T1- and T2-weighted fast spin-echo imaging of the brachial plexus and cervical spine with IDEAL water–fat separation

Accelerated 3D MR neurography of the brachial plexus using deep learning-constrained compressed sensing

OBJECTIVES

To explore the use of deep learning-constrained compressed sensing (DLCS) in improving image quality and acquisition time for 3D MRI of the brachial plexus.

METHODS

Fifty-four participants who underwent contrast-enhanced imaging and forty-one participants who underwent unenhanced imaging were included. Sensitivity encoding with an acceleration of 2 × 2 (SENSE4x), CS with an acceleration of 4 (CS4x), and DLCS with acceleration of 4 (DLCS4x) and 8 (DLCS8x) were used for MRI of the brachial plexus. Apparent signal-to-noise ratios (aSNRs), apparent contrast-to-noise ratios (aCNRs), and qualitative scores on a 4-point scale were evaluated and compared by ANOVA and the Friedman test. Interobserver agreement was evaluated by calculating the intraclass correlation coefficients.

RESULTS

DLCS4x achieved higher aSNR and aCNR than SENSE4x, CS4x, and DLCS8x (all p < 0.05). For the root segment of the brachial plexus, no statistically significant differences in the qualitative scores were found among the four sequences. For the trunk segment, DLCS4x had higher scores than SENSE4x (p = 0.04) in the contrast-enhanced group and had higher scores than SENSE4x and DLCS8x in the unenhanced group (all p < 0.05). For the divisions, cords, and branches, DLCS4x had higher scores than SENSE4x, CS4x, and DLCS8x (all p ≤ 0.01). No overt difference was found among SENSE4x, CS4x, and DLCS8x in any segment of the brachial plexus (all p > 0.05).

CONCLUSIONS

In three-dimensional MRI for the brachial plexus, DLCS4x can improve image quality compared with SENSE4x and CS4x, and DLCS8x can maintain the image quality compared to SENSE4x and CS4x.

CLINICAL RELEVANCE STATEMENT

Deep learning-constrained compressed sensing can improve the image quality or accelerate acquisition of 3D MRI of the brachial plexus, which should be benefit in evaluating the brachial plexus and its branches in clinical practice.

KEY POINTS

•Deep learning-constrained compressed sensing showed higher aSNR, aCNR, and qualitative scores for the brachial plexus than SENSE and CS at the same acceleration factor with similar scanning time. •Deep learning-constrained compressed sensing at acceleration factor of 8 had comparable aSNR, aCNR, and qualitative scores to SENSE4x and CS4x with approximately half the examination time. •Deep learning-constrained compressed sensing may be helpful in clinical practice for improving image quality and acquisition time in three-dimensional MRI of the brachial plexus.

Patterns of Vertebral Bone Marrow Edema in the Normal Healing Process of Lumbar Interbody Fusion: Baseline Data for Diagnosis of Pathological Events

STUDY DESIGN

Retrospective investigation using a prospectively collected database.

OBJECTIVE

To examine the appearance and characteristics of vertebral bone marrow edema (BME) in the normal healing of lumbar interbody fusion.

SUMMARY OF BACKGROUND DATA

Although BME in pathological spinal conditions has been well-documented, the patterns and characteristics of BME in the normal healing process of spinal fusion remains unexplored.

MATERIALS AND METHODS

We reviewed imaging from 225 patients with normal healing following posterior lumbar interbody fusion or transforaminal lumbar interbody fusion. BME was identified on magnetic resonance imaging at the third postoperative week and categorized with respect to its appearance, including assessment of area and extension within the relevant vertebrae.

RESULTS

Three hundred eighty-nine of the 450 instrumented vertebrae (86.4%) displayed evidence BME. All instances of BME were associated with the area of contact with the endplate. The average extent of BME was 32.7±1.0%. BME within normal healing following interbody fusion could be categorized into four types: no edema (13.6%), anterior corner (36.6%), around-the-cage focal (48.0%), and diffuse (1.8%). Anterior corner BME was significantly associated with instances of single cage placement than in dual cages (42.6% vs. 24.7%, P =0.0002). Single cages had a significantly higher rate of BME than dual cages (92.0% vs. 75.3%, P <0.0001). The extent of BME was significantly greater in the single cage cohort (36.9% vs. 24.2% in dual cages, P <0.0001).

CONCLUSIONS

This serves as the first study demonstrating the patterns of BME associated with normal healing following lumbar interbody fusion procedures. Anterior corner BME and around-the-cage focal BME were the most common patterns encountered, with diffuse BME a relatively rare pattern. These findings might contribute to the better differentiation of postoperative pathological events from normal healing following lumbar interbody fusion.

LEVEL OF EVIDENCE

4.

Imaging of Bone Marrow: From Science to Practice

The study of the bone marrow may pose important challenges, due to its changing features over the life span, metabolic stress, and in cases of disease or treatment. Bone marrow adipocytes serve as storage tissue, but they also have endocrine and paracrine functions, contributing to local and systemic metabolism.Among different techniques, magnetic resonance (MR) has the benefit of imaging bone marrow directly. The use of advanced MR techniques for bone marrow study has rapidly found clinical applications. Beyond the clinical uses, it has opened up pathways to assess and quantify bone marrow components, establishing the groundwork for further study of its implications in physiologic and pathologic conditions.We summarize the features of the bone marrow as an organ, address the different modalities available for its study, with a special focus on MR advanced techniques and their addition to analysis in recent years, and review some of the challenges in interpreting the appearance of bone marrow.

