Systematic evaluation of human soft tissue attenuation correction in whole-body PET/MR: Implications from PET/CT for optimization of MR-based AC in patients with normal lung tissue.

BACKGROUND: Attenuation correction (AC) is an important methodical step in positron emission tomography/magnetic resonance imaging (PET/MRI) to correct for attenuated and scattered PET photons. PURPOSE: The overall quality of magnetic resonance (MR)-based AC in whole-body PET/MRI was evaluated in direct comparison to computed tomography (CT)-based AC serving as reference. The quantitative impact of isolated tissue classes in the MR-AC was systematically investigated to identify potential optimization needs and strategies. METHODS: Data of n = 60 whole-body PET/CT patients with normal lung tissue and without metal implants/prostheses were used to generate six different AC-models based on the CT data for each patient, simulating variations of MR-AC. The original continuous CT-AC (CT-org) is referred to as reference. A pseudo MR-AC (CT-mrac), generated from CT data, with four tissue classes and a bone atlas represents the MR-AC. Relative difference in linear attenuation coefficients (LAC) and standardized uptake values were calculated. From the results two improvements regarding soft tissue AC and lung AC were proposed and evaluated. RESULTS: The overall performance of MR-AC is in good agreement compared to CT-AC. Lungs, heart, and bone tissue were identified as the regions with most deviation to the CT-AC (myocardium -15%, bone tissue -14%, and lungs ±20%). Using single-valued LACs for AC in the lung only provides limited accuracy. For improved soft tissue AC, splitting the combined soft tissue class into muscles and organs each with adapted LAC could reduce the deviations to the CT-AC to < ±1%. For improved lung AC, applying a gradient LAC in the lungs could remarkably reduce over- or undercorrections in PET signal compared to CT-AC (±5%). CONCLUSIONS: The AC is important to ensure best PET image quality and accurate PET quantification for diagnostics and radiotherapy planning. The optimized segment-based AC proposed in this study, which was evaluated on PET/CT data, inherently reduces quantification bias in normal lung tissue and soft tissue compared to the CT-AC reference.

Grad-CAM Guided U-Net for MRI-based Pseudo-CT Synthesis.

In this paper, we address the task of image-to-image translation from MRI to CT domain. We propose a 2D U-Net-based deep learning approach for pseudo-CT synthesis that incorporates an additional Grad-CAM guided attention mechanism for superior image translation of bone regions. The suggested architecture consists of image-to-image translation and image classification modules. We first train our classifier to distinguish between MR and CT images. After that, we utilize it in combination with the Grad-CAM technique to provide additional guidance to our image-to-image translation network. We generate CT-class-specific localization maps for both CT and pseudo-CT images and then compare them. Thus, we force the image-to-image translation network to focus on relevant attributes of the CT class, such as bone structures, while learning to synthesize pseudo-CTs. The performance of the proposed approach is evaluated on the publicly available RIRE data set. Since MR and CT images in this data set are not correctly aligned with each other, we also briefly describe the applied image registration procedure. The experimental results are compared to the baseline U-Net model and demonstrate both qualitative and quantitative improvements, whereas significant performance gain is achieved for bone regions. Clinical Relevance- MRI-based pseudo-CT synthesis is essential for attenuation correction of PET in combined PET/MRI systems and plays a vital role in MRI-only radiotherapy planning. Accurate pseudo-CTs can prevent patients from harmful and unnecessary radiation exposure.

MR-based truncation correction using an advanced HUGE method to improve attenuation correction in PET/MR imaging of obese patients.

