Multishot diffusion-prepared magnitude-stabilized balanced steady-state free precession sequence for distortion-free diffusion imaging.

PURPOSE: To develop and evaluate a multishot diffusion-prepared (DP) magnitude-stabilized balanced steady-state free precession (bSSFP) diffusion imaging sequence with improved geometric fidelity. METHODS: A signal spoiler (magnitude stabilizer; MS) was implemented in a DP-bSSFP diffusion sequence. Effects of magnitude stabilizers with respect to phase errors were simulated using Bloch simulation. Phantom study was conducted to compare the apparent diffusion coefficient (ADC) accuracy and geometric reliability, quantified using target registration error (TRE), with diffusion-weighted single-shot echo-planar imaging (DW-ssEPI). Six volunteers were recruited. DW-ssEPI, DP-bSSFP with and without ECG triggering, and DP-MS-bSSFP with and without ECG triggering were acquired 10 times with b = 500 s/mm2 in a single-shot manner to evaluate magnitude variability. Diffusion trace images and diffusion tensor images were acquired using a 4-shot DP-MS-bSSFP. RESULTS: Simulation showed that the DP-MS-bSSFP approach is insensitive to phase errors. The DP-MS-bSSFP approach had satisfactory ADC accuracy on the phantom with <5% difference with DW-ssEPI. The mean/max TRE for DW-ssEPI was 2.31/4.29 mm and was 0.51/1.20 mm for DP-MS-bSSFP. In the repeated single-shot study, DP-bSSFP without ECG triggering had severe signal void artifacts and exhibited a nonrepeatable pattern, which can be partially mitigated by ECG triggering. Adding the MS provided stable signal magnitude across all repetitions. High-quality ADC maps and color-coded fractional anisotropy maps were generated using the 4-shot DP-MS-bSSFP. The mean/max TRE was 2.89/10.80 mm for DW-ssEPI and 0.59/1.69 mm for DP-MS-bSSFP. Good agreements of white matter ADC, cerebrospinal fluid ADC, and white matter fractional anisotropy value were observed between DP-MS-bSSFP and DW-ssEPI. CONCLUSION: The proposed DP-MS-bSSFP approach provided high-quality diffusion-weighted and diffusion-tensor images with minimal geometric distortion.

Accurate, precise, simultaneous myocardial T1 and T2 mapping using a radial sequence with inversion recovery and T2 preparation.

We propose a simultaneous myocardial T1 and T2 mapping technique using a radial sequence with inversion recovery and T2 preparation, which achieves high accuracy and precision, with T1 and T2 reproducibility similar to the Modified Look-Locker Inversion recovery (MOLLI) sequence and the conventional bright blood T2 mapping technique, respectively. The sequence was developed by incorporating gold angle radial fast low angle shot (FLASH) readout combined with an inversion pulse and T2prep pulses. The extended Bloch equation simulation with slice profile correction (BLESSPC) algorithm was proposed to reconstruct T1 and T2 maps at the same time in a few seconds, while maintaining good T1 and T2 estimation accuracy. Accuracy and precision were compared among the proposed technique, MOLLI and conventional T2 mapping techniques using phantom studies, 10 healthy volunteers and three patients. In phantom studies, the proposed technique was more accurate than MOLLI (P < 0.05) while achieving similar precision (P = 0.3) in T1 estimation, and was more accurate (P < 0.05) and precise (P < 0.001) than conventional T2 mapping (two-parameter fitting) in T2 estimation. In vivo, the proposed technique achieved significantly higher T1 values (P < 0.001) and similar reproducibility (P = 0.3) compared with MOLLI, with significantly lower T2 values (P < 0.001) and similar reproducibility (P = 0.6) compared with the conventional T2 mapping technique. Thus, the proposed radial T1-T2 mapping technique allows for accurate, precise, simultaneous myocardial T1 and T2 mapping in an 11-heartbeat single breath-hold acquisition.

Accelerated noncontrast-enhanced 4-dimensional intracranial MR angiography using golden-angle stack-of-stars trajectory and compressed sensing with magnitude subtraction.

