Incidence and severity of pulmonary embolism in COVID-19 infection: Ancestral, Alpha, Delta, and Omicron variants.

Little information is available regarding incidence and severity of pulmonary embolism (PE) across the periods of ancestral strain, Alpha, Delta, and Omicron variants. The aim of this study is to investigate the incidence and severity of PE over the dominant periods of ancestral strain and Alpha, Delta, and Omicron variants. We hypothesized that the incidence and the severity by proximity of PE in patients with the newer variants and vaccination would be decreased compared with those in ancestral and earlier variants. Patients with COVID-19 diagnosis between March 2020 and February 2022 and computed tomography pulmonary angiogram performed within a 6-week window around the diagnosis (-2 to +4 weeks) were studied retrospectively. The primary endpoints were the associations of the incidence and location of PE with the ancestral strain and each variant. Of the 720 coronavirus disease 2019 patients with computed tomography pulmonary angiogram (58.6 ± 17.2 years; 374 females), PE was diagnosed among 42/358 (12%) during the ancestral strain period, 5/60 (8%) during the Alpha variant period, 16/152 (11%) during the Delta variant period, and 13/150 (9%) during the Omicron variant period. The most proximal PE (ancestral strain vs variants) was located in the main/lobar arteries (31% vs 6%-40%), in the segmental arteries (52% vs 60%-75%), and in the subsegmental arteries (17% vs 0%-19%). There was no significant difference in both the incidence and location of PE across the periods, confirmed by multivariable logistic regression models. In summary, the incidence and severity of PE did not significantly differ across the periods of ancestral strain and Alpha, Delta, and Omicron variants.

Severe COVID-19 pneumonia leads to post-COVID-19 lung abnormalities on follow-up CT scans.

Purpose: To investigate the association of the maximal severity of pneumonia on CT scans obtained within 6-week of diagnosis with the subsequent development of post-COVID-19 lung abnormalities (Co-LA). Methods: COVID-19 patients diagnosed at our hospital between March 2020 and September 2021 were studied retrospectively. The patients were included if they had (1) at least one chest CT scan available within 6-week of diagnosis; and (2) at least one follow-up chest CT scan available ≥ 6 months after diagnosis, which were evaluated by two independent radiologists. Pneumonia Severity Categories were assigned on CT at diagnosis according to the CT patterns of pneumonia and extent as: 1) no pneumonia (Estimated Extent, 0%); 2) non-extensive pneumonia (GGO and OP, <40%); and 3) extensive pneumonia (extensive OP and DAD, >40%). Co-LA on follow-up CT scans, categorized using a 3-point Co-LA Score (0, No Co-LA; 1, Indeterminate Co-LA; and 2, Co-LA). Results: Out of 132 patients, 42 patients (32%) developed Co-LA on their follow-up CT scans 6-24 months post diagnosis. The severity of COVID-19 pneumonia was associated with Co-LA: In 47 patients with extensive pneumonia, 33 patients (70%) developed Co-LA, of whom 18 (55%) developed fibrotic Co-LA. In 52 with non-extensive pneumonia, 9 (17%) developed Co-LA: In 33 with no pneumonia, none (0%) developed Co-LA. Conclusions: Higher severity of pneumonia at diagnosis was associated with the increased risk of development of Co-LA after 6-24 months of SARS-CoV-2 infection.

External Hardware and Sensors, for Improved MRI.

Complex engineered systems are often equipped with suites of sensors and ancillary devices that monitor their performance and maintenance needs. MRI scanners are no different in this regard. Some of the ancillary devices available to support MRI equipment, the ones of particular interest here, have the distinction of actually participating in the image acquisition process itself. Most commonly, such devices are used to monitor physiological motion or variations in the scanner's imaging fields, allowing the imaging and/or reconstruction process to adapt as imaging conditions change. "Classic" examples include electrocardiography (ECG) leads and respiratory bellows to monitor cardiac and respiratory motion, which have been standard equipment in scan rooms since the early days of MRI. Since then, many additional sensors and devices have been proposed to support MRI acquisitions. The main physical properties that they measure may be primarily "mechanical" (eg acceleration, speed, and torque), "acoustic" (sound and ultrasound), "optical" (light and infrared), or "electromagnetic" in nature. A review of these ancillary devices, as currently available in clinical and research settings, is presented here. In our opinion, these devices are not in competition with each other: as long as they provide useful and unique information, do not interfere with each other and are not prohibitively cumbersome to use, they might find their proper place in future suites of sensors. In time, MRI acquisitions will likely include a plurality of complementary signals. A little like the microbiome that provides genetic diversity to organisms, these devices can provide signal diversity to MRI acquisitions and enrich measurements. Machine-learning (ML) algorithms are well suited at combining diverse input signals toward coherent outputs, and they could make use of all such information toward improved MRI capabilities. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 1.

