Ultra-high field magnetic resonance imaging in human epilepsy: A systematic review

RATIONALE

Resective epilepsy surgery is an evidence-based curative treatment option for patients with drug-resistant focal epilepsy. The major preoperative predictor of a good surgical outcome is detection of an epileptogenic lesion by magnetic resonance imaging (MRI). Application of ultra-high field (UHF) MRI, i.e. field strengths ≥ 7 Tesla (T), may increase the sensitivity to detect such a lesion.

METHODS

A keyword search strategy was submitted to Pubmed, EMBASE, Cochrane Database and clinicaltrials.gov to select studies on UHF MRI in patients with epilepsy. Follow-up study selection and data extraction were performed following PRISMA guidelines. We focused on I) diagnostic gain of UHF- over conventional MRI, II) concordance of MRI-detected lesion, seizure onset zone and surgical decision-making, and III) postoperative histopathological diagnosis and seizure outcome.

RESULTS

Sixteen observational cohort studies, all using 7T MRI were included. Diagnostic gain of 7T over conventional MRI ranged from 8% to 67%, with a pooled gain of 31%. Novel techniques to visualize pathological processes in epilepsy and lesion detection are discussed. Seizure freedom was achieved in 73% of operated patients; no seizure outcome comparison was made between 7T MRI positive, 7T negative and 3T positive patients. 7T could influence surgical decision-making, with high concordance of lesion and seizure onset zone. Focal cortical dysplasia (54%), hippocampal sclerosis (12%) and gliosis (8.1%) were the most frequently diagnosed histopathological entities.

SIGNIFICANCE

UHF MRI increases, yet variably, the sensitivity to detect an epileptogenic lesion, showing potential for use in clinical practice. It remains to be established whether this results in improved seizure outcome after surgical treatment. Prospective studies with larger cohorts of epilepsy patients, uniform scan and sequence protocols, and innovative post-processing technology are equally important as further increasing field strengths. Besides technical ameliorations, improved correlation of imaging features with clinical semiology, histopathology and clinical outcome has to be established.

MRI phase offset correction method impacts quantitative susceptibility mapping

Individual channel ultra-high field (7T) phase images have to be phase offset corrected prior to the mapping of magnetic susceptibility of tissue. Whilst numerous methods have been proposed for gradient recalled echo MRI phase offset correction, it remains unclear how they affect quantitative magnetic susceptibility values derived from phase images. Methods already proposed either employ a single or multiple echo time MRI data. In terms of the latter, offsets can be derived using an ultra-short echo time acquisition, or by estimating the offset based on two echo points with the assumption of linear phase evolution with echo time. Our evaluation involved 32 channel multi-echo time 7T GRE (Gradient Recalled Echo) and ultra-short echo time PETRA (Pointwise Encoding Time Reduction with Radial Acquisition) MRI data collected for a susceptibility phantom and three human brains. The combined phase images generated using four established offset correction methods (two single and two multiple echo time) were analysed, followed by an assessment of quantitative susceptibility values obtained for a phantom and human brains. The effectiveness of each method in removing the offsets was shown to reduce with increased echo time, decreased signal intensity and reduced overlap in coil sensitivity profiles. Quantitative susceptibility values and how they change with echo time were found to be method specific. Phase offset correction methods based on single echo time data have a tendency to produce more accurate and less noisy quantitative susceptibility maps in comparison with methods employing multiple echo time data.

Reduced striatal GABA in unmedicated children with ADHD at 7T

Attention-deficit hyperactive disorder (ADHD) is characterized by inattention and increased impulsive and hypermotoric behaviors.Despite the high prevalence and impact of ADHD, little is known about the underlying neurophysiology of ADHD. The main inhibitory and excitatory neurotransmitters γ-aminobutyric acid (GABA) and glutamate are receiving increased attention in ADHD and can be measured using Magnetic Resonance Spectroscopy (MRS). However, MRS studies in ADHD are limited. We measured GABA and glutamate in young unmedicated participants, utilizing high magnetic field strength. Fifty unmedicated children (26 with ADHD, 24 controls) aged 5-9 years completed MRS at 7T and behavioral testing. GABA and glutamate were measured in dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), premotor cortex (PMC), and striatum, and estimated using LCModel. Children with ADHD showed poorer inhibitory control and significantly reduced GABA/Cr in the striatum, but not in ACC, DLPFC, or PMC regions. There were no significant group differences for Glu/Cr levels, or correlations with behavioral manifestations of ADHD. The primary finding of this study is a reduction of striatal GABA levels in unmedicated children with ADHD at 7T. These findings provide guidance for future studies or interventions. Reduced striatal GABA may be a marker for specific GABA-related treatment for ADHD.

