Assessment of cerebral perfusion in moyamoya disease with dynamic pseudo-continuous arterial spin labeling using a variable repetition time scheme with optimized background suppression.

PURPOSE: Accurate assessment of cerebral perfusion in moyamoya disease is necessary to determine the indication for treatment. We aimed to investigate the usefulness of dynamic PCASL using a variable TR scheme with optimized background suppression in the evaluation of cerebral perfusion in moyamoya disease. METHODS: We retrospectively analyzed the images of 24 patients (6 men and 18 women, mean age 31.4 ± 18.2 years) with moyamoya disease; each of whom was imaged with both dynamic PCASL using the variable-TR scheme and 123IMP SPECT with acetazolamide challenge. ASL dynamic data at 10 phases are acquired by changing the LD and PLD. The background suppression timing was optimized for each phase. CBF and ATT were measured with ASL, and CBF and CVR to an acetazolamide challenge were measured with SPECT. RESULTS: A significant moderate correlation was found between the CBF measured by dynamic PCASL and that by SPECT (r = 0.53, P < 0.001). The CBF measured by dynamic PCASL (52.5 ± 13.3 ml/100 mg/min) was significantly higher than that measured by SPECT (43.0 ± 12.6 ml/100 mg/min, P < 0.001). The ATT measured by dynamic PCASL showed a significant correlation with the CVR measured by SPECT (r = 0.44, P < 0.001). ATT was significantly longer in areas where the CVR was impaired (CVR < 18.4%, ATT = 1812 ± 353 ms) than in areas where it was preserved (CVR > 18.4%, ATT = 1301 ± 437 ms, P < 0.001). The ROC analysis showed a moderate accuracy (AUC = 0.807, sensitivity = 87.7%, specificity = 70.4%) when the cutoff value of ATT was set at 1518 ms. CONCLUSION: Dynamic PCASL using this scheme was found to be useful for assessing cerebral perfusion in moyamoya disease.

Visualization of cerebrospinal fluid dynamics using multi-spin echo acquisition cine imaging (MUSACI).

PURPOSE: To evaluate the visualization of CSF dynamics using the novel method multi-spin echo acquisition cine imaging (MUSACI). METHODS: MUSACI is based on multi-echo volume isotropic turbo spin-echo acquisition (VISTA) with pulse gating. MUSACI images were acquired in 11 healthy volunteers (7 men, 4 women; age range, 24-46 y, mean age, 31.9 ± 5.51 y). We compared the CSF signal intensities (SIs) at multiple values of the effective echo time (TEeff ) at the lateral ventricle, the foramen of Monro, the third ventricle, and the fourth ventricle. We compared the CSF SI changes in MUSACI at multiple TEeff and the mean velocities in phase contrast (PC) at each trigger delay at the foramen of Monro, the third ventricle, and the fourth ventricle. RESULTS: The anterograde CSF motion from the aqueduct to the fourth ventricle, the retrograde motion from the aqueduct to the third ventricle, and the retrograde motion from the foramen of Monro to the lateral ventricle were observed with MUSACI. The CSF SIs at each TEeff in the foramen of Monro, the third ventricle, and the fourth ventricle were significantly lower than that at each TEeff in the lateral ventricle (P < 0.05). The CSF SI in MUSACI changed with the TEeff , and the CSF movements were observed at each trigger delay in PC. CONCLUSION: MUSACI can provide both high-resolution anatomical detail of the CSF passageways and physiologic information regarding CSF dynamics in a single scan.

Glycosaminoglycan chemical exchange saturation transfer in human lumbar intervertebral discs: Effect of saturation pulse and relationship with low back pain.

PURPOSE: To evaluate the dependence of saturation pulse power and duration on glycosaminoglycan chemical exchange saturation transfer (gagCEST) imaging and assess the degeneration of human lumbar intervertebral discs (IVDs) using this method. MATERIALS AND METHODS: All images were acquired on a 3T magnetic resonance imaging (MRI) scanner. The CEST effects were measured in the glycosaminoglycan (GAG) phantoms with different concentrations. In the human study, CEST effects were measured in the nucleus pulposus of IVD. We compared the CEST effects among the different saturation pulse powers (0.4, 0.8, and 1.6 µT) or durations (0.5, 1.0, and 2.0 sec) at each Pfirrmann grade (I-V). The relationship between the CEST effects and low back pain was also evaluated. RESULTS: The phantom study showed high correlations between the CEST effects and GAG concentration (R2 = 0.863, P < 0.0001, linear regression). In the human study, the CEST effect obtained with the 0.8 µT power was significantly greater than those obtained with 0.4 (P < 0.01) and 1.6 µT power (P < 0.05) at Pfirrmann grade I. The CEST effect obtained with a 1.0-sec duration was significantly greater than those derived with 0.5 and 2.0 sec (P < 0.01) durations at Pfirrmann grades I and II. The CEST effects in the group with moderate low back pain were significantly lower than those in the groups without pain (P < 0.001) and with mild pain (P = 0.0216). CONCLUSION: The contrast of gagCEST imaging in the lumbar IVDs varied with saturation pulse power and duration. GagCEST imaging may serve as a tool for evaluating IVD degeneration in the lumbar spine. LEVEL OF EVIDENCE: 2 J. Magn. Reson. Imaging 2017;45:863-871.

