An approach to evaluation of the point-spread function for 23 Na magnetic resonance imaging.

Despite the technical challenges that require lengthy acquisitions to overcome poor signal-to-noise ratio (SNR), sodium (23 Na) magnetic resonance imaging (MRI) is an intriguing area of research due to its essential role in human metabolism. Low SNR images can impact the measurement of the point-spread function (PSF) by adding uncertainty into the resulting quantities. Here, we present methods to calculate the PSF by using the modulation transfer function (MTF), and a 3D-printed line-pair phantom in the context of 23 Na MRI. A simulation study investigated the effect of noise on the resulting MTF curves, which were derived by direct modulation (DM) and a method utilizing Fourier harmonics (FHs). Experimental data utilized a line-pair phantom with nine spatial frequencies, filled with different concentrations (15, 30, and 60 mM) of sodium in 3% agar. MTF curves were calculated using both methods from data acquired from density-adapted 3D radial projections (DA-3DRP) and Fermat looped orthogonally encoded trajectories (FLORET). Simulations indicated that the DM method increased variability in the MTF curves at all tested noise levels over the FH method. For the experimental data, the FH method resulted in PSFs with a narrower full width half maximum with reduced variability, although the improvement in variability was not as pronounced as predicted by simulations. The DA-3DRP data indicated an improvement in the PSF over FLORET. It was concluded that a 3D-printed line-pair phantom represents a convenient method to measure the PSF experimentally. The MTFs from the noisy images in 23 Na MRI have reduced variability from a FH method over DM.

Tissue Sodium Concentration within White Matter Correlates with the Extent of Small Vessel Disease.

INTRODUCTION: Sodium MRI (23Na MRI) derived biomarkers such as tissue sodium concentration (TSC) provide valuable information on cell function and brain tissue viability and has become a reliable tool for the assessment of brain tumors and ischemic stroke beyond pathoanatomical morphology. Patients with major stroke often suffer from different degrees of underlying white matter lesions (WMLs) attributed to chronic small vessel disease. This study aimed to evaluate the WM TSC in patients with an acute ischemic stroke and to correlate the TSC with the extent of small vessel disease. Furthermore, the reliability of relative TSC (rTSC) compared to absolute TSC in these patients was analyzed. METHODOLOGY: We prospectively examined 62 patients with acute ischemic stroke (73 ± 13 years) between November 2016 and August 2019 from which 18 patients were excluded and thus 44 patients were evaluated. A 3D 23Na MRI was acquired in addition to a T2-TIRM and a diffusion-weighted image. Coregistration and segmentation were performed with SPM 12 based on the T2-TIRM image. The extension of WM T2 hyperintense lesions in each patient was classified using the Fazekas scale of WMLs. The absolute TSC in the WM region was correlated to the Fazekas grades. The stroke region was manually segmented on the coregistered absolute diffusion coefficient image and absolute, and rTSC was calculated in the stroke region and compared to nonischemic WM region. Statistical significance was evaluated using the Student t-test. RESULTS: For patients with Fazekas grade I (n = 25, age: 68.5 ± 15.1 years), mean TSC in WM was 55.57 ± 7.43 mM, and it was not statistically significant different from patients with Fazekas grade II (n = 7, age: 77.9 ± 6.4 years) with a mean TSC in WM of 53.9 ± 6.4 mM, p = 0.58. For patients with Fazekas grade III (n = 9, age: 81.4 ± 7.9 years), mean TSC in WM was 68.7 ± 10.5 mM, which is statistically significantly higher than the TSC in patients with Fazekas grade I and II (p < 0.001 and p = 0.05, respectively). There was a positive correlation between the TSC in WM and the Fazekas grade with r = 0.48 p < 0.001. The rTSC in the stroke region was statistically significant difference between low (0 and I) and high (2 and 3) Fazekas grades (p = 0.0353) whereas there was no statistically significant difference in absolute TSC in the stroke region between low (0 and I) and high (2 and 3) Fazekas grades. CONCLUSION: The significant difference in absolute TSC in WM in patients with severe small vessel disease; Fazekas grade 3 can lead to inaccuracies using rTSC quantification for evaluation of acute ischemic stroke using 23 Na MRI. The study, therefore, emphasizes the importance of absolute tissue sodium quantification.