A probabilistic atlas of finger dominance in the primary somatosensory cortex

With the advent of ultra-high field (7T), high spatial resolution functional MRI (fMRI) has allowed the differentiation of the cortical representations of each of the digits at an individual-subject level in human primary somatosensory cortex (S1). Here we generate a probabilistic atlas of the contralateral SI representations of the digits of both the left and right hand in a group of 22 right-handed individuals. The atlas is generated in both volume and surface standardised spaces from somatotopic maps obtained by delivering vibrotactile stimulation to each distal phalangeal digit using a travelling wave paradigm. Metrics quantify the likelihood of a given position being assigned to a digit (full probability map) and the most probable digit for a given spatial location (maximum probability map). The atlas is validated using a leave-one-out cross validation procedure. Anatomical variance across the somatotopic map is also assessed to investigate whether the functional variability across subjects is coupled to structural differences. This probabilistic atlas quantifies the variability in digit representations in healthy subjects, finding some quantifiable separability between digits 2, 3 and 4, a complex overlapping relationship between digits 1 and 2, and little agreement of digit 5 across subjects. The atlas and constituent subject maps are available online for use as a reference in future neuroimaging studies.

A Data-Driven Multi-scale Technique for fMRI Mapping of the Human Somatosensory Cortex

A previously introduced Bayesian non-parametric multi-scale technique, called iterated Multigrid Priors (iMGP) method, is used to map the topographic organization of human primary somatosensory cortex (S1). We analyze high spatial resolution fMRI data acquired at ultra-high field (UHF, 7T) in individual subjects during vibrotactile stimulation applied to each distal phalange of the left hand digits using both a travelling-wave (TW) and event-related (ER) paradigm design. We compare the somatotopic digit representations generated in S1 using the iMGP method with those obtained using established fMRI paradigms and analysis techniques: Fourier-based analysis of travelling-wave data and General Linear Model (GLM) analysis of event-related data. Maps derived with the iMGP method are similar to those derived with the standard analysis, but in contrast to the Fourier-based analysis, the iMGP method reveals overlap of activity from adjacent digit representations in S1. These findings validate the use of the iMGP method as an alternative to study digit representations in S1, particularly with the TW design as an attractive means to study cortical reorganization in patient populations such dystonia and carpal tunnel syndrome, where the degree of spatial overlap of cortical finger representations is of interest.

High resolution time-of-flight MR-angiography at 7 T exploiting VERSE saturation, compressed sensing and segmentation

BACKGROUND

3D Time-of-Flight (TOF) MR-angiography (MRA) substantially benefits from ultra-high magnetic field strengths (≥7 T) due to increased Signal-to-Noise ratio and improved contrast. However, high-resolution TOF-MRA usually requires long acquisition times. In addition, specific absorption rate constraints limit the choice of optimal pulse sequence parameters, especially if venous saturation is employed.

PURPOSE

To implement and evaluate an arterial TOF-MRA for accelerated high-resolution angiography at ultra-high magnetic field strength.

FIELD STRENGTHS/SEQUENCE

7 T modified gradient-echo TOF sequence including venous saturation using Variable-Rate Selective Excitation (VERSE), Compressed Sensing (CS) and sparse application of saturation pulses, called segmentation, were included for acceleration.

ASSESSMENT

To analyze the acceleration techniques all volunteers were examined with the same protocols. CS with different sampling patterns and regularization factors as well as segmentation were applied for acceleration. For comparison, conventional acceleration techniques were applied (GRAPPA PAT 3 and Partial Fourier (6/8 in slice/phase encoding)). Images were co-registered and 40 mm thick transversal maximum intensity projections were created to calculate the relative number of vessels. To analyze the visibility of small vessels, the lenticulostriate arteries (LSA) were examined. This was done via multiscale vessel enhancement filtering in a VOI and quantification via Fiji ImageJ as well as qualitatively evaluation by two radiologists. Additionally, the venous/arterial vessel-to-background ratios (vVBR/aVBR) were calculated for chosen protocols.