PURPOSE: To evaluate the feasibility and performance of compressed sensing (CS) with magnitude subtraction regularization in accelerating non-contrast-enhanced dynamic intracranial MR angiography (NCE-dMRA). METHODS: A CS algorithm was introduced in NCE-dMRA by exploiting the sparsity of the magnitude difference of the control and label images. The NCE-dMRA data were acquired using golden-angle stack-of-stars trajectory on six healthy volunteers and one patient with arteriovenous fistula. Images were reconstructed using (i) the proposed magnitude-subtraction CS (MS-CS); (ii) complex-subtraction CS; (iii) independent CS; and (iv) view-sharing with k-space weighted image contrast (KWIC). The dMRA image quality was compared across the four reconstruction strategies. The proposed MS-CS method was further compared with KWIC for temporal fidelity of depicting dynamic flow. RESULTS: The proposed MS-CS method was able to reconstruct NCE-dMRA images with detailed vascular structures and clean background. It provided better subjective image quality than the other two CS strategies (P < 0.05). Compared with KWIC, MS-CS showed similar image quality, but reduced temporal blurring in delineating the fine distal arteries. CONCLUSIONS: The MS-CS method is a promising CS technique for accelerating NCE-dMRA acquisition without compromising image quality and temporal fidelity. Magn Reson Med 79:867-878, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Improved 4D cardiac functional assessment for pediatric patients using motion-weighted image reconstruction.

OBJECTIVE: Our aim was to develop and evaluate a motion-weighted reconstruction technique for improved cardiac function assessment in 4D magnetic resonance imaging (MRI). MATERIALS AND METHODS: A flat-topped, two-sided Gaussian kernel was used to weigh k-space data in each target cardiac phase and adjacent two temporal phases during the proposed phase-by-phase reconstruction algorithm. The proposed method (Strategy 3) was used to reconstruct 18 cardiac phases based on data acquired using a previously proposed technique [4D multiphase steady-state imaging with contrast enhancement (MUSIC) technique and its self-gated extension using rotating Cartesian k-space (ROCK-MUSIC) from 12 pediatric patients. As a comparison, the same data set was reconstructed into nine phases using a phase-by-phase method (Strategy 1), 18 phases using view sharing (Strategy 4), and 18 phases using a temporal regularized method (Strategy 2). Regional image sharpness and left ventricle volumetric measurements were used to compare the four reconstructions quantitatively. RESULTS: Strategies 1 and 4 generated significantly sharper images of static structures (P ≤ 0.018) than Strategies 2 and 3 but significantly more blurry (P ≤ 0.021) images of the heart. Left ventricular volumetric measurements from the nine-phase reconstruction (Strategy 1) correlated moderately (r < 0.8) with the 2D cine, whereas the remaining three techniques had a higher correlation (r > 0.9). The computational burden of Strategy 2 was six times that of Strategy 3. CONCLUSION: The proposed method of motion-weighted reconstruction improves temporal resolution in 4D cardiac imaging with a clinically practical workflow.

Golden-ratio rotated stack-of-stars acquisition for improved volumetric MRI.

PURPOSE: To develop and evaluate an improved stack-of-stars radial sampling strategy for reducing streaking artifacts. METHODS: The conventional stack-of-stars sampling strategy collects the same radial angle for every partition (slice) encoding. In an undersampled acquisition, such an aligned acquisition generates coherent aliasing patterns and introduces strong streaking artifacts. We show that by rotating the radial spokes in a golden-angle manner along the partition-encoding direction, the aliasing pattern is modified, resulting in improved image quality for gridding and more advanced reconstruction methods. Computer simulations were performed and phantom as well as in vivo images for three different applications were acquired. RESULTS: Simulation, phantom, and in vivo experiments confirmed that the proposed method was able to generate images with less streaking artifact and sharper structures based on undersampled acquisitions in comparison with the conventional aligned approach at the same acceleration factors. By combining parallel imaging and compressed sensing in the reconstruction, streaking artifacts were mostly removed with improved delineation of fine structures using the proposed strategy. CONCLUSIONS: We present a simple method to reduce streaking artifacts and improve image quality in 3D stack-of-stars acquisitions by re-arranging the radial spoke angles in the 3D partition direction, which can be used for rapid volumetric imaging. Magn Reson Med 78:2290-2298, 2017. © 2017 International Society for Magnetic Resonance in Medicine.