Comparison between 3-point Dixon- and CHESS-based OMERACT-recommended MRI protocols in hands of patients with suspicion of early rheumatoid arthritis

PURPOSE

To compare fat suppression effectiveness, image quality and disease activity scores between MRI protocols based on the Dixon method and the Chemical Shift Selective (CHESS) technique in hands of patients with suspicion of early rheumatoid arthritis (RA).

METHOD

Both hands of 28 patients (19 women; mean age 45.2 years old) with suspicion of early RA were prospectively imaged with Dixon- and CHESS-based OMERACT recommended protocols at 1.5 T including fat-suppressed T2-weighted and contrast-enhanced T1-weighted imaging. Two radiologists (R1/R2) separately assessed effectiveness of fat suppression and determined RAMRIS scores woth the Dixon- and CHESS-based protocols. R1 repeated the RAMRIS scoring and measured contrast-to-noise ratios (CNRs) on Dixon and CHESS images. Statistics included 2-way ANOVA test for the comparison of CNRs and Bland-Altman methodology for inter-technique and intra-observer agreement (p < 0.05).

RESULTS

Fat suppression failure occurred in up to 1 patient with the Dixon- and 25 patients with the CHESS-based protocols. CNRs were significantly higher on T1-weighted and lower on T2-weighted Dixon images than on the corresponding CHESS images (p ≤ 0.042). Median bias of the difference between Dixon- and CHESS-based RAMRIS scores was not significantly different from 0 (-0.8 to +1.0 and -1.1 to +1.4 for R1/R2). Median bias of the difference between RAMRIS scores at first and second readings was significantly different from 0 with the CHESS-based protocols (-0.8 to +1.7) but not with the Dixon-based protocols (+0.0 to +1.0).

CONCLUSIONS

Dixon sequences yield more effective fat suppression and more reproducible RAMRIS scoring than CHESS sequences in hands with suspicion of early RA.

Tri-modal imaging of gold-dotted magnetic nanoparticles for magnetic resonance imaging, computed tomography and intravascular ultrasound: an in vitro study

Aim: To examine the multimodal contrasting ability of gold-dotted magnetic nanoparticles (Au*MNPs) for magnetic resonance (MR), computed tomography (CT) and intravascular ultrasound (IVUS) imaging. Materials & methods: Au*MNPs were prepared by adapting an impregnation method, without using surface capping reagents and characterized (transmission electron microscopy, x-ray diffraction and Fourier-transform infrared spectroscopy) with their in vitro cytotoxicity assessed, followed by imaging assessments. Results: The contrast-enhancing ability of Au*MNPs was shown to be concentration-dependent across MR, CT and IVUS imaging. The Au content of the Au*MNP led to evident increases of the IVUS signal. Conclusion: We demonstrated that Au*MNPs showed concentration-dependent contrast-enhancing ability in MRI and CT imaging, and for the first-time in IVUS imaging due to the Au content. These Au*MNPs are promising toward solidifying tri-modal imaging-based theragnostics.

The Dixon technique for MRI of the bone marrow

Dixon sequences are established as a reliable MRI technique that can be used for problem-solving in the assessment of bone marrow lesions. Unlike other fat suppression methods, Dixon techniques rely on the difference in resonance frequency between fat and water and in a single acquisition, fat only, water only, in-phase and out-of-phase images are acquired. This gives Dixon techniques the unique ability to quantify the amount of fat within a bone lesion, allowing discrimination between marrow-infiltrating and non-marrow-infiltrating lesions such as focal nodular marrow hyperplasia. Dixon can be used with gradient echo and spin echo techniques, both two-dimensional and three-dimensional imaging. Another advantage is its rapid acquisition time, especially when using traditional two-point Dixon gradient echo sequences. Overall, Dixon is a robust fat suppression method that can also be used with intravenous contrast agents. After reviewing the available literature, we would like to advocate the implementation of additional Dixon sequences as a problem-solving tool during the assessment of bone marrow pathology.

A mask method to assess the uniformity of fat suppression in phantom studies

Fat suppression is a technique used to suppress the signals from adipose tissues, during clinical evaluation of the tissues near the fat-tissue boundary. However, in cases where the scan area has a complicated shape, the effect of fat suppression may demonstrate poor uniformity, resulting in diagnosis-related difficulties. To improve the uniformity of fat suppression, phantom studies are more suitable than volunteer studies. In this study, we evaluated the reliability of the region of interest (ROI) dependency using an unevenness phantom, to develop a method to assess the uniformity of fat suppression while using whole magnetic resonance imaging by masking the surrounding phantom. We modulated different ROI sizes, which were eroded from 100% to approximately 50%, and observed that the normalized absolute average deviation and error increased with decreased ROI. Using our method, more objective, concrete, and accurate data could be obtained by including the whole-body phantom (whole poor uniformity area).

