Targeted single-shot methods for diffusion-weighted imaging in the kidneys

RadioGraphics Update: Functional MR Neurography in Evaluation of Peripheral Nerve Trauma and Postsurgical Assessment

Editor's Note.-Articles in the RadioGraphics Update section provide current knowledge to supplement or update information found in full-length articles previously published in RadioGraphics. Authors of the previously published article provide a brief synopsis that emphasizes important new information such as technological advances, revised imaging protocols, new clinical guidelines involving imaging, or updated classification schemes. Articles in this section are published solely online and are linked to the original article. ^©RSNA, 2021.

Correction of Artifacts Induced by B0 Inhomogeneities in Breast MRI Using Reduced-Field-of-View Echo-Planar Imaging and Enhanced Reversed Polarity Gradient Method

BACKGROUND

Diffusion-weighted (DW) echo-planar imaging (EPI) is prone to geometric distortions due to B₀ inhomogeneities. Both prospective and retrospective approaches have been developed to decrease and correct such distortions.

PURPOSE

The purpose of this work was to evaluate the performance of reduced-field-of-view (FOV) acquisition and retrospective distortion correction methods in decreasing distortion artifacts for breast imaging. Coverage of the axilla in reduced-FOV DW magnetic resonance imaging (MRI) and residual distortion were also assessed.

STUDY TYPE

Retrospective.

POPULATION/PHANTOM

Breast phantom and 169 women (52.4 ± 13.4 years old) undergoing clinical breast MRI.

FIELD STRENGTH/SEQUENCE

A 3.0 T/ full- and reduced-FOV DW gradient-echo EPI sequence.

ASSESSMENT

Performance of reversed polarity gradient (RPG) and FSL topup in correcting breast full- and reduced-FOV EPI data was evaluated using the mutual information (MI) metric between EPI and anatomical images. Two independent breast radiologists determined if coverage on both EPI data sets was adequate to evaluate axillary nodes and identified residual nipple distortion artifacts.

STATISTICAL TESTS

Two-way repeated-measures analyses of variance and post hoc tests were used to identify differences between EPI modality and distortion correction method. Generalized linear mixed effects models were used to evaluate differences in axillary coverage and residual nipple distortion.

RESULTS

In a breast phantom, residual distortions were 0.16 ± 0.07 cm and 0.22 ± 0.13 cm in reduced- and full-FOV EPI with both methods, respectively. In patients, MI significantly increased after distortion correction of full-FOV (11 ± 5% and 18 ± 9%, RPG and topup) and reduced-FOV (8 ± 4% both) EPI data. Axillary nodes were observed in 99% and 69% of the cases in full- and reduced-FOV EPI images. Residual distortion was observed in 93% and 0% of the cases in full- and reduced-FOV images.

DATA CONCLUSION

Minimal distortion was achieved with RPG applied to reduced-FOV EPI data. RPG improved distortions for full-FOV images but with more modest improvements and limited correction near the nipple.

EVIDENCE LEVEL

3 TECHNICAL EFFICACY: Stage 1.

Spectral diffusion analysis of kidney intravoxel incoherent motion MRI in healthy volunteers and patients with renal pathologies

PURPOSE

To assess the feasibility of measuring tubular and vascular signal fractions in the human kidney using nonnegative least-square (NNLS) analysis of intravoxel incoherent motion data collected in healthy volunteers and patients with renal pathologies.

METHODS

MR imaging was performed at 3 Tesla in 12 healthy subjects and 3 patients with various kidney pathologies (fibrotic kidney disease, failed renal graft, and renal masses). Relative signal fractions f and mean diffusivities of the diffusion components in the cortex, medulla, and renal lesions were obtained using the regularized NNLS fitting of the intravoxel incoherent motion data. Test-retest repeatability of the NNLS approach was tested in 5 volunteers scanned twice.

RESULTS

In the healthy kidneys, the NNLS method yielded diffusion spectra with 3 distinguishable components that may be linked to the slow tissue water diffusion, intermediate tubular and vascular flow, and fast blood flow in larger vessels with the relative signal fractions, f_slow , f_interm and f_fast , respectively. In the pathological kidneys, the diffusion spectra varied substantially from those acquired in the healthy kidneys. Overall, the renal cyst showed substantially higher f_interm and lower f_slow , whereas the fibrotic kidney, failed renal graft, and renal cell carcinoma demonstrated the opposite trend.