PURPOSE: Truncation artifacts in the periphery of the magnetic resonance (MR) field-of-view (FOV) and thus, in the MR-based attenuation correction (AC) map, may hamper accurate positron emission tomography (PET) quantification in whole-body PET/MR, which is especially problematic in patients with obesity with overall large body dimensions. Therefore, an advanced truncation correction (TC) method to extend the conventional MR FOV is needed. METHODS: The extent of MR-based AC-map truncations in obese patients was determined in a dataset including n  =  10 patients that underwent whole-body PET/MR exams. Patient inclusion criteria were defined as BMI > 30 kg/m2 and body weight > 100 kg. Truncations in PET/MR patients with obesity were quantified comparing the MR-based AC-map volume to segmented non-AC PET data, serving as the reference body volume without truncations to demonstrate the need of improved TC. The new method implemented in this study, termed "advanced HUGE," was modified and extended from the original HUGE method by Blumhagen et al. in order to provide improved TC across the entire axial MR FOV and to unlock new clinical applications of PET/MR. Advanced HUGE was then systematically tested in PET/MR NEMA phantom measurements. Relative differences between computed tomography (CT) AC PET data of the phantom setup (reference) and MR-based Dixon AC, respectively Dixon + advanced HUGE AC, were calculated. The applicability of the method for advanced TC was then demonstrated in first MR-based measurements in healthy volunteers. RESULTS: It was found that the MR-based AC maps of obese patients often reveal truncations in the anterior-posterior direction. Especially, the abdominal region could benefit from improved TC, where maximal relative differences in the AC-map volume up to -17% were calculated. Applying advanced HUGE to improve the MR-based AC in PET/MR, PET quantification errors in the large-volume phantom setup could be considerably reduced from average -18.6% (Dixon AC) to 4.6% compared to the CT AC reference. Volunteer measurements demonstrate that formerly missing AC-map volume in the Dixon-VIBE AC-map could be added due to advanced HUGE in the anterior-posterior direction and thus, potentially improves AC in PET/MR. CONCLUSIONS: The advanced HUGE method for truncation correction considerably reduces truncations in the anterior-posterior direction demonstrated in phantom measurements and healthy volunteers and thus, further improves MR-based AC in PET/MR imaging.

Impact of respiratory motion correction on lesion visibility and quantification in thoracic PET/MR imaging.

The impact of a method for MR-based respiratory motion correction of PET data on lesion visibility and quantification in patients with oncologic findings in the lung was evaluated. Twenty patients with one or more lesions in the lung were included. Hybrid imaging was performed on an integrated PET/MR system using 18F-FDG as radiotracer. The standard thoracic imaging protocol was extended by a free-breathing self-gated acquisition of MR data for motion modelling. PET data was acquired simultaneously in list-mode for 5-10 mins. One experienced radiologist and one experienced nuclear medicine specialist evaluated and compared the post-processed data in consensus regarding lesion visibility (scores 1-4, 4 being best), image noise levels (scores 1-3, 3 being lowest noise), SUVmean and SUVmax. Motion-corrected (MoCo) images were additionally compared with gated images. Non-motion-corrected free-breathing data served as standard of reference in this study. Motion correction generally improved lesion visibility (3.19 ± 0.63) and noise ratings (2.95 ± 0.22) compared to uncorrected (2.81 ± 0.66 and 2.95 ± 0.22, respectively) or gated PET data (2.47 ± 0.93 and 1.30 ± 0.47, respectively). Furthermore, SUVs (mean and max) were compared for all methods to estimate their respective impact on the quantification. Deviations of SUVmax were smallest between the uncorrected and the MoCo lesion data (average increase of 9.1% of MoCo SUVs), while SUVmean agreed best for gated and MoCo reconstructions (MoCo SUVs increased by 1.2%). The studied method for MR-based respiratory motion correction of PET data combines increased lesion sharpness and improved lesion activity quantification with high signal-to-noise ratio in a clinical setting. In particular, the detection of small lesions in moving organs such as the lung and liver may thus be facilitated. These advantages justify the extension of the PET/MR imaging protocol by 5-10 minutes for motion correction.

Non-invasive tumor decoding and phenotyping of cerebral gliomas utilizing multiparametric 18F-FET PET-MRI and MR Fingerprinting.

OBJECTIVES: The introduction of the 2016 WHO classification of CNS tumors has made the combined molecular and histopathological characterization of tumors a pivotal part of glioma patient management. Recent publications on radiogenomics-based prediction of the mutational status have demonstrated the predictive potential of imaging-based, non-invasive tissue characterization algorithms. Hence, the aim of this study was to assess the potential of multiparametric 18F-FET PET-MRI including MR fingerprinting accelerated with machine learning and radiomic algorithms to predict tumor grading and mutational status of patients with cerebral gliomas. MATERIALS AND METHODS: 42 patients with suspected primary brain tumor without prior surgical or systemic treatment or biopsy underwent an 18F-FET PET-MRI examination. To differentiate the mutational status and the WHO grade of the cerebral tumors, support vector machine and random forest were trained with the radiomics signature of the multiparametric PET-MRI data including MR fingerprinting. Surgical sampling served as a gold standard for histopathological reference and assessment of mutational status. RESULTS: The 5-fold cross-validated area under the curve in predicting the ATRX mutation was 85.1%, MGMT mutation was 75.7%, IDH1 was 88.7%, and 1p19q was 97.8%. The area under the curve of differentiating low-grade glioma vs. high-grade glioma was 85.2%. CONCLUSION: 18F-FET PET-MRI and MR fingerprinting enable high-quality imaging-based tumor decoding and phenotyping for differentiation of low-grade vs. high-grade gliomas and for prediction of the mutational status of ATRX, IDH1, and 1p19q. These initial results underline the potential of 18F-FET PET-MRI to serve as an alternative to invasive tissue characterization.

