High-performance low field MRI enables visualization of persistent pulmonary damage after COVID-19.

The outbreak of coronavirus disease 2019 (COVID-19) with the origin of the spread assumed to be located in Wuhan, China, began in December 2019, and is continuing until now. With the COVID-19 pandemic showing a progressive spread throughout the countries of the world, there is emerging interest for the potential long-term consequences of suffering from a COVID-19 pneumonia. Imaging plays a central role in the diagnosis and management of COVID-19 pneumonia, with chest X-ray examinations and computed tomography (CT) being undoubtedly the modalities most widely used, allowing for a fast and sensitive detection of infiltration patterns associated with COVID-19 pneumonia. For a better understanding of underlying pathomechanisms of pulmonary damage, longitudinal imaging series are warranted, for which CT is of limited usability due to repeated exposure of X-rays. Recent advances in MRI suggested that high-performance low-field MRI might represent a valuable method for pulmonary imaging without the need of radiation exposure. However, so far, low-field MRI has not been applied to study pulmonary damage after COVID-19 pneumonia. We present a case report of a patient who suffered from COVID-19 pneumonia using 0.55 T MRI for follow-up examinations three months after initial infection. Low-field MRI enables a precise visualization of persistent pulmonary changes including ground-glass opacities, which are consistent with CT performed on the same day. Low-field MRI seems to be feasible in the detection of pulmonary involvement in patients with COVID-19 pneumonia and may have the potential for repetitive lung examinations in monitoring the reconvalescence after pulmonary infections.

Fast Abdominal Contrast-Enhanced Imaging With High Parallel-Imaging Factors Using a 60-Channel Receiver Coil Setup: Comparison With The Standard Coil Setup.

PURPOSE: The aim of this study was to assess a novel 60-channel receiver body coil (B60) setup for accelerated contrast-enhanced abdominal magnetic resonance imaging (MR) imaging with respect to signal-to-noise ratio (SNR) and image quality using high parallel-imaging technique (PAT) factors in comparison to a standard 30-channel coil setup. METHODS: All imaging data were acquired on a 3 T MR scanner using a novel B60 receiver coil setup in comparison to a standard 30-channel setup serving as reference standard. Phantom measurements were performed to systematically evaluate SNR and geometry factor performance in an ex vivo setting. To assess the in vivo application, additional measurements in 5 healthy volunteers and 17 patients were performed using a 3-dimensional T1w gradient-echo sequences with different acceleration factors. At first, the volunteers were examined. In a second step, standard contrast-enhanced abdominal images were acquired in the 17 patients, who were randomly assigned into 2 groups (group A: 60-channel, n = 8; group B: 30-channel, n = 9). Image quality, noise, lesion conspicuity, and artifacts were assessed by 2 radiologists independently on a 5-point Likert scale (5 = excellent). RESULTS: The phantom study revealed substantial advantages (SNR and geometry factor) of the B60 coil for measurements in the head-to-feet phase encoding direction, whereas only minor differences were found in other directions. Comparison of image quality in volunteers revealed significantly higher ratings of the B60 setup for all acquisitions (P ≤ 0.032), except for PAT = none. In patients, similar results were observed with comparable image quality at lower PAT factors and significantly superior image quality of the B60 setup for higher PAT factors (2 × 2 and 3 × 2; P = 0.008). CONCLUSIONS: The 60-channel coil setup facilitates improved SNR and image quality at high PAT factors with diagnostic image quality, which allows for accelerated contrast-enhanced MR imaging of the abdomen.

Understanding 3D TSE Sequences: Advantages, Disadvantages, and Application in MSK Imaging.