RESULTS

For the acceleration of a high resolution TOF-MRA (0.31 mm isotropic), under-sampling of 9.6 showed aliasing artifacts, whereas 7.2 showed no aliasing. The regularization factor R had a strong impact on the image quality according to smoothing (R = 0.01 to R = 0.005) and noise (R = 0.0005 to R = 0.00005). With the alternating sampling patterns it was shown that the k-space center should not be under-sampled too much. Additionally segmentation could be verified to be feasible for stronger acceleration with sufficient venous suppression.

CONCLUSION

The combination of several independent techniques (VERSE, CS with acceleration factor 7.2, R = 0.001, Poisson disc radius of 80%, 3 segments) enables the application of high-resolution (0.31 mm isotropic) TOF-MRA with venous saturation at 7 T in clinical time settings (TA ≈ 5 min) and within the SAR limits.

Multi-slice passband bSSFP for human and rodent fMRI at ultra-high field

Balanced steady-state free precession (bSSFP) can be used as an alternative to gradient-echo (GE) EPI for BOLD functional MRI when image distortions and signal drop-outs are severe such as at ultra-high field. However, 3D-bSSFP acquisitions have distinct drawbacks on either human or animal MR systems. On clinical scanners, 3D imaging is suboptimal for localized fMRI applications. It can also display distortions when acceleration methods such as spiral read-outs are used, and, compared to multi-slice acquisitions, suffers from increased sensitivity to motion or physiological noise which further results in blurring. On pre-clinical systems, 3D acquisitions have low temporal resolution due to limited acceleration options, while single slice often results in insufficient coverage. The aim of the present study was to implement a multi-slice bSSFP acquisition with Cartesian read-out to obtain non-distorted BOLD fMRI activation maps in the human and rat brain at ultra-high field. We show that, when using a new pseudo-steady-state, the bSSFP signal characteristics are preserved. In the human brain at 7 T, we demonstrate that both task- and resting-state fMRI can be performed with multi-slice bSSFP, with a temporal SNR that matches that of 3D-bSSFP, resulting in - at least - equal performance. In the rat brain at 14 T, we show that the multi-slice bSSFP protocol has similar sensitivity to gradient-echo EPI for task fMRI, while benefitting from much reduced distortions and drop-outs. The advantages of passband bSSFP at 14 T in comparison with GE-EPI are expected to be even more marked for mouse brain.

Investigating the variability of cardiac pulse artifacts across heartbeats in simultaneous EEG-fMRI recordings: A 7T study

Electroencephalography (EEG) recordings performed in magnetic resonance imaging (MRI) scanners are affected by complex artifacts caused by heart function, often termed pulse artifacts (PAs). PAs can strongly compromise EEG data quality, and remain an open problem for EEG-fMRI. This study investigated the properties and mechanisms of PA variability across heartbeats, which has remained largely unaddressed to date, and evaluated its impact on PA correction approaches. Simultaneous EEG-fMRI was performed at 7T on healthy participants at rest or under visual stimulation, with concurrent recordings of breathing and cardiac activity. PA variability was found to contribute to EEG variance with more than 500 μV² at 7T, which extrapolates to 92 μV² at 3T. Clustering analyses revealed that PA variability not only is linked to variations in head position/orientation, as previously hypothesized, but also, and more importantly, to the respiratory cycle and to heart rate fluctuations. The latter mechanisms are associated to short-timescale variability (even across consecutive heartbeats), and their importance varied across EEG channels. In light of this PA variability, three PA correction techniques were compared: average artifact subtraction (AAS), optimal basis sets (OBS), and an approach based on K-means clustering. All methods allowed the recovery of visual evoked potentials from the EEG data; nonetheless, OBS and K-means tended to outperform AAS, likely due to the inability of the latter in modeling short-timescale variability. Altogether, these results offer novel insights into the dynamics and underlying mechanisms of the pulse artifact, with important consequences for its correction, relevant to most EEG-fMRI applications.

