Real-time interactive MRI on a conventional scanner

Real-time interactive coronary MRA

An interactive real-time imaging system capable of rapid coronary artery imaging is described. High-resolution spiral and circular echo planar trajectories were used to achieve 0.8 x 1.6 mm2 resolution in 135 ms (CEPI) or 1.13 x 1.13 mm2 resolution in 189 ms (spirals), over a 20-cm FOV. Using a sliding window reconstruction, display rates of up to 37 images/sec were achieved. Initial results indicate this technique can perform as a high-quality 2D coronary localizer and with SNR improvement may enable rapid screening of the coronary tree.

Effect of windowing and zero-filled reconstruction of MRI data on spatial resolution and acquisition strategy

Standard, MR spin-warp sampling strategies acquire data on a rectangular k-space grid. That method samples data from the "corners" of k-space, i.e., data that lie in a region of k-space outside of an ellipse just inscribed in the rectangular boundary. Illustrative calculations demonstrate that the data in the corners of k-space contribute to the useful resolution only if an interpolation method such as a zero-filled reconstruction is used. The consequences of this finding on data acquisition and data windowing strategies are discussed. A further implication of this result is that the spatial resolution of images reconstructed with zero-filling (but without radial windowing) is expected to display angular dependence, even when the phase- and frequency-encoded resolutions are identical. This hypothesis is experimentally verified with a slit geometry phantom. It is also observed that images reconstructed without zero-filling do not display the angular dependence of spatial resolution predicted solely by the maximal k-space extent of the raw data. The implications of these results for 3D contrast-enhanced angiographic acquisitions with elliptical centric view ordering are explored with simulations.

Rapid evaluation of left ventricular volume and mass without breath-holding using real-time interactive cardiac magnetic resonance imaging system

OBJECTIVES

The purpose of this study was to validate cardiac measurements derived from real-time cardiac magnetic resonance imaging (MRI) as compared with well-validated conventional cine MRI.

BACKGROUND

Although cardiac MRI provides accurate assessment of left ventricular (LV) volume and mass, most techniques have been relatively slow and required electrocardiogram (ECG) gating over many heart beats. A newly developed real-time MRI system allows continuous real-time dynamic acquisition and display without cardiac gating or breath-holding.

METHODS

Fourteen healthy volunteers and nine patients with heart failure underwent real-time and cine MRI in the standard short-axis orientation with a 1.5T MRI scanner. Nonbreath-holding cine MRI was performed with ECG gating and respiratory compensation. Left ventricular end-diastolic volume (LVEDV), left ventricular endsystolic volume (LVESV), ejection fraction (EF) and LV mass calculated from the images obtained by real-time MRI were compared to those obtained by cine MRI.

RESULTS

The total study time including localization for real-time MRI was significantly shorter than cine MRI (8.6 +/- 2.3 vs. 24.7 +/- 3.5 min, p < 0.001). Both imaging techniques yielded good quality images allowing cardiac measurements. The measurements of LVEDV, LVESV, EF and LV mass obtained with real-time MRI showed close correlation with those obtained with cine MRI (LVEDV: r = 0.985, p < 0.001; LVESV: r = 0.994, p < 0.001; EF: r = 0.975, p < 0.001; LV mass: r = 0.977, p < 0.001).

CONCLUSIONS

Real-time MRI provides accurate measurements of LV volume and mass in a time-efficient manner with respect to image acquisition.

Qualitative and quantitative analysis of regional left ventricular wall dynamics using real-time magnetic resonance imaging: comparison with conventional breath-hold gradient echo acquisition in volunteers and patients

A real-time magnetic resonance imaging (MRI) acquisition sequence was evaluated for the assessment of left ventricular wall motion (WM) and wall thickening (WT). Ten normal volunteers and 21 patients were studied. Short-axis cine images of the left ventricle (LV) were acquired with a fast gradient echo and an ultrafast segmented echo-planar imaging (EPI) sequence. Qualitative and quantitative analysis of WM and WT was performed on a segmental basis. Qualitative scores agreed between the two methods in 691 of 724 segments (95.4%) with good reproducibility. Quantitative measurements of WM and WT were significantly lower (P < 0.001) with the real-time method (WM: mean bias, 0.49 mm; WT: mean bias, 0.61 mm). The largest differences were observed in the anterior and lateral segments and in patients with dilated ventricles. The lower resolution of the real-time sequence and artifacts was probably responsible for these differences. In conclusion, real-time cardiac MRI can be used for qualitative assessment of wall dynamics but is presently insufficient for quantitative analysis.