Three-dimensional (3D) turbo-spin echo (TSE) sequences have outgrown the stage of mere sequence optimization and by now are clinically applicable. Image blurring and acquisition times have been reduced, and contrast for T1-, T2-, and moderately T2-weighted (or intermediate-weighted) fat-suppressed variants has been optimized. Data on sound-to-noise ratio efficiency and contrast are available for moderately T2-weighted fat-saturated sequence protocols. The 3-T MRI scanners help to better exploit isotropic spatial resolution and multiplanar reformatting. Imaging times range from 5 to 10 minutes, and they are shorter than the cumulative acquisition times of three separate orthogonal two-dimensional (2D) sequences. Recent suggestions go beyond secondary reformations by using online 3D rendering for image evaluation. Comparative clinical studies indicate that the diagnostic performance of 3D TSE for imaging of internal derangements of joints is at least comparable with conventional 2D TSE with potential advantages of 3D TSE for small highly curved structures. But such studies, especially those with direct arthroscopic correlation, are still sparse. Whether 3D TSE will succeed in entering clinical routine imaging on a broader scale will depend on further published clinical evidence, on further reduction of imaging time, and on improvement of its integration into daily practice.

Whole-body diffusion-weighted MRI with apparent diffusion coefficient mapping for early response monitoring in multiple myeloma: preliminary results.

OBJECTIVE: The purpose of our study was to prospectively assess the feasibility of whole-body diffusion-weighted imaging (DWI) for short-term evaluation of response to treatment in multiple myeloma patients using a single-shot echo-planar imaging DWI sequence with a Stejskal-Tanner diffusion encoding scheme and spectral fat suppression. SUBJECTS AND METHODS: Twelve consecutive patients (nine men and three women; mean age, 61.4 years; age range, 54-79 years) underwent whole-body DWI (b = 50, 400, and 800 s/mm(2)) both at baseline and 3 weeks (mean, 23 days) after onset of therapy. Bone marrow and extramedullary manifestations were evaluated by quantitative image analysis using measurements of the mean apparent diffusion coefficient (ADC). These parameters were correlated with myeloma response according to standard criteria and were evaluated parallel to MRI and continuously for more than 6 months afterward. RESULTS: Fifty-three myeloma lesions, 50 medullary (28 axial and 22 appendicular skeleton) and three extramedullary, were analyzed. Eleven patients were classified as responders and one as a nonresponder. DWI results accurately (100%) correlated with disease course according to standard clinical and laboratory criteria. All involved lesions showed restricted diffusion at baseline. ADC quantification yielded an increase of 63.9% (range, 8.7-211.3%) in responders and a decrease of 7.8% in the sole nonresponding patient during therapy. In parallel, M-gradient measurement showed a mean decrease of 45.1% (range, 19.6-88.8%) in responders and an increase of 21.8% in the nonresponder. Amplitude of response measured by the course of ADC values proved higher in the appendicular skeleton (99.8%) compared with the axial skeleton (54.3%) (p = 0.037). CONCLUSION: Whole-body DWI with ADC analysis represents a feasible diagnostic tool for assessment of short-term treatment response in myeloma patients.

High-resolution cartilage imaging of the knee at 3T: basic evaluation of modern isotropic 3D MR-sequences.

PURPOSE: To evaluate qualitative and quantitative image quality parameters of isotropic three-dimensional (3D) cartilage-imaging magnetic resonance (MR)-sequences at 3T. MATERIALS AND METHODS: The knees of 10 healthy volunteers (mean age, 24.4±5.6 years) were scanned at a 3T MR scanner with water-excited 3D Fast-Low Angle Shot (FLASH), True Fast Imaging with Steady-state Precession (TrueFISP), Sampling Perfection with Application-optimized Contrast using different flip-angle Evolutions (SPACE) as well as conventional and two individually weighted Double-Echo Steady-State (DESS) sequences. The MR images were evaluated qualitatively and quantitatively (signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), SNR efficiency, CNR efficiency). Quantitative parameters were compared by means of a Tukey-test and sequences were ranked according to SNR/CNR, SNR/CNR efficiency and qualitative image grading. RESULTS: The highest SNR was measured for SPACE (34.0±5.6), the highest CNR/CNR efficiency (cartilage/fluid) for the individually weighted DESS (46.9±18.0/2.18±0.84). SPACE, individually weighted and conventional DESS were ranked best with respect to SNR/CNR and SNR/CNR efficiency. The DESS sequences also performed best in the qualitative evaluation. TrueFISP performed worse, FLASH worst. The individually weighted DESS sequences were generally better than the conventional DESS with the significant increase of cartilage-fluid contrast (46.9±18.0/31.9±11.4 versus 22.0±7.3) as main advantage. CONCLUSION: Individually weighted DESS is the most promising candidate; all tested sequences performed better than FLASH.