Self-gated 4D multiphase, steady-state imaging with contrast enhancement (MUSIC) using rotating cartesian K-space (ROCK): Validation in children with congenital heart disease.

PURPOSE: To develop and validate a cardiac-respiratory self-gating strategy for the recently proposed multiphase steady-state imaging with contrast enhancement (MUSIC) technique. METHODS: The proposed SG strategy uses the ROtating Cartesian K-space (ROCK) sampling, which allows for retrospective k-space binning based on motion surrogates derived from k-space center line. The k-space bins are reconstructed using a compressed sensing algorithm. Ten pediatric patients underwent cardiac MRI for clinical reasons. The original MUSIC and 2D-CINE images were acquired as a part of the clinical protocol, followed by the ROCK-MUSIC acquisition, all under steady-state intravascular distribution of ferumoxytol. Subjective scores and image sharpness were used to compare the images of ROCK-MUSIC and original MUSIC. RESULTS: All scans were completed successfully without complications. The ROCK-MUSIC acquisition took 5 ± 1 min, compared to 8 ± 2 min for the original MUSIC. Image scores of ROCK-MUSIC were significantly better than original MUSIC at the ventricular outflow tracts (3.9 ± 0.3 vs. 3.3 ± 0.6, P < 0.05). There was a strong trend toward superior image scores for ROCK-MUSIC in the other anatomic locations. CONCLUSION: ROCK-MUSIC provided images of equal or superior image quality compared to original MUSIC, and this was achievable with 40% savings in scan time and without the need for physiologic signal. Magn Reson Med 78:472-483, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Accelerated ferumoxytol-enhanced 4D multiphase, steady-state imaging with contrast enhancement (MUSIC) cardiovascular MRI: validation in pediatric congenital heart disease.

The purpose of this work was to validate a parallel imaging (PI) and compressed sensing (CS) combined reconstruction method for a recently proposed 4D non-breath-held, multiphase, steady-state imaging technique (MUSIC) cardiovascular MRI in a cohort of pediatric congenital heart disease patients. We implemented a graphics processing unit accelerated CS-PI combined reconstruction method and applied it in 13 pediatric patients who underwent cardiovascular MRI after ferumoxytol administration. Conventional breath-held contrast-enhanced magnetic resonance angiography (CE-MRA) was first performed during the first pass of ferumoxytol injection, followed by the original MUSIC and the proposed CS-PI MUSIC during the steady-state distribution phase of ferumoxytol. Qualities of acquired images were then evaluated using a four-point scale. Left ventricular volumes and ejection fractions calculated from the original MUSIC and the CS-PI MUSIC were also compared with conventional multi-slice 2D cardiac cine MRI. The proposed CS-PI MUSIC reduced the imaging time of the MUSIC acquisition to 4.6 ± 0.4 min from 8.9 ± 1.2 min. Computationally intensive image reconstruction was completed within 5 min without interruption of sequential clinical scans. The proposed method (mean 3.3-4.0) provided image quality comparable to that of the original MUSIC (3.2-4.0) (all P ≥ 0.42), and better than conventional breath-held first-pass CE-MRA (1.1-3.3) for 13 anatomical structures (all P ≤ 0.0014) with good inter-observer agreement (κ > 0.46). The calculated ventricular volumes and ejection fractions from both original MUSIC (r > 0.90) and CS-PI MUSIC (r > 0.85) correlated well with 2D cine imaging. In conclusion, PI and CS were successfully incorporated into the 4D MUSIC acquisition to further reduce scan time by approximately 50% while maintaining highly comparable image quality in a clinically practical reconstruction time.

4D MUSIC CMR: value-based imaging of neonates and infants with congenital heart disease.