Frequency Offset Corrected Inversion Pulse for B0 and B1 Insensitive Fat Suppression at 3T: Application to MR Neurography of Brachial Plexus

BACKGROUND

The 3D short tau inversion recovery (STIR) sequence is routinely used in clinical MRI to achieve robust fat suppression. However, the performance of the commonly used adiabatic inversion pulse, hyperbolic secant (HS), is compromised in challenging areas with increased B₀ and B₁ inhomogeneities, such as brachial plexus at 3T.

PURPOSE

To demonstrate the frequency offset corrected inversion (FOCI) pulse as an efficient fat suppression STIR pulse with increased robustness to B₀ and B₁ inhomogeneities at 3T, compared to the HS pulse.

STUDY TYPE

Prospective.

SUBJECTS/PHANTOM

Initial evaluation was performed in phantoms and one healthy volunteer by varying the B₁ field, while subsequent comparison was performed in three healthy volunteers and five patients without varying the B₁ .

FIELD STRENGTH/SEQUENCE

3T; 3D TSE-STIR with HS and FOCI pulses.

ASSESSMENT

Brachial plexus images were qualitatively evaluated by two musculoskeletal radiologists independently using a four-point grading scale for fat suppression, shading artifacts, and nerve visualization.

STATISTICAL TEST

The Wilcoxon signed-rank test with P < 0.05 was considered statistically significant.

RESULTS

Simulations and phantom experiments demonstrated broader bandwidth (2.5 kHz vs. 0.83 kHz, increased B₀ robustness) at the same adiabatic threshold and lower adiabatic threshold (5 μT vs. 7 μT at 3.5 ppm, increased B₁ robustness) at the same bandwidth with the FOCI pulse compared to the HS pulse With increased bandwidth, the FOCI pulse achieved robust fat suppression even at 50% of maximum B₁ strength, while the HS pulse required >75% of maximum B₁ strength. Compared to the standard 3D TSE-STIR with HS pulse, the FOCI pulse achieved uniform fat suppression (P < 0.05), better nerve visualization (P < 0.05), and minimal shading artifacts (P < 0.01) in brachial plexus at 3T.

DATA CONCLUSION

The FOCI pulse has increased robustness to B₀ and B₁ inhomogeneities, compared to the HS pulse, and enables uniform fat suppression in brachial plexus at 3T.

LEVEL OF EVIDENCE

1 Techinical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;48:1104-1111.

Use of chemical shift encoded magnetic resonance imaging (CSE-MRI) for high resolution fat-suppressed imaging of the brachial and lumbosacral plexuses

PURPOSE

In the era of increasingly complex surgical techniques for peripheral nerve repair, there is a need for high spatial resolution imaging of the neural plexuses in the body. We describe our experience with chemical shift encoded MRI and its implications for patient management.

MATERIALS AND METHODS

IDEAL water-fat separation is a chemical shift based method of homogeneously suppressing signal from fat, while maintaining adequate signal. This technique was used in clinical practice and the patient images reviewed.

RESULTS

IDEAL water-fat separation was shown to improve visualization of the brachial and lumbosacral plexuses with good fat suppression and high signal to noise ratio.

CONCLUSION

IDEAL water - fat separation is an excellent technique to use in the imaging of the brachial and lumbosacral plexuses as it balances the need for homogeneous fat suppression with maintenance of excellent signal to noise ratio.

MRI findings of spinal accessory neuropathy

AIM

To characterise the magnetic resonance imaging (MRI) appearance of patients with spinal accessory nerve (SAN) denervation.

MATERIAL AND METHODS

Twelve patients who had SAN denervation on electromyography (EMG) were included. The sternocleidomastoid and trapezius muscles and the SAN were assessed using MRI.

RESULTS

Trapezius muscle atrophy was seen in 11 (92%), and of those patients, T2/short tau inversion recovery (STIR) signal hyperintensity was also demonstrated in seven (58%). All three patients with prior neck surgery had scarring around the SAN, and one of these patients demonstrated a neuroma, which was confirmed surgically.

CONCLUSION

Features of SAN neuropathy on MRI include atrophy and T2/STIR signal hyperintensity of the trapezius, and in patients who have had posterior triangle neck surgery, scarring may be seen around the nerve.

T2-weighted IDEAL fast spin echo imaging of the brachial plexus: comparison with STIR

BACKGROUND

Short TI inversion-recovery (STIR) imaging is widely used, but its signal-to-noise-ratio (SNR) is relatively low. Iterative decomposition of water and fat with echo asymmetric and least-squares estimation (IDEAL) imaging has demonstrated promising results in several areas.

PURPOSE

To compare T2-weighted fast spin-echo IDEAL (T2W IDEAL-FSE) with STIR to determine which sequence is superior to image the brachial plexus.

MATERIAL AND METHODS

The brachial plexus was imaged in 18 patients and six volunteers. The patients' diseases comprised of: suspected chronic inflammatory demyelinating polyneuropathy (CIDP), brachial plexus palsy of unknown origin, and suspected amyotrophic lateral sclerosis. Frontal partial MIP images were acquired. Image quality was qualitatively and independently scored by two radiologists on a three-point grading scale for noise, visibility of the nerve roots, and overall image quality. Inter-observer agreement of the rating by two readers was assessed. The SNR and contrast-to-noise-ratio (CNR) were quantitatively calculated, and differences between T2W IDEAL-FSE and STIR were compared.