MRI of the knee at 3T: first clinical results with an isotropic PDfs-weighted 3D-TSE-sequence.

PURPOSE: To clinically evaluate MRI of the knee using a highly resolved isotropic fat-saturated (fs) proton-density weighted 3D-TSE-sequence (SPACE) at 3T. MATERIALS AND METHODS: Imaging was performed on a 3T-scanner (Magnetom TRIO). For technical evaluation, sagittally orientated SPACE-datasets (repetition-time [TR], 1200 milliseconds/[TE], 30 milliseconds/voxel-size, 0.5 mm3/acquisition time, 10:35 minutes) were acquired from the dominant knee of 10 healthy volunteers. In the 3 major anatomic planes, 0.5, 1, and 2 mm thick reconstructions were performed. Signal-to-noise (SNR), SNR-efficiency, contrast-to-noise (CNR) ratios, and anatomic detail visualization were compared with a state-of-the-art 2D-TSE-sequence in 3 imaging planes (TR, 3200 milliseconds/TE, 30 milliseconds/acquisition time, 12:34 minutes). Sixty patients with cartilage and meniscus pathologies were examined with these techniques. Patient SPACE-datasets were assessed in 1-mm thick reconstructions. Arthroscopical correlation was available for 18 patients. Lesion detection and diagnostic confidence were assessed by 2 radiologists independently. Statistical analysis was performed using 95% confidence intervals, Wilcoxon signed rank tests, and Weighted-kappa. RESULTS: SNR-efficiency of SPACE was 4 to 5 times higher than for 2D-TSE-sequences. SNR and CNR of 1-mm thick SPACE-reconstructions were comparable to 2D-TSE-sequences and provided superior visualization of small structures such as meniscal roots.Correlation with arthroscopy did not show significant differences between 2D- and 3D-sequences. One reader detected significantly more cartilage abnormalities with the 2D-TSE-sequence (131 vs. 151, P = 0.04), probably because of an unfamiliar fluid/cartilage contrast. Diagnostic confidence was significantly higher for meniscus abnormalities for SPACE for 1 reader. Intersequence-correlation was excellent (kappa = 0.82-0.92). Interreader-correlation was good to excellent (kappa = 0.71-0.80), intrareader-correlation was excellent (kappa = 0.90-0.92) for both sequences. CONCLUSIONS: Time-efficient 3D-TSE-imaging of the knee at 3T is feasible with adequate SNR and CNR and excellent anatomic detail visualization. Detection and visualization of meniscus and cartilage pathologies is comparable to standard 2D-TSE-sequences. 3D-TSE-sequences with consecutive multiplanar reconstruction may become a valuable component of future knee-MRI protocols.

High-resolution morphological and biochemical imaging of articular cartilage of the ankle joint at 3.0 T using a new dedicated phased array coil: in vivo reproducibility study.