A 32-channel parallel transmit system add-on for 7T MRI.

PURPOSE: A 32-channel parallel transmit (pTx) add-on for 7 Tesla whole-body imaging is presented. First results are shown for phantom and in-vivo imaging. METHODS: The add-on system consists of a large number of hardware components, including modulators, amplifiers, SAR supervision, peripheral devices, a control computer, and an integrated 32-channel transmit/receive body array. B1+ maps in a phantom as well as B1+ maps and structural images in large volunteers are acquired to demonstrate the functionality of the system. EM simulations are used to ensure safe operation. RESULTS: Good agreement between simulation and experiment is shown. Phantom and in-vivo acquisitions show a field of view of up to 50 cm in z-direction. Selective excitation with 100 kHz sampling rate is possible. The add-on system does not affect the quality of the original single-channel system. CONCLUSION: The presented 32-channel parallel transmit system shows promising performance for ultra-high field whole-body imaging.

The cerebellum is involved in processing of predictions and prediction errors in a fear conditioning paradigm.

Prediction errors are thought to drive associative fear learning. Surprisingly little is known about the possible contribution of the cerebellum. To address this question, healthy participants underwent a differential fear conditioning paradigm during 7T magnetic resonance imaging. An event-related design allowed us to separate cerebellar fMRI signals related to the visual conditioned stimulus (CS) from signals related to the subsequent unconditioned stimulus (US; an aversive electric shock). We found significant activation of cerebellar lobules Crus I and VI bilaterally related to the CS+ compared to the CS-. Most importantly, significant activation of lobules Crus I and VI was also present during the unexpected omission of the US in unreinforced CS+ acquisition trials. This activation disappeared during extinction when US omission became expected. These findings provide evidence that the cerebellum has to be added to the neural network processing predictions and prediction errors in the emotional domain.

Reproducibility and Repeatability of MR Fingerprinting Relaxometry in the Human Brain.

Background Only sparse literature investigates the reproducibility and repeatability of relaxometry methods in MRI. However, statistical data on reproducibility and repeatability of any quantitative method is essential for clinical application. Purpose To evaluate the reproducibility and repeatability of two-dimensional fast imaging with steady-state free precession MR fingerprinting in vivo in human brains. Materials and Methods Two-dimensional section-selective MR fingerprinting based on a steady-state free precession sequence with an external radiofrequency transmit field, or B1+, correction was used to generate T1 and T2 maps. This prospective study was conducted between July 2017 and January 2018 with 10 scanners from a single manufacturer, including different models, at four different sites. T1 and T2 relaxation times and their variation across scanners (reproducibility) as well as across repetitions on a scanner (repeatability) were analyzed. The relative deviations of T1 and T2 to the average (95% confidence interval) were calculated for several brain compartments. Results Ten healthy volunteers (mean age ± standard deviation, 28.5 years ± 6.9; eight men, two women) participated in this study. Reproducibility and repeatability of T1 and T2 measures in the human brain varied across brain compartments (1.8%-20.9%) and were higher in solid tissues than in the cerebrospinal fluid. T1 measures in solid tissue brain compartments were more stable compared with T2 measures. The half-widths of the confidence intervals for relative deviations were 3.4% for mean T1 and 8.0% for mean T2 values across scanners. Intrascanner repeatability half-widths of the confidence intervals for relative deviations were in the range of 2.0%-3.1% for T1 and 3.1%-7.9% for T2. Conclusion This study provides values on reproducibility and repeatability of T1 and T2 relaxometry measured with fast imaging with steady-state free precession MR fingerprinting in brain tissues of healthy volunteers. Reproducibility and repeatability are considerably higher in solid brain compartments than in cerebrospinal fluid and are higher for T1 than for T2. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Barkhof and Parker in this issue.

Development and evaluation of a 16-channel receive-only RF coil to improve 7T ultra-high field body MRI with focus on the spine.