RESULTS

Qualitatively, each score for T2W IDEAL-FSE was significantly higher (P < 0.01) than that for STIR. Quantitatively, both SNR and CNR for T2W IDEAL-FSE (45.3 ± 12.6 and 27.1 ± 12.1, respectively) were significantly higher (P < 0.001) than those for STIR (17.4 ± 6.1 and 8.2 ± 4.7, respectively).

CONCLUSION

T2W IDEAL-FSE could be used to replace STIR for visualization of the brachial plexus.

Approach to MR Imaging of the Elbow and Wrist: Technical Aspects and Innovation

Wrist and elbow MR imaging technology is advancing at a dramatic rate. Wrist and elbow MR imaging is performed at medium and higher field strengths with more specialized surface coils and more variable pulse sequences and postprocessing techniques. High field imaging and improved coils lead to an increased signal-to-noise ratio and increased variety of soft tissue contrast options. Three-dimensional imaging is improving in terms of usability and artifacts. Some of these advances have challenges in wrist and elbow imaging, such as postoperative patient imaging, cartilage mapping, and molecular imaging. This review considers technical advances in hardware and software and their clinical applications.

Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system

Fat suppression is an important technique in musculoskeletal imaging to improve the visibility of bone-marrow lesions; evaluate fat in soft-tissue masses; optimize the contrast-to-noise ratio in magnetic resonance (MR) arthrography; better define lesions after administration of contrast material; and avoid chemical shift artifacts, primarily at 3-T MR imaging. High-field-strength (eg, 3-T) MR imaging has specific technical characteristics compared with lower-field-strength MR imaging that influence the use and outcome of various fat-suppression techniques. The most commonly used fat-suppression techniques for musculoskeletal 3-T MR imaging include chemical shift (spectral) selective (CHESS) fat saturation, inversion recovery pulse sequences (eg, short inversion time inversion recovery [STIR]), hybrid pulse sequences with spectral and inversion-recovery (eg, spectral adiabatic inversion recovery and spectral attenuated inversion recovery [SPAIR]), spatial-spectral pulse sequences (ie, water excitation), and the Dixon techniques. Understanding the different fat-suppression options allows radiologists to adopt the most appropriate technique for their clinical practice.

Effects of inhaled fluticasone on upper airway during sleep and wakefulness in asthma: a pilot study

STUDY OBJECTIVE

Obstructive sleep apnea is prevalent among people with asthma, but underlying mechanisms remain unknown. Inhaled corticosteroids may contribute. We tested the effects of orally inhaled fluticasone propionate (FP) on upper airway (UAW) during sleep and wakefulness.

STUDY DESIGN

16-week single-arm study.

PARTICIPANTS

18 (14 females, mean [ ± SD] age 26 ± 6 years) corticosteroid-naïve subjects with mild asthma (FEV1 89 ± 8% predicted).

INTERVENTIONS

High dose (1,760 mcg/day) inhaled FP.

MEASUREMENTS

(1) UAW collapsibility (passive critical closing pressure [Pcrit]); (2) tongue strength (maximum isometric pressure-Pmax, in KPa) and endurance-time (in seconds) able to maintain 50% Pmax across 3 trials (Ttot)-at anterior and posterior locations; (3) fat fraction and volume around UAW, measured by magnetic resonance imaging in three subjects.

RESULTS

Pcrit overall improved (became more negative) (mean ± SE) (-8.2 ± 1.1 vs. -12.2 ± 2.2 cm H2O, p = 0.04); the response was dependent upon baseline characteristics, with older, male gender, and worse asthma control predicting Pcrit deterioration (less negative). Overall, Pmax increased (anterior p = 0.02; posterior p = 0.002), but Ttot generally subsided (anterior p = 0.0007; posterior p = 0.06), unrelated to Pcrit response. In subjects studied with MRI, fat fraction and volume increased by 20.6% and 15.4%, respectively, without Pcrit changes, while asthma control appeared improved.

CONCLUSIONS

In this study of young, predominantly female, otherwise healthy subjects with well-controlled asthma and stiff upper airways, 16-week high dose FP treatment elicited Pcrit changes which may be dependent upon baseline characteristics, and determined by synchronous and reciprocally counteracting local and lower airway effects. The long-term implications of these changes on sleep disordered breathing severity remain to be determined.

MRI detection of brown adipose tissue with low fat content in newborns with hypothermia

PURPOSE

To report the observation of brown adipose tissue (BAT) with low fat content in neonates with hypoxic-ischemic encephalopathy (HIE) after they have undergone hypothermia therapy.

MATERIALS AND METHODS

The local ethics committee approved the imaging study. Ten HIE neonates (3 males, 7 females, age range: 2-3days) were studied on a 3-T MRI system using a low-flip-angle (3°) six-echo proton-density-weighted chemical-shift-encoded water-fat pulse sequence. Fat-signal fraction (FF) measurements of supraclavicular and interscapular (nape) BAT and adjacent subcutaneous white adipose tissues (WAT) were compared to those from five non-HIE neonates, two recruited for the present investigation and three from a previous study.