Advanced cardiac MR imaging of ischemic heart disease

Important advances in rapid magnetic resonance (MR) imaging technology and its application to cardiovascular imaging have been made during the past decade. High-field-strength clinical magnets, high-performance gradient hardware, and ultrafast pulse sequence technology are rapidly making the vision of a comprehensive "one-stop shop" cardiac MR imaging examination a reality. This examination is poised to have a significant effect on the management of coronary artery disease by means of assessment of wall motion with tagging and pharmacologic stress testing, evaluation of the coronary microvasculature with perfusion imaging, and direct visualization of the coronary arteries with MR coronary angiography. This article reviews current state-of-the-art pulse sequence technology and its application to the evaluation of ischemic heart disease by means of MR tagging with dobutamine stress testing, MR perfusion imaging, and MR coronary angiography. Cutting edge areas of research in coil design and exciting new areas of metabolic and oxygen level-dependent imaging are also explored.

Interactive reduced FOV imaging for projection reconstruction and spiral acquisition

MR fluoroscopy is likely to gain increasing importance for the visualization of dynamic processes such as cardiac function and for the guidance of interventional procedures. In many applications the dynamic processes are restricted to a part of the object under study making reduced field of view (rFOV) imaging desirable. The restriction to a smaller FOV can either be used to increase the spatial or the temporal resolution. In projection reconstruction (PR) and spiral imaging severe backfolding artifacts occur if a rFOV is used. In this paper efficient suppression schemes are proposed for PR- and spiral imaging to avoid backfolding artifacts. Evaluation of the proposed schemes was done on an interactive real-time MR-scanner. Cardiac function studies clearly showed the potential of this technique for PR- and spiral imaging.

Real-time black-blood MRI using spatial presaturation

A real-time interactive black-blood imaging system is described. Rapid blood suppression is achieved by exciting and dephasing slabs outside the imaging slice before each imaging excitation. Sharp-profiled radio frequency saturation pulses placed close to the imaging slice provide good blood suppression, even in views containing slow through-plane flow. In vivo results indicate that this technique improves endocardial border definition during systole in real-time cardiac wall-motion studies. Phantom and animal results indicate that this technique nearly eliminates flow artifacts in real-time intravascular studies. J. Magn. Reson. Imaging 2001;13:807-812.

Rapid ventricular assessment using real-time interactive multislice MRI

A multislice real-time imaging technique is described which can provide continuous visualization of the entire left ventricle under resting and stress conditions. Three dynamically adjustable slices containing apical, mid, and base short axis views are imaged 16 times/sec (48 images/sec), with each image providing 3.12 mm resolution over a 20 cm field of view. Initial studies indicate that this technique is useful for the assessment of LV function by providing simultaneous real-time visualization of all 16 wall segments. This technique may also be used for stress LV function and, when used in conjunction with contrast agents, myocardial perfusion imaging. Magn Reson Med 45:371-375, 2001.

A rapid look-up table method for reconstructing MR images from arbitrary K-space trajectories

Look-up tables (LUTs) are a common method for increasing the speed of many algorithms. Their use can be extended to the reconstruction of nonuniformly sampled k-space data using either a discrete Fourier transform (DFT) algorithm or a convolution-based gridding algorithm. A table for the DFT would be precalculated arrays of weights describing how each data point affects all of image space. A table for a convolution-based gridding operation would be a precalculated table of weights describing how each data point affects a small k-space neighborhood. These LUT methods were implemented in C++ on a modest personal computer system; they allowed a radial k-space acquisition sequence, consisting of 180 views of 256 points each, to be gridded in 36.2 ms, or, in approximately 800 ns/point. By comparison, a similar implementation of the gridding operation, without LUTs, required 45 times longer (1639.2 ms) to grid the same data. This was possible even while using a 4 x 4 Kaiser-Bessel convolution kernel, which is larger than typically used. These table-based computations will allow real time reconstruction in the future and can currently be run concurrently with the acquisition allowing for completely real-time gridding.

A truly hybrid interventional MR/X-ray system: feasibility demonstration

A system enabling both x-ray fluoroscopy and MRI in a single exam, without requiring patient repositioning, would be a powerful tool for image-guided interventions. We studied the technical issues related to acquisition of x-ray images inside an open MRI system (GE Signa SP). The system includes a flat-panel x-ray detector (GE Medical Systems) placed under the patient bed, a fixed-anode x-ray tube overhead with the anode-cathode axis aligned with the main magnetic field and a high-frequency x-ray generator (Lunar Corp.). New challenges investigated related to: 1) deflection and defocusing of the electron beam of the x-ray tube; 2) proper functioning of the flat panel; 3) effects on B0 field homogeneity; and 4) additional RF noise in the MR images. We have acquired high-quality x-ray and MR images without repositioning the object using our hybrid system, which demonstrates the feasibility of this new configuration. Further work is required to ensure that the highest possible image quality is achieved with both MR and x-ray modalities.

An efficient region of interest acquisition method for dynamic magnetic resonance imaging

Motivated by work in the area of dynamic magnetic resonance imaging (MRI), we develop a new approach to the problem of reduced-order MRI acquisition. Efforts in this field have concentrated on the use of Fourier and singular value decomposition (SVD) methods to obtain low-order representations of an entire image plane. We augment this work to the case of imaging an arbitrarily-shaped region of interest (ROI) embedded within the full image. After developing a natural error metric for this problem, we show that determining the minimal order required to meet a prescribed error level is in general intractable, but can be solved under certain assumptions. We then develop an optimization approach to the related problem of minimizing the error for a given order. Finally, we demonstrate the utility of this approach and its advantages over existing Fourier and SVD methods on a number of MRI images.