CONCLUSION

NNLS-based intravoxel incoherent motion could potentially become a valuable tool in assessing changes in tubular and vascular volume fractions under pathophysiological conditions.

Diffusion tensor magnetic resonance imaging of the postoperative spine with metallic implants

There has been a growing need to understand the mechanism of development of acute spinal cord injury (SCI) and to optimize treatment. The paramagnetic nature of metallic implants has hampered the application of diffusion tensor imaging (DTI) in postsurgical SCI monitoring. We describe here a successful implementation of spinal DTI in postsurgical SCI patients. Data were acquired using a single-shot turbo-spin-echo sequence, where an extra gradient is applied before the refocusing pulse train to eliminate contributions from the non-Carr-Purcell-Meiboom-Gill components following a diffusion preparation block where a single-spin echo scheme is deployed. The DTI images were acquired in axial orientation with a 2 x 2 x 4 mm³ resolution and a total of 18 slices. Diffusion gradients were applied in six directions with b values of 0 and 600 seconds/mm² . The whole scan took ~10 minutes. The sequence was compared with SENSE-DW-EPI and ZOOM-DW-EPI on a phantom, eight patients with either anterior or posterior titanium alloy implants, and a pork loin with a similar implant. The protocol resulted in dramatically reduced geometric distortions compared with routine imaging sequences, however, the SNR efficiency was compromised. The spinal cord signal displacement was 0.68±1.00 mm (mean±SD, n = 8) for the proposed protocol, and 5.14±3.07 and 2.82±1.60 mm for the SENSE-DW-EPI and ZOOM-DW-EPI sequences, respectively. Fiber tracking was achieved in the presence of implants, which in one case was accompanied by central spinal cord caviation. Mathematical analysis concluded that the proposed protocol would be generally applicable in the spinal cord when the titanium alloy implant is ~15 mm away (<0.5 kHz B₀ field drift). The protocol described is capable of DTI in postsurgery SCI patients with metallic implants at sufficient resolution and SNR.

Optimal acquisition scheme for flow-compensated intravoxel incoherent motion diffusion-weighted imaging in the abdomen: An accurate and precise clinically feasible protocol

PURPOSE

Flow-compensated (FC) diffusion-weighted MRI (DWI) for intravoxel-incoherent motion (IVIM) modeling allows for a more detailed description of tissue microvasculature than conventional IVIM. The long acquisition time of current FC-IVIM protocols, however, has prohibited clinical application. Therefore, we developed an optimized abdominal FC-IVIM acquisition with a clinically feasible scan time.

METHODS

Precision and accuracy of the FC-IVIM parameters were assessed by fitting the FC-IVIM model to signal decay curves, simulated for different acquisition schemes. Diffusion-weighted acquisitions were added subsequently to the protocol, where we chose the combination of b-value, diffusion time and gradient profile (FC or bipolar) that resulted in the largest improvement to its accuracy and precision. The resulting two optimized FC-IVIM protocols with 25 and 50 acquisitions (FC-IVIMopt25 and FC-IVIMopt50 ), together with a complementary acquisition consisting of 50 diffusion-weighting (FC-IVIMcomp ), were acquired in repeated abdominal free-breathing FC-IVIM imaging of seven healthy volunteers. Intersession and intrasession within-subject coefficient of variation of the FC-IVIM parameters were compared for the liver, spleen, and kidneys.

RESULTS

Simulations showed that the performance of FC-IVIM improved in tissue with larger perfusion fraction and signal-to-noise ratio. The scan time of the FC-IVIMopt25 and FC-IVIMopt50 protocols were 8 and 16 min. The best in vivo performance was seen in FC-IVIMopt50 . The intersession within-subject coefficients of variation of FC-IVIMopt50 were 11.6%, 16.3%, 65.5%, and 36.0% for FC-IVIM model parameters diffusivity, perfusion fraction, characteristic time and blood flow velocity, respectively.

CONCLUSIONS

We have optimized the FC-IVIM protocol, allowing for clinically feasible scan times (8-16 min).