RESULTS

In HIE neonates, the FF range for the supraclavicular, interscapular, and subcutaneous regions was 10.3%-29.9%, 28.0%-57.9%, and 62.6%-88.0%, respectively. In non-HIE neonates, the values were 23.7%-42.2% (p=0.01), 45.4%-59.5% (p=0.06), and 67.8%-86.3% (p=0.38), respectively. On an individual basis, supraclavicular BAT FF was consistently the lowest, interscapular BAT values were higher, and subcutaneous WAT values were the highest (p<0.01).

CONCLUSION

We speculate that hypothermia therapy in HIE neonates likely promotes BAT-mediated non-shivering thermogenesis, which subsequently leads to a depletion of the tissue's intracellular fat stores. We believe that this is consequently reflected in lower FF values, particularly in the supraclavicular BAT depot, in contrast to non-HIE neonates.

Fat deposition in dilated cardiomyopathy assessed by CMR

OBJECTIVES

The aim of this study was to prospectively investigate the prevalence of fat deposition in idiopathic dilated cardiomyopathy (DCM) by fat-water separation imaging. An auxiliary aim was to determine the relationship between left ventricular (LV) fat deposition and characteristic myocardial fibrosis, as well as cardiac functional parameters.

BACKGROUND

Idiopathic DCM remains the most common cause of heart failure in young people referred for cardiac transplantation; little is known about the clinical value of fat deposition in DCM.

METHODS

A total of 124 patients with DCM were studied after written informed consent was obtained. The magnetic resonance imaging scan protocols included a series of short-axis LV cine imaging for functional analysis, fat-water separation imaging, and late gadolinium enhancement (LGE) imaging. Fat deposition and fibrosis location were compared to the scar regions on LGE images using a 17-segment model. Statistical comparisons of LV global functional parameters, fibrosis volumes, and fat deposition were carried out using the Pearson correlation, Student t test, and multiple regressions.

RESULTS

The patients had a 41.9% (52 of 124) prevalence of positive LGE, and 12.9% (16 of 124) fat deposition prevalence was found in this DCM cohort. The patients with fat deposition had larger LV end-diastolic volume (LVEDV) index (140.8 ± 20.2 ml/m(2) vs. 123.4 ± 15.8 ml/m(2); p < 0.01), larger LV end-systolic volume (LVESV) index (111.3 ± 19.2 ml/m(2) vs. 87.0 ± 20.3 ml/m(2); p < 0.01), and decreased LV ejection fraction (LVEF) (21.1 ± 7.1% vs. 30.0 ± 10.7%; p < 0.01). Higher volumes of LGE were found in the group with myocardial fat deposition (18.39 ± 9.0 ml vs. 13.40 ± 6.54 ml; p = 0.001), as well as a higher percentage of LGE/LV mass (19.11 ± 7.78% vs. 13.60 ± 4.58%; p = 0.000). The volume of fat deposition was correlated with scar volume, LVEF, LVEDV index, and LVESV index.

CONCLUSIONS

Fat deposition is a common phenomenon in DCM, and it is associated with DCM characteristics such as fibrosis volume and LV function.

MR imaging techniques for pancreas

Pancreatic magnetic resonance (MR) imaging has become a useful tool in evaluating pancreatic disorders. Technical innovations in MR imaging have evolved over the last decade, with most sequences being performed in one or a few breath-holds. Three-dimensional sequences with thin, contiguous slices allow for improved spatial resolution on the postgadolinium images and MR cholangiopancreatography (MRCP). The diagnostic potential of MRCP is equivalent to endoscopic retrograde pancreatography, particularly when intravenous secretin is used to enhance the pancreatic duct assessment. This article highlights the advantages and disadvantages of state-of-the-art and emerging pulse sequences and their application to imaging pancreatic diseases.

MR imaging of the spine at 3.0T with T2-weighted IDEAL fast recovery fast spin-echo technique

Objective

To compare the iterative decomposition of water and fat with echo asymmetry and the least-squares estimation (IDEAL) method with a fat-saturated T2-weighted (T2W) fast recovery fast spin-echo (FRFSE) imaging of the spine.

Materials and Methods

Images acquired at 3.0 Tesla (T) in 35 patients with different spine lesions using fat-saturated T2W FRFSE imaging were compared with T2W IDEAL FRFSE images. Signal-to-noise ratio (SNR)-efficiencies measurements were made in the vertebral bodies and spinal cord in the mid-sagittal plane or nearest to the mid-sagittal plane. Images were scored with the consensus of two experienced radiologists on a four-point grading scale for fat suppression and overall image quality. Statistical analysis of SNR-efficiency, fat suppression and image quality scores was performed with a paired Student's t test and Wilcoxon's signed rank test.

Results

Signal-to-noise ratio-efficiency for both vertebral body and spinal cord was higher with T2W IDEAL FRFSE imaging (p < 0.05) than with T2W FRFSE imaging. T2W IDEAL FRFSE demonstrated superior fat suppression (p < 0.01) and image quality (p < 0.01) compared to fat-saturated T2W FRFSE.