Lead-free MCP to improve coincidence time resolution and reduce MCP direct interactions.

Achieving direct imaging of the annihilation position of a positron on an event-by-event basis using an ultrafast detector would have a great impact on the field of nuclear medicine. Cherenkov emission is the most attractive physical phenomenon for realizing such an ultrafast timing performance. Moreover, a microchannel-plate photomultiplier tube (MCP-PMT) is one of the most promising photodetectors for fully exploiting the fast timing properties of Cherenkov emission owing to its excellent single photon time resolution of 25 ps full width at half maximum (FWHM). However, as the MCP structure generally contains a lead compound, the gamma rays frequently and directly interact with the MCP, resulting in the degradation of its timing performance and generation of undesirable side peaks in its coincidence timing histogram. To overcome this problem, we have developed a new MCP-PMT based on an MCP consisting of borosilicate glass, thus drastically reducing the probability of the photoelectric effect occurring in the MCP. To evaluate its insensitivity to gamma rays and its timing performance, a coincidence experiment was performed and showed that the probability of direct interactions was reduced by a factor of 3.4. Moreover, a coincidence time resolution of 35.4 ± 0.4 ps FWHM, which is equivalent to a position resolution of 5.31 mm, was obtained without any pulse height/area cut, improving to 28.7 ± 3.0 ps when selecting on the highest amplitude events by careful optimization of the voltage divider circuit of the new MCP-PMT. The timing performance of this new MCP-PMT presents an important step toward making direct imaging possible.

Sodium (23Na) MRI of the Kidney: Basic Concept.

The handling of sodium by the renal system is a key indicator of renal function. Alterations in the corticomedullary distribution of sodium are considered important indicators of pathology in renal diseases. The derangement of sodium handling can be noninvasively imaged using sodium magnetic resonance imaging (23Na MRI), with data analysis allowing for the assessment of the corticomedullary sodium gradient. Here we introduce sodium imaging, describe the existing methods, and give an overview of preclinical sodium imaging applications to illustrate the utility and applicability of this technique for measuring renal sodium handling.This chapter is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This introduction chapter is complemented by two separate chapters describing the experimental procedure and data analysis.

Sodium (23Na) MRI of the Kidney: Experimental Protocol.

Sodium handling is a key physiological hallmark of renal function. Alterations are generally considered a pathophysiologic event associated with kidney injury, with disturbances in the corticomedullary sodium gradient being indicative of a number of conditions. This experimental protocol review describes the individual steps needed to perform 23Na MRI; allowing accurate monitoring of the renal sodium distribution in a step-by-step experimental protocol for rodents.This chapter is based upon work from the PARENCHIMA COST Action, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This experimental protocol chapter is complemented by two separate chapters describing the basic concept and data analysis.

Analysis Protocol for Renal Sodium (23Na) MR Imaging.

The signal acquired in sodium (23Na) MR imaging is proportional to the concentration of sodium in a voxel, and it is possible to convert between the two using external calibration phantoms. Postprocessing, and subsequent analysis, of sodium renal images is a simple task that can be performed with readily available software. Here we describe the process of conversion between sodium signal and concentration, estimation of the corticomedullary sodium gradient and the procedure used for quadrupolar relaxation analysis.This chapter is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This analysis protocol chapter is complemented by two separate chapters describing the basic concept and experimental procedure.

Tissue sodium content in patients with systemic lupus erythematosus: association with disease activity and markers of inflammation.

