracted attenuation was -59.9 HU (-66.3, -51.8HU). There was a positive correlation with bone marrow plasma cell infiltration percentage (Spearman's rho: + 0.79, p < 0.001). CONCLUSION: Whole skeleton calcium-subtracted attenuation is associated with the degree of bone marrow infiltration by plasma cells, providing an objective measure of marrow involvement with the potential to allow earlier detection of disease.

Neural network dose prediction for rectal spacer stratification in dose-escalated prostate radiotherapy.

PURPOSE: To develop a knowledge-based decision-support system capable of stratifying patients for rectal spacer (RS) insertion based on neural network predicted rectal dose, reducing the need for time- and resource-intensive radiotherapy (RT) planning. METHODS: Forty-four patients treated for prostate cancer were enrolled into a clinical trial (NCT03238170). Dose-escalated prostate RT plans were manually created for 30 patients with simulated boost volumes using a conventional treatment planning system (TPS) and used to train a hierarchically dense 3D convolutional neural network to rapidly predict RT dose distributions. The network was used to predict rectal doses for 14 unseen test patients, with associated toxicity risks calculated according to published data. All metrics obtained using the network were compared to conventionally planned values. RESULTS: The neural network stratified patients with an accuracy of 100% based on optimal rectal dose-volume histogram constraints and 78.6% based on mandatory constraints. The network predicted dose-derived grade 2 rectal bleeding risk within 95% confidence limits of -1.9% to +1.7% of conventional risk estimates (risk range 3.5%-9.9%) and late grade 2 fecal incontinence risk within -0.8% to +1.5% (risk range 2.3%-5.7%). Prediction of high-resolution 3D dose distributions took 0.7 s. CONCLUSIONS: The feasibility of using a neural network to provide rapid decision support for RS insertion prior to RT has been demonstrated, and the potential for time and resource savings highlighted. Directly after target and healthy tissue delineation, the network is able to (i) risk stratify most patients with a high degree of accuracy to prioritize which patients would likely derive greatest benefit from RS insertion and (ii) identify patients close to the stratification threshold who would require conventional planning.

Distortion-free 3D diffusion imaging of the prostate using a multishot diffusion-prepared phase-cycled acquisition and dictionary matching.

PURPOSE: To achieve three-dimensional (3D) distortion-free apparent diffusion coefficient (ADC) maps for prostate imaging using a multishot diffusion prepared-gradient echo (msDP-GRE) sequence and ADC dictionary matching. METHODS: The msDP-GRE sequence is combined with a 3D Cartesian, centric k-space trajectory with center oversampling. Oversampled k-space center averaging and phase cycling are used to address motion- and eddy current-induced magnitude corruption. Extended-phase-graph (EPG) simulations and ADC dictionary matching are used to compensate for T1 effects. To shorten the acquisition time, each volume is undersampled by a factor of two and reconstructed using iterative sensitivity encoding. The proposed approach is characterized using simulations and validated in a kiwifruit phantom, comparing the msDP-GRE ADC maps obtained using both standard monoexponential fitting and dictionary matching with the clinical standard single-shot diffusion weighted-echo planar imaging (ssDW-EPI) ADC. Initial in vivo feasibility is tested in three healthy subjects, and geometric distortion is compared with anatomical T2 -weighted-turbo spin echo. RESULTS: In the kiwifruit phantom experiment, the signal magnitude could be recovered using k-space center averaging and phase cycling. No statistically significant difference was observed in the ADC values estimated using msDP-GRE with dictionary matching and clinical standard DW-EPI (P < .05). The in vivo prostate msDP-GRE scans were free of geometric distortion caused by off-resonance susceptibility, and the ADC values in the prostate were in agreement with values found in the published literature. CONCLUSION: Nondistorted 3D ADC maps of the prostate can be achieved using a msDP sequence and dictionary matching.

Accelerated 3D T2 w-imaging of the prostate with 1-millimeter isotropic resolution in less than 3 minutes.