Ultrafast pulse sequence techniques for cardiac magnetic resonance imaging

Cardiac magnetic resonance imaging is a rapidly emerging field that has seen tremendous advances in the past decade. Central to the development of effective imaging strategies has been the advent of high-performance gradient hardware and the exploitation of their speed characteristics through specialized pulse sequences well suited for cardiac imaging. These advances have facilitated unprecedented acquisition times that now approach echocardiographic frame rates, while maintaining excellent image quality. This article provides a detailed overview of advanced pulse sequence technology and approaches currently taken to maximize speed performance and image quality. In particular, segmented K-space techniques that include single-echo and multiecho spoiled gradient-echo imaging as well as steady-state free precession imaging are discussed. Finally, spiral and fast spin-echo techniques are explored. Examples of common applications of these pulse sequences are presented.

Coronary artery magnetic resonance imaging: a patient-tailored approach

Coronary artery magnetic resonance imaging strategies have tended to focus on the use of a single method performed during either breath-holding or free-breathing for all patients. However, significant variations exist among patients in terms of breath-holding ability and respiratory regularity that make the use of a single technique alone not universally successful. Therefore, it is prudent to make available a number of magnetic resonance imaging methods such that an appropriate respiratory motion reduction strategy can be tailored to suit the patient's respiratory pattern and characteristics. A tailored approach that can draw on different image acquisition techniques for coronary artery imaging is presented. A decision tree is proposed to triage patients into imaging regimes with the greatest probability of success, according to the patient's ability to breath-hold or exhibit steady respiration. Methods include volume free-breathing acquisitions using navigator echoes for respiratory monitoring in the 8- to 10-min scan time range, two-dimensional spiral navigators (2- to 3-min scan time), breath-held multislice and vessel-tracking spirals (16- to 20-second scan time), and real-time imaging approaches incorporating adaptive signal averaging. The development of multiple acquisition strategies substantially improves the opportunities to generate high-quality, diagnostic images of the coronary arteries.

Human cardiac imaging at 3 T using phased array coils

Using a two-element phased array receiver coil, single breath-hold, ECG gated cardiac images of signal-to-noise ratios up to 130 and contrast-to-noise ratios exceeding 35 between myocardium and blood were recorded at 3 T. At several locations within the myocardium, T*(2) and B(0) inhomogeneity were determined. Because of shorter T*(2) times and larger B(0) inhomogeneities attributable to enhanced susceptibility effects, real-time cardiac imaging, the use of spiral scans, and echo planar imaging are expected to be considerably more difficult at 3 T.

Coronary angiography by real-time MRI with adaptive averaging

Cardiac and respiratory motion present significant challenges for MR coronary angiography, which have not been completely resolved to date by either breath-holding or respiratory navigation. Adaptive averaging during real-time MRI may provide a useful alternative to these techniques. In this method, cross-correlation is used to automatically identify those real-time imaging frames in which the vessel is present, and to determine the location of the vessel within each frame. This information is then used for selective averaging of frames to increase the signal-to-noise ratio and to improve visualization of the vessel. The correlation theorem was employed to raise the speed of this algorithm by up to two orders of magnitude. Segmenting data collection and reconstruction into subimages allows the extension of this technique to higher spatial resolution. Adaptive averaging provides a robust method for coronary MRI which requires no breath-holding, navigation, or ECG gating.

Reversed spiral MR imaging

Reversed spiral imaging is discussed as an approach that provides strong intrinsic T *(2) contrast without the need for long repetition times. In comparison to the conventional forward spiral method, the T *(2) contrast achieved by reversing the spiral k-space trajectory is similar and differs only for very fast relaxing species. The flow and motion sensitivity of the reversed approach is the same if flow compensation is applied, except for a flow-dependent voxel shift and the sign of the artifact pattern. By simulations as well as phantom and in vivo experiments, it is shown that the image quality in reversed spiral imaging is comparable to that obtained with the forward spiral method.

Interactive fast spin-echo imaging

It is shown that a spin-echo sequence may be used to acquire T(2)-weighted, high-resolution, high-SNR sections at quasi-real-time frame rates for interactive, diagnostic imaging. A single-shot fast spin-echo sequence was designed which employs driven equilibrium to realign transverse magnetization remaining at the final spin echo. Driven equilibrium is shown to improve T(2) contrast at a given TR, or conversely to reduce TR by approximately 1000 msec and thus increase temporal resolution while maintaining a given level of contrast. Wiener demodulation of k-space data prior to reconstruction is shown to reduce blurring caused by T(2)-decay while constraining noise often associated with other inverse filters. Images are continuously acquired, reconstructed, and displayed at rates of one image every one to two seconds, while section position and contrast may be altered interactively. The clinical utility of this method is demonstrated with applications to dynamic pelvic floor imaging and interactive obstetric imaging.