OBJECTIVES: Sodium (Na+) is stored in the skin and muscle and plays an important role in immune regulation. In animal models, increased tissue Na+ is associated with activation of the immune system, and high salt intake exacerbates autoimmune disease and worsens hypertension. However, there is no information about tissue Na+ and human autoimmune disease. We hypothesized that muscle and skin Na+ content is (a) higher in patients with systemic lupus erythematosus (SLE) than in control subjects, and (b) associated with blood pressure, disease activity, and inflammation markers (interleukin (IL)-6, IL-10 and IL-17 A) in SLE. METHODS: Lower-leg skin and muscle Na+ content was measured in 23 patients with SLE and in 28 control subjects using 23Na+ magnetic resonance imaging. Demographic and clinical information was collected from interviews and chart review, and blood pressure was measured. Disease activity was assessed using the SLE Disease Activity Index (SLEDAI). Plasma inflammation markers were measured by multiplex immunoassay. RESULTS: Muscle Na+ content was higher in patients with SLE (18.8 (16.7-18.3) mmol/L) than in control subjects (15.8 (14.7-18.3) mmol/L; p < 0.001). Skin Na+ content was also higher in SLE patients than in controls, but this difference was not statistically significant. Among patients with SLE, muscle Na+ was associated with SLEDAI and higher concentrations of IL-10 after adjusting for age, race, and sex. Skin Na+ was significantly associated with systolic blood pressure, but this was attenuated after covariate adjustment. CONCLUSION: Patients with SLE had higher muscle Na+ content than control subjects. In patients with SLE, higher muscle Na+ content was associated with higher disease activity and IL-10 concentrations.

Assessment of Low-Grade Focal Cartilage Lesions in the Knee With Sodium MRI at 7 T: Reproducibility and Short-Term, 6-Month Follow-up Data.

OBJECTIVES: Several articles have investigated potential of sodium (Na) magnetic resonance imaging (MRI) for the in vivo evaluation of cartilage health, but so far no study tested its feasibility for the evaluation of focal cartilage lesions of grade 1 or 2 as defined by the International Cartilage Repair Society. The aims of this study were to evaluate the ability of Na-MRI to differentiate between early focal lesions and normal-appearing cartilage, to evaluate within-subject reproducibility of Na-MRI, and to monitor longitudinal changes in participants with low-grade, focal chondral lesions. MATERIALS AND METHODS: Thirteen participants (mean age, 50.1 ± 10.9 years; 7 women, 6 men) with low-grade, focal cartilage lesions in the weight-bearing region of femoral cartilage were included in this prospective cohort study. Participants were assessed at baseline, 1 week, 3 months, and 6 months using morphological MRI at 3 T and 7 T, compositional Na-MRI at 7 T, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Na signal intensities corrected for coil sensitivity and partial volume effect (Na-cSI) were calculated in the lesion, and in weight-bearing and non-weight-bearing regions of healthy femoral cartilage. Coefficients of variation, repeated measures analysis of covariance models, and Pearson correlation coefficients were calculated to evaluate within-subject reproducibility as well as cross-sectional and longitudinal changes in Na-cSI values. RESULTS: The mean coefficients of variation of Na-cSI values between the baseline and 1-week follow-up were 5.1% or less in all cartilage regions. Significantly lower Na-cSI values were observed in lesion than in weight-bearing and non-weight-bearing regions at all time points (all P values ≤ 0.002). Although a significant decrease from baseline Na-cSI values in lesion was found at 3-month visit (P = 0.015), no substantial change was observed at 6 months. KOOS scores have improved in all subscales at 3 months and 6 months visit, with a significant increase observed only in the quality of life subscale (P = 0.004). CONCLUSIONS: In vivo Na-MRI is a robust and reproducible method that allows to differentiate between low-grade, focal cartilage lesions and normal-appearing articular cartilage, which supports the concept that compositional cartilage changes can be found early, before the development of advanced morphological changes visible at clinical 3-T MRI.

Accelerated quantification of tissue sodium concentration in skeletal muscle tissue: quantitative capability of dictionary learning compressed sensing.