Diffusion-weighted Renal MRI at 9.4 Tesla Using RARE to Improve Anatomical Integrity

Diffusion-weighted magnetic resonance imaging (DWI) is a non-invasive imaging technique sensitive to tissue water movement. By enabling a discrimination between tissue properties without the need of contrast agent administration, DWI is invaluable for probing tissue microstructure in kidney diseases. DWI studies commonly make use of single-shot Echo-Planar Imaging (ss-EPI) techniques that are prone to suffering from geometric distortion. The goal of the present study was to develop a robust DWI technique tailored for preclinical magnetic resonance imaging (MRI) studies that is free of distortion and sensitive to detect microstructural changes. Since fast spin-echo imaging techniques are less susceptible to B₀ inhomogeneity related image distortions, we introduced a diffusion sensitization to a split-echo Rapid Acquisition with Relaxation Enhancement (RARE) technique for high field preclinical DWI at 9.4 T. Validation studies in standard liquids provided diffusion coefficients consistent with reported values from the literature. Split-echo RARE outperformed conventional ss-EPI, with ss-EPI showing a 3.5-times larger border displacement (2.60 vs. 0.75) and a 60% higher intra-subject variability (cortex = 74%, outer medulla = 62% and inner medulla = 44%). The anatomical integrity provided by the split-echo RARE DWI technique is an essential component of parametric imaging on the way towards robust renal tissue characterization, especially during kidney disease.

Consensus-based technical recommendations for clinical translation of renal diffusion-weighted MRI

Objectives

Standardization is an important milestone in the validation of DWI-based parameters as imaging biomarkers for renal disease. Here, we propose technical recommendations on three variants of renal DWI, monoexponential DWI, IVIM and DTI, as well as associated MRI biomarkers (ADC, D, D*, f, FA and MD) to aid ongoing international efforts on methodological harmonization.

Materials and methods

Reported DWI biomarkers from 194 prior renal DWI studies were extracted and Pearson correlations between diffusion biomarkers and protocol parameters were computed. Based on the literature review, surveys were designed for the consensus building. Survey data were collected via Delphi consensus process on renal DWI preparation, acquisition, analysis, and reporting. Consensus was defined as ≥ 75% agreement.

Results

Correlations were observed between reported diffusion biomarkers and protocol parameters. Out of 87 survey questions, 57 achieved consensus resolution, while many of the remaining questions were resolved by preference (65–74% agreement). Summary of the literature and survey data as well as recommendations for the preparation, acquisition, processing and reporting of renal DWI were provided.

Discussion

The consensus-based technical recommendations for renal DWI aim to facilitate inter-site harmonization and increase clinical impact of the technique on a larger scale by setting a framework for acquisition protocols for future renal DWI studies. We anticipate an iterative process with continuous updating of the recommendations according to progress in the field.

Electronic supplementary material

The online version of this article (10.1007/s10334-019-00790-y) contains supplementary material, which is available to authorized users.

Diffusion-weighted MRI of the lung at 3T evaluated using echo-planar-based and single-shot turbo spin-echo-based acquisition techniques for radiotherapy applications

Purpose

To compare single‐shot echo‐planar (SS‐EPI)‐based and turbo spin‐echo (SS‐TSE)‐based diffusion‐weighted imaging (DWI) in Non‐Small Cell Lung Cancer (NSCLC) patients and to characterize the distributions of apparent diffusion coefficient (ADC) values generated by the two techniques.

Methods

Ten NSCLC patients were enrolled in a prospective IRB‐approved study to compare and optimize DWI using EPI and TSE‐based techniques for radiotherapy planning. The imaging protocol included axial T2w, EPI‐based DWI and TSE‐based DWI on a 3 T Philips scanner. Both EPI‐based and TSE‐based DWI sequences used three b values (0, 400, and 800 s/mm²). The acquisition times for EPI‐based and TSE‐based DWI were 5 and 8 min, respectively. DW‐MR images were manually coregistered with axial T2w images, and tumor volume contoured on T2w images were mapped onto the DWI scans. A pixel‐by‐pixel fit of tumor ADC was calculated based on monoexponential signal behavior. Tumor ADC mean, standard deviation, kurtosis, and skewness were calculated and compared between EPI and TSE‐based DWI. Image distortion and ADC values between the two techniques were also quantified using fieldmap analysis and a NIST traceable ice‐water diffusion phantom, respectively.

Results

The mean ADC for EPI and TSE‐based DWI were 1.282 ± 0.42 × 10⁻³ and 1.211 ± 0.31 × 10⁻³ mm²/s. The average skewness and kurtosis were 0.14 ± 0.4 and 2.43 ± 0.40 for DWI‐EPI and −0.06 ± 0.69 and 2.89 ± 0.62 for DWI‐TSE. Fieldmap analysis showed a mean distortion of 13.72 ± 8.12 mm for GTV for DWI‐EPI and 0.61 ± 0.4 mm for DWI‐TSE. ADC values obtained using the diffusion phantom for the two techniques were within 0.03 × 10⁻³ mm²/s with respect to each other as well as the established values.