Pros and cons of ultra-high-field MRI/MRS for human application

Magnetic resonance imaging and spectroscopic techniques are widely used in humans both for clinical diagnostic applications and in basic research areas such as cognitive neuroimaging. In recent years, new human MR systems have become available operating at static magnetic fields of 7 T or higher (≥300 MHz proton frequency). Imaging human-sized objects at such high frequencies presents several challenges including non-uniform radiofrequency fields, enhanced susceptibility artifacts, and higher radiofrequency energy deposition in the tissue. On the other side of the scale are gains in signal-to-noise or contrast-to-noise ratio that allow finer structures to be visualized and smaller physiological effects to be detected. This review presents an overview of some of the latest methodological developments in human ultra-high field MRI/MRS as well as associated clinical and scientific applications. Emphasis is given to techniques that particularly benefit from the changing physical characteristics at high magnetic fields, including susceptibility-weighted imaging and phase-contrast techniques, imaging with X-nuclei, MR spectroscopy, CEST imaging, as well as functional MRI. In addition, more general methodological developments such as parallel transmission and motion correction will be discussed that are required to leverage the full potential of higher magnetic fields, and an overview of relevant physiological considerations of human high magnetic field exposure is provided.

Depth-dependent intracortical myelin organization in the living human brain determined by in vivo ultra-high field magnetic resonance imaging

BACKGROUND

Intracortical myelin is a key determinant of neuronal synchrony and plasticity that underpin optimal brain function. Magnetic resonance imaging (MRI) facilitates the examination of intracortical myelin but presents with methodological challenges. Here we describe a whole-brain approach for the in vivo investigation of intracortical myelin in the human brain using ultra-high field MRI.

METHODS

Twenty-five healthy adults were imaged in a 7 Tesla MRI scanner using diffusion-weighted imaging and a T₁-weighted sequence optimized for intracortical myelin contrast. Using an automated pipeline, T₁ values were extracted at 20 depth-levels from each of 148 cortical regions. In each cortical region, T₁ values were used to infer myelin concentration and to construct a non-linearity index as a measure the spatial distribution of myelin across the cortical ribbon. The relationship of myelin concentration and the non-linearity index with other neuroanatomical properties were investigated. Five patients with multiple sclerosis were also assessed using the same protocol as positive controls.

RESULTS

Intracortical T₁ values decreased between the outer brain surface and the gray-white matter boundary following a slope that showed a slight leveling between 50% and 75% of cortical depth. Higher-order regions in the prefrontal, cingulate and insular cortices, displayed higher non-linearity indices than sensorimotor regions. Across all regions, there was a positive association between T₁ values and non-linearity indices (P < 10^-5). Both T₁ values (P < 10^-5) and non-linearity indices (P < 10^-15) were associated with cortical thickness. Higher myelin concentration but only in the deepest cortical levels was associated with increased subcortical fractional anisotropy (P = 0.05).

CONCLUSIONS

We demonstrate the usefulness of an automatic, whole-brain method to perform depth-dependent examination of intracortical myelin organization. The extracted metrics, T₁ values and the non-linearity index, have characteristic patterns across cortical regions, and are associated with thickness and underlying white matter microstructure.

Visualizing the Human Subcortex Using Ultra-high Field Magnetic Resonance Imaging

With the recent increased availability of ultra-high field (UHF) magnetic resonance imaging (MRI), substantial progress has been made in visualizing the human brain, which can now be done in extraordinary detail. This review provides an extensive overview of the use of UHF MRI in visualizing the human subcortex for both healthy and patient populations. The high inter-subject variability in size and location of subcortical structures limits the usability of atlases in the midbrain. Fortunately, the combined results of this review indicate that a large number of subcortical areas can be visualized in individual space using UHF MRI. Current limitations and potential solutions of UHF MRI for visualizing the subcortex are also discussed.

Signal compartments in ultra-high field multi-echo gradient echo MRI reflect underlying tissue microstructure in the brain

Gradient recalled echo magnetic resonance imaging (GRE-MRI) at ultra-high field holds great promise for new contrast mechanisms and delineation of putative tissue compartments that contribute to the multi-echo GRE-MRI signal may aid structural characterization. Several studies have adopted the three water-pool compartment model to study white matter brain regions, associating individual compartments with myelin, axonal and extracellular water. However, the number and identifiability of GRE-MRI signal compartments has not been fully explored. We undertook this task for human brain imaging data. Multiple echo time GRE-MRI data were acquired in five healthy participants, specific anatomical structures were segmented in each dataset (substantia nigra, caudate, insula, putamen, thalamus, fornix, internal capsule, corpus callosum and cerebrospinal fluid), and the signal fitted with models comprising one to six signal compartments using a complex-valued plane wave formulation. Information criteria and cluster analysis methods were used to ascertain the number of distinct compartments within the signal from each structure and to determine their respective frequency shifts. We identified five principal signal compartments with different relative contributions to each structure's signal. Voxel-based maps of the volume fraction of each of these compartments were generated and demonstrated spatial correlation with brain anatomy.