COVID-19 Vaccination reduced pneumonia severity.

Purpose: To investigate the effect of vaccinations and boosters on the severity of COVID-19 pneumonia on CT scans during the period of Delta and Omicron variants. Methods: Retrospectively studied were 303 patients diagnosed with COVID-19 between July 2021 and February 2022, who had obtained at least one CT scan within 6 weeks around the COVID-19 diagnosis (-2 to +4 weeks). The severity of pneumonia was evaluated with a 6-point scale Pneumonia Score. The association between demographic and clinical data and vaccination status (booster/additional vaccination, complete vaccination and un-vaccination) and the difference between Pneumonia Scores by vaccination status were investigated. Results: Of 303 patients (59.4 ± 16.3 years; 178 females), 62 (20 %) were in the booster/additional vaccination group, 117 (39 %) in the complete vaccination group, and 124 (41 %) in the unvaccinated group. Interobserver agreement of the Pneumonia Score was high (weighted kappa score = 0.875). Patients in the booster/additionally vaccinated group tended to be older (P = 0.0085) and have more underlying comorbidities (P < 0.0001), and the Pneumonia Scores were lower in the booster/additionally vaccinated [median 2 (IQR 0-4)] and completely vaccinated groups [median 3 (IQR 1-4)] than those in the unvaccinated group [median 4 (IQR 2-4)], respectively (P < 0.0001 and P < 0.0001, respectively). A multivariable linear analysis adjusted for confounding factors confirmed the difference. Conclusion: Vaccinated patients, with or without booster/additional vaccination, had milder COVID-19 pneumonia on CT scans than unvaccinated patients during the period of Delta and Omicron variants. This study supports the efficacy of the vaccine against COVID-19 from a radiological perspective.

A relaxometry method that emphasizes practicality and availability.

PURPOSE: Although many methods have been proposed to quantitatively map the main MRI parameters (e.g., T1 , T2 , C × M0 ), these methods often involve special sequences not readily available on clinical scanners and/or may require long scan times. In contrast, the proposed method can readily run on most scanners, offer flexible tradeoffs between scan time and image quality, and map MRI parameters jointly to ensure spatial alignment. METHODS: The approach is based on the multi-shot spin-echo (SE) EPI sequence. The corresponding signal equation was derived and strategies for solving it were developed. As usual with multi-shot EPI, scan time can readily be traded-off against image quality by adjusting the echo train length. Validation was performed against reference relaxometry methods, in gel phantoms with varying concentrations of gadobutrol and gadoterate meglumine contrast agents. In vivo examples are further presented, from 3 neuroradiology patients. RESULTS: Bland-Altman analysis was performed: for T2 , as compared to 2D SE, bias was 0.29 ms and the 95% limits of agreement ranged from -1.15 to +1.73 ms. For T1 , compared to inversion-recovery SE (and MOLLI), bias was -20.2 ms (and -14.5 ms) and the limits of agreement ranged from -62.4 to +22.0 ms (and -53.8 to +24.9 ms). The mean relative T1 error between the proposed method and each of the 2 reference methods was similar to that of the reference methods among themselves. CONCLUSION: In the constellation of existing relaxometry methods, the proposed method is meant to stand out in terms of its practicality and availability.

Ultrasound-based sensors for respiratory motion assessment in multimodality PET imaging.