PURPOSE: A 16-channel receive (16Rx) radiofrequency (RF) array for 7T ultra-high field body MR imaging is presented. The coil is evaluated in conjunction with a 16-channel transmit/receive (16TxRx) coil and additionally with a 32-channel transmit/receive (32TxRx) remote body coil for RF transmit and serving as receive references. METHODS: The 16Rx array consists of 16 octagonal overlapping loops connected to custom-built detuning boards with preamplifiers. Performance metrics like noise correlation, g-factors, and signal-to-noise ratio gain were compared between 4 different RF coil configurations. In vivo body imaging was performed in volunteers using radiofrequency shimming, time interleaved acquisition of modes (TIAMO), and 2D spatially selective excitation using parallel transmit (pTx) in the spine. RESULTS: Lower g-factors were obtained when using the 16Rx coil in addition to the 16TxRx array coil configuration versus the 16TxRx array alone. Distinct signal-to-noise ratio gain using the 16Rx coil could be demonstrated in the spine region both for a comparison with the 16TxRx coil (>50% gain) in vivo and the 32TxRx coil (>240% gain) in a phantom. The 16Rx coil was successfully applied to improve anatomical imaging in the abdomen and 2D spatially selective excitation in the spine of volunteers. CONCLUSION: The novel 16-channel Rx-array as an add-on to multichannel TxRx RF coil configurations provides increased signal-to-noise ratio, lower g-factors, and thus improves 7T ultra-high field body MR imaging.

Enhanced Neural Reinstatement for Evoked Facial Pain Compared With Evoked Hand Pain.

Memory retrieval is accompanied by a reactivation of cortical and subcortical areas that have been active during encoding. This neural reinstatement is stronger during retrieval of pain-associated material compared with other unpleasant events. In this functional magnetic resonance imaging study, we investigated the differences in neural reinstatement during recognition of visual stimuli that had been paired with face or hand pain during memory encoding. Body site-specific neural reinstatement was tested in 23 healthy young volunteers who performed a visual categorization and a surprise recognition task. Our data shows increased neural reinstatement in task-specific and encoding-related areas, such as the parahippocampus (left: x = -26, y = -30, z = -18, t = 4.11; right: x = 26, y = -38, z = -6, t = 4.36), precuneus (x = 2, y = -56, z = 2, t = 3.77), fusiform gyrus (left: x = -24, y = -26, z = -20, t = 5.41; right: x = 18, y = -58, z = -14, t = 4.52), and amygdala (x = -34, y = -4, z = -20, t = 4.49) for pictures that were previously presented with face compared with hand pain. These results correlated with the individual's recognition confidence, although recognition rates did not differ between the conditions. Functional connectivity was increased between the amygdala and parahippocampus (x = 34, y = -10, z = -28, t = 5.13) for pictures that had previously been paired with face compared with hand pain. Our results were positively correlated with pain-related fear, represented by neural activation in the thalamus (x = -14, y = -35, z = 4, t = 3.54). The reported results can be interpreted as compensatory resource activation and support the notion of a stronger affective component of face compared with hand pain, potentially in line with its greater biological relevance. PERSPECTIVE: This study demonstrates neural reinstatement of face pain-related information, which might be related to the increased biological and affective component of face pain compared with pain on the extremities. Our results might contribute to the understanding of the development and prevalence of head and face pain conditions.

A dual-tuned 13 C/1 H head coil for PET/MR hybrid neuroimaging: Development, attenuation correction, and first evaluation.

PURPOSE: This study aims to develop, implement, and evaluate a dual-tuned 13 C/1 H head coil for integrated positron emission tomography/magnetic resonance (PET/MR) neuroimaging. The radiofrequency (RF) head coil is designed for optimized MR imaging performance and PET transparency and attenuation correction (AC) is applied for accurate PET quantification. MATERIAL AND METHODS: A dual-tuned 13 C/1 H RF head coil featuring a 16-rung birdcage was designed to be used for integrated PET/MR hybrid imaging. While the open birdcage design can be considered inherently PET transparent, all further electronic RF components were placed as far as possible outside of the field-of-view (FOV) of the PET detectors. The RF coil features a rigid geometry and thin-walled casing. Attenuation correction of the RF head coil is performed by generating and applying a dedicated 3D CT-based template attenuation map (µmap). Attenuation correction was systematically evaluated in phantom experiments using a large-volume cylindrical emission phantom filled with 18-F-Fluordesoxyglucose (FDG) radiotracer. The PET/MR imaging performance and PET attenuation correction were then evaluated in a patient study including six patients. RESULTS: The dual-tuned RF head coil causes a mean relative attenuation difference of 8.8% across the volume of the cylindrical phantom, while the local relative differences range between 1% and 25%. Applying attenuation correction, the relative difference between the two measurements with and without RF coil is reduced to mean value of 0.5%, with local differences of ±3.6%. The quantitative results of the phantom measurements were corroborated by patient PET/MR measurements. Patient scans using the RF head coil show a decrease of PET signal of 5.17% ± 0.81% when compared to the setup without RF head coil in place, which served as a reference scan. When applying attenuation correction of the RF coil in the patient measurements, the mean difference to a measurement without RF coil was reduced to -0.87% ± 0.65%. CONCLUSION: A dual-tuned 13 C/1 H RF head coil was designed and evaluated regarding its potential use in integrated PET/MR hybrid imaging. Attenuation correction was successfully applied. In conclusion, the RF head coil was successfully integrated into PET/MR hybrid imaging and can now be used for 13 C/1 H multinuclear hybrid neuroimaging in future studies.