Amide proton transfer-weighted imaging with a short acquisition time based on a self B0 correction using the turbo spin echo-Dixon method: A phantom study.

PURPOSE: Conventional amide proton transfer (APT)-weighted imaging requires a chemical exchange saturation transfer (CEST) sequence with multiple saturation frequency offsets and a B0 correction sequence, plus a long acquisition time that can be reduced by applying the conventional method using CEST images with seven radiation pulses (i.e., the seven-points method). For a further reduction of acquisition times, we propose fast two-dimensional (2D) APT-weighted imaging based on a self B0 correction using the turbo spin echo (TSE)-Dixon method. We conducted a phantom study to investigate the accuracy of TSE-Dixon APT-weighted imaging. METHODS: We prepared two types of phantoms with six samples for a concentrationdependent evaluation and a pH-dependent evaluation. APT-weighted images were acquired by the conventional, seven-points, and TSE-Dixon methods. Linear regression analyses assessed the dependence between each method's APT signal intensities (SIs) and the concentration or pH. We performed a one-way analysis of variance with Tukey's honestly significant difference post hoc test to compare the APT SIs among the three methods. The agreement of the APT SIs between the conventional and seven-points or TSE-Dixon methods was assessed by a Bland- Altman plot analysis. RESULTS: The APT SIs of all three acquisition methods showed positive concentration dependence and pH dependence. No significant differences were observed in the APT SIs between the conventional and TSE-Dixon methods at each concentration. The Bland-Altman plot analyses showed that the APT SIs measured with the seven-points method resulted in 0.42% bias and narrow 95% limits of agreement (LOA) (0.93%-0.09%) compared to the conventional method. The APT SIs measured using the TSE-Dixon method showed 0.14% bias and similar 95% LOA (-0.33% to 0.61%) compared with the seven-points method. The APT SIs of all three methods showed positive pH dependence. At each pH, no significant differences in the APT SIs were observed among the methods. Bland-Altman plot analyses showed that the APT SIs measured with the seven-points method resulted in low bias (0.03%) and narrow 95% LOA (-0.30% to 0.36%) compared to the conventional method. The APT SIs measured by the TSE-Dixon method showed slightly larger bias (0.29%) and similar 95% LOA (from -0.15% to 0.72%) compared to those measured by the seven-points method. CONCLUSION: These results demonstrated that our proposed method has the same concentration dependence and pH dependence as the conventional method and the seven-points method. We thus expect that APT-weighted imaging with less influence of motion can be obtained in clinical examinations.

Improvement of image quality for bright-blood image in VISIBLE (volume isotropic simultaneous interleaved bright- and black-blood examination) by using k-space reordering and startup echoes.

PURPOSE: A volume isotropic simultaneous interleaved bright- and black-blood examination (VISIBLE) can simultaneously acquire images with suppressed vascular signals (black-blood images) and images without suppression (bright-blood images). We aimed to improve of the bright-blood images by adjusting the k-space filling and using startup echo. METHODS: The k-space arrangement of bright-blood images in the conventional VISIBLE followed a low-to-high frequency order, whereas that in the proposed VISIBLE sequence was in the reversed order, and a startup echo was added. The effects of startup echo on the signal-to-noise ratio (SNR) were evaluated using phantoms, considering both white matter (WM) and post-contrast blood. Data from copper sulfate phantoms were acquired in 1D Fourier transform mode using both the conventional and proposed methods of the two VISIBLE sequences. The signal behavior with each sequence was evaluated. Fourteen patients with a total of 21 metastases were included in the study. For each patient, VISIBLE images of both conventional and proposed methods were obtained consecutively after the contrast agent administration. Using clinical images, we conducted a comparison of the SNR and contrast-to-noise ratio (CNR) for tumors, normal WM, and blood vessels between the conventional and proposed VISIBLE sequences. RESULTS: There was no significant difference in SNRs for both black- and bright-blood images between the conventional sequence and the proposed sequence with different number of startup echoes, however, the SNR of the proposed sequence decreased with increasing number of startup echoes in both black- and bright-images. The signal behavior of the bright-blood image reached a "steady state" when the startup echo exceeded 20. The SNRs of blood vessels in the bright-blood images did not differ significantly between conventional and proposed VISIBLE sequences. The SNRs of WM in the bright-blood images was significantly larger in the conventional sequence than in the proposed sequence. The SNRs of tumors in bright blood images was significantly larger in the proposed sequence than in the conventional sequence. The CNRs between tumors and WM, vessels and WM in the bright-blood images were significantly higher in the proposed sequence than in the conventional sequence. CONCLUSION: The use of the startup echo in combination with the high-to-low frequency k-space ordering method resulted in improved CNR of the bright-blood images in the VISIBLE sequence.