Breathing motion can displace internal organs by up to several cm; as such, it is a primary factor limiting image quality in medical imaging. Motion can also complicate matters when trying to fuse images from different modalities, acquired at different locations and/or on different days. Currently available devices for monitoring breathing motion often do so indirectly, by detecting changes in the outline of the torso rather than the internal motion itself, and these devices are often fixed to floors, ceilings or walls, and thus cannot accompany patients from one location to another. We have developed small ultrasound-based sensors, referred to as 'organ configuration motion' (OCM) sensors, that attach to the skin and provide rich motion-sensitive information. In the present work we tested the ability of OCM sensors to enable respiratory gating duringin vivoPET imaging. A motion phantom involving an FDG solution was assembled, and two cancer patients scheduled for a clinical PET/CT exam were recruited for this study. OCM signals were used to help reconstruct phantom andin vivodata into time series of motion-resolved images. As expected, the motion-resolved images captured the underlying motion. In Patient #1, a single large lesion proved to be mostly stationary through the breathing cycle. However, in Patient #2, several small lesions were mobile during breathing, and our proposed new approach captured their breathing-related displacements. In summary, a relatively inexpensive hardware solution was developed here for respiration monitoring. Because the proposed sensors attach to the skin, as opposed to walls or ceilings, they can accompany patients from one procedure to the next, potentially allowing data gathered in different places and at different times to be combined and compared in ways that account for breathing motion.

Ultrasound-based sensors to monitor physiological motion.

PURPOSE: Medical procedures can be difficult to perform on anatomy that is constantly moving. Respiration displaces internal organs by up to several centimeters with respect to the surface of the body, and patients often have limited ability to hold their breath. Strategies to compensate for motion during diagnostic and therapeutic procedures require reliable information to be available. However, current devices often monitor respiration indirectly, through changes on the outline of the body, and they may be fixed to floors or ceilings, and thus unable to follow a given patient through different locations. Here we show that small ultrasound-based sensors referred to as "organ configuration motion" (OCM) sensors can be fixed to the abdomen and/or chest and provide information-rich, breathing-related signals. METHODS: By design, the proposed sensors are relatively inexpensive. Breathing waveforms were obtained from tissues at varying depths and/or using different sensor placements. Validation was performed against breathing waveforms derived from magnetic resonance imaging (MRI) and optical tracking signals in five and eight volunteers, respectively. RESULTS: Breathing waveforms from different modalities were scaled so they could be directly compared. Differences between waveforms were expressed in the form of a percentage, as compared to the amplitude of a typical breath. Expressed in this manner, for shallow tissues, OCM-derived waveforms on average differed from MRI and optical tracking results by 13.1% and 15.5%, respectively. CONCLUSION: The present results suggest that the proposed sensors provide measurements that properly characterize breathing states. While OCM-based waveforms from shallow tissues proved similar in terms of information content to those derived from MRI or optical tracking, OCM further captured depth-dependent and position-dependent (i.e., chest and abdomen) information. In time, the richer information content of OCM-based waveforms may enable better respiratory gating to be performed, to allow diagnostic and therapeutic equipment to perform at their best.

Expanding Applications of Pulmonary MRI in the Clinical Evaluation of Lung Disorders: Fleischner Society Position Paper.

Pulmonary MRI provides structural and quantitative functional images of the lungs without ionizing radiation, but it has had limited clinical use due to low signal intensity from the lung parenchyma. The lack of radiation makes pulmonary MRI an ideal modality for pediatric examinations, pregnant women, and patients requiring serial and longitudinal follow-up. Fortunately, recent MRI techniques, including ultrashort echo time and zero echo time, are expanding clinical opportunities for pulmonary MRI. With the use of multicoil parallel acquisitions and acceleration methods, these techniques make pulmonary MRI practical for evaluating lung parenchymal and pulmonary vascular diseases. The purpose of this Fleischner Society position paper is to familiarize radiologists and other interested clinicians with these advances in pulmonary MRI and to stratify the Society recommendations for the clinical use of pulmonary MRI into three categories: (a) suggested for current clinical use, (b) promising but requiring further validation or regulatory approval, and (c) appropriate for research investigations. This position paper also provides recommendations for vendors and infrastructure, identifies methods for hypothesis-driven research, and suggests opportunities for prospective, randomized multicenter trials to investigate and validate lung MRI methods.

Improved PRF-based MR thermometry using k-space energy spectrum analysis.