Impact of improved attenuation correction featuring a bone atlas and truncation correction on PET quantification in whole-body PET/MR.

PURPOSE: Recent studies have shown an excellent correlation between PET/MR and PET/CT hybrid imaging in detecting lesions. However, a systematic underestimation of PET quantification in PET/MR has been observed. This is attributable to two methodological challenges of MR-based attenuation correction (AC): (1) lack of bone information, and (2) truncation of the MR-based AC maps (µmaps) along the patient arms. The aim of this study was to evaluate the impact of improved AC featuring a bone atlas and truncation correction on PET quantification in whole-body PET/MR. METHODS: The MR-based Dixon method provides four-compartment µmaps (background air, lungs, fat, soft tissue) which served as a reference for PET/MR AC in this study. A model-based bone atlas provided bone tissue as a fifth compartment, while the HUGE method provided truncation correction. The study population comprised 51 patients with oncological diseases, all of whom underwent a whole-body PET/MR examination. Each whole-body PET dataset was reconstructed four times using standard four-compartment µmaps, five-compartment µmaps, four-compartment µmaps + HUGE, and five-compartment µmaps + HUGE. The SUVmax for each lesion was measured to assess the impact of each µmap on PET quantification. RESULTS: All four µmaps in each patient provided robust results for reconstruction of the AC PET data. Overall, SUVmax was quantified in 99 tumours and lesions. Compared to the reference four-compartment µmap, the mean SUVmax of all 99 lesions increased by 1.4 ± 2.5% when bone was added, by 2.1 ± 3.5% when HUGE was added, and by 4.4 ± 5.7% when bone + HUGE was added. Larger quantification bias of up to 35% was found for single lesions when bone and truncation correction were added to the µmaps, depending on their individual location in the body. CONCLUSION: The novel AC method, featuring a bone model and truncation correction, improved PET quantification in whole-body PET/MR imaging. Short reconstruction times, straightforward reconstruction workflow, and robust AC quality justify further routine clinical application of this method.

Fast and accurate multi-channel B1+ mapping based on the TIAMO technique for 7T UHF body MRI.

PURPOSE: Current methods for mitigation of transmit field B1+ inhomogeneities at ultrahigh field (UHF) MRI by multi-channel radiofrequency (RF) shimming rely on accurate B1+ mapping. This can be time consuming when many RF channels have to be mapped for in vivo body MRI, where the B1 maps should ideally be acquired within a single breath-hold. Therefore, a new B1+ mapping technique (B1TIAMO) is proposed. METHODS: The performance of this technique is validated against an established method (DREAM) in phantom measurements for a cylindrical head phantom with an 8-channel transmit/receive (Tx/Rx) array. Furthermore, measurements for a 32-channel Tx/Rx remote array are conducted in a large body phantom and the |B1+| map reliability is validated against simulations of the transmit RF field distribution. Finally, in vivo results of this new mapping technique for human abdomen are presented. RESULTS: For the head phantom (8-channel Tx/Rx coil), the single |B1+| comparison between B1 TIAMO, the direct DREAM measurements, and simulation data showed good agreement with 10-19% difference. For the large body phantom (32-channel Tx/Rx coil), B1TIAMO matched the RF field simulations well. CONCLUSION: The results demonstrate the potential to acquire 32 accurate single-channel B1+ maps for large field-of-view body imaging within only a single breath-hold of 16 s at 7T UHF MRI. Magn Reson Med 79:2652-2664, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Parallel transmit capability of various RF transmit elements and arrays at 7T MRI.