OBJECTIVE: To accelerate tissue sodium concentration (TSC) quantification of skeletal muscle using 23Na MRI and 3D dictionary-learning compressed sensing (3D-DLCS). MATERIALS AND METHODS: Simulations and in vivo 23Na MRI examinations of calf muscle were performed with a nominal spatial resolution of [Formula: see text]. Fully sampled and three undersampled 23Na MRI data sets (undersampling factors (USF) = 3, 4.4, 6.7) were evaluated. Ten healthy subjects were examined on a 3 Tesla MRI system. Results of the simulation study and the in vivo measurements were compared to the ground truth (GT) and the fully sampled fast Fourier transform (NUFFT) reconstruction, respectively. RESULTS: Reconstruction results of simulated data with optimized 3D-DLCS yielded a lower deviation (< 4%) from the GT than results of the NUFFT reconstruction (> 5%) and a lower standard deviation (SD). For in vivo measurements, a TSC of [Formula: see text] was observed. The mean deviation from the reference is lower for the undersampled 3D-DLCS reconstructions (3.4%) than for NUFFT reconstructions (4.6%). SD is reduced using 3D-DLCS. Compared to a fully sampled NUFFT reconstruction, acquisition time could be reduced by a factor of 4.4 while maintaining similar quantitative accuracy. DISCUSSION: The optimized 3D-DLCS reconstruction enables accelerated TSC measurements with high quantification accuracy.

Molecular imaging of the prostate: Comparing total sodium concentration quantification in prostate cancer and normal tissue using dedicated 13 C and 23 Na endorectal coils.

BACKGROUND: There has been recent interest in nonproton MRI including hyperpolarized carbon-13 (13 C) imaging. Prostate cancer has been shown to have a higher tissue sodium concentration (TSC) than normal tissue. Sodium (23 Na) and 13 C nuclei have a frequency difference of only 1.66 MHz at 3T, potentially enabling 23 Na imaging with a 13 C-tuned coil and maximizing the metabolic information obtained from a single study. PURPOSE: To compare TSC measurements from a 13 C-tuned endorectal coil to those quantified with a dedicated 23 Na-tuned coil. STUDY TYPE: Prospective. POPULATION: Eight patients with biopsy-proven, intermediate/high risk prostate cancer imaged prior to prostatectomy. SEQUENCE: 3T MRI with separate dual-tuned 1 H/23 Na and 1 H/13 C endorectal receive coils to quantify TSC. ASSESSMENT: Regions-of-interest for TSC quantification were defined for normal peripheral zone (PZ), normal transition zone (TZ), and tumor, with reference to histopathology maps. STATISTICAL TESTS: Two-sided Wilcoxon rank sum with additional measures of correlation, coefficient of variation, and Bland-Altman plots to assess for between-test differences. RESULTS: Mean TSC for normal PZ and TZ were 39.2 and 33.9 mM, respectively, with the 23 Na coil and 40.1 and 36.3 mM, respectively, with the 13 C coil (P = 0.22 and P = 0.11 for the intercoil comparison, respectively). For tumor tissue, there was no statistical difference between the overall mean tumor TSC measured with the 23 Na coil (41.8 mM) and with the 13 C coil (46.6 mM; P = 0.38). Bland-Altman plots showed good repeatability for tumor TSC measurements between coils, with a reproducibility coefficient of 9 mM; the coefficient of variation between the coils was 12%. The Pearson correlation coefficient for TSC between coils for all measurements was r = 0.71 (r2 = 0.51), indicating a strong positive linear relationship. The mean TSC within PZ tumors was significantly higher compared with normal PZ for both the 23 Na coil (45.4 mM; P = 0.02) and the 13 C coil (49.4 mM; P = 0.002). DATA CONCLUSION: We demonstrated the feasibility of using a carbon-tuned coil to quantify TSC, enabling dual metabolic information from a single coil. This approach could make the acquisition of both 23 Na-MRI and 13 C-MRI feasible in a single clinical imaging session. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:90-97.

Quantification of sodium T1 in abdominal tissues at 3 T.