Visualization and temporal/spatial characterization of cardiac radiofrequency ablation lesions using magnetic resonance imaging

BACKGROUND

The purpose of this study was to describe a system and method for creating, visualizing, and monitoring cardiac radiofrequency ablation (RFA) therapy during magnetic resonance imaging (MRI).

METHODS AND RESULTS

RFA was performed in the right ventricular apex of 6 healthy mongrel dogs with a custom 7F nonmagnetic ablation catheter (4-mm electrode) in a newly developed real-time interactive cardiac MRI system. Catheters were positioned to intracardiac targets by use of an MRI fluoroscopy sequence, and ablated tissue was imaged with T2-weighted fast spin-echo and contrast-enhanced T1-weighted gradient-echo sequences. Lesion size by MRI was determined and compared with measurements at gross and histopathological examination. Ablated areas of myocardium appeared as hyperintense regions directly adjacent to the catheter tip and could be detected 2 minutes after RF delivery. Lesions reached maximum size approximately 5 minutes after ablation, whereas lesion signal intensity increased linearly with time but then reached a plateau at 12.2+/-2.1 minutes. Lesion size by MR correlated well with actual postmortem lesion size and histological necrosis area (55.4+/-7.2 versus 49.7+/-5.9 mm(2), r=0.958, P<0.05).

CONCLUSIONS

RFA can be performed in vivo in a new real-time interactive cardiac MRI system. The spatial and temporal extent of cardiac lesions can be visualized and monitored by T2- and T1-weighted imaging, and MRI lesion size agrees well with actual postmortem lesion size. MRI-guided RFA may be a useful approach to help facilitate anatomic lesion placement and to provide insight into the biophysical effects of new ablation techniques and technologies.

Noninvasive modalities. Cardiac MR imaging

As outlined in this article, the strength of MR imaging is that it can provide flow, function, and in some cases metabolic data in a single examination, independent of patient body habitus. Future prospects for real-time imaging and in vivo mapping of fiber orientation promise further advances in our understanding of the structure-function relationship in diastole. Many of the MR imaging methods that have been developed for cardiovascular imaging are now mature and available on state-of-the-art scanners. Although MR imaging can provide detailed characterization of diastolic function, there is a paucity of clinical results which could lead to use guidelines. When more clinicians have access and become familiar with MR imaging, and the type of information that it can provide, clinical trials will be needed to establish the role of MR imaging for evaluation of diastolic function. In the meantime, MR imaging remains an excellent research tool for this application and will help yield further insights into the pathophysiology of diastolic dysfunction.

Spiral scan peripheral nerve stimulation

Time-varying magnetic fields induce electric fields that can cause physiological stimulation. Stimulation has been empirically characterized as a function of dB/dt and duration based on experiments using trapezoidal and sinusoidal gradient waveforms with constant ramp time, amplitude, and direction. For two-dimensional (2D) spiral scans, the readout gradient waveforms are frequency- and amplitude-modulated sinusoids on two orthogonal axes in quadrature. The readout gradient waveform therefore rotates with amplitude and angular velocity that are generally not constant. It does not automatically follow that spiral stimulation thresholds can be predicted using available stimulation models. We scanned 18 normal volunteers with a 2D spiral scan and measured global thresholds for axial, sagittal, and coronal planes. We concluded that the stimulation model evaluated accurately predicts slew rate-limited spiral mean stimulation thresholds, if the effective ramp time is chosen to be the half-period at the end of the spiral readout.

Real-time image reconstruction for spiral MRI using fixed-point calculation

Because spiral magnetic resonance imaging (MRI) is more robust to motion artifacts than echo planar imaging (EPI), spiral imaging method is more suitable in real-time imaging applications where dynamic processes are to be observed. The major hurdle to use spiral imaging method in real-time applications is its slow reconstruction speed. Since spiral trajectories do not sample data on rectilinear grids, raw data must be regridded before inverse fast Fourier transform (FFT). At present, the computational cost for the spiral reconstruction algorithm is still too high and it is not fast enough to achieve the minimum speed requirement of 20 frames/s for real-time imaging applications. In this paper, we propose to replace floating-point calculations with fixed-point calculations in the reconstruction algorithm to remove the computational bottlenecks. To overcome the quantization and round-off errors introduced by fixed-point calculations, we devise a method to find the optimal precision for the fixed-point representation. Adding with a highly efficient vector-radix two-dimensional (2-D) FFT algorithm and modifications to speed up the gridding convolution, we have cut the reconstruction time by 42% and achieved real-time reconstruction at 30 frames/s for 128 x 128 matrices on low-cost PC's.

Noninvasive imaging in congenital heart disease

Imaging algorithms in congenital heart disease, as in the patient with acquired heart diseases continue to evolve, with more and more information gleaned noninvasively. The emphasis will be on the newer aspects of imaging, not cross sectional echocardiography with color Doppler.