Effect of Saturation Pulse Duration and Power on pH-weighted Amide Proton Transfer Imaging: A Phantom Study.

PURPOSE: Amide proton transfer (APT) imaging may detect changes in tissues' pH based on the chemical exchange saturation transfer (CEST) phenomenon, and thus it may be useful for identifying the penumbra in ischemic stroke patients. We investigated the effect of saturation pulse duration and power on the APT effect in phantoms with different pH values. METHODS: Five samples were prepared from a 1:10 solution of egg-white albumin in phosphate-buffered saline at pH 6.53-7.65. The APT signal intensity (SI) was defined as asymmetry of the magnetization transfer ratio at 3.5 ppm. We measured the APT SIs in the egg-white albumin samples of different pH values with saturation pulse durations of 0.5, 1.0, 2.0, and 3.0 sec and saturation pulse powers of 0.5, 1.5, and 2.5 µT. The relative change in the APT SI in relation to the saturation duration and power at different pH values was defined as follows: (APT SI each saturation pulse - APT SI shortest or weakest pulse)/APT SIshortest or weakest pulse. The dependence of the APT SI on pH and the relative change in the APT SI were calculated as the slope of the linear regression. RESULTS: The lower the pH, the larger the relative change in the APT SI, due to the change in saturation pulse duration and power. The APT SI was highly correlated with the pH at all saturation pulse durations and powers. CONCLUSION: The influence of saturation duration and power on the APT effect was greater at lower pH than higher pH. The combination of saturation pulse ≥ 1.0 s and power ≥ 1.5 µT was useful for the sensitive detection of changes in APT effects in the egg-white albumin samples with different pH values.

Grading of gliomas using 3D CEST imaging with compressed sensing and sensitivity encoding.

PURPOSE: We evaluated the usefulness of three-dimensional (3D) chemical exchange saturation transfer (CEST) imaging with compressed sensing and sensitivity encoding (CS-SENSE) for differentiating low-grade gliomas (LGGs) from high-grade gliomas (HGGs). METHODS: We evaluated 28 patients (mean age 51.0 ± 13.9 years, 13 males, 15 females) including 12 with LGGs and 16 with HGGs, all acquired using a 3 T magnetic resonance (MR) scanner. Nine slices were acquired for 3D CEST imaging, and one slice was acquired for two-dimensional (2D) CEST imaging. Two radiological technologists each drew a region of interest (ROI) surrounding the high-signal-intensity area(s) on the fluid-attenuated inversion recovery image of each patient. We compared the magnetization transfer ratio asymmetry (MTRasym) at 3.5 ppm in the tumors among the (i) single-slice 2D CEST imaging ("2D"), (ii) all tumor slices of the 3D CEST imaging (3Dall), and (iii) a representative tumor slice of 3D CEST imaging (maximum signal intensity [3Dmax]). The relationship between the MTRasym at 3.5 ppm values measured by these three methods and the Ki-67 labeling index (LI) of the tumors was assessed. Diagnostic performance was evaluated with a receiver operating characteristic analysis. The Ki-67LI and MTRasym at 3.5 ppm values were compared between the LGGs and HGGs. RESULTS: A moderate positive correlation between the MTRasym at 3.5 ppm and the Ki-67LI was observed with all three methods. All methods proved a significantly larger MTRasym at 3.5 ppm for the HGGs compared to the LGGs. All methods showed equivalent diagnostic performance. The signal intensity varied depending on the slice position in each case. CONCLUSIONS: The 3D CEST imaging provided the MTRasym at 3.5 ppm for each slice cross-section; its diagnostic performance was also equivalent to that of 2D CEST imaging.

Three-dimensional chemical exchange saturation transfer imaging using compressed SENSE for full z-spectrum acquisition.