BACKGROUND: 4D Multiphase Steady State Imaging with Contrast (MUSIC) acquires high-resolution volumetric images of the beating heart during uninterrupted ventilation. We aim to evaluate the diagnostic performance and clinical impact of 4D MUSIC in a cohort of neonates and infants with congenital heart disease (CHD). METHODS: Forty consecutive neonates and infants with CHD (age range 2 days to 2 years, weight 1 to 13 kg) underwent 3.0 T CMR with ferumoxytol enhancement (FE) at a single institution. Independently, two readers graded the diagnostic image quality of intra-cardiac structures and related vascular segments on FE-MUSIC and breath held FE-CMRA images using a four-point scale. Correlation of the CMR findings with surgery and other imaging modalities was performed in all patients. Clinical impact was evaluated in consensus with referring surgeons and cardiologists. One point was given for each of five key outcome measures: 1) change in overall management, 2) change in surgical approach, 3) reduction in the need for diagnostic catheterization, 4) improved assessment of risk-to-benefit for planned intervention and discussion with parents, 5) accurate pre-procedural roadmap. RESULTS: All FE-CMR studies were completed successfully, safely and without adverse events. On a four-point scale, the average FE-MUSIC image quality scores were >3.5 for intra-cardiac structures and >3.0 for coronary arteries. Intra-cardiac morphology and vascular anatomy were well visualized with good interobserver agreement (r = 0.46). Correspondence between the findings on MUSIC, surgery, correlative imaging and autopsy was excellent. The average clinical impact score was 4.2 ± 0.9. In five patients with discordant findings on echo/MUSIC (n = 5) and catheter angiography/MUSIC (n = 1), findings on FE-MUSIC were shown to be accurate at autopsy (n = 1) and surgery (n = 4). The decision to undertake biventricular vs univentricular repair was amended in 2 patients based on FE-MUSIC findings. Plans for surgical approaches which would have involved circulatory arrest were amended in two of 28 surgical cases. In all 28 cases requiring procedural intervention, FE-MUSIC provided accurate dynamic 3D roadmaps and more confident risk-to-benefit assessments for proposed interventions. CONCLUSIONS: FE-MUSIC CMR has high clinical impact by providing accurate, high quality, simple and safe dynamic 3D imaging of cardiac and vascular anatomy in neonates and infants with CHD. The findings influenced patient management in a positive manner.

Segmented golden ratio radial reordering with variable temporal resolution for dynamic cardiac MRI.

PURPOSE: Golden ratio (GR) radial reordering allows for retrospective choice of temporal resolution by providing a near-uniform k-space sampling within any reconstruction window. However, when applying GR to electrocardiogram (ECG)-gated cardiac imaging, the k-space coverage may not be as uniform because a single reconstruction window is broken into several temporally isolated ones. The goal of this study was to investigate the image artifacts caused by applying GR to ECG-gated cardiac imaging and to propose a segmented GR method to address this issue. METHODS: Computer simulation and phantom experiments were used to evaluate the image artifacts resulting from three k-space sampling patterns (ie, uniform radial, conventional GR, and segmented GR). Two- and three-dimensional cardiac cine images were acquired in seven healthy subjects. Imaging artifacts due to k-space sampling nonuniformity were graded on a 5-point scale by an experienced cardiac imaging reader. RESULTS: Segmented GR provides more uniform k-space sampling that is independent of heart-rate variation than conventional GR. Cardiac cine images using segmented GR have significantly higher and more reliable image quality than conventional GR. CONCLUSION: Segmented GR successfully addresses the nonuniform sampling that occurs with combining conventional GR with ECG gating. This technique can potentially be applied to any ECG-gated cardiac imaging application to allow for retrospective selection of a reconstruction window. Magn Reson Med 76:94-103, 2016. © 2015 Wiley Periodicals, Inc.

Rapid quantitative T2 mapping of the prostate using three-dimensional dual echo steady state MRI at 3T.