INTRODUCTION: Although relevant for assessment of sodium in multiple endocrine pathways, 23Na-T1 quantification is challenging due to technical limitations (SAR, B1 inhomogeneity) or influence of tissue's local molecular dynamics. Hereby, we propose T1 quantification of 23Na-MRI signal acquired over the abdomen using a centric-reordered saturation-recovery (SR) true fast imaging with steady state precession (TrueFISP) sequence. MATERIALS AND METHODS: Measurements were performed at 3T using a dual-tunable 23Na/1H coil in 7 healthy volunteers (TR/TE = 858-928/1.57 ms; flip angle = 90°; bandwidth = 450 Hz/px; voxel size = 5 × 5 × 10 mm3). Variable T1-weighting was achieved applying non-selective saturation pre-pulses delayed from the centre of the k-space acquisition by 25, 40, 60, 120 and 250 ms. T1-curve fitting was performed slice-wise, separately for average intensity values from the manually segmented areas of the renal parenchyma and spinal canal, over the increasing SR times- assuming monoexponential signal pattern. RESULTS: Mean ± standard deviation of 23Na-T1 was found as 29 ± 10 ms and 35 ± 8 ms for the renal parenchyma and the spinal canal, respectively. DISCUSSION: 23Na-T1 quantification using a SR-TrueFISP is feasible in clinical settings, in the images constrained by clinically applicable acquisition time of reduced spatial resolution or averages.

Comparison of optimized intensity correction methods for 23Na MRI of the human brain using a 32-channel phased array coil at 7 Tesla.

PURPOSE: To correct for the non-homogeneous receive profile of a phased array head coil in sodium magnetic resonance imaging (23Na MRI). METHODS: 23Na MRI of the human brain (n = 8) was conducted on a 7T MR system using a dual-tuned quadrature 1H/23Na transmit/receive birdcage coil, equipped with a 32-channel receive-only array. To correct the inhomogeneous receive profile four different methods were applied: (1) the uncorrected phased array image and an additionally acquired birdcage image as reference image were low-pass filtered and divided by each other. (2) The second method substituted the reference image by a support region. (3) By averaging the individually calculated receive profiles, a universal sensitivity map was obtained and applied. (4) The receive profile was determined by a pre-scanned large uniform phantom. The calculation of the sensitivity maps was optimized in a simulation study using the normalized root-mean-square error (NRMSE). All methods were evaluated in phantom measurements and finally applied to in vivo 23Na MRI data sets. The in vivo measurements were partial volume corrected and for further evaluation the signal ratio between the outer and inner cerebrospinal fluid compartments (CSFout:CSFin) was calculated. RESULTS: Phantom measurements show the correction of the intensity profile applying the given methods. Compared to the uncorrected phased array image (NRMSE = 0.46, CSFout:CSFin = 1.71), the quantitative evaluation of simulated and measured intensity corrected human brain data sets indicates the best performance utilizing the birdcage image (NRMSE = 0.39, CSFout:CSFin = 1.00). However, employing a support region (NRMSE = 0.40, CSFout:CSFin = 1.17), a universal sensitivity map (NRMSE = 0.41, CSFout:CSFin = 1.05) or a pre-scanned sensitivity map (NRMSE = 0.42, CSFout:CSFin = 1.07) shows only slightly worse results. CONCLUSION: Acquiring a birdcage image as reference image to correct for the receive profile demonstrates the best performance. However, when aiming to reduce acquisition time or for measurements without existing birdcage coil, methods that use a support region as reference image, a universal or a pre-scanned sensitivity map provide good alternatives for correction of the receive profile.

Cardiorenal sodium MRI in small rodents using a quadrature birdcage volume resonator at 9.4 T.

OBJECTIVE: Design, implementation, evaluation and application of a quadrature birdcage radiofrequency (RF) resonator tailored for renal and cardiac sodium (23Na) magnetic resonance imaging (MRI) in rats at 9.4 T. MATERIALS AND METHODS: A low pass birdcage resonator (16 rungs, din = 62 mm) was developed. The transmission field (B1+) was examined with EMF simulations. The scattering parameter (S-parameter) and the quality factor (Q-factor) were measured. For experimental validation B1+-field maps were acquired with the double-angle method. In vivo sodium imaging of the heart (spatial resolution: (1 × 1 × 5) mm3) and kidney (spatial resolution: (1 × 1 × 10) mm3) was performed with a FLASH technique. RESULTS: The RF resonator exhibits RF characteristics, transmission field homogeneity and penetration that afford 23Na MR in vivo imaging of the kidney and heart at 9.4 T. For the renal cortex and medulla a SNRs of 8 and 13 were obtained and a SNRs of 14 and 15 were observed for the left and right ventricle. DISCUSSION: These initial results obtained in vivo in rats using the quadrature birdcage volume RF resonator for 23Na MRI permit dedicated studies on experimental models of cardiac and renal diseases, which would contribute to translational research of the cardiorenal syndrome.