Dynamic imaging of hyperpolarized (3)He distribution in rat lungs using interleaved-spiral scans

The use of spiral scan techniques is investigated for (3)He lung imaging on small animals. Dynamic series of up to 40 high temporal resolution (3)He ventilation images are obtained using a single bolus of gas. General properties of the spiral technique are discussed and compared to those of standard imaging techniques in relation to the specific case of rare gas imaging. To improve temporal resolution of the image series, the efficiency of a sliding window technique, combining data from two consecutive spiral images, is demonstrated. An example of the typical global (3)He signal variation during the (3)He breathing of the animal is shown. Pixel-by-pixel measurements of the (3)He signal derivative during the gas inspiration are performed. A corresponding lung map of the magnetization per time unit entering the lung during gas inflow is presented.

Pulse sequences for interventional magnetic resonance imaging

Interventional magnetic resonance imaging (iMRI) is different from diagnostic magnetic resonance imaging (MRI) in its spatial, temporal, and contrast resolution requirements due to its specific clinical applications. As a result, the pulse sequences used in iMRI often are significantly different than those used in the more conventional diagnostic arena. The focus of this article is to summarize how iMRI is different from diagnostic MRI, to describe a variety of MRI pulse sequences and sequence strategies that have evolved because of these differences, and to describe some MRI sequence strategies that are in development and may be seen in future iMRI applications.

Combined connectivity and a gray-level morphological filter in magnetic resonance coronary angiography

A connectivity algorithm combined with a new gray-level morphological filter dramatically improves the segmentation of tortuous coronary arteries from 3D MRI. Small coronary arteries are segmented from the larger ventricles with a new filter. These blood vessels are segmented from the noise background with connectivity. Coronary angiograms were computed in nine datasets acquired on volunteers with 3D stack of spirals and contrast-enhanced navigator sequences by both a maximum intensity projection and surface rendering. Surface images provided depth information needed to distinguish branching arteries from crossing veins. Magn Reson Med 43:892-895, 2000.

In vivo magnetic resonance evaluation of atherosclerotic plaques in the human thoracic aorta: a comparison with transesophageal echocardiography

BACKGROUND

The structure and composition of aortic atherosclerotic plaques are associated with the risk of future cardiovascular events. Magnetic resonance (MR) imaging may allow accurate visualization and characterization of aortic plaques.

METHODS AND RESULTS

We developed a noninvasive MR method, free of motion and blood flow artifacts, for submillimeter imaging of the thoracic aortic wall. MR imaging was performed on a clinical MR system in 10 patients with aortic plaques identified by transesophageal echocardiography (TEE). Plaque composition, extent, and size were assessed from T1-, proton density-, and T2- weighted images. Comparison of 25 matched MR and TEE cross-sectional aortic plaque images showed a strong correlation for plaque composition (chi(2) = 43.5, P<0.0001; 80% overall agreement; n = 25) and mean maximum plaque thickness (r = 0.88, n = 25; 4.56+/-0.21 mm by MR and 4.62+/-0.31 mm by TEE). Overall aortic plaque extent as assessed by TEE and MR was also statistically significant (chi(2) = 61.77, P<0.0001; 80% overall agreement; n = 30 regions).

CONCLUSIONS

This study demonstrates that noninvasive MR evaluation of the aorta compares well with TEE imaging for the assessment of atherosclerotic plaque thickness, extent, and composition. This MR method may prove useful for the in vivo study of aortic atherosclerosis.

Partial-FOV reconstruction in dynamic spiral imaging

In many applications of dynamic MR imaging, only a portion of the field-of-view (FOV) exhibits considerable variations in time. In such cases, a prior knowledge of the static part of the image allows a partial-FOV reconstruction of the dynamic section using only a fraction of the raw data. This method of reconstruction generally results in higher temporal resolution, because the scan time for partial-FOV data is shorter. The fidelity of this reconstruction technique depends, among other factors, on the accuracy of the prior information of the static section. This information is usually derived from the reconstructed images at previous time frames. This data, however, is normally corrupted by the motion artifact Because the temporal frequency contents of the motion artifact is very similar to that of the dynamic section, a temporal low-pass filter can efficiently remove this artifact from the static data. The bandwidth of the filter can be obtained from the rate of variations inside and outside the dynamic area. In general, when the temporal bandwidth is not spatially uniform, a bank of low-pass filters can provide a proper suppression of the motion artifact outside the dynamic section. This reconstruction technique is adapted for spiral acquisition and is successfully applied to cardiac fluoroscopy, doubling the temporal resolution.

Real-time color flow MRI

A real-time interactive color flow MRI system capable of rapidly visualizing cardiac and vascular flow is described. Interleaved spiral phase contrast datasets are acquired continuously, while real-time gridding and phase differencing is used to compute density and velocity maps. These maps are then displayed using a color overlay similar to what is used by ultrasound. For cardiac applications, 6 independent images/sec are acquired with in-plane resolution of 2.4 mm over a 20 cm field of view (FOV). Sliding window reconstruction achieves display rates up to 18 images/sec. Appropriate tradeoffs are made for other applications. Flow phantom studies indicate this technique accurately measures velocities up to 2 m/sec, and accurately captures real-time velocity waveforms (comparable to continuous wave ultrasound). In vivo studies indicate this technique is useful for imaging cardiac and vascular flow, particularly valvular regurgitation. Arbitrary scan planes can be quickly localized, and flow measured in any direction.