PURPOSE: To develop and evaluate a rapid three-dimensional (3D) quantitative T2 mapping method for prostate cancer imaging using dual echo steady state (DESS) MRI at 3T. METHODS: In simulations, DESS-T2 mapping in the presence of T1 and B1+ variations was evaluated. In a phantom and in healthy volunteers (n = 4), 3D DESS-T2 mapping was compared with a two-dimensional turbo spin echo (TSE) approach. In volunteers and a pilot patient study (n = 29), quantitative T2 in normal prostate anatomical zones and in suspected cancerous lesions was evaluated. RESULTS: The simulated bias for DESS-T2 was < 2% (5%) for typically observed T1 ( B1+) variations. In phantoms and in vivo, high correlation of DESS-T2 and TSE-T2 (r2 = 0.98 and 0.88, P < 0.001) was found. DESS-T2 in the normal peripheral zone and transition zone was 115 ± 26 ms and 64 ± 7 ms, respectively, in healthy volunteers and 129 ± 39 ms and 83 ± 12 ms, respectively, in patients. In suspected cancerous lesions, DESS-T2 was 72 ± 14 ms, which was significantly decreased from the normal peripheral zone (P < 0.001) but not from the transition zone. CONCLUSION: Rapid 3D T2 mapping in the entire prostate can be performed in 1 min using DESS MRI. Magn Reson Med 76:1720-1729, 2016. © 2016 International Society for Magnetic Resonance in Medicine.

3D isotropic resolution diffusion-prepared magnitude-stabilized bSSFP imaging with high geometric fidelity at 1.5 Tesla.

INTRODUCTION: MRI has been increasingly used in radiation therapy to facilitate tumor and organ delineation and assess treatment response. Diffusion MRI can provide cellularity information and may enable functional-based treatment planning and adaptation. However, strong distortion associated with the conventional diffusion-weighted single-shot echo-planar imaging (DW-ssEPI) sequence is problematic for accurate target delineation. The goal of this work is to propose a 3D diffusion sequence with minimal distortion for radiation therapy applications. METHODS: A 3D diffusion-prepared magnitude-stabilized balanced steady-state free precession sequence (DP-MS-bSSFP) was developed. A 2D navigator was acquired during the linear catalyzation stage of the bSSFP readout to estimate the phase, which was then used in a plane-by-plane low-rank constrained reconstruction to correct the shot-to-shot k-space inconsistency. A diffusion phantom was scanned to evaluate and compare the geometric reliability and apparent diffusion coefficient (ADC) accuracy with the conventional DW-ssEPI. Eight landmarks were selected on each slice of the images to calculate the target registration error (TRE), which was used as a surrogate for geometric fidelity. The phantom was scanned under both 0℃ and room temperature. Brain scans were performed on five healthy volunteers. In the first volunteer, protocols of 1, 2, and 4 shots per Kz plane were compared. In vivo geometric fidelity and ADC accuracy were evaluated on the remaining four volunteers using the protocol of four shots per Kz plane. In the geometric fidelity study, 8-10 landmarks were picked on each slice to calculate the TRE. Regions of interest were placed on the white matter, the cerebellum, and the cerebrospinal fluid region to evaluate the ADC agreement between DW-ssEPI and DP-MS using the Bland-Altman plot. All scans were performed at 1.5 mm isotropic resolution to meet the high-resolution requirement of many radiotherapy applications. RESULTS: The DP-MS had drastically improved geometric accuracy compared with DW-ssEPI on the phantom. The mean TRE decreased from 2.09 mm to 0.70 mm. The percentage difference of the ADC values between the two diffusion sequences were less than 5.5% and 7% for the 0℃ and room temperature study, respectively. The DW-ssEPI had strong distortion and susceptibility-related artifacts at tissue air boundary, whereas distortion was minimal in DP-MS images. Overall, the mean/max TRE was over 2 mm/7 mm in the volunteers for DW-ssEPI, whereas less than 0.8 mm/2 mm for DP-MS. Good ADC agreement was observed for the white matter, the cerebellum, and the CSF based on the Bland-Altman plots. CONCLUSION: A 3D diffusion sequence was developed and validated. It provided high-resolution diffusion imaging with mean distortion less than 1 mm at 1.5 T, and is a promising imaging technique for treatment planning and adaptive radiotherapy.