Pulse sequences and parallel imaging for high spatiotemporal resolution MRI at ultra-high field

The SNR and CNR benefits of ultra-high field (UHF) have helped push the envelope of achievable spatial resolution in MRI. For applications based on susceptibility contrast where there is a large CNR gain, high quality sub-millimeter resolution imaging is now being routinely performed, particularly in fMRI and phase imaging/QSM. This has enabled the study of structure and function of very fine-scale structures in the brain. UHF has also helped push the spatial resolution of many other MRI applications as will be outlined in this review. However, this push in resolution comes at a cost of a large encoding burden leading to very lengthy scans. Developments in parallel imaging with controlled aliasing and the move away from 2D slice-by-slice imaging to much more SNR-efficient simultaneous multi-slice (SMS) and 3D acquisitions have helped address this issue. In particular, these developments have revolutionized the efficiency of UHF MRI to enable high spatiotemporal resolution imaging at an order of magnitude faster acquisition. In addition to describing the main approaches to these techniques, this review will also outline important key practical considerations in using these methods in practice. Furthermore, new RF pulse design to tackle the B1+ and SAR issues of UHF and the increased SAR and power requirement of SMS RF pulses will also be touched upon. Finally, an outlook into new developments of smart encoding in more dimensions, particularly through using better temporal/across-contrast encoding and reconstruction will be described. Just as controlled aliasing fully exploits spatial encoding in parallel imaging to provide large multiplicative gains in accelerations, the complimentary use of these new approaches in temporal and across-contrast encoding are expected to provide exciting opportunities for further large gains in efficiency to further push the spatiotemporal resolution of MRI.

Surface-based characteristics of the cerebellar cortex visualized with ultra-high field MRI

Although having a relatively homogeneous cytoarchitectonic organization, the cerebellar cortex is a heterogeneous region characterized by different amounts of myelin, iron and protein expression profiles. In this study, we used quantitative T₁ and T₂* mapping at ultra-high field (7T) MRI to investigate the tissue characteristics of the cerebellar gray matter surface and its layers. Detailed subject-specific surfaces were generated at three different cortical depths and averaged across subjects to create averaged T₁- and T₂*-maps on the cerebellar surface. T₁ surfaces showed an alternation of lower and higher T₁ values when going from the median to the lateral part of the cerebellar hemispheres. In addition, longer T₁ values were observed in the more superficial gray matter layers. T₂*-maps showed a similar longitudinal pattern, but no change related to the cortical depths. These patterns are possibly due to variations in the level of myelination, iron and zebrin protein expression.

Quantification of perivascular spaces at 7T: A potential MRI biomarker for epilepsy

PURPOSE

7T (7T) magnetic resonance imaging (MRI) facilitates the visualization of the brain with resolution and contrast beyond what is available at conventional clinical field strengths, enabling improved detection and quantification of small structural features such as perivascular spaces (PVSs). The distribution of PVSs, detected in vivo at 7T, may act as a biomarker for the effects of epilepsy. In this work, we systematically quantify the PVSs in the brains of epilepsy patients and compare them to healthy controls.

METHODS

T₂-weighted turbo spin echo images were obtained at 7T on 21 epilepsy patients and 17 healthy controls. For all subjects, PVSs were manually marked on Osirix image analysis software. Marked PVSs with diameter≥0.5mm were then mapped by hemisphere and lobe. The asymmetry index (AI) was calculated for each region and the maximum asymmetry index (|AI_max|) was reported for each subject. The asymmetry in epilepsy subjects was compared to that of controls, and the region with highest asymmetry was compared to the suspected seizure onset zone.

RESULTS

There was a significant difference between the |AI_max| in epilepsy subjects and in controls (p=0.016). In 72% of patients, the region or lobe of the brain showing maximum PVS asymmetry was the same as the region containing the suspected seizure onset zone.

CONCLUSION

These findings suggest that epilepsy may be associated with significantly asymmetric distribution of PVSs in the brain. Furthermore, the region of maximal asymmetry of the PVSs may help provide localization or confirmation of the seizure onset zone.

Laminar fMRI: What can the time domain tell us?