PURPOSE: Proton resonance frequency (PRF) thermometry encodes information in the phase of MRI signals. A multiplicative factor converts phase changes into temperature changes, and this factor includes the TE. However, phase variations caused by B0 and/or B1 inhomogeneities can effectively change TE in ways that vary from pixel to pixel. This work presents how spatial phase variations affect temperature maps and how to correct for corresponding errors. METHODS: A method called "k-space energy spectrum analysis" was used to map regions in the object domain to regions in the k-space domain. Focused ultrasound heating experiments were performed in tissue-mimicking gel phantoms under two scenarios: with and without proper shimming. The second scenario, with deliberately de-adjusted shimming, was meant to emulate B0 inhomogeneities in a controlled manner. The TE errors were mapped and compensated for using k-space energy spectrum analysis, and corrected results were compared with reference results. Furthermore, a volunteer was recruited to help evaluate the magnitude of the errors being corrected. RESULTS: The in vivo abdominal results showed that the TE and heating errors being corrected can readily exceed 10%. In phantom results, a linear regression between reference and corrected temperatures results provided a slope of 0.971 and R2 of 0.9964. Analysis based on the Bland-Altman method provided a bias of -0.0977°C and 95% limits of agreement that were 0.75°C apart. CONCLUSION: Spatially varying TE errors, such as caused by B0 and/or B1 inhomogeneities, can be detected and corrected using the k-space energy spectrum analysis method, for increased accuracy in proton resonance frequency thermometry.

Relative Magnetic Force Measures and Their Potential Role in MRI Safety Practice.

BACKGROUND: Magnetic field markings are occasionally used at MRI sites to provide visual feedback of magnetic field strength at locations within the MRI scan room for safety purposes. In addition to magnetic field line markings, relative magnetic force, or ratio of magnetic to gravitational forces on an object, may be considered a useful complementary metric to quantify the risk associated with bringing objects containing ferromagnetic material into the magnetic field. PURPOSE: To develop and validate methods for deriving useful relative magnetic-force measures including a simple force index for application to MRI safety. STUDY TYPE: Phantom. PHANTOM: A special-purpose rig was built to experimentally measure relative magnetic forces on small ferromagnetic objects. FIELD STRENGTH: Ranging from 1.5T to 7T. ASSESSMENT: Quantitative comparisons were made between theoretical and measured relative magnetic forces on six objects containing ferromagnetic material: a piece of iron, a paper clip, a Kelly clamp, nail clippers, a cell phone, and a small permanent magnet. STATISTICAL TESTS: An analysis based on the Bland-Altman method was employed. RESULTS: After correction of the 1.5T data to account for assumed positioning errors of the test rig, limits of agreement between measured and estimated relative forces in the four MRI systems were ±0.16, where a relative force of 1.0 indicates that the magnetic force is equal to gravitation force. There was no significant bias in the data (P < = 0.05). DATA CONCLUSION: Accurate measures of relative magnetic forces on ferromagnetic objects can be derived for MRI safety purposes. LEVEL OF EVIDENCE: 1 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2020;51:1260-1271.

Multi-pathway multi-echo acquisition and neural contrast translation to generate a variety of quantitative and qualitative image contrasts.

PURPOSE: Clinical exams typically involve acquiring many different image contrasts to help discriminate healthy from diseased states. Ideally, 3D quantitative maps of all of the main MR parameters would be obtained for improved tissue characterization. Using data from a 7-min whole-brain multi-pathway multi-echo (MPME) scan, we aimed to synthesize several 3D quantitative maps (T1 and T2 ) and qualitative contrasts (MPRAGE, FLAIR, T1 -weighted, T2 -weighted, and proton density [PD]-weighted). The ability of MPME acquisitions to capture large amounts of information in a relatively short amount of time suggests it may help reduce the duration of neuro MR exams. METHODS: Eight healthy volunteers were imaged at 3.0T using a 3D isotropic (1.2 mm) MPME sequence. Spin-echo, MPRAGE, and FLAIR scans were performed for training and validation. MPME signals were interpreted through neural networks for predictions of different quantitative and qualitative contrasts. Predictions were compared to reference values at voxel and region-of-interest levels. RESULTS: Mean absolute errors (MAEs) for T1 and T2 maps were 216 ms and 11 ms, respectively. In ROIs containing white matter (WM) and thalamus tissues, the mean T1 /T2 predicted values were 899/62 ms and 1139/58 ms, consistent with reference values of 850/66 ms and 1126/58 ms, respectively. For qualitative contrasts, signals were normalized to those of WM, and MAEs for MPRAGE, FLAIR, T1 -weighted, T2 -weighted, and PD-weighted contrasts were 0.14, 0.15, 0.13, 0.16, and 0.05, respectively. CONCLUSIONS: Using an MPME sequence and neural-network contrast translation, whole-brain results were obtained with a variety of quantitative and qualitative contrast in ~6.8 min.