Parallel imaging and convolutional neural network combined fast MR image reconstruction: Applications in low-latency accelerated real-time imaging.

PURPOSE: To develop and evaluate a parallel imaging and convolutional neural network combined image reconstruction framework for low-latency and high-quality accelerated real-time MR imaging. METHODS: Conventional Parallel Imaging reconstruction resolved as gradient descent steps was compacted as network layers and interleaved with convolutional layers in a general convolutional neural network. All parameters of the network were determined during the offline training process, and applied to unseen data once learned. The proposed network was first evaluated for real-time cardiac imaging at 1.5 T and real-time abdominal imaging at 0.35 T, using threefold to fivefold retrospective undersampling for cardiac imaging and threefold retrospective undersampling for abdominal imaging. Then, prospective undersampling with fourfold acceleration was performed on cardiac imaging to compare the proposed method with standard clinically available GRAPPA method and the state-of-the-art L1-ESPIRiT method. RESULTS: Both retrospective and prospective evaluations confirmed that the proposed network was able to images with a lower noise level and reduced aliasing artifacts in comparison with the single-coil based and L1-ESPIRiT reconstructions for cardiac imaging at 1.5 T, and the GRAPPA and L1-ESPIRiT reconstructions for abdominal imaging at 0.35 T. Using the proposed method, each frame can be reconstructed in less than 100 ms, suggesting its clinical compatibility. CONCLUSION: The proposed Parallel Imaging and convolutional neural network combined reconstruction framework is a promising technique that allows low-latency and high-quality real-time MR imaging.

MR image reconstruction using deep learning: evaluation of network structure and loss functions.

BACKGROUND: To review and evaluate approaches to convolutional neural network (CNN) reconstruction for accelerated cardiac MR imaging in the real clinical context. METHODS: Two CNN architectures, Unet and residual network (Resnet) were evaluated using quantitative and qualitative assessment by radiologist. Four different loss functions were also considered: pixel-wise (L1 and L2), patch-wise structural dissimilarity (Dssim) and feature-wise (perceptual loss). The networks were evaluated using retrospectively and prospectively under-sampled cardiac MR data. RESULTS: Based on our assessments, we find that Resnet and Unet achieve similar image quality but that former requires only 100,000 parameters compared to 1.3 million parameters for the latter. The perceptual loss function performed significantly better than L1, L2 or Dssim loss functions as determined by the radiologist scores. CONCLUSIONS: CNN image reconstruction using Resnet yields comparable image quality to Unet with 10X the number of parameters. This has implications for training with significantly lower data requirements. Network training using the perceptual loss function was found to better agree with radiologist scoring compared to L1, L2 or Dssim loss functions.

Accelerated 3D bSSFP imaging for treatment planning on an MRI-guided radiotherapy system.

PURPOSE: The purpose of this study was to introduce a compressed sensing and parallel imaging-combined technique to reduce the acquisition time of planning MRI for MR-guided radiotherapy (MRgRT) systems. METHODS AND MATERIALS: A variable-density Poisson-Disk (VDPD) undersampling acquisition along with compressed sensing reconstruction technique was developed and compared with the current planning MR protocol, which uses an optimized balanced steady-state free precession sequence with 7.5-fold (7.5×) acceleration achieved by GRAPPA and partial Fourier. The image quality of GRAPPA and VDPD with 7.5× and 15× acceleration was compared with fully sampled images on a phantom. Two volunteers were recruited to compare the in vivo imaging performance. Ten patients with abdominal tumors were scanned using the conventional GRAPPA 7.5× (25 s) and the proposed VDPD 15× (12.5 s) sequences. Three readers scored the two approaches in terms of the quality for organ and tumor delineation. The gross tumor volume (GTV) and two kidneys were contoured. Differences in centroid location and contour volumes, Dice coefficients, and mean distance-to-agreement (MDA) between contours draw on the two techniques were calculated. All studies were performed on a 0.35 T MRgRT system. RESULTS: In the phantom study, VDPD with 15× acceleration rate had lower noise level than GRAPPA with 7.5× acceleration. In both the phantom and volunteer study, noise amplification was apparent when the acceleration rate was increased from 7.5× to 15× in the GRAPPA acquisition, whereas it was minimally increased using the VDPD approach. In the patient study, no significant difference was found for the scoring and contouring statistics between the two techniques, whereas VDPD only took half the scan time as GRAPPA. Volume difference for the GTV and two kidneys between GRAPPA 7.5× and VDPD 15× was around 7.6%, 1.3%, and 2.8%, respectively; while the Dice index was approximately 0.85, 0.92, and 0.90, respectively. CONCLUSION: The proposed technique reduced the acquisition time by half and provided comparable or improved image quality than the standard planning MRI protocol.