PURPOSE: To evaluate the accuracy of three-dimensional (3D) chemical exchange saturation transfer (CEST) imaging with a compressed sensing (CS) and sensitivity encoding (SENSE) technique (CS-SENSE) for full z-spectrum acquisition. METHODS: All images were acquired on 3-T magnetic resonance imaging (MRI) scanner. In the phantom study, we used the acidoCEST imaging. The phantoms were prepared in seven vials containing different concentrations of iopamidol mixed in phosphate-buffered solution with different pH values. The CEST ratios were calculated from the two CEST effects. We compared the CEST ratios obtained with three different 3D CEST imaging protocols (CS-SENSE factor 5, 7, 9) with those obtained with the 2D CEST imaging as a reference standard. In the clinical study, 21 intracranial tumor patients (mean 49.7 ± 17.2 years, 7 males and 14 females) were scanned. We compared the intratumor magnetization transfer ratio asymmetry (MTRasym) obtained with 3D CEST imaging with those obtained with 2D CEST imaging as a reference standard. RESULTS: A smaller CS-SENSE factor resulted in higher agreement and better correlations with the 2D CEST imaging in the phantom study (CS-SENSE 5; ICC = 0.977, R2 = 0.8943, P < 0.0001: CS-SENSE 7; ICC = 0.970, R2 = 0.9013, P < 0.0001: CS-SENSE 9; ICC = 0.934, R2 = 0.8156 P < 0.0001). In the brain tumors, the means and percentile values of MTRasym at 2.0 and 3.5 ppm showed high linear correlations (R2 = 0.7325-0.8328, P < 0.0001) and high ICCs (0.859-0.907), which enabled successful multi-slice CEST imaging. CONCLUSIONS: The 3D CEST imaging with CS-SENSE provided equivalent contrast to 2D CEST imaging; moreover, a z-spectrum with a wide scan range could be obtained.

Optimization of the refocusing flip angle in the characterization of cerebrospinal fluid dynamics using multi-spin echo acquisition cine imaging (MUSACI).

PURPOSE: Multi-spin echo acquisition cine imaging (MUSACI) is a method used for cerebrospinal fluid (CSF) dynamics imaging based on the proton phase dispersion and flow void using 3D multi-spin echo imaging. In a previous study, the refocusing flip angle of MUSACI was set at a constant 80°. We conducted the present study to investigate the preservation the CSF signal intensity even in a long echo train and improve the ability to visualize CSF movement by modifying the refocusing flip angle in MUSACI. METHODS: The MUSACI images were acquired in 10 healthy volunteers (7 men and 3 women; age range 24-44 years; mean age 29.4 ±â€¯6.2 years) with a 3.0 Tesla MR scanner. Five refocusing flip angle sets were applied: constant 30°, constant 50°, constant 80°, pseudo-steady state (PSS) 50°-70°-100° (PSS50°), and PSS80°-100°-130° (PSS80°). In all sequences, the in-plane spatial resolution was 0.58 × 0.58 mm2, and the CSF movement for one heartbeat was drawn at 80-msec intervals. The signal intensity (SI) of CSF in the lateral ventricle, the foramen of Monro, the third ventricle, the fourth ventricle, and the pons was measured on MUSACI. Pearson's correlation coefficient was calculated between the CSF SI and effective echo time (TE; TEeff) in the lateral ventricle. RESULTS: Both antegrade and retrograde CSF movements on the midsagittal MUSACI images and the retrograde CSF movement in the foramen of Monro was observed in all sequences with the constant flip angles. A strong reverse correlation between the CSF SI in the lateral ventricle and TEeff values was observed with constant 30° (r = -0.96, p < 0.01), constant 50° (r = -0.97, p < 0.01) and constant 80° (r = -0.88, p < 0.01). A weak positive correlation was observed with PSS50° (r = 0.28, p = 0.43), and a moderate reverse correlation was observed at PSS80° (r = -0.60, p = 0.07). The SI values of the foramen of Monro, the third ventricle, and the fourth ventricle were significantly lower than that of the lateral ventricle, and those values were higher than that of the pons in both the constant 80° sequence and the PSS 50° sequence. CONCLUSION: PSS50° could be the optimal flip angle scheme for MUSACI, because the SI changes due to CSF movement and the SI preservation due to a long echo train were large due to the use of the refocusing flip angle method.

Impact of pixel-based machine-learning techniques on automated frameworks for delineation of gross tumor volume regions for stereotactic body radiation therapy.