The rapid developments in functional MRI (fMRI) acquisition methods and hardware technologies in recent years, particularly at high field (≥7 T), have enabled unparalleled visualization of functional detail at a laminar or columnar level, bringing fMRI close to the intrinsic resolution of brain function. These advances highlight the potential of high resolution fMRI to be a valuable tool to study the fundamental processing performed in cortical micro-circuits, and their interactions such as feedforward and feedback processes. Notably, because fMRI measures neuronal activity via hemodynamics, the ultimate resolution it affords depends on the spatial specificity of hemodynamics to neuronal activity at a detailed spatial scale, and by the evolution of this specificity over time. Several laminar (≤1 mm spatial resolution) fMRI studies have examined spatial characteristics of the measured hemodynamic signals across cortical depth, in light of understanding or improving the spatial specificity of laminar fMRI. Few studies have examined temporal features of the hemodynamic response across cortical depth. Temporal features of the hemodynamic response offer an additional means to improve the specificity of fMRI, and could help target neuronal processes and neurovascular coupling relationships across laminae, for example by differences in the onset times of the response across cortical depth. In this review, we discuss factors that affect the timing of neuronal and hemodynamic responses across laminae, touching on the neuronal laminar organization, and focusing on the laminar vascular organization. We provide an overview of hemodynamics across the cortical vascular tree based on optical imaging studies, and review temporal aspects of hemodynamics that have been examined across cortical depth in high spatiotemporal resolution fMRI studies. Last, we discuss the limits and potential of high spatiotemporal resolution fMRI to study laminar neurovascular coupling and neuronal processes.

A purpose-built neck coil for black-blood DANTE-prepared carotid artery imaging at 7T

Atherosclerotic plaques in the bifurcation of the carotid arteries can pose a significant health risk due to possible plaque rupture and subsequent stroke. The assessment of plaques, and evaluation of the risk they pose, can be performed with Black-Blood (BB) vessel wall magnetic resonance imaging. However, resolution at standard clinical field strengths (up to 3T) is limited, hampering reliable assessment and diagnosis. The aim of this study was to investigate the benefits of 7T MRI using a BB application that has been successful at clinical field strengths. Therefore, for BB imaging, each sequence was preceded with 'Delay Alternating with Nutation for Tailored Excitation' (DANTE) preparation pulses for blood signal suppression. A coil comprising a 4-channel Tx array was designed and built to provide the required excitation coverage for the DANTE train; and a 4-channel Rx array was constructed to target the carotid bifurcation. Human and phantom results showed satisfactory blood suppression and comparable SNR and CNR to 3T, therefore demonstrating the feasibility of the application at 7T. However, the imposed SAR restrictions led to long scan times and subsequent motion artifacts. Thus, more accurate local SAR supervision schemes are required which could lead to a further improvement of BB DANTE vessel wall imaging at 7T.

Diffusion MRI of the human brain at ultra-high field (UHF): A review

The continued drive towards MRI scanners operating at increasingly higher main magnetic fields is primarily motivated by the maxim that more teslas mean more signal and lead to better images. This promise of increased signal, which cannot easily be achieved in other ways, encourages efforts to overcome the inextricable technical challenges which accompany this endeavor. Unlike for many applications, however, diffusion imaging is not currently able to directly reap these potential signal gains - at the time of writing it seems fair to say that, for matched gradient and RF hardware, the majority of diffusion images acquired at 7T, while comparable in quality to those achievable at 3T, do not demonstrate a clear advantage over what can be obtained at lower field. This does not mean that diffusion imaging at UHF is not a worthwhile pursuit - but more a reflection of the fact that the associated challenges are manifold - and converting the potential of higher field strengths into 'better' diffusion imaging is by no means a straightforward task. This article attempts to summarize the specific reasons that make diffusion imaging at UHF more complicated than one might expect, and to highlight the range of developments that have already been made which have enabled diffusion images of excellent quality to be acquired at 7T.