Respiratory motion-resolved, self-gated 4D-MRI using Rotating Cartesian K-space (ROCK): Initial clinical experience on an MRI-guided radiotherapy system.

PURPOSE: To optimize and evaluate the respiratory motion-resolved, self-gated 4D-MRI using Rotating Cartesian K-space (ROCK-4D-MRI) method in a 0.35 T MRI-guided radiotherapy (MRgRT) system. METHODS AND MATERIALS: The study included seven patients with abdominal tumors treated on the MRgRT system. ROCK-4D-MRI and 2D-CINE, was performed immediately after one of the treatment fractions. Motion quantification based on 4D-MRI was compared with those based on 2D-CINE. The image quality of 4D-MRI was evaluated against 4D-CT. The gross tumor volumes (GTV) were defined based on individual respiratory phases of both 4D-MRI and 4D-CT and compared for their variability over the respiratory cycle. RESULT: The motion measurements based on 4D-MRI matched well with 2D-CINE, with differences of 1.04 ±â€¯0.52 mm in the superior-inferior and 0.54 ±â€¯0.21 mm in the anterior-posterior directions. The image quality scores of 4D-MRI were significantly higher than 4D-CT, with better tumor contrast (3.29 ±â€¯0.76 vs. 1.86 ±â€¯0.90) and less motion artifacts (3.57 ±â€¯0.53 vs. 2.29 ±â€¯0.95). The GTVs were more consistent in 4D-MRI than in 4D-CT, with significantly smaller GTV variability (9.31 ±â€¯4.58% vs. 34.27 ±â€¯23.33%). CONCLUSION: Our study demonstrated the clinical feasibility of using the ROCK-4D-MRI to acquire high quality, respiratory motion-resolved 4D-MRI in a low-field MRgRT system. The 4D-MRI image could provide accurate dynamic information for radiotherapy treatment planning.

Respiratory motion-resolved, self-gated 4D-MRI using rotating cartesian k-space (ROCK).

PURPOSE: To propose and validate a respiratory motion resolved, self-gated (SG) 4D-MRI technique to assess patient-specific breathing motion of abdominal organs for radiation treatment planning. METHODS: The proposed 4D-MRI technique was based on the balanced steady-state free-precession (bSSFP) technique and 3D k-space encoding. A novel rotating cartesian k-space (ROCK) reordering method was designed which incorporates repeatedly sampled k-space centerline as the SG motion surrogate and allows for retrospective k-space data binning into different respiratory positions based on the amplitude of the surrogate. The multiple respiratory-resolved 3D k-space data were subsequently reconstructed using a joint parallel imaging and compressed sensing method with spatial and temporal regularization. The proposed 4D-MRI technique was validated using a custom-made dynamic motion phantom and was tested in six healthy volunteers, in whom quantitative diaphragm and kidney motion measurements based on 4D-MRI images were compared with those based on 2D-CINE images. RESULTS: The 5-minute 4D-MRI scan offers high-quality volumetric images in 1.2 × 1.2 × 1.6 mm3 and eight respiratory positions, with good soft-tissue contrast. In phantom experiments with triangular motion waveform, the motion amplitude measurements based on 4D-MRI were 11.89% smaller than the ground truth, whereas a -12.5% difference was expected due to data binning effects. In healthy volunteers, the difference between the measurements based on 4D-MRI and the ones based on 2D-CINE were 6.2 ± 4.5% for the diaphragm, 8.2 ± 4.9% and 8.9 ± 5.1% for the right and left kidney. CONCLUSION: The proposed 4D-MRI technique could provide high-resolution, high-quality, respiratory motion-resolved 4D images with good soft-tissue contrast and are free of the "stitching" artifacts usually seen on 4D-CT and 4D-MRI based on resorting 2D-CINE. It could be used to visualize and quantify abdominal organ motion for MRI-based radiation treatment planning.