PURPOSE: In this work, 22 configurations for remote radiofrequency (RF) coil arrays consisting of different transmit element designs for 7 Tesla (T) ultrahigh-field MRI are compared by numerical simulations. METHODS: Investigated transmit RF element types are rectangular loops, micro striplines, micro striplines with meanders, 250-mm shielded dipoles with meanders, and lambda over two dipoles with and without shield. These elements are combined in four different configurations of circumferential RF body arrays with four or eight transmit elements each. Comparisons included coupling behavior, degrees of freedom offered by the individual transmit patterns, and metrics like power and specific absorption rate efficiency. RESULTS: Coupling between neighboring RF elements is elevated (up to -7 dB) for all arrays with eight elements, whereas it is below -25 dB for arrays with only four elements. The cumulative sum of singular values points out highest degrees of freedom for the central transversal, reduced values in the central coronal, and minimum values in the sagittal slice. Concerning power and SAR efficiency, eight lambda over two dipoles are most advantageous. CONCLUSIONS: Among the investigated remote arrays and parameters, a combination of eight dipoles appears to be most favorable for potential use in 7T body MRI. Magn Reson Med 79:1116-1126, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

MR-based truncation and attenuation correction in integrated PET/MR hybrid imaging using HUGE with continuous table motion.

PURPOSE: The objective of this study was to introduce and evaluate a method for MR-based attenuation and truncation correction in phantom and patient measurements to improve PET quantification in PET/MR hybrid imaging. METHODS: The fully MR-based method HUGE (B0 Homogenization using gradient enhancement) provides field-of-view extension in MR imaging, which can be used for truncation correction and improved PET quantification in PET/MR hybrid imaging. The HUGE method in this recent implementation is combined with continuously moving table data acquisition to provide a seamless nontruncated whole-body data set of the outer patient contours to complete the established standard MR-based Dixon-VIBE data for attenuation correction. The method was systematically evaluated in NEMA standard phantom experiments to investigate the impact of HUGE truncation correction on PET quantification. The method was then applied to 24 oncologic patients in whole-body PET/MR hybrid imaging. The impact of MR-based truncation correction with HUGE on PET data was compared to the impact of the established PET-based MLAA algorithm for contour detection. RESULTS: In phantom and in all patient measurements, the standard Dixon-VIBE attenuation correction data show geometric distortions and signal truncations at the edges of the MR imaging field-of-view. In contrast, the Dixon-VIBE-based attenuation correction data additionally extended by applying HUGE shows significantly less distortion and truncations and due to the continuously moving table acquisition robustly provides smooth outer contours of the patient arms. In the investigated patient cases, MLAA frequently showed an overestimation of arm volume and associated artifacts limiting contour detection. When applying HUGE, an average relative increase in SUVmean in patients' lesion of 4.2% and for MLAA of 4.6% were measured, when compared to standard Dixon-VIBE only. In specific lesions maximal differences in SUVmean up to 13% for HUGE and 14% for MLAA were measured. Quantification in truncated regions showed maximal differences up to 40% for both, MLAA and HUGE. Average differences in those regions in SUVmean for HUGE are 13.3% and 14.6% for MLAA. In a patient with I-124 radiotracer PET-based MLAA contour detection completely failed in this specific case, whereas HUGE as MR-based approach provided accurate truncation correction. CONCLUSIONS: The HUGE method for truncation correction combined with continuous table movement extends the lateral MR field-of-view and effectively reduces truncations along the outer contours of the patient's arms in whole-body PET/MR imaging. HUGE as a fully MR-based approach is independent of the choice of radiotracer, thus also offering robust truncation correction in patients that are not injected with Fluordesoxyglucose (FDG) as radiotracer. Therefore, this method improves the standard Dixon MR-based attenuation correction and PET image quantification in whole-body PET/MR imaging applications.

Evaluation of fast highly undersampled contrast-enhanced MR angiography (sparse CE-MRA) in intracranial applications - initial study.