Conclusion

As compared with fat-saturated T2W FRFSE, IDEAL can provide a higher image quality, higher SNR-efficiency, and consistent, robust and uniform fat suppression. T2W IDEAL FRFSE is a promising technique for MR imaging of the spine at 3.0T.

Prospective comparison of image quality and diagnostic accuracy of 0.5 molar gadobenate dimeglumine and 1.0 molar gadobutrol in contrast-enhanced run-off magnetic resonance angiography of the lower extremities

PURPOSE

To compare image quality and diagnostic accuracy of 0.5 molar gadobenate dimeglumine and 1.0 molar gadobutrol in contrast-enhanced (CE) magnetic resonance angiography (MRA) of the lower extremities interindividually.

MATERIALS AND METHODS

The study was approved by our Institutional Review Board. Written informed consent was obtained from all patients before enrollment in the study. We prospectively included 74 patients (21 women, 53 men; mean age ± SD: 67.9 ± 11.0 years) with suspected peripheral occlusive vascular disease. All patients underwent a contrast-enhanced MRA of both lower extremities with either 0.1 mL/kg body weight gadobutrol or gadobenate dimeglumine. Image quality, stenosis grade, and artifacts were assessed by two blinded, independent investigators. Signal intensity (SI), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured by a third investigator. Contrast agent groups were compared to each other using a two-sided Student's t-test.

RESULTS

The results did not show significant differences for SI, SNR, or CNR. Both investigators were in significant accordance (P < 0.05) with regard to stenosis detection.

CONCLUSION

We conclude that application of standard clinical doses (0.1 mL/kg body weight) of both contrast agents provides similar diagnostic results and gadolinium dose could be reduced by the application of a single dose of gadobenate dimeglumine for CE run-off MRA.

T(2)-weighted 3D fast spin echo imaging with water-fat separation in a single acquisition

PURPOSE

To develop a robust 3D fast spin echo (FSE) T(2)-weighted imaging method with uniform water and fat separation in a single acquisition, amenable to high-quality multiplanar reformations.

MATERIALS AND METHODS

The Iterative Decomposition of water and fat with Echo Asymmetry and Least squares estimation (IDEAL) method was integrated with modulated refocusing flip angle 3D-FSE. Echoes required for IDEAL processing were acquired by shifting the readout gradient with respect to the Carr-Purcell-Meiboom-Gill echo. To reduce the scan time, an alternative data acquisition using two gradient echoes per repetition was implemented. Using the latter approach, a total of four gradient echoes were acquired in two repetitions and used in the modified IDEAL reconstruction.

RESULTS

3D-FSE T(2)-weighted images with uniform water-fat separation were successfully acquired in various anatomies including breast, abdomen, knee, and ankle in clinically feasible scan times, ranging from 5:30-8:30 minutes. Using water-only and fat-only images, in-phase and out-of-phase images were reconstructed.

CONCLUSION

3D-FSE-IDEAL provides volumetric T(2)-weighted images with uniform water and fat separation in a single acquisition. High-resolution images with multiple contrasts can be reformatted to any orientation from a single acquisition. This could potentially replace 2D-FSE acquisitions with and without fat suppression and in multiple planes, thus improving overall imaging efficiency.

Noise analysis for 3-point chemical shift-based water-fat separation with spectral modeling of fat

PURPOSE

To model the theoretical signal-to-noise ratio (SNR) behavior of 3-point chemical shift-based water-fat separation, using spectral modeling of fat, with experimental validation for spin-echo and gradient-echo imaging. The echo combination that achieves the best SNR performance for a given spectral model of fat was also investigated.

MATERIALS AND METHODS

Cramér-Rao bound analysis was used to calculate the best possible SNR performance for a given echo combination. Experimental validation in a fat-water phantom was performed and compared with theory. In vivo scans were performed to compare fat separation with and with out spectral modeling of fat.

RESULTS

Theoretical SNR calculations for methods that include spectral modeling of fat agree closely with experimental SNR measurements. Spectral modeling of fat more accurately separates fat and water signals, with only a slight decrease in the SNR performance of the water-only image, although with a relatively large decrease in the fat SNR performance.

CONCLUSION

The optimal echo combination that provides the best SNR performance for water using spectral modeling of fat is very similar to previous optimizations that modeled fat as a single peak. Therefore, the optimal echo spacing commonly used for single fat peak models is adequate for most applications that use spectral modeling of fat.

Magnetic resonance separation imaging using a divided inversion recovery technique (DIRT)

The divided inversion recovery technique is an MRI separation method based on tissue T(1) relaxation differences. When tissue T(1) relaxation times are longer than the time between inversion pulses in a segmented inversion recovery pulse sequence, longitudinal magnetization does not pass through the null point. Prior to additional inversion pulses, longitudinal magnetization may have an opposite polarity. Spatial displacement of tissues in inversion recovery balanced steady-state free-precession imaging has been shown to be due to this magnetization phase change resulting from incomplete magnetization recovery. In this paper, it is shown how this phase change can be used to provide image separation. A pulse sequence parameter, the time between inversion pulses (T180), can be adjusted to provide water-fat or fluid separation. Example water-fat and fluid separation images of the head, heart, and abdomen are presented. The water-fat separation performance was investigated by comparing image intensities in short-axis divided inversion recovery technique images of the heart. Fat, blood, and fluid signal was suppressed to the background noise level. Additionally, the separation performance was not affected by main magnetic field inhomogeneities.