Prostate cancer: MR imaging and thermometry during microwave thermal ablation-initial experience

Percutaneous interstitial microwave thermoablation of locally recurrent prostate carcinoma was continually guided with magnetic resonance (MR) imaging. Phase images and data were obtained with a rapid gradient-echo technique and were used to derive tissue temperature change on the basis of proton-resonance shift. Thermally devitalized regions correlated well with the phase image findings. MR imaging-derived temperatures were linearly related to the fluoroptic tissue temperatures. MR imaging can be used to guide thermoablation.

Linear combination steady-state free precession MRI

A new, fast, spectrally selective steady-state free precession (SSFP) imaging method is presented. Combining k-space data from SSFP sequences with certain phase schedules of radiofrequency excitation pulses permits manipulation of the spectral selectivity of the image. For example, lipid and water can be resolved. The contrast of each image depends on both T1 and T2, and the relative contribution of the two relaxation mechanisms to image contrast can be controlled by adjusting the flip angle. Several potential applications of the technique, referred to as linear combination steady-state free precession (LCSSFP), are demonstrated: fast musculoskeletal, abdominal, angiographic, and brain imaging.

Contrast-enhanced 3D MR breathhold imaging of porcine coronary arteries using fluoroscopic localization and bolus triggering

The purpose of this study was to develop cardiac-gated contrast-enhanced 3D MRA for imaging the coronary arteries of pigs. Each major coronary artery was imaged individually in a single 3D slab in one breathhold. To permit acquisition within a breathhold, a limited number of partitions (12-16) were collected in a single, oblique, thin 3D slab. Typical resolution of the acquisition was 0.8 (X) x 1.6 (Y) x 1.6 (Z) mm. MR fluoroscopic localization was used to establish the 3D double-oblique orientation. Real-time MR fluoroscopy was also used to instantaneously trigger the 3D scan after detection in the aortic root of the intravenously administered contrast bolus. Six pigs were used in the study. Each pig was scanned on two separate days. Images routinely show the majority of the length of the three principal coronary arteries. Magn Reson Med 42:1159-1165, 1999.

Real-time adaptive functional MRI

Adaptively limiting image acquisition to areas of interest will allow more efficient data acquisition time for in-depth characterization of areas of brain activation. We designed and implemented an adaptive image acquisition scheme that uses a multiresolution-based strategy to zoom into the regions of cortical activity. Real-time pulse prescription and data processing capabilities were combined with spatially selective radiofrequency encoding. The method was successfully demonstrated in volunteers performing simple sensorimotor paradigms for simultaneous activation of primary motor and cerebellar areas. We believe that real-time adaptation of spatial and temporal sampling to task-related changes will increase the efficiency and flexibility of functional mapping experiments. Contrast-to-noise analysis in selected regions-of-interest was performed to quantitatively assess the multiresolution adaptive approach.

MRI techniques for cardiovascular imaging

Over the last several years, cardiovascular MRI has benefited from a number of technical advances which have improved routine clinical imaging techniques. As a result, MRI is now well positioned to realize its longstanding promise of becoming the comprehensive cardiac imaging test of choice in many clinical settings. This may be achieved using a combination of basic advanced techniques. In this overview, the basic cardiac MRI techniques which are clinically useful are reviewed, and the recent technical advances which are clinically promising are described. These advances include routine black blood and cine bright blood techniques that are high speed (<10s per black blood image or cine slice), multislice whole heart perfusion imaging methods, and recently emerging real-time imaging methodologies. J Magn. Reson. Imaging 1999;10:590-601.

Coronary venous oximetry using MRI

Based on the Fick law, coronary venous blood oxygen measurements have value for assessing functional parameters such as the coronary flow reserve. At present, the application of this measure is restricted by its invasive nature. This report describes the design and testing of a noninvasive coronary venous blood oxygen measurement using MRI, with a preliminary focus on the coronary sinus. After design optimization including a four-coil phased array and an optimal set of data acquisition parameters, quality tests indicate measurement precision on the order of the gold standard optical measurement (3%O(2)). Comparative studies using catheter sampling suggest reasonable accuracy (3 subjects), with variability dominated by sampling location uncertainty ( approximately 7%O(2)). Intravenous dipyridamole (5 subjects) induces significant changes in sinus blood oxygenation (22 +/- 9% O(2)), corresponding to flow reserves of 1.8 +/- 0.4, suggesting the potential for clinical utility. Underestimation of flow reserve is dominated by right atrial mixing and the systemic effects of dipyridamole. Magn Reson Med 42:837-848, 1999.