OBJECTIVES: To assess the image quality of sparsely sampled contrast-enhanced MR angiography (sparse CE-MRA) providing high spatial resolution and whole-head coverage. MATERIALS AND METHODS: Twenty-three patients scheduled for contrast-enhanced MR imaging of the head, (N = 19 with intracranial pathologies, N = 9 with vascular diseases), were included. Sparse CE-MRA at 3 Tesla was conducted using a single dose of contrast agent. Two neuroradiologists independently evaluated the data regarding vascular visibility and diagnostic value of overall 24 parameters and vascular segments on a 5-point ordinary scale (5 = very good, 1 = insufficient vascular visibility). Contrast bolus timing and the resulting arterio-venous overlap was also evaluated. Where available (N = 9), sparse CE-MRA was compared to intracranial Time-of-Flight MRA. RESULTS: The overall rating across all patients for sparse CE-MRA was 3.50 ± 1.07. Direct influence of the contrast bolus timing on the resulting image quality was observed. Overall mean vascular visibility and image quality across different features was rated good to intermediate (3.56 ± 0.95). The average performance of intracranial Time-of-Flight was rated 3.84 ± 0.87 across all patients and 3.54 ± 0.62 across all features. CONCLUSION: Sparse CE-MRA provides high-quality 3D MRA with high spatial resolution and whole-head coverage within short acquisition time. Accurate contrast bolus timing is mandatory. KEY POINTS: • Sparse CE-MRA enables fast vascular imaging with full brain coverage. • Volumes with sub-millimetre resolution can be acquired within 10 seconds. • Reader's ratings are good to intermediate and dependent on contrast bolus timing. • The method provides an excellent overview and allows screening for vascular pathologies.

Real-time SPARSE-SENSE cardiac cine MR imaging: optimization of image reconstruction and sequence validation.

OBJECTIVES: Improved real-time cardiac magnetic resonance (CMR) sequences have currently been introduced, but so far only limited practical experience exists. This study aimed at image reconstruction optimization and clinical validation of a new highly accelerated real-time cine SPARSE-SENSE sequence. METHODS: Left ventricular (LV) short-axis stacks of a real-time free-breathing SPARSE-SENSE sequence with high spatiotemporal resolution and of a standard segmented cine SSFP sequence were acquired at 1.5 T in 11 volunteers and 15 patients. To determine the optimal iterations, all volunteers' SPARSE-SENSE images were reconstructed using 10-200 iterations, and contrast ratios, image entropies, and reconstruction times were assessed. Subsequently, the patients' SPARSE-SENSE images were reconstructed with the clinically optimal iterations. LV volumetric values were evaluated and compared between both sequences. RESULTS: Sufficient image quality and acceptable reconstruction times were achieved when using 80 iterations. Bland-Altman plots and Passing-Bablok regression showed good agreement for all volumetric parameters. CONCLUSIONS: 80 iterations are recommended for iterative SPARSE-SENSE image reconstruction in clinical routine. Real-time cine SPARSE-SENSE yielded comparable volumetric results as the current standard SSFP sequence. Due to its intrinsic low image acquisition times, real-time cine SPARSE-SENSE imaging with iterative image reconstruction seems to be an attractive alternative for LV function analysis. KEY POINTS: • A highly accelerated real-time CMR sequence using SPARSE-SENSE was evaluated. • SPARSE-SENSE allows free breathing in real-time cardiac cine imaging. • For clinically optimal SPARSE-SENSE image reconstruction, 80 iterations are recommended. • Real-time SPARSE-SENSE imaging yielded comparable volumetric results as the reference SSFP sequence. • The fast SPARSE-SENSE sequence is an attractive alternative to standard SSFP sequences.

Compressed sensing cine imaging with high spatial or high temporal resolution for analysis of left ventricular function.

PURPOSE: To assess two compressed sensing cine magnetic resonance imaging (MRI) sequences with high spatial or high temporal resolution in comparison to a reference steady-state free precession cine (SSFP) sequence for reliable quantification of left ventricular (LV) volumes. MATERIALS AND METHODS: LV short axis stacks of two compressed sensing breath-hold cine sequences with high spatial resolution (SPARSE-SENSE HS: temporal resolution: 40 msec, in-plane resolution: 1.0 × 1.0 mm(2) ) and high temporal resolution (SPARSE-SENSE HT: temporal resolution: 11 msec, in-plane resolution: 1.7 × 1.7 mm(2) ) and of a reference cine SSFP sequence (standard SSFP: temporal resolution: 40 msec, in-plane resolution: 1.7 × 1.7 mm(2) ) were acquired in 16 healthy volunteers on a 1.5T MR system. LV parameters were analyzed semiautomatically twice by one reader and once by a second reader. The volumetric agreement between sequences was analyzed using paired t-test, Bland-Altman plots, and Passing-Bablock regression. RESULTS: Small differences were observed between standard SSFP and SPARSE-SENSE HS for stroke volume (SV; -7 ± 11 ml; P = 0.024), ejection fraction (EF; -2 ± 3%; P = 0.019), and myocardial mass (9 ± 9 g; P = 0.001), but not for end-diastolic volume (EDV; P = 0.079) and end-systolic volume (ESV; P = 0.266). No significant differences were observed between standard SSFP and SPARSE-SENSE HT regarding EDV (P = 0.956), SV (P = 0.088), and EF (P = 0.103), but for ESV (3 ± 5 ml; P = 0.039) and myocardial mass (8 ± 10 ml; P = 0.007). Bland-Altman analysis showed good agreement between the sequences (maximum bias ≤ -8%). CONCLUSION: Two compressed sensing cine sequences, one with high spatial resolution and one with high temporal resolution, showed good agreement with standard SSFP for LV volume assessment. J. Magn. Reson. Imaging 2016;44:366-374.