Accelerated Segmented Diffusion-Weighted Prostate Imaging for Higher Resolution, Higher Geometric Fidelity, and Multi-b Perfusion Estimation.

PURPOSE: The aim of this study was to improve the geometric fidelity and spatial resolution of multi-b diffusion-weighted magnetic resonance imaging of the prostate. MATERIALS AND METHODS: An accelerated segmented diffusion imaging sequence was developed and evaluated in 25 patients undergoing multiparametric magnetic resonance imaging examinations of the prostate. A reduced field of view was acquired using an endorectal coil. The number of sampled diffusion weightings, or b-factors, was increased to allow estimation of tissue perfusion based on the intravoxel incoherent motion (IVIM) model. Apparent diffusion coefficients measured with the proposed segmented method were compared with those obtained with conventional single-shot echo-planar imaging (EPI). RESULTS: Compared with single-shot EPI, the segmented method resulted in faster acquisition with 2-fold improvement in spatial resolution and a greater than 3-fold improvement in geometric fidelity. Apparent diffusion coefficient values measured with the novel sequence demonstrated excellent agreement with those obtained from the conventional scan (R = 0.91 for bmax = 500 s/mm and R = 0.89 for bmax = 1400 s/mm). The IVIM perfusion fraction was 4.0% ± 2.7% for normal peripheral zone, 6.6% ± 3.6% for normal transition zone, and 4.4% ± 2.9% for suspected tumor lesions. CONCLUSIONS: The proposed accelerated segmented prostate diffusion imaging sequence achieved improvements in both spatial resolution and geometric fidelity, along with concurrent quantification of IVIM perfusion.

Dispersion in Tissue-Mimicking Gels Measured with Shear Wave Elastography and Torsional Vibration Rheometry.

Dispersion, or the frequency dependence of mechanical parameters, is a primary confounding factor in elastography comparisons. We present a study of dispersion in tissue-mimicking gels over a wide frequency band using a combination of ultrasound shear wave elastography (SWE), and a novel torsional vibration rheometry which allows independent mechanical measurement of SWE samples. Frequency-dependent complex shear modulus was measured in homogeneous gelatin hydrogels of two different bloom strengths while controlling for confounding factors such as temperature, water content and material aging. Furthermore, both techniques measured the same physical samples, thereby eliminating possible variation caused by batch-to-batch gel variation, sample geometry differences and boundary artifacts. The wide-band measurement, from 1 to 1800 Hz, captured a 30%-50% increase in the storage modulus and a nearly linear increase with frequency of the loss modulus. The magnitude of the variation suggests that accounting for dispersion is essential for meaningful comparisons between SWE implementations.

Multipathway multi-echo (MPME) imaging: all main MR parameters mapped based on a single 3D scan.

PURPOSE: Quantitative parameter maps, as opposed to qualitative grayscale images, may represent the future of diagnostic MRI. A new quantitative MRI method is introduced here that requires a single 3D acquisition, allowing good spatial coverage to be achieved in relatively short scan times. METHODS: A multipathway multi-echo sequence was developed, and at least 3 pathways with 2 TEs were needed to generate T1 , T2 , T2* , B1+ , and B0 maps. The method required the central k-space region to be sampled twice, with the same sequence but with 2 very different nominal flip angle settings. Consequently, scan time was only slightly longer than that of a single scan. The multipathway multi-echo data were reconstructed into parameter maps, for phantom as well as brain acquisitions, in 5 healthy volunteers at 3 T. Spatial resolution, matrix size, and FOV were 1.2 × 1.0 × 1.2 mm3 , 160 × 192 × 160, and 19.2 × 19.2 × 19.2 cm3 (whole brain), acquired in 11.5 minutes with minimal acceleration. Validation was performed against T1 , T2 , and T2* maps calculated from gradient-echo and spin-echo data. RESULTS: In Bland-Altman plots, bias and limits of agreement for T1 and T2 results in vivo and in phantom were -2.9/±125.5 ms (T1 in vivo), -4.8/±20.8 ms (T2 in vivo), -1.5/±18.1 ms (T1 in phantom), and -5.3/±7.4 ms (T2 in phantom), for regions of interest including given brain structures or phantom compartments. Due to relatively high noise levels, the current implementation of the approach may prove more useful for region of interest-based as opposed to pixel-based interpretation. CONCLUSIONS: We proposed a novel approach to quantitatively map MR parameters based on a multipathway multi-echo acquisition.