Real-time interactive magnetic resonance imaging with multiple coils for the assessment of left ventricular function

Interactive real-time examination of left ventricular function in healthy volunteers both under rest and stress conditions has been performed. For this purpose, a system combining an interactive user interface, an ultrafast segmented echo-planar imaging sequence, and real-time reconstruction and display of the acquired images was designed. Magnetic resonance images were acquired at rates of up to 20 images per second with multiple receiver coils. By using a sliding window reconstruction technique, reconstruction rates of up to 60 images per second were achieved with a latency of < 100 msec. The quality of the real-time images was evaluated both qualitatively and quantitatively and was found to be appropriate for the determination of left ventricular function. It is concluded that the combination of dedicated components provides a convenient modality for the high-quality visualization of left ventricular function under rest and stress conditions at video frame rates with magnetic resonance imaging. J. Magn. Reson. Imaging 1999;10:826-832.

Unaliasing by fourier-encoding the overlaps using the temporal dimension (UNFOLD), applied to cardiac imaging and fMRI

In several applications, MRI is used to monitor the time behavior of the signal in an organ of interest; e.g., signal evolution because of physiological motion, activation, or contrast-agent accumulation. Dynamic applications involve acquiring data in a k-t space, which contains both temporal and spatial information. It is shown here that in some dynamic applications, the t axis of k-t space is not densely filled with information. A method is introduced that can transfer information from the k axes to the t axis, allowing a denser, smaller k-t space to be acquired, and leading to significant reductions in the acquisition time of the temporal frames. Results are presented for cardiac-triggered imaging and functional MRI (fMRI), and are compared with data obtained in a conventional way. The temporal resolution was increased by nearly a factor of two in the cardiac-triggered study, and by as much as a factor of eight in the fMRI study. This increase allowed the acquisition of fMRI activation maps, even when the acquisition time for a single full time frame was actually longer than the paradigm cycle period itself. The new method can be used to significantly reduce the acquisition time of the individual temporal frames in certain dynamic studies. This can be used, for example, to increase the temporal or spatial resolution, increase the spatial coverage, decrease the total imaging time, or alter sequence parameters e.g., repetition time (TR) and echo time (TE) and thereby alter contrast. Magn Reson Med 42:813-828, 1999.

Improvements in spiral MR imaging

The basic principles of spiral MR image acquisition and reconstruction are summarised with the aim to explain how high quality spiral images can be obtained. The sensitivity of spiral imaging to off-resonance effects, gradient system imperfections and concomitant fields are outlined and appropriate measures for corrections are discussed in detail. Phantom experiments demonstrate the validity of the correction approaches. Furthermore, in-vivo results are shown to demonstrate the applicability of the corrections under in-vivo conditions. The spiral image quality thus obtained was found to be comparable to that obtainable with robust spin warp sequences.

Small bowel MRI using water as a contrast medium

Magnetic resonance imaging (MRI) of the small bowel has been limited by lack of an adequate luminal contrast medium and problems with image artefacts. In this study we investigate the feasibility of imaging the luminal small bowel using rapid heavily T2w techniques, similar to those used for MR cholangiopancreatography, combined with oral water loading. Eight volunteers were examined after drinking 1-21 of water using serial, multisection, half-Fourier single shot rapid acquisition with relaxation enhancement (RARE) acquisitions. The examinations were continued until the terminal ileum was reached or the water reabsorbed. The results were subjectively assessed for visibility of the small bowel. In all subjects the duodenum, jejunum and ileum were well demonstrated with valvulae conniventes clearly visible. The water column reached the terminal ileum and the caecum in six of the eight subjects but in the remaining two water remained in the small bowel and was ultimately reabsorbed. These preliminary results suggest that with further refinement such an approach may be practical for clinical magnetic resonance imaging of the small bowel.

Nonsubtractive spiral phase contrast velocity imaging

Phase contrast velocity imaging is a standard method for accurate in vivo flow measurement. One drawback, however, is that it lengthens the scan time (or reduces the achievable temporal resolution) because one has to acquire two or more images with different flow sensitivities and subtract their phases to produce the final velocity image. Without this step, non-flow-related phase variations will give rise to an erroneous, spatially varying background velocity. In this paper, we introduce a novel phase contrast velocity imaging technique that requires the acquisition of only a single image. The idea is to estimate the background phase variation from the flow-encoded image itself and then have it removed, leaving only the flow-related phase to generate a corrected flow image. This technique is sensitive to flow in one direction and requires 50% less scan time than conventional phase contrast velocity imaging. Phantom and in vivo results were obtained and compared with those of the conventional method, demonstrating the new method's effectiveness in measuring flow in various vessels of the body. Magn Reson Med 42:704-713, 1999.