High and ultra-high b-value diffusion-weighted imaging in prostate cancer: a quantitative analysis.

BACKGROUND: Diffusion-weighted imaging (DWI) is routinely used in magnetic resonance imaging (MRI) of prostate cancer. However, the routine use of b values higher than 1000 s/mm(2) is not clear up to present. Moreover, the complex diffusion behavior of malignant and benign prostate tissues hampers precise predictions of contrast in DWI images and apparent diffusion coefficient (ADC) maps. PURPOSE: To quantitatively analyze DWI with different b values in prostate cancer and to identify b values best suitable for cancer detection. MATERIAL AND METHODS: Forty-one patients with histologically proven prostate cancer were examined with high resolution T2-weighted imaging and DWI at 3 Tesla. Five different b values (0, 800, 1000, 1500, 2000 s/mm(2)) were applied. ADC values of tumors and reference areas were measured on ADC maps derived from different pairs of b values. Furthermore, signal intensities of DW images of tumors and reference areas were measured. For analysis, contrast ratios of ADC values and signal intensities of DW images were calculated and compared. RESULTS: No significant differences were found between contrast ratios measured on ADC maps of all analyzed b value pairs (P = 0.43). Contrast ratios calculated from signal intensities of DW images were highest at b values of 1500 and 2000 s/mm(2) and differed significantly from contrast ratios at b values of 800 and 1000 s/mm(2) (P < 0.01). CONCLUSION: Whereas contrast in ADC maps does not significantly change with different b values, contrast ratios of DW images are significantly higher at b-values of 1500 and 2000 s/mm(2) in comparison to b values of 800 and 1000 s/mm(2). Therefore, diagnostic performance of DWI in prostate cancer might be increased by application of b values higher than 1000 s/mm(2).

Simultaneous positron emission tomography/magnetic resonance imaging for whole-body staging in patients with recurrent gynecological malignancies of the pelvis: a comparison to whole-body magnetic resonance imaging alone.

OBJECTIVES: The objective of this study was to assess the diagnostic value of integrated positron emission tomography/magnetic resonance imaging (PET/MRI) for whole-body staging of patients with recurrent gynecological pelvic malignancies, in comparison to whole-body MRI alone. MATERIALS AND METHODS: The study was approved by the local institutional ethics committee. Written informed consent was obtained before each examination. Thirty-four consecutive patients with a suspected recurrence of cervical (n = 18) or ovarian (n = 16) cancer were prospectively enrolled for an integrated PET/MRI examination, which comprised a diagnostic, contrast-enhanced whole-body MRI protocol including dedicated sagittal dynamic imaging of the pelvis. Two radiologists separately evaluated the data sets regarding lesion count, lesion detection, lesion characterization, and diagnostic confidence. Mean and median values were calculated for each rating. Statistical analyses were performed both per-patient and per-lesion bases using a Wilcoxon signed-rank test to indicate potential significant differences among PET/MRI and MRI (alone) data sets. RESULTS: Malignant lesions were present in 25 of the 34 patients. Positron emission tomography/magnetic resonance imaging offered correct and superior identification of all 25 patients with cancer recurrence, compared with MRI alone (23/25). A total of 118 lesions (malignant, 89; benign, 29) were detected. Positron emission tomography/magnetic resonance imaging correctly identified 88 (98.9%) of 89 malignant lesions, whereas MRI alone allowed for correct identification of 79 (88.8%) of the 89 malignant lesions. In addition, PET/MRI provided significantly higher lesion contrast and diagnostic confidence in the detection of malignant lesions (P < 0.001) compared with MRI alone. CONCLUSIONS: These first results demonstrate the high diagnostic potential of integrated PET/MRI for the assessment of recurrence of female pelvic malignancies compared with MRI alone.