OBJECTIVE: The objective of this study was to evaluate the feasibility and reproducibility of high-resolution magnetic resonance imaging (MRI) and quantitative T2 mapping of the talocrural cartilage within a clinically applicable scan time using a new dedicated ankle coil and high-field MRI. MATERIALS AND METHODS: Ten healthy volunteers (mean age 32.4 years) underwent MRI of the ankle. As morphological sequences, proton density fat-suppressed turbo spin echo (PD-FS-TSE), as a reference, was compared with 3D true fast imaging with steady-state precession (TrueFISP). Furthermore, biochemical quantitative T2 imaging was prepared using a multi-echo spin-echo T2 approach. Data analysis was performed three times each by three different observers on sagittal slices, planned on the isotropic 3D-TrueFISP; as a morphological parameter, cartilage thickness was assessed and for T2 relaxation times, region-of-interest (ROI) evaluation was done. Reproducibility was determined as a coefficient of variation (CV) for each volunteer; averaged as root mean square (RMSA) given as a percentage; statistical evaluation was done using analysis of variance. RESULTS: Cartilage thickness of the talocrural joint showed significantly higher values for the 3D-TrueFISP (ranging from 1.07 to 1.14 mm) compared with the PD-FS-TSE (ranging from 0.74 to 0.99 mm); however, both morphological sequences showed comparable good results with RMSA of 7.1 to 8.5%. Regarding quantitative T2 mapping, measurements showed T2 relaxation times of about 54 ms with an excellent reproducibility (RMSA) ranging from 3.2 to 4.7%. CONCLUSION: In our study the assessment of cartilage thickness and T2 relaxation times could be performed with high reproducibility in a clinically realizable scan time, demonstrating new possibilities for further investigations into patient groups.

Black-blood diffusion-weighted EPI acquisition of the liver with parallel imaging: comparison with a standard T2-weighted sequence for detection of focal liver lesions.

OBJECTIVES: To evaluate the performance of black-blood diffusion-weighted (DW)-EPI sequences with parallel imaging for the detection of focal liver lesions in comparison with a standard T2-weighted (T2-w) sequence. MATERIALS AND METHODS: Twenty patients with known or suspected focal liver lesions underwent liver MRI using a DW-EPI sequence with a b-value of 50 S/mm2 (TR/TE 2200/50 ms) and a standard fat-saturated T2-w sequence (TR/TE 2800/107 ms) with 6-mm slice thickness on a 1.5-T MRI system. Both sequences used parallel imaging with an acceleration factor of 2. Overall image quality and degree of artifacts were compared on a 5-point scale with 5 being the most desirable score. The detection rate and the level of confidence with regard to lesion detection were evaluated for both sequences in comparison to a contrast-enhanced (Gadolinium and SPIO) MR examination, which was used as the standard of reference. RESULTS: The DW-EPI sequence showed significantly (P < 0.05) improved overall image quality (average score 4.15 vs. 3.63) and fewer artifacts (average score 4.2 vs. 3.5) in comparison with the T2-w sequence. The sensitivity for lesion detection was superior in the DW-EPI sequence (83% vs. 61%). The level of confidence in the detection of focal liver lesions was also superior for the DW-EPI sequence in comparison with the T2-w sequence (average score 3.9 vs. 3.2). CONCLUSIONS: DW-EPI sequences for liver-imaging are feasible with parallel imaging and show excellent image quality. They may contribute to more easy and confident lesion detection in comparison with T2-w sequences.

Optimized T1-weighted contrast for single-slab 3D turbo spin-echo imaging with long echo trains: application to whole-brain imaging.

T(1)-weighted contrast is conventionally obtained using multislice two-dimensional (2D) spin-echo (SE) imaging. Achieving isotropic, high spatial resolution is problematic with conventional methods due to a long acquisition time, imperfect slice profiles, or high-energy deposition. Single-slab 3D SE imaging was recently developed employing long echo trains with variable low flip angles to address these problems. However, long echo trains may yield suboptimal T(1)-weighted contrast, since T(2) weighting of the signals tends to develop along the echo train. Image blurring may also occur if high spatial frequency signals are acquired with low signal intensity. The purpose of this work was to develop an optimized T(1)-weighted version of single-slab 3D SE imaging with long echo trains. Refocusing flip angles were calculated based on a tissue-specific prescribed signal evolution. Spatially nonselective excitation was used, followed by half-Fourier acquisition in the in-plane phase encoding (PE) direction. Restore radio frequency (RF) pulses were applied at the end of the echo train to optimize T(1)-weighted contrast. Imaging parameters were optimized by using Bloch equation simulation, and imaging studies of healthy subjects were performed to investigate the feasibility of whole-brain imaging with isotropic, high spatial resolution. The proposed technique permitted highly-efficient T(1)-weighted 3D SE imaging of the brain.