MR fluoroscopy using projection reconstruction multi-gradient-echo (prMGE) MRI

A projection reconstruction multi-gradient-echo (prMGE) technique is presented. The introduced technique is an extension of a standard projection reconstruction steady-state gradient-echo technique allowing for the acquisition of several gradient echoes after each excitation of the spin system. Each echo train is used for acquiring data of a certain angular segment of k-space. By use of echo trains consisting of up to four echoes, the overall acquisition time for a 128(2) image can be reduced to 150 ms without sacrificing image quality. Results are presented for cardiac fluoroscopy, for the visualization of swallowing, and for the visualization of joint motion. For all investigated applications promising results have been obtained. Especially in parts of the body where motion on an even shorter time scale than the acquisition process or significant in-plane or through-plane flow are within the field of view, the introduced technique appears to be a promising technique for MR fluoroscopy. Magn Reson Med 42:324-334, 1999.

A flexible view ordering technique for high-quality real-time 2DFT MR fluoroscopy

A method to tailor the view order to the reconstruction cycle is introduced for real-time MRI. It is well known that view sharing and oversampling central k-space views can improve the temporal resolution of gradient-echo pulse sequences. By ordering phase-encodes to synchronize k-space acquisition with the reconstruction cycle, apparent temporal resolution can match the frame rate with as few as one-fourth of the phase-encodes sampled per reconstruction. Spatial resolution is maintained by periodically updating high spatial frequencies. In addition to apparent temporal resolution, three other criteria for real-time imaging are identified and evaluated: display latency, dispersion, and frame-to-frame consistency. Latency is minimized by ordering views in a reverse-centric manner within each reconstruction interval, sampling high-energy views immediately prior to beginning reconstruction. Dispersion is kept low and consistent by synchronizing acquisition and reconstruction, thus avoiding poorly timed reconstruction instances. Real-time implementation demonstrates pulsatile time-of-flight blood signal enhancement in humans.

Prospective MR signal-based cardiac triggering

A cardiac motion compensation method using magnetic resonance signal-based triggering is presented. The method interlaces a triggering pulse sequence with an imaging sequence. The triggering sequence is designed to measure aortic blood velocity, from which cardiac phase can be inferred. The triggering sequence is executed repeatedly and the acquired data processed after each sequence iteration. When the desired phase of the cardiac cycle is detected, data are acquired using the imaging sequence. A signal-processing unit of a conventional scanner is used to process the triggering data in real time and issue triggering commands. Alternatively, a workstation, with a bus adaptor, can access data as they are acquired, process and display the data, and issue triggering commands. With a graphical user interface, the triggering pulse sequence and data-processing techniques can be modified instantaneously to optimize triggering. The technique is demonstrated with coronary artery imaging using both conventional two-dimensional Fourier transform scans and spiral trajectories.

Real-time cardiac MRI using DSP's

A real-time cardiac magnetic resonance imaging (MRI) system has been implemented using digital signal processing (DSP) technology. The system enables real-time acquisition, processing, and display of ungated cardiac movies at moderate video rates of 20 images/s. A custom graphical user interface (GUI) provides interactive control of data acquisition parameters and image display functions. Images can be compressed into moving-picture experts group (MPEG) movies, but are displayed on the console without compression during the scan. Compared to existing real-time MRI systems, implementation with DSP's allows rapid parallel computations, fast data transfers, and greater system flexibility, including the ability to scale to multiple channels, at the expense of somewhat higher component cost.

Off-resonance correction of MR images

In magnetic resonance imaging (MRI), the spatial inhomogeneity of the static magnetic field can cause degraded images if the reconstruction is based on inverse Fourier transformation. This paper presents and discusses a range of fast reconstruction algorithms that attempt to avoid such degradation by taking the field inhomogeneity into account. Some of these algorithms are new, others are modified versions of known algorithms. Speed and accuracy of all these algorithms are demonstrated using spiral MRI.

1999 Gary J. Becker Young Investigator Award. MR-guided transjugular portosystemic shunt placement in a swine model

PURPOSE

To evaluate the performance of portal venous puncture with use of magnetic resonance (MR) guidance, and to place a transjugular intrahepatic portosystemic shunt (TIPS) in a swine model.

MATERIALS AND METHODS

A study of 12 swine was performed to evaluate the ability of interventional MR imaging to guide portal vein puncture and TIPS placement. Six swine had catheters placed in the right hepatic vein under C-arm fluoroscopy. A nitinol guide wire was left in the vein and the animals were then moved into an open configuration MR imaging unit. A TIPS needle set was used to puncture the portal vein using MR fluoroscopy. The animals were transferred to the C-arm, and venography confirmed portal vein puncture. A follow-up study was performed in six additional swine to place a TIPS using only MR imaging guidance. MR tracking was used to advance a catheter from the right atrium into the inferior vena cava. Puncture of the portal vein was performed and a nitinol stent was placed, bridging the hepatic parenchyma. MR venogram confirmed placement.

RESULTS

Successful portal vein puncture was achieved in all animals. The number of punctures required decreased from 12 in the first animal to a single puncture in the last eight swine. A stent was successfully placed across the hepatic tract in all six swine.

CONCLUSIONS

Real-time MR imaging proved to be a feasible method to guide portal vein puncture and TIPS placement in pigs.