PURPOSE: To achieve 3D T2 w imaging of the prostate with 1-mm isotropic resolution in less than 3 min. METHODS: We devised and implemented a 3D T2 -prepared multishot balanced steady state free precession (T2 prep-bSSFP) acquisition sequence with a variable density undersampled trajectory combined with a total variation regularized iterative SENSE (TV-SENSE) reconstruction. Prospectively undersampled images of the prostate (acceleration factor R = 3) were acquired in 11 healthy subjects in an institutional review board-approved study. Image quality metrics (subjective signal-to-noise ratio, contrast, sharpness, and overall prostate image quality) were evaluated by 2 radiologists. Scores of the proposed accelerated sequence were compared using the Wilcoxon signed-rank and Kruskal-Wallis non-parametric tests to prostate images acquired using a fully sampled 3D T2 prep-bSSFP acquisition, and with clinical standard 2D and 3D turbo spin echo (TSE) T2 w acquisitions. A P-value < 0.05 was considered significant. RESULTS: The 3× accelerated 3D T2 prep-bSSFP images required a scan time (min:s) of 2:45, while the fully sampled 3D T2 prep-bSSFP and clinical standard 3D TSE images were acquired in 8:23 and 7:29, respectively. Image quality scores (contrast, sharpness, and overall prostate image quality) of the accelerated 3D T2 prep-bSSFP, fully sampled T2 prep-bSSFP, and clinical standard 3D TSE acquisitions along all 3 spatial dimensions were not significantly different (P > 0.05). CONCLUSION: 3D T2 w images of the prostate with 1-mm isotropic resolution can be acquired in less than 3 min, with image quality that is comparable to a clinical standard 3D TSE sequence but only takes a third of the acquisition time.

Accelerated 3D T2 mapping with dictionary-based matching for prostate imaging.

PURPOSE: To develop a fast and accurate method for 3D T2 mapping of prostate cancer using undersampled acquisition and dictionary-based fitting. METHODS: 3D high-resolution T2 -weighted images (0.9 × 0.9 × 3 mm3 ) were obtained with a multishot T2 -prepared balanced steady-state free precession (T2 -prep-bSSFP) acquisition sequence using a 3D variable density undersampled Cartesian trajectory. Each T2 -weighted image was reconstructed using total variation regularized sensitivity encoding. A flexible simulation framework based on extended phase graphs generated a dictionary of magnetization signals, which was customized to the proposed sequence. The dictionary was matched to the acquired T2 -weighted images to retrieve quantitative T2 values, which were then compared to gold-standard spin echo acquisition values using monoexponential fitting. The proposed approach was validated in simulations and a T1 /T2 phantom, and feasibility was tested in 8 healthy subjects. RESULTS: The simulation analysis showed that the proposed T2 mapping approach is robust to noise and typically observed T1 variations. T2 values obtained in the phantom with T2 prep-bSSFP and the acquisition-specific, dictionary-based matching were highly correlated with the gold-standard spin echo method (r = 0.99). Furthermore, no differences were observed with the accelerated acquisition compared to the fully sampled acquisition (r = 0.99). T2 values obtained in prostate peripheral zone, central gland, and muscle in healthy subjects (age, 26 ± 6 years) were 97 ± 14, 76 ± 7, and 36 ± 3 ms, respectively. CONCLUSION: 3D quantitative T2 mapping of the whole prostate can be achieved in 3 minutes.

Imaging biomarkers in oncology: Basics and application to MRI.

Cancer remains a global killer alongside cardiovascular disease. A better understanding of cancer biology has transformed its management with an increasing emphasis on a personalized approach, so-called "precision cancer medicine." Imaging has a key role to play in the management of cancer patients. Imaging biomarkers that objectively inform on tumor biology, the tumor environment, and tumor changes in response to an intervention complement genomic and molecular diagnostics. In this review we describe the key principles for imaging biomarker development and discuss the current status with respect to magnetic resonance imaging (MRI). LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 5 J. Magn. Reson. Imaging 2018;48:13-26.

Free-breathing liver fat quantification using a multiecho 3D stack-of-radial technique.