Tumor detection by diffusion-weighted MRI and ADC-mapping--initial clinical experiences in comparison to PET-CT.

OBJECTIVE: To evaluate the clinical potential of diffusion-weighted-imaging (DWI) with apparent diffusion coefficient (ADC)-mapping for tumor detection. MATERIALS AND METHODS: A single-shot echo-planar-imaging DWI sequence with fat suppression and ability for navigator-based respiratory triggering was implemented. Nineteen patients (11 melanoma, 4 prostate cancer, 1 non-Hodgkin lymphoma, and 3 lung cancer) were examined by positron emission tomography (PET) with an integrated computed tomography scanner (PET-CT) and DWI. Images at b = 0, 400, and 1000 s/mm2 were acquired and ADC maps were generated. PET examinations were used as a reference for tumor detection. Four hundred twenty-four regions of interest were used for DWI and 73 for PET data evaluation. RESULTS: DWI and ADC maps were of diagnostic quality. Metastases with increased tracer uptake were clearly visualized at b = 1000 s/mm2 with the exception of mediastinal lymph node metastases in cases of lung cancer. ADC mapping did not improve detection rates. CONCLUSIONS: DWI is a feasible clinical technique, improving the assessment of metastatic spread in routine magnetic resonance imaging examinations.

Quantitative T2 mapping of matrix-associated autologous chondrocyte transplantation at 3 Tesla: an in vivo cross-sectional study.

OBJECTIVES: To evaluate magnetic resonance (MR) T2 mapping for characterization of cartilage repair tissue following matrix-associated autologous cartilage transplantation (MACT). MATERIALS AND METHODS: Fifteen patients were evaluated following MACT using a 3T MR scanner. Patients were categorized into 2 postoperative intervals: I: 3-13 months, II: 19-42 months. Mean T2 relaxation times calculated from multiple spin-echo sequence were determined in regions of interest (MACT and normal hyaline cartilage) and T2 line profiles through the repair tissue and control sites were acquired. RESULTS: Mean global T2 values of repair tissue in group I were significantly higher than at control sites (P < 0.05). Repair tissue in group II showed no significant difference to control sites. Repair tissue T2 line profiles normalized over time toward the control sites. CONCLUSIONS: T2 mapping allows visualization of cartilage repair tissue maturation. Global T2 repair tissue values approach that of control sites after more than 1.5 years, similar behavior is seen in the zonal organization.

Diagnosis of articular cartilage abnormalities of the knee: prospective clinical evaluation of a 3D water-excitation true FISP sequence.

PURPOSE: To prospectively evaluate the accuracy of three-dimensional (3D) water-excitation true fast imaging with steady-state precession (FISP) in the assessment of cartilage abnormalities of the knee, by using surgery as the reference standard. MATERIALS AND METHODS: The study was approved by the hospital institutional review board. Written informed consent was obtained from all patients. Twenty-nine patients (30 knees) with a mean age of 56 years (range, 18-86 years) were prospectively evaluated with a sagittal 3D true FISP magnetic resonance (MR) sequence. The mean interval between MR imaging and surgery was 1 day (range, 0-9 days). During surgery, the articular surfaces of the knee were evaluated by using a modified Noyes score. The MR images were evaluated by two blinded readers on two separate occasions. Diagnostic performance was evaluated by setting the cutoff for abnormality between grade 1 (intact cartilage surface) and grade 2 (cartilage defects). Statistical methods used included calculation of sensitivity, specificity, and accuracy, with 95% confidence intervals (Wilson score method) and calculation of kappa values with standard errors. RESULTS: Overall sensitivity, specificity, and accuracy for the two readers and the two evaluations ranged from 56% to 66%, 78% to 93%, and 71% to 75%, respectively. Interobserver agreement was substantial for both the first (kappa = 0.73) and the second (kappa = 0.65) evaluation. Intraobserver agreement was almost perfect (kappa = 0.84) for reader 1 and moderate (kappa = 0.60) for reader 2. CONCLUSION: The 3D water-excitation true FISP MR sequence allows assessment of the articular cartilage of the knee with moderate-to-high specificity and low-to-moderate sensitivity.