Application of a forward model of axisymmetric shear wave propagation in viscoelastic media to shear wave elastography.

A simple but general solution of Navier's equation for axisymmetric shear wave propagation in a homogeneous isotropic viscoelastic medium is presented. It is well-suited for use as a forward model for some acoustic radiation force impulse based shear wave elastography applications because it does not require precise knowledge of the strength of the source, nor its spatial or temporal distribution. Instead, it depends on two assumptions: (1) the source distribution is axisymmetric and confined to a small region near the axis of symmetry, and (2) the propagation medium is isotropic and homogeneous. The model accounts for the vector polarization of shear waves and exactly represents geometric spreading of the shear wavefield, whether spherical, cylindrical, or neither. It makes no assumption about the frequency dependence of material parameters, i.e., it is material-model independent. Validation using measured shear wavefields excited by acoustic radiation force in a homogeneous gelatin sample show that the model accounts for well over 90% of the measured wavefield "energy." An optimal fit of the model to simulated shear wavefields with noise in a homogeneous viscoelastic medium enables estimation of both the shear storage modulus and shear wave attenuation to within 1%.

The physics of MRI safety.

The main risks associated with magnetic resonance imaging (MRI) have been extensively reported and studied; for example, everyday objects may turn into projectiles, energy deposition can cause burns, varying fields can induce nerve stimulation, and loud noises can lead to auditory loss. The present review article is geared toward providing intuition about the physical mechanisms that give rise to these risks. On the one hand, excellent literature already exists on the practical aspect of risk management, with clinical workflow and recommendations. On the other hand, excellent technical articles also exist that explain these risks from basic principles of electromagnetism. We felt that an underserved niche might be found between the two, ie, somewhere between basic science and practical advice, to help develop intuition about electromagnetism that might prove of practical value when working around MR scanners. Following a wide-ranging introduction, risks originating from the main magnetic field, the excitation RF electromagnetic field, and switching of the imaging gradients will be presented in turn. LEVEL OF EVIDENCE: 5 Technical Efficacy: 1 J. Magn. Reson. Imaging 2018;47:28-43.

Dual-Pathway sequences for MR thermometry: When and where to use them.

PURPOSE: Dual-pathway sequences have been proposed to help improve the temperature-to-noise ratio (TNR) in MR thermometry. The present work establishes how much of an improvement these so-called "PSIF-FISP" sequences may bring in various organs and tissues. METHODS: Simulations and TNR calculations were validated against analytical equations, phantom, abdomen, and brain scans. Relative TNRs for PSIF-FISP, as compared to a dual-FISP reference standard, were calculated for flip angle (FA) = 1 to 85 º and repetition time (TR) = 6 to 60 ms, for gray matter, white matter, cervix, endometrium, myometrium, prostate, kidney medulla and cortex, bone marrow, pancreas, spleen, muscle, and liver tissues. RESULTS: PSIF-FISP was TNR superior in the kidney, pelvis, spleen, or gray matter at most tested TR and FA settings, and benefits increased at shorter TRs. PSIF-FISP was TNR superior in other tissues, e.g., liver, muscle, pancreas, for only short TR settings (20 ms or less). The TNR benefits of PSIF-FISP increased slightly with FA, and strongly with decreasing TR. Up to two- to three-fold reductions in TR with 20% TNR gains were achievable. In any given tissue, TNR performance is expected to further improve with heating, due to changes in relaxation rates. CONCLUSION: Dual-pathway PSIF-FISP can improve TNR and acquisition speed over standard gradient-recalled echo sequences, but optimal acquisition parameters are tissue dependent. Magn Reson Med 77:1193-1200, 2017. © 2016 International Society for Magnetic Resonance in Medicine.