The aim of this study was to investigate the impact of pixel-based machine learning (ML) techniques, i.e., fuzzy-c-means clustering method (FCM), and the artificial neural network (ANN) and support vector machine (SVM), on an automated framework for delineation of gross tumor volume (GTV) regions of lung cancer for stereotactic body radiation therapy. The morphological and metabolic features for GTV regions, which were determined based on the knowledge of radiation oncologists, were fed on a pixel-by-pixel basis into the respective FCM, ANN, and SVM ML techniques. Then, the ML techniques were incorporated into the automated delineation framework of GTVs followed by an optimum contour selection (OCS) method, which we proposed in a previous study. The three-ML-based frameworks were evaluated for 16 lung cancer cases (six solid, four ground glass opacity (GGO), six part-solid GGO) with the datasets of planning computed tomography (CT) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT images using the three-dimensional Dice similarity coefficient (DSC). DSC denotes the degree of region similarity between the GTVs contoured by radiation oncologists and those estimated using the automated framework. The FCM-based framework achieved the highest DSCs of 0.79±0.06, whereas DSCs of the ANN-based and SVM-based frameworks were 0.76±0.14 and 0.73±0.14, respectively. The FCM-based framework provided the highest segmentation accuracy and precision without a learning process (lowest calculation cost). Therefore, the FCM-based framework can be useful for delineation of tumor regions in practical treatment planning.

Effect of the saturation pulse duration on chemical exchange saturation transfer in amide proton transfer MR imaging: a phantom study.

Amide proton transfer (APT) contrast imaging is based on the chemical exchange saturation transfer (CEST) of protons between the amide groups and bulk water. Here, we demonstrate the effect of the saturation pulse duration on CEST in APT imaging with use of a clinical MR scanner. Four samples were prepared from chicken egg white diluted with H2O. Experiments were performed on a 3T clinical MR scanner with use of a body coil for two-channel parallel radiofrequency transmission. APT images were acquired at six frequency offsets (± 3.0, ± 3.5, ± 4.0 ppm) with respect to the water resonance as well as one far off-resonant frequency (-160 ppm) for signal normalization. The CEST effect was defined as asymmetry of the magnetization transfer ratio at 3.5 ppm. We measured the CEST effects in the egg white samples with different concentrations at seven saturation pulse durations. The influence of the extension of repetition time (TR) on the CEST effect was also evaluated. The CEST effect was not influenced by the change in TR. The CEST effect was increased significantly with the concentration when the duration was ≥1.0 s (P < 0.01). The CEST effect was highly correlated with the concentration at all saturation pulse durations, and its increase ratio was higher at longer saturation pulse durations. In conclusion, a long saturation pulse duration is useful for the sensitive detection of mobile proteins and peptides in APT imaging.

Automated measurement of cerebral cortical thickness based on fuzzy membership map derived from MR images for evaluation of Alzheimer's disease.

We have proposed an automated method for three-dimensional (3D) measurement of cerebral cortical thicknesses based on fuzzy membership maps derived from magnetic resonance (MR) images for evaluation of Alzheimer's disease (AD). The cerebral cortical thickness was three-dimensionally measured on each cortical surface voxel by using a localized gradient vector trajectory in a fuzzy membership map. The proposed method could be useful for the 3D measurement of the cerebral cortical thickness on individual cortical surface voxels as an atrophy feature in AD.

Computer-aided beam arrangement based on similar cases in radiation treatment-planning databases for stereotactic lung radiation therapy.

The purpose of this study was to develop a computer-aided method for determination of beam arrangements based on similar cases in a radiotherapy treatment-planning database for stereotactic lung radiation therapy. Similar-case-based beam arrangements were automatically determined based on the following two steps. First, the five most similar cases were searched, based on geometrical features related to the location, size and shape of the planning target volume, lung and spinal cord. Second, five beam arrangements of an objective case were automatically determined by registering five similar cases with the objective case, with respect to lung regions, by means of a linear registration technique. For evaluation of the beam arrangements five treatment plans were manually created by applying the beam arrangements determined in the second step to the objective case. The most usable beam arrangement was selected by sorting the five treatment plans based on eight plan evaluation indices, including the D95, mean lung dose and spinal cord maximum dose. We applied the proposed method to 10 test cases, by using an RTP database of 81 cases with lung cancer, and compared the eight plan evaluation indices between the original treatment plan and the corresponding most usable similar-case-based treatment plan. As a result, the proposed method may provide usable beam arrangements, which have no statistically significant differences from the original beam arrangements (P > 0.05) in terms of the eight plan evaluation indices. Therefore, the proposed method could be employed as an educational tool for less experienced treatment planners.