Quantitative assessment of patellar cartilage volume and thickness at 3.0 tesla comparing a 3D-fast low angle shot versus a 3D-true fast imaging with steady-state precession sequence for reproducibility.

OBJECTIVES: We sought to compare patellar cartilage volume and thickness measurement between 3D-FLASH and 3D-True fast imaging with steady-state precession (FISP) image data at 3.0 T. MATERIALS AND METHODS: One knee each of 6 healthy adults was examined by axial magnetic resonance imaging (MRI) performed with a 3D-fast flow angle shot (FLASH) water-excitation sequence and a 3D-TrueFISP water-excitation sequence (spatial resolution 0.31 x 0.31 x 1.5 mm3). Patellar cartilage volume and mean/maximum thickness were calculated. Intraindividual/average reproducibility and interindividual variability were determined from 3 consecutive data sets acquired for each volunteer and sequence. RESULTS: Patellar cartilage volume and thickness as well as reproducibility was slightly but not significantly lower for the 3D-TrueFISP data than for the 3D-FLASH data (volume: 3.4-6.3 mL (3D-FLASH)/3.1-6.0 mL (3D-TrueFISP), average reproducibility 1.8% (3D-FLASH)/4.4% (3D-TrueFISP); mean thickness: 2.1-2.8 mm (3D-FLASH)/1.9-2.6 mm (3D-TrueFISP), average reproducibility 2.8% (3D-FLASH)/3.8% (3D-TrueFISP); maximum thickness: 4.7-6.6 mm (3D-FLASH)/4.5-6.2 mm (3D-TrueFISP), average reproducibility 2.6% (3D-FLASH)/4.1% (3D-TrueFISP)). Interindividual variability was comparable for both sequence techniques. CONCLUSION: At 3.0 T, the 3D-FLASH sequence showed tendency to be slightly superior to the 3D-TrueFISP sequence considering robust and valid assessment of quantitative cartilage parameters in young healthy adults, although there was found no significant statistical difference between both imaging techniques. However, in patients suffering from osteoarthritis (OA), the 3D-TrueFISP sequence might prove advantageous for monitoring of disease progression and evaluation of therapy success, particularly because the substantially higher signal to noise ratio/contrast to noise ratio values might allow for higher spatial resolution and hence for improvement of the accuracy of segmentation process especially at the articular surface.

Magnetic resonance imaging of the body trunk using a single-slab, 3-dimensional, T2-weighted turbo-spin-echo sequence with high sampling efficiency (SPACE) for high spatial resolution imaging: initial clinical experiences.

PURPOSE: The authors conducted a clinical evaluation of single-slab, 3-dimensional, T2-weighted turbo-spin-echo (TSE) with high sampling efficiency (SPACE) for high isotropic body imaging with large field-of-view (FoV). MATERIALS AND METHODS: Fifty patients were examined in clinical routine with SPACE (regions of interest: pelvis n=30, lower spine n=12, upper spine n=6, extremities n=4) at 1.5 T. For achieving a high sampling efficiency, parallel imaging, high turbofactor, and magnetization restore pulses were used. In contrast to a conventional TSE imaging technique with constant flip angle refocusing, the refocusing pulse train of the SPACE sequence consists of variable flip angle radiofrequency pulses along the echo train. RESULTS: Signal-to-noise ratio and contrast-to-noise ratio of SPACE images were of sufficient diagnostic value. The possibility of image reconstruction in multiple planes was of clinical relevance in all cases and simplified data analysis. CONCLUSION: The achievement of 3-dimensional, T2-weighted TSE magnetic resonance imaging with isotropic and high spatial resolution and interactive 3-dimensional visualization essentially improve the diagnostic potential of magnetic resonance imaging.