The clinical relevance of distortion correction in presurgical fMRI at 7T

Presurgical planning with fMRI benefits from increased reliability and the possibility to reduce measurement time introduced by using ultra-high field. Echo-planar imaging suffers, however, from geometric distortions which scale with field strength and potentially give rise to clinically significant displacement of functional activation. We evaluate the effectiveness of a dynamic distortion correction (DDC) method based on unmodified single-echo EPI in the context of simulated presurgical planning fMRI at 7T and compare it with static distortion correction (SDC). The extent of distortion in EPI and activation shifts are investigated in a group of eleven patients with a range of neuropathologies who performed a motor task. The consequences of neglecting to correct images for susceptibility-induced distortions are assessed in a clinical context. It was possible to generate time series of EPI-based field maps which were free of artifacts in the eloquent brain areas relevant to presurgical fMRI, despite the presence of signal dropouts caused by pathologies and post-operative sites. Distortions of up to 5.1mm were observed in the primary motor cortex in raw EPI. These were accurately corrected with DDC and slightly less accurately with SDC. The dynamic nature of distortions in UHF clinical fMRI was demonstrated via investigation of temporal variation in voxel shift maps, confirming the potential inadequacy of SDC based on a single reference field map, particularly in the vicinity of pathologies or in the presence of motion. In two patients, the distortion correction was potentially clinically significant in that it might have affected the localization or interpretation of activation and could thereby have influenced the treatment plan. Distortion correction is shown to be effective and clinically relevant in presurgical planning at 7T.

Fast triple-spin-echo Dixon (FTSED) sequence for water and fat imaging

A number of 'Dixon' techniques based on fast spin echo (FSE) sequence have been proposed and successfully used in many branches of medicine. Some require only one scan, but most of them need multiple scans and long scan times. This article describes a new fast triple-spin-echo Dixon (FTSED) technique suitable for ultra-high field MRI, in which three specific time shifts are introduced in the echo train; thus, three images with defined water-fat phase-differences (0, π, 2π) are encoded in the phase of the acquired images without extreme restrictions upon the echo duration. The water and fat images are then calculated by iterative least-squares estimation method. The sequence was successfully implemented at a 9.4T ultra-high field MRI system and tested on a phantom and a rat.

A method for the dynamic correction of B0-related distortions in single-echo EPI at 7T

We propose a method to calculate field maps from the phase of each EPI in an fMRI time series. These field maps can be used to correct the corresponding magnitude images for distortion caused by inhomogeneity in the static magnetic field. In contrast to conventional static distortion correction, in which one ‘snapshot’ field map is applied to all subsequent fMRI time points, our method also captures dynamic changes to B₀ which arise due to motion and respiration. The approach is based on the assumption that the non-B₀-related contribution to the phase measured by each radio-frequency coil, which is dominated by the coil sensitivity, is stable over time and can therefore be removed to yield a field map from EPI.

Our solution addresses imaging with multi-channel coils at ultra-high field (7 T), where phase offsets vary rapidly in space, phase processing is non-trivial and distortions are comparatively large. We propose using dual-echo gradient echo reference scan for the phase offset calculation, which yields estimates with high signal-to-noise ratio. An extrapolation method is proposed which yields reliable estimates for phase offsets even where motion is large and a tailored phase unwrapping procedure for EPI is suggested which gives robust results in regions with disconnected tissue or strong signal decay.

Phase offsets are shown to be stable during long measurements (40 min) and for large head motions. The dynamic distortion correction proposed here is found to work accurately in the presence of large motion (up to 8.1°), whereas a conventional method based on single field map fails to correct or even introduces distortions (up to 11.2 mm). Finally, we show that dynamic unwarping increases the temporal stability of EPI in the presence of motion.

Our approach can be applied to any EPI measurements without the need for sequence modification.

Pulsed arterial spin labelling at ultra-high field with a B 1 (+) -optimised adiabatic labelling pulse

OBJECTIVE

Arterial spin labelling (ASL) techniques benefit from the increased signal-to-noise ratio and the longer T 1 relaxation times available at ultra-high field. Previous pulsed ASL studies at 7 T concentrated on the superior regions of the brain because of the larger transmit radiofrequency inhomogeneity experienced at ultra-high field that hinders an adequate inversion of the blood bolus when labelling in the neck. Recently, researchers have proposed to overcome this problem with either the use of dielectric pads, through dedicated transmit labelling coils, or special adiabatic inversion pulses.

MATERIALS AND METHODS

We investigate the performance of an optimised time-resampled frequency-offset corrected inversion (TR-FOCI) pulse designed to cause inversion at much lower peak B 1 (+) . In combination with a PICORE labelling, the perfusion signal obtained with this pulse is compared against that obtained with a FOCI pulse, with and without dielectric pads.

RESULTS

Mean grey matter perfusion with the TR-FOCI was 52.5 ± 10.3 mL/100 g/min, being significantly higher than the 34.6 ± 2.6 mL/100 g/min obtained with the FOCI pulse. No significant effect of the dielectric pads was observed.