PURPOSE: The diagnostic gold standard for nonalcoholic fatty liver disease is an invasive biopsy. Noninvasive Cartesian MRI fat quantification remains limited to a breath-hold (BH). In this work, a novel free-breathing 3D stack-of-radial (FB radial) liver fat quantification technique is developed and evaluated in a preliminary study. METHODS: Phantoms and healthy subjects (n = 11) were imaged at 3 Tesla. The proton-density fat fraction (PDFF) determined using FB radial (with and without scan acceleration) was compared to BH single-voxel MR spectroscopy (SVS) and BH 3D Cartesian MRI using linear regression (correlation coefficient ρ and concordance coefficient ρc ) and Bland-Altman analysis. RESULTS: In phantoms, PDFF showed significant correlation (ρ > 0.998, ρc > 0.995) and absolute mean differences < 2.2% between FB radial and BH SVS, as well as significant correlation (ρ > 0.999, ρc > 0.998) and absolute mean differences < 0.6% between FB radial and BH Cartesian. In the liver and abdomen, PDFF showed significant correlation (ρ > 0.986, ρc > 0.985) and absolute mean differences < 1% between FB radial and BH SVS, as well as significant correlation (ρ > 0.996, ρc > 0.995) and absolute mean differences < 0.9% between FB radial and BH Cartesian. CONCLUSION: Accurate 3D liver fat quantification can be performed in 1 to 2 min using a novel FB radial technique. Magn Reson Med 79:370-382, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Irreversible Electroporation: Defining the MRI Appearance of the Ablation Zone With Histopathologic Correlation in a Porcine Liver Model.

OBJECTIVE: The purpose of this study is to evaluate the MRI appearance of the irreversible electroporation zone in porcine liver, with histopathologic correlation. MATERIALS AND METHODS: Nine irreversible electroporation ablations were percutaneously created in two Yorkshire pigs. Irreversible electroporation was performed with a bipolar 16-gauge electrode with 3-cm exposure tip and fixed 8-mm interpolar distance. Gadoxetate disodium-enhanced 3-T MRI was performed 50 hours after irreversible electroporation. Livers were harvested immediately after MRI for histopathologic analysis. Ablation zone size was measured on each pulse sequence and correlated with pathologic ablation zone size. Qualitative MRI features of the ablation zone were assessed, and contrast-to-noise ratios (CNRs) were calculated. Statistical analysis included Pearson correlation and t tests. RESULTS: Histopathologically, three distinct layers were present in the irreversible electroporation ablation zone: an inner layer of coagulative necrosis (hyperintense at T1- and T2-weighted imaging and nonenhancing), a middle layer of congestion and hemorrhage (hypointense at T1-weighted imaging, hyperintense at T2-weighted imaging and DWI, and progressively enhancing but hypointense at the hepatobiliary phase), and a peripheral layer of inflammation (hyperintense at the arterial phase but isointense at all other sequences). The hepatobiliary phase ablation zone size showed the highest correlation with the pathologic ablation zone size (r = 0.973). This correlation was significant (p < 0.001). T2-weighted imaging had the highest lesion-to-normal tissue CNR. CONCLUSION: The irreversible electroporation ablation zone contains three distinct histopathologic zones, each with unique MRI features. T2-weighted imaging had the highest CNR, and the hepatobiliary phase had the strongest correlation with ablation zone size.

Optimization and evaluation of reference region variable flip angle (RR-VFA) B1+ and T1 Mapping in the Prostate at 3T.

PURPOSE: To optimize and evaluate the reference region variable flip angle (RR-VFA) technique for simultaneous B1+ and T1 mapping of the prostate at 3 Tesla (T). MATERIALS AND METHODS: The fat region surrounding the prostate was first identified using a fractional fat segmentation constant (tF ) and a signal fat-fraction threshold (rF ), and the relative flip angle (FA) was characterized using an effective fat T1 (T1f ) within the fat region. Optimal values of tF , rF , and T1f were chosen by comparing relative FA maps using RR-VFA (ARR-VFA ) with a reference relative FA maps (AREF ) in the surrounding fat and evaluating interpolation errors within the prostate. The optimized RR-VFA was evaluated in volunteers at 3T on a single scanner (n = 10) and across three scanners (n = 4). RESULTS: tF , rF and T1f were optimized as 0.5, 90%, and 320 ms, respectively. Prostate ARR-VFA showed differences of 30% among volunteers on one scanner, with no significant differences between ARR-VFA and AREF (P = 0.41). Prostate T1 after B1+ correction was 1998 ± 113 ms with significantly (P = 0.004) lower standard deviation than T1 before B1+ correction. The average coefficient of variation of prostate T1 across multiple scanners decreased from 15% to 5% after B1+ correction. CONCLUSION: The optimized RR-VFA can simultaneously measure B1+ and T1 in the prostate without the need for an additional scan and improve T1 consistency within and across MRI scanners at 3T. LEVEL OF EVIDENCE: 3 J. Magn. Reson. Imaging 2017;45:751-760.

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.

A 16-channel MR coil for simultaneous PET/MR imaging in breast cancer.