Imaging Salt Uptake Dynamics in Plants Using PET.

Soil salinity is a global environmental challenge for crop production. Understanding the uptake and transport properties of salt in plants is crucial to evaluate their potential for growth in high salinity soils and as a basis for engineering varieties with increased salt tolerance. Positron emission tomography (PET), traditionally used in medical and animal imaging applications for assessing and quantifying the dynamic bio-distribution of molecular species, has the potential to provide useful measurements of salt transport dynamics in an intact plant. Here we report on the feasibility of studying the dynamic transport of 22Na in millet using PET. Twenty-four green foxtail (Setaria viridis L. Beauv.) plants, 12 of each of two different accessions, were incubated in a growth solution containing 22Na+ ions and imaged at 5 time points over a 2-week period using a high-resolution small animal PET scanner. The reconstructed PET images showed clear evidence of sodium transport throughout the whole plant over time. Quantitative region-of-interest analysis of the PET data confirmed a strong correlation between total 22Na activity in the plants and time. Our results showed consistent salt transport dynamics within plants of the same variety and important differences between the accessions. These differences were corroborated by independent measurement of Na+ content and expression of the NHX transcript, a gene implicated in sodium transport. Our results demonstrate that PET can be used to quantitatively evaluate the transport of sodium in plants over time and, potentially, to discern differing salt-tolerance properties between plant varieties. In this paper, we also address the practical radiation safety aspects of working with 22Na in the context of plant imaging and describe a robust pipeline for handling and incubating plants. We conclude that PET is a promising and practical candidate technology to complement more traditional salt analysis methods and provide insights into systems-level salt transport mechanisms in intact plants.

23Na MRI of human skeletal muscle using long inversion recovery pulses.

23Na inversion recovery (IR) imaging allows for a weighting toward intracellular sodium in the human calf muscle and thus enables an improved analysis of pathophysiological changes of the muscular ion homeostasis. However, sodium signal-to-noise ratio (SNR) is low, especially when using IR sequences. 23Na has a nuclear spin of 3/2 and therefore experiences a strong electrical quadrupolar interaction. This results in very short relaxation times as well as in possible residual quadrupolar splitting. Consequently, relaxation effects during a radiofrequency pulse can no longer be neglected and even allow for increasing SNR as has previously been shown for human brain and knee. The aim of this work was to increase the SNR in 23Na IR imaging of the human calf muscle by using long inversion pulses instead of the usually applied short pulses. First, the influence of the inversion pulse length (1 to 20 ms) on the SNR as well as on image contrast was simulated for different model environments and verified by phantom measurements. Depending on the model environment (agarose 4% and 8%, xanthan 2% and 3%), SNR values increased by a factor of 1.15 up to 1.35, while NaCl solution was successfully suppressed. Thus, image contrast between the non-suppressed model compartments changes with IR pulse length. Finally, in vivo measurements of the human calf muscle of ten healthy volunteers were conducted at 3 Tesla. On average, a 1.4-fold increase in SNR could be achieved by increasing the inversion pulse length from 1 ms to 20 ms, leaving all other parameters - including the scan time - constant. This enables 23Na IR MRI with improved spatial resolution or reduced acquisition time.

Cardiorenal sodium MRI at 7.0 Tesla using a 4/4 channel 1 H/23 Na radiofrequency antenna array.