Distortion-free diffusion MRI using an MRI-guided Tri-Cobalt 60 radiotherapy system: Sequence verification and preliminary clinical experience.

PURPOSE: Monitoring tumor response during the course of treatment and adaptively modifying treatment plan based on tumor biological feedback may represent a new paradigm for radiotherapy. Diffusion MRI has shown great promises in assessing and predicting tumor response to radiotherapy. However, the conventional diffusion-weighted single-shot echo-planar-imaging (DW-ssEPI) technique suffers from limited resolution, severe distortion, and possibly inaccurate ADC at low field strength. The purpose of this work was to develop a reliable, accurate and distortion-free diffusion MRI technique that is practicable for longitudinal tumor response evaluation and adaptive radiotherapy on a 0.35 T MRI-guided radiotherapy system. METHODS: A diffusion-prepared turbo spin echo readout (DP-TSE) sequence was developed and compared with the conventional diffusion-weighted single-shot echo-planar-imaging sequence on a 0.35 T MRI-guided radiotherapy system (ViewRay). A spatial integrity phantom was used to quantitate and compare the geometric accuracy of the two diffusion sequences for three orthogonal orientations. The apparent diffusion coefficient (ADC) accuracy was evaluated on a diffusion phantom under both 0 °C and room temperature to cover a diffusivity range between 0.40 × 10-3 and 2.10 × 10-3 mm2 /s. Ten room temperature measurements repeated on five different days were conducted to assess the ADC reproducibility of DP-TSE. Two glioblastoma (GBM) and six sarcoma patients were included to examine the in vivo feasibility. The target registration error (TRE) was calculated to quantitate the geometric accuracy where structural CT or MR images were co-registered to the diffusion images as references. ADC maps from DP-TSE and DW-ssEPI were calculated and compared. A tube phantom was placed next to patients not treated on ViewRay, and ADCs of this reference tube were also compared. RESULTS: The proposed DP-TSE passed the spatial integrity test (< 1 mm within 100 mm radius and < 2 mm within 175 mm radius) under the three orthogonal orientations. The detected errors were 0.474 ± 0.355 mm, 0.475 ± 0.287 mm, and 0.546 ± 0.336 mm in the axial, coronal, and sagittal plane. DW-ssEPI, however, failed the tests due to severe distortion and low signal intensity. Noise correction must be performed for the DW-ssEPI to avoid ADC quantitation errors, whereas it is optional for DP-TSE. At 0 °C, the two sequences provided accurate quantitation with < 3% variation with the reference. In the room temperature study, discrepancies between ADCs from DP-TSE and the reference were within 4%, but could be as high as 8% for DW-ssEPI after the noise correction. Excellent ADC reproducibility with a coefficient of variation < 5% was observed among the 10 measurements of DP-TSE, indicating desirable robustness for ADC-based tumor response assessment. In vivo TRE in DP-TSE was less than 1.6 mm overall, whereas it could be greater than 12 mm in DW-ssEPI. For GBM patients, the CSF and brain tissue ADCs from DP-TSE were within the ranges found in literature. ADC differences between the two techniques were within 8% among the six sarcoma patients. For the reference tube that had a relatively low diffusivity, the two diffusion sequences provided matched measurements. CONCLUSION: A diffusion technique with excellent geometric fidelity, accurate, and reproducible ADC measurement was demonstrated for longitudinal tumor response assessment using a low-field MRI-guided radiotherapy system.