OBJECTIVES: To implement and evaluate a dedicated receiver array coil for simultaneous positron emission tomography/magnetic resonance (PET/MR) imaging in breast cancer. METHODS: A 16-channel receiver coil design was optimized for simultaneous PET/MR imaging. To assess MR performance, the signal-to-noise ratio, parallel imaging capability and image quality was evaluated in phantoms, volunteers and patients and compared to clinical standard protocols. For PET evaluation, quantitative (18) F-FDG PET images of phantoms and seven patients (14 lesions) were compared to images without the coil. In PET image reconstruction, a CT-based template of the coil was combined with the MR-acquired attenuation correction (AC) map of the phantom/patient. RESULTS: MR image quality was comparable to clinical MR-only examinations. PET evaluation in phantoms showed regionally varying underestimation of the standardised uptake value (SUV; mean 22 %) due to attenuation caused by the coil. This was improved by implementing the CT-based coil template in the AC (<2 % SUV underestimation). Patient data indicated that including the coil in the AC increased the SUV values in the lesions (21 ± 9 %). CONCLUSIONS: Using a dedicated PET/MR breast coil, state-of-the-art MRI was possible. In PET, accurate quantification and image homogeneity could be achieved if a CT-template of this coil was included in the AC for PET image reconstruction. KEY POINTS: • State-of-the-art breast MRI using a dedicated PET/MR breast coil is feasible. • A multi-channel design facilitates shorter MR acquisition times via parallel imaging. • An MR coil inside a simultaneous PET/MR system causes PET photon attenuation. • Including a coil CT-template in PET image reconstruction results in recovering accurate quantification.

Self-gated MRI motion modeling for respiratory motion compensation in integrated PET/MRI.

Accurate localization and uptake quantification of lesions in the chest and abdomen using PET imaging is challenged by respiratory motion occurring during the exam. This work describes how a stack-of-stars MRI acquisition on integrated PET/MRI systems can be used to derive a high-resolution motion model, how many respiratory phases need to be differentiated, how much MRI scan time is required, and how the model is employed for motion-corrected PET reconstruction. MRI self-gating is applied to perform respiratory gating of the MRI data and simultaneously acquired PET raw data. After gated PET reconstruction, the MRI motion model is used to fuse the individual gates into a single, motion-compensated volume with high signal-to-noise ratio (SNR). The proposed method is evaluated in vivo for 15 clinical patients. The gating requires 5-7 bins to capture the motion to an average accuracy of 2mm. With 5 bins, the motion-modeling scan can be shortened to 3-4 min. The motion-compensated reconstructions show significantly higher accuracy in lesion quantification in terms of standardized uptake value (SUV) and different measures of lesion contrast compared to ungated PET reconstruction. Furthermore, unlike gated reconstructions, the motion-compensated reconstruction does not lead to SNR loss.

Convenient synthesis of (68)Ga-labeled gadolinium(III) complexes: towards bimodal responsive probes for functional imaging with PET/MRI.

A killer application? Recently, fully integrated full-body positron-emission tomography (PET) and magnetic-resonance imaging (MRI) scanners were brought to market, allowing simultaneous recording of complementary 3D data sets. By using bimodal PET/MRI probes (see figure), in vivo 3D mapping of various parameters with medical relevance could become feasible.

Hybrid PET/MR imaging of the heart: potential, initial experiences, and future prospects.

PET/CT and other combined scanners have in the past decade rapidly emerged as important research tools and are proving to be invaluable for improved diagnostics in routine nuclear medicine. The design of hybrid PET/MR scanners presented a formidable technical challenge, and only recently were these instruments introduced to the market. Initial expectations of the performance of these scanners have been high, notably because of the potential for superior tissue contrast inherent in the MR modality, as well as the potential for multiparametric functional imaging in conjunction with PET. However, the additional value and potential clinical role that these new systems might bring to the cardiac field have yet to be documented. This review presents a comparative summary of the existing applications for PET and MR in the field of cardiology and suggests potential cardiac applications exploiting unique properties of the newly introduced combined instrumentation.

B1+-mapping with the transient phase of unbalanced steady-state free precession.