CONCLUSION

The usage of the B 1 (+) -optimised TR-FOCI pulse results in a significantly higher perfusion signal. PICORE-ASL is feasible at ultra-high field with no changes to operating conditions.

Improving the clinical potential of ultra-high field fMRI using a model-free analysis method based on response consistency

Objective

To develop an analysis method that is sensitive to non-model-conform responses often encountered in ultra-high field presurgical planning fMRI. Using the consistency of time courses over a number of experiment repetitions, it should exclude low quality runs and generate activation maps that reflect the reliability of responses.

Materials and methods

7 T fMRI data were acquired from six healthy volunteers: three performing purely motor tasks and three a visuomotor task. These were analysed with the proposed approach (UNBIASED) and the GLM.

Results

UNBIASED results were generally less affected by false positive results than the GLM. Runs that were identified as being of low quality were confirmed to contain little or no activation. In two cases, regions were identified as activated in UNBIASED but not GLM results. Signal changes in these areas were time-locked to the task, but were delayed or transient.

Conclusion

UNBIASED is shown to be a reliable means of identifying consistent task-related signal changes regardless of response timing. In presurgical planning, UNBIASED could be used to rapidly generate reliable maps of the consistency with which eloquent brain regions are activated without recourse to task timing and despite modified hemodynamics.

Electronic supplementary material

The online version of this article (doi:10.1007/s10334-016-0533-8) contains supplementary material, which is available to authorized users.

Presurgical brain mapping in epilepsy using simultaneous EEG and functional MRI at ultra-high field: feasibility and first results

OBJECTIVES

The aim of this study was to demonstrate that eloquent cortex and epileptic-related hemodynamic changes can be safely and reliably detected using simultaneous electroencephalography (EEG)-functional magnetic resonance imaging (fMRI) recordings at ultra-high field (UHF) for clinical evaluation of patients with epilepsy.

MATERIALS AND METHODS

Simultaneous EEG-fMRI was acquired at 7 T using an optimized setup in nine patients with lesional epilepsy. According to the localization of the lesion, mapping of eloquent cortex (language and motor) was also performed in two patients.

RESULTS

Despite strong artifacts, efficient correction of intra-MRI EEG could be achieved with optimized artifact removal algorithms, allowing robust identification of interictal epileptiform discharges. Noise-sensitive topography-related analyses and electrical source localization were also performed successfully. Localization of epilepsy-related hemodynamic changes compatible with the lesion were detected in three patients and concordant with findings obtained at 3 T. Local loss of signal in specific regions, essentially due to B 1 inhomogeneities were found to depend on the geometric arrangement of EEG leads over the cap.

CONCLUSION

These results demonstrate that presurgical mapping of epileptic networks and eloquent cortex is both safe and feasible at UHF, with the benefits of greater spatial resolution and higher blood-oxygenation-level-dependent sensitivity compared with the more traditional field strength of 3 T.

(31)P CSI of the human brain in healthy subjects and tumor patients at 9.4 T with a three-layered multi-nuclear coil: initial results

OBJECTIVE

Investigation of the feasibility and performance of phosphorus ((31)P) magnetic resonance spectroscopic imaging (MRSI) at 9.4 T with a three-layered phosphorus/proton coil in human normal brain tissue and tumor.

MATERIALS AND METHODS

A multi-channel (31)P coil was designed to enable MRSI of the entire human brain. The performance of the coil was evaluated by means of electromagnetic field simulations and actual measurements. A 3D chemical shift imaging approach with a variable repetition time and flip angle was used to increase the achievable signal-to-noise ratio of the acquired (31)P spectra. The impact of the resulting k-space modulation was investigated by simulations. Three tumor patients and three healthy volunteers were scanned and differences between spectra from healthy and cancerous tissue were evaluated qualitatively.

RESULTS

The high sensitivity provided by the 27-channel (31)P coil allowed acquiring CSI data in 22 min with a nominal voxel size of 15 × 15 × 15 mm(3). Shimming and anatomical localization could be performed with the integrated four-channel proton dipole array. The amplitudes of the phosphodiesters and phosphoethanolamine appeared reduced in tumorous tissue for all three patients. A neutral or slightly alkaline pH was measured within the brain lesions.

CONCLUSION

These initial results demonstrate that (31)P 3D CSI is feasible at 9.4 T and could be performed successfully in healthy subjects and tumor patients in under 30 min.