PURPOSE: Cardiorenal syndrome describes disorders of the heart and the kidneys in which a dysfunction of 1 organ induces a dysfunction in the other. This work describes the design, evaluation, and application of a 4/4-channel hydrogen-1/sodium (1 H/23 Na) RF array tailored for cardiorenal MRI at 7.0 Tesla (T) for a better physiometabolic understanding of cardiorenal syndrome. METHODS: The dual-frequency RF array is composed of a planar posterior section and a modestly curved anterior section, each section consisting of 2 loop elements tailored for 23 Na MR and 2 loopole-type elements customized for 1 H MR. Numerical electromagnetic field and specific absorption rate simulations were carried out. Transmission field ( B1+ ) uniformity was optimized and benchmarked against electromagnetic field simulations. An in vivo feasibility study was performed. RESULTS: The proposed array exhibits sufficient RF characteristics, B1+ homogeneity, and penetration depth to perform 23 Na MRI of the heart and kidney at 7.0 T. The mean B1+ field for sodium in the heart is 7.7 ± 0.8 µT/√kW and in the kidney is 6.9 ± 2.3 µT/√kW. The suitability of the RF array for 23 Na MRI was demonstrated in healthy subjects (acquisition time for 23 Na MRI: 18 min; nominal isotropic spatial resolution: 5 mm [kidney] and 6 mm [heart]). CONCLUSION: This work provides encouragement for further explorations into densely packed multichannel transceiver arrays tailored for 23 Na MRI of the heart and kidney. Equipped with this technology, the ability to probe sodium concentration in the heart and kidney in vivo using 23 Na MRI stands to make a critical contribution to deciphering the complex interactions between both organs.

A dual-tuned multichannel bilateral RF coil for 1 H/23 Na breast MRI at 7 T.

PURPOSE: Sodium MRI has shown promise for monitoring neoadjuvant chemotherapy response in breast cancer. The purpose of this work was to build a dual-tuned bilateral proton/sodium breast coil for 7T MRI that provides sufficient SNR to enable sodium breast imaging in less than 10 minutes. METHODS: The proton/sodium coil consists of 2 shielded unilateral units: 1 for each breast. Each unit consists of 3 nested layers: (1) a 3-loop solenoid for sodium excitation, (2) a 3-loop solenoid for proton excitation and signal reception, and (3) a 4-channel receive array for sodium signal reception. Benchmark measurements were performed in phantoms with and without the sodium receive array insert. In vivo images were acquired on a healthy volunteer. RESULTS: The sodium receive array boosted 1.5 to 3 times the SNR compared with the solenoid. Proton SNR loss due to residual interaction with the sodium array was less than 10%. The coil enabled sodium imaging in vivo with 2.8-mm isotropic nominal resolution (~5-mm real resolution) in 9:36 minutes. CONCLUSION: The coil design that we propose addresses challenges associated with sodium's low SNR from a hardware perspective and offers the opportunity to investigate noninvasively breast tumor metabolism as a function of sodium concentration in patients undergoing neoadjuvant chemotherapy.

Quantitative Brain Sodium MRI Depicts Corticospinal Impairment in Amyotrophic Lateral Sclerosis.

Background Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that mainly affects the upper and lower motor neurons. Recent sodium (23Na) MRI studies have shown that abnormal sodium concentration is related to neuronal suffering in neurodegenerative conditions. Purpose To use 23Na MRI to investigate abnormal sodium concentrations and map their distribution in the brains of study participants with ALS as compared with healthy control subjects. Materials and Methods Twenty-seven participants with ALS (mean age, 54 years ± 10 [standard deviation], eight women) and 30 healthy control subjects (mean age, 50 years ± 10; 16 women) were prospectively recruited between September 2015 and October 2017 and were examined by using conventional proton MRI and sodium MRI at 3 T. Voxel-based statistical mapping was used to compare quantitative whole-brain total sodium concentration (TSC) maps in participants with ALS with those in control subjects and to localize regions of abnormal elevated TSC. Potential overlap of abnormal elevated TSC with regions of atrophy as detected with 1H MRI also was investigated. Results Voxel-based statistical mapping analyses revealed higher sodium concentration in motor regions (bilateral precentral gyri, corticospinal tracts, and the corpus callosum) of participants with ALS (two-sample t test, P < .005; age and sex as covariates). In these regions, mean TSC was higher in participants with ALS (mean, 45.6 mmol/L wet tissue ± 3.2) than in control subjects (mean, 41.8 mmol/L wet tissue ± 2.7; P < .001; Cohen d = 1.28). Brain regions showing higher TSC represented a volume of 15.4 cm3 that did not overlap with gray matter atrophy occupying a volume of 16.9 cm3. Elevated TSC correlated moderately with corticospinal conduction failure assessed with transcranial magnetic stimulation in the right upper limb (Spearman ρ = -0.57; 95% confidence interval: -0.78, -0.16; P = .005; n = 23). Conclusion Quantitative 23Na MRI is sensitive to alterations of brain sodium homeostasis within disease-relevant regions in patients with amyotrophic lateral sclerosis (ALS). This supports further investigation of abnormal sodium concentration as a potential marker of neurodegenerative processes in patients with ALS that could be used as a secondary endpoint in clinical trials. © RSNA, 2019 Online supplemental material is available for this article.