PURPOSE: A novel B1+-mapping technique (B1-TRAP) is presented, which derives the actual flip angle from the frequency of signal oscillations, observed in the transient phase of unbalanced steady-state free precession sequences. THEORY: For short repetition times (TR), the angular frequency of distinct oscillations in the transient phase of steady-state free precession sequences is proven to be approximately proportional to the actual flip angle: ω⋅TR≈α. The result is not influenced by off-resonance and it can be shown that deviations are only of second order in the small parameter TR/T2. METHODS: B1-TRAP makes use of this effect through a frequency analysis of the transient phase of a train of steady-state free precession signals. RESULTS: In terms of reliability and time efficiency, a two-dimensional multislice implementation was found to be optimal. Unlike many steady-state B1+-mapping methods, the accuracy of B1-TRAP was not impaired by imperfect slice profiles. CONCLUSION: Simulations, phantom, and in vivo measurements showed that B1-TRAP offers a good compromise with respect to speed, robustness, and accuracy.

Self-gated radial MRI for respiratory motion compensation on hybrid PET/MR systems.

Accurate localization and uptake quantification of lesions in the chest and abdomen using PET imaging is challenging due to the respiratory motion during the exam. The advent of hybrid PET/MR systems offers new ways to compensate for respiratory motion without exposing the patient to additional radiation. The use of self-gated reconstructions of a 3D radial stack-of-stars GRE acquisition is proposed to derive a high-resolution MRI motion model. The self-gating signal is used to perform respiratory binning of the simultaneously acquired PET raw data. Matching mu-maps are generated for every bin, and post-reconstruction registration is performed in order to obtain a motion-compensated PET volume from the individual gates. The proposed method is demonstrated in-vivo for three clinical patients. Motion-corrected reconstructions are compared against ungated and gated PET reconstructions. In all cases, motion-induced blurring of lesions in the liver and lung was substantially reduced, without compromising SNR as it is the case for gated reconstructions.

Single-breath xenon polarization transfer contrast (SB-XTC): implementation and initial results in healthy humans.

PURPOSE: To implement and characterize a single-breath xenon transfer contrast (SB-XTC) method to assess the fractional diffusive gas transport F in the lung: to study the dependence of F and its uniformity as a function of lung volume; to estimate local alveolar surface area per unit gas volume S(A)/V(Gas) from multiple diffusion time measurements of F; to evaluate the reproducibility of the measurements and the necessity of B(1) correction in cases of centric and sequential encoding. MATERIALS AND METHODS: In SB-XTC three or four gradient echo images separated by inversion/saturation pulses were collected during a breath-hold in eight healthy volunteers, allowing the mapping of F (thus S(A)/V(Gas)) and correction for other contributions such as T(1) relaxation, RF depletion and B(1) inhomogeneity from inherently registered data. RESULTS: Regional values of F and its distribution were obtained; both the mean value and heterogeneity of F increased with the decrease of lung volume. Higher values of F in the bases of the lungs in supine position were observed at lower volumes in all volunteers. Local S(A)/V(Gas) (with a mean ± standard deviation of S(A)/V(Gas) = 89 ± 30 cm(-1)) was estimated in vivo near functional residual capacity. Calibration of SB-XTC on phantoms highlighted the necessity for B(1) corrections when k-space is traversed sequentially; with centric ordering B(1) distribution correction is dispensable. CONCLUSION: The SB-XTC technique is implemented and validated for in vivo measurements of local S(A)/V(Gas).

32-channel phased-array receive with asymmetric birdcage transmit coil for hyperpolarized xenon-129 lung imaging.

Hyperpolarized xenon-129 has the potential to become a noninvasive contrast agent for lung MRI. In addition to its utility for imaging of ventilated airspaces, the property of xenon to dissolve in lung tissue and blood upon inhalation provides the opportunity to study gas exchange. Implementations of imaging protocols for obtaining regional parameters that exploit the dissolved phase are limited by the available signal-to-noise ratio, excitation homogeneity, and length of acquisition times. To address these challenges, a 32-channel receive-array coil complemented by an asymmetric birdcage transmit coil tuned to the hyperpolarized xenon-129 resonance at 3 T was developed. First results of spin-density imaging in healthy subjects and subjects with obstructive lung disease demonstrated the improvements in image quality by high-resolution ventilation images with high signal-to-noise ratio. Parallel imaging performance of the phased-array coil was demonstrated by acceleration factors up to three in 2D acquisitions and up to six in 3D acquisitions. Transmit-field maps showed a regional variation of only 8% across the whole lung. The newly developed phased-array receive coil with the birdcage transmit coil will lead to an improvement in existing imaging protocols, but moreover enable the development of new, functional lung imaging protocols based on the improvements in excitation homogeneity, signal-to-noise ratio, and acquisition speed.