State-of-the-art pancreatic MRI

OBJECTIVE

The purpose of this article is to discuss the most current techniques used for pancreatic imaging, highlighting the advantages and disadvantages of state-of-the-art and emerging pulse sequences and their application to pancreatic disease.

CONCLUSION

Given the technologic advances of the past decade, pancreatic MRI protocols have evolved. Most sequences can now be performed in one or a few breath-holds; 3D sequences with thin, contiguous slices offer improved spatial resolution; and better fat and motion suppression allow improved contrast resolution and image quality. The diagnostic potential of MRCP is now almost as good as ERCP, with pancreatic MRI as the main imaging technique to investigate biliopancreatic pain, chronic pancreatitis, and cystic pancreatic tumors at many institutions. In addition, functional information is provided with secretin-enhanced MRCP.

Myocardial fat quantification in humans: Evaluation by two-point water-fat imaging and localized proton spectroscopy

Proton MR spectroscopy ((1)H-MRS) has been used for in vivo quantification of intracellular triglycerides within the sarcolemma. The purpose of this study was to assess whether breath-hold dual-echo in- and out-of-phase MRI at 3.0 T can quantify the fat content of the myocardium. Biases, including T(1), T*(2), and noise, that confound the calculation of the fat fraction were carefully corrected. Thirty-four of 46 participants had both MRI and MRS data. The fat fractions from MRI showed a strong correlation with fat fractions from MRS (r = 0.78; P < 0.05). The mean myocardial fat fraction for all 34 subjects was 0.7 +/- 0.5% (range: 0.11-3%) assessed with MRS and 1.04 +/- 0.4% (range: 0.32-2.44%) assessed with in- and out-of-phase MRI (P < 0.05). Scanning times were less than 15 sec for Dixon imaging, plus an additional minute for the acquisition used for T*(2) calculation, and 15-20 min for MRS. The average postprocessing time for MRS was 3 min and 5 min for MRI including T*(2) measurement. We conclude that the dual echo method provides a rapid means to detect and quantifying myocardial fat content in vivo. Correction/adjustment for field inhomogeneity using three or more echoes seems crucial for the dual echo approach.

Pelvic imaging using a T1W fat-suppressed three-dimensional dual echo Dixon technique at 3T

PURPOSE

To compare two T1-weighted (T1W) fat-suppressed sequences for 3D breath-hold pre- and postcontrast fat-suppressed T1W imaging of the female pelvis at 3T.

MATERIALS AND METHODS

Pelvic MRI scans of 16 female patients were retrospectively identified who were scanned with two 3D breath-hold sequences: 1) a fast spoiled gradient echo sequence with spectral inversion at lipids (SPECIAL) (called 3D FSPGR), and 2) a dual-echo two-point Dixon (DE Dixon) sequence. Contrast between soft tissue and fat, soft tissue and fluid, and fat and fluid was measured on pre- and postcontrast images. Additionally, two readers subjectively scored the images for degree and homogeneity of fat suppression plus presence and severity of artifacts.

RESULTS

Contrast between muscle and myometrium to fat was improved with the Dixon technique (0.61 vs. 0.09 and 0.7 vs. 0.3, respectively, P < 0.001). Both readers agreed that fat suppression was stronger with the Dixon sequence (P < 0.001 and P = 0.06). Artifacts were equivalent (P = 0.53 and 0.65).

CONCLUSION

The 3D DE Dixon sequence achieved stronger fat suppression in the female pelvis when compared to a 3D FSPGR sequence with SPECIAL.

Segmented echo planar MR imaging of the brachial plexus with inversion recovery magnetization preparation at 3.0T

PURPOSE

To evaluate the image quality of segmented echo planar MRI with inversion recovery magnetization preparation (seg-IR-EPI) to depict the anatomy and pathologic changes involving the brachial plexus.

MATERIALS AND METHODS

The coronal seg-IR-EPI sequence was performed on 30 healthy volunteers and 20 patients. Postprocessing techniques were used to generate images of brachial plexus and the images acquired were qualitatively evaluated by two experienced radiologists based on grading of the morphological images. Signal-to-noise ratios (SNRs) and nerve soft tissue contrast-to-noise-ratios (CNRs) were calculated and the normalized SNR (SNRn) and the normalized CNR (CNRn) were compared with the STIR TSE sequence.

RESULTS

Although seg-IR-EPI had more ghosting artifacts than STIR TSE, excellent general image appearance with minor blurring can be achieved with seg-IR-EPI. In all healthy volunteers the means of CNRn were significantly greater for seg-IR-EPI than for STIR-TSE, while the means of SNRn were significantly lower for seg-IR-EPI than for STIR-TSE.

CONCLUSION

In the present study the seg-IR-EPI sequence obtained uniform fat suppression and high-contrast T2-weighted images of brachial plexus. Our data suggest that the seg-IR-EPI sequence may provide high fidelity in evaluating brachial plexus.