Tissue sodium content in patients with type 2 diabetes mellitus.

BACKGROUND: Tissue sodium content by 23Na magnetic resonance imaging (MRI) has been found to be increased in arterial hypertension. We analyzed whether tissue sodium content is increased in patients with type-2 diabetes (T2DM). METHODS: Patients with T2DM were compared to those with primary hypertension. Patients with T2DM were off any antidiabetic and hypertensive patients off any antihypertensive therapy for at least 4 weeks. Skin and muscle sodium content was assessed non-invasively with a 3.0 T clinical MRI system (Magnetom Verio, Siemens Health Care, Erlangen, Germany) in each patient. RESULTS: In patients with T2DM (N = 59) we observed significantly greater muscle sodium content (diabetes: 20.6 ±â€¯3.5 vs hypertension: 16.3 ±â€¯2.5 mmol/l, p < 0.001) and skin sodium content (diabetes: 24.5 ±â€¯7.2 vs hypertension: 20.6 ±â€¯5.7 mmol/l, p = 0.01) than in those with primary hypertension (N = 33). When potential confounders (age, body mass index, gender, systolic and diastolic blood pressure, estimated glomerular filtration rate) were entered in a covariance analysis, both skin sodium content (p = 0.037) and muscle sodium content (p < 0.001) were still clearly elevated. CONCLUSION: Patients with T2DM have greater skin and muscle sodium content. These are the first known data to demonstrate increased tissue sodium content in patients with T2DM, measured by 23Na magnetic resonance imaging. Since tissue sodium content is related to organ damage, therapeutic intervention should aim at reducing tissue sodium content.

Corrections of myocardial tissue sodium concentration measurements in human cardiac 23 Na MRI at 7 Tesla.

PURPOSE: To quantify the tissue sodium concentration (TSC) in cardiac 23 Na MRI. To evaluate the influence of different correction methods on the measured myocardial TSC. METHODS: 23 Na MRI of four healthy subjects was conducted at a whole-body 7T MRI system using an oval-shaped 23 Na birdcage coil. Data acquisition was performed with a density-adapted 3D radial pulse sequence using a golden angle projection scheme. 1 H MRI data were acquired at a 3T MRI system to generate a myocardial mask. Retrospective cardiac and respiratory gating were used to reconstruct 23 Na MRI data in the diastolic phase and exhaled state. B0 and B1 inhomogeneity and partial volume (PV) effects were corrected. Relaxation times and TSC of ex vivo blood samples and calf muscle were determined. These values were used in the PV correction to estimate myocardial TSC, which was compared with the measured TSC of calf muscle. RESULTS: Without any correction the measured myocardial TSC was (54 ± 5) mM. The applied correction methods reduced these values by (48 ± 5)% to (29 ± 3) mM, where PV correction had the largest effect (reduction of (34 ± 1)%). Respiratory and cardiac motion gating decreased the concentrations by (11 ± 1)%. With the applied setup, the corrections of B0 and B1 inhomogeneity (reduction of (3 ± 2)%) had negligible influences on TSC values. The resulting myocardial TSC was approximately 1.4-fold higher than the measured TSC of calf muscle tissue of the same healthy subjects ((20 ± 3) mM). CONCLUSION: For quantitative human cardiac 23 Na MRI several corrections are needed and ranked for our setup: PV correction, respiratory and cardiac gating, correction for B1 inhomogeneity effects.