Iterative Decomposition of Water and Fat with Echo Asymmetric and Least–-Squares Estimation (IDEAL) (Reeder et al. 2005) Automated Spine Survey Iterative Scan Technique (ASSIST) (Weiss et al. 2006)

Background and Purpose

Multi-parametric MRI of the entire spine is technologist-dependent, time consuming, and often limited by inhomogeneous fat suppression. We tested a technique to provide rapid automated total spine MRI screening with improved tissue contrast through optimized fat-water separation.

Methods

The entire spine was auto-imaged in two contiguous 35 cm field of view (FOV) sagittal stations, utilizing out-of-phase fast gradient echo (FGRE) and T1 and/or T2 weighted fast spin echo (FSE) IDEAL (Iterative Decomposition of Water and Fat with Echo Asymmetric and Least-squares Estimation) sequences. 18 subjects were studied, one twice at 3.0T (pre and post contrast) and one at both 1.5 T and 3.0T for a total of 20 spine examinations (8 at 1.5 T and 12 at 3.0T). Images were independently evaluated by two neuroradiologists and run through Automated Spine Survey Iterative Scan Technique (ASSIST) analysis software for automated vertebral numbering.

Results

In all 20 total spine studies, neuroradiologist and computer ASSIST labeling were concordant. In all cases, IDEAL provided uniform fat and water separation throughout the entire 70 cm FOV imaged. Two subjects demonstrated breast metastases and one had a large presumptive schwannoma. 14 subjects demonstrated degenerative disc disease with associated Modic Type I or II changes at one or more levels. FGRE ASSIST afforded subminute submillimeter in-plane resolution of the entire spine with high contrast between discs and vertebrae at both 1.5 and 3.0T. Marrow signal abnormalities could be particularly well characterized with IDEAL derived images and parametric maps.

Conclusion

IDEAL ASSIST is a promising MRI technique affording a rapid automated high resolution, high contrast survey of the entire spine with optimized tissue characterization.

Age, gender, and skeletal variation in bone marrow composition: a preliminary study at 3.0 Tesla

PURPOSE

To evaluate the efficacy of MR Spectroscopy (MRS) at 3.0 Tesla for the assessment of normal bone marrow composition and assess the variation in terms of age, gender, and skeletal site.

MATERIALS AND METHODS

A total of 16 normal subjects (aged between eight and 57 years) were investigated on a 3.0 Tesla GE Signa system. To investigate axial and peripheral skeleton differences, non-water-suppressed spectra were acquired from single voxels in the calcaneus and lumbar spine. In addition, spectra were acquired at multiple vertebral bodies to assess variation within the lumbar spine. Data was also correlated with bone mineral density (BMD) measured in six subjects using dual-energy X-ray absorptiometry (DXA).

RESULTS

Fat content was an order of magnitude greater in the heel compared to the spine. An age-related increase was demonstrated in the spine with values greater in men compared to female subjects. Significant trends in vertebral bodies within the same subjects were also shown, with fat content increasing L5 > L1. Population coefficient of variation (CV) was greater for fat fraction (FF) compared to BMD.

CONCLUSION

Significant normal variations of marrow composition have been demonstrated, which provide important data for the future interpretation of patient investigations.

Cutting-edge imaging of the spine

Damage to the spinal cord may be caused by a wide range of pathologies and generally results in profound functional disability. A reliable diagnostic workup of the spine is very important because even relatively small lesions in this part of the central nervous system can have a profound clinical impact. MR imaging has become the method of choice for the detection and diagnosis of many spine disorders. Various innovative MR imaging methods have been developed to improve neuroimaging, including better pulse sequences and new MR contrast parameters. These new "cutting-edge" technologies have the potential to impact profoundly the ease and confidence of spinal disease interpretation and offer a more efficient diagnostic workup of patients suffering from spinal disease.

Water-fat separation with IDEAL gradient-echo imaging

PURPOSE

To combine gradient-echo (GRE) imaging with a multipoint water-fat separation method known as "iterative decomposition of water and fat with echo asymmetry and least squares estimation" (IDEAL) for uniform water-fat separation. Robust fat suppression is necessary for many GRE imaging applications; unfortunately, uniform fat suppression is challenging in the presence of B(0) inhomogeneities. These challenges are addressed with the IDEAL technique.

MATERIALS AND METHODS

Echo shifts for three-point IDEAL were chosen to optimize noise performance of the water-fat estimation, which is dependent on the relative proportion of water and fat within a voxel. Phantom experiments were performed to validate theoretical SNR predictions. Theoretical echo combinations that maximize noise performance are discussed, and examples of clinical applications at 1.5T and 3.0T are shown.

RESULTS

The measured SNR performance validated theoretical predictions and demonstrated improved image quality compared to unoptimized echo combinations. Clinical examples of the liver, breast, heart, knee, and ankle are shown, including the combination of IDEAL with parallel imaging. Excellent water-fat separation was achieved in all cases. The utility of recombining water and fat images into "in-phase," "out-of-phase," and "fat signal fraction" images is also discussed.

CONCLUSION

IDEAL-SPGR provides robust water-fat separation with optimized SNR performance at both 1.5T and 3.0T with multicoil acquisitions and parallel imaging in multiple regions of the body.