Conclusions

Diffusion‐weighted turbo spin‐echo shows better geometrical accuracy compared to DWI‐EPI. Mean ADC values were similar with both acquisitions but the shape of the histograms was different based on the skewness and kurtosis values. The impact of differences in respiratory technique on ADC values requires further investigation.

Early assessment of acute kidney injury using targeted field of view diffusion-weighted imaging: An in vivo study

Acute kidney injury (AKI) is a common complication in various clinical settings. In recent years, AKI diagnostics have been investigated intensively showing the emerging need for early characterization of this disease. To verify whether targeted field-of-view diffusion-weighted imaging (tFOV-DWI) is feasible to significantly improve the performance of traditional full field-of-view diffusion-weighted imaging (fFOV-DWI) in the early assessment of AKI. 14 rabbits with unilateral AKI were induced by injection of microspheres under the guidance of digital subtraction angiography (DSA). All rabbits underwent tFOV-DWI and fFOV-DWI immediately after the surgery. Artifacts, distortion and lesion identification were graded by two experienced radiologists, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured. Apparent diffusion coefficient (ADC) maps were then derived. Blood samples were collected pre- and post-surgery and serum creatinine weres measured. Renal specimen and biopsy were performed as the reference standard. Student t-test was used to ascertain statistical significance between the above parameters for tFOV-DWI and fFOV-DWI. The interobserver agreement and ADC measurements agreement were assessed. A higher percentage of renal lesions (17 out of 19) were detected in tFOV-DWI compared with fFOV-DWI (14 out of 19). Significant differences were observed in ADC value for both techniques between the lesion regions and normal tissues (p < 0.001). Histological findings were inversely correlated with ADC values of tFOV-DWI (r = -0.97, P < 0.001 for cortex; r = -0.98, P < 0.001 for medulla) and fFOV-DWI sequences (r = -0.95, P < 0.001 for cortex; r = -0.98, P < 0.001 for medulla). Those tFOV-DW images rated by the radiologists exhibit superior performance in terms of all assessed measures (P < 0.05), and interobserver agreement was excellent (ICC, 0.78 to 0.92). Besides, the ADC values derived from tFOV-DWI had a satisfactory agreement with those estimated by fFOV-DWI. The animal study demonstrates that the tFOV-DWI strategy provided visually better image quality and lesion depiction than conventional fFOV-DWI for early assessment of AKI.

Renal Functional MRI and Its Application

Renal function varies according to the nature and stage of diseases. Renal functional magnetic resonance imaging (fMRI), a technique considered superior to the most common method used to estimate the glomerular filtration rate, allows for noninvasive, accurate measurements of renal structures and functions in both animals and humans. It has become increasingly prevalent in research and clinical applications. In recent years, renal fMRI has developed rapidly with progress in MRI hardware and emerging postprocessing algorithms. Function-related imaging markers can be acquired via renal fMRI, encompassing water molecular diffusion, perfusion, and oxygenation. This review focuses on the progression and challenges of the main renal fMRI methods, including dynamic contrast-enhanced MRI, blood oxygen level-dependent MRI, diffusion-weighted imaging, diffusion tensor imaging, arterial spin labeling, fat fraction imaging, and their recent clinical applications.

LEVEL OF EVIDENCE

5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:863-881.

Value of intravoxel incoherent motion in assessment of pathological grade of clear cell renal cell carcinoma

Background Intravoxel incoherent motion (IVIM) can provide a unique view of tissue perfusion without the use of exogenous contrast agents. Purpose To investigate the value of IVIM in assessing grades of clear cell renal cell carcinoma (CRCC). Material and Methods A total of 107 patients with pathologically proven CRCC were included, 26 with grade I, 27 with grade II, 25 with grade III, and 29 with grade IV. These tumors were divided into low (I + II) and high grades (III + IV). Nine b values (0, 30, 50, 80, 150, 300, 500, 800, and 1500 s/mm²) were used in diffusion-weighted imaging (DWI). The tissue diffusivity (D), pseudodiffusivity (D*), and perfusion fraction (f) were calculated using bi-exponential fitting of the diffusion data. Results The D values of the four groups were 1.83 ± 0.38, 1.23 ± 0.19, 1.07 ± 0.26, and 0.37 ± 0.11 × 10^-3 mm²/s ( P < 0.05). The D* values of the four groups were 0.079 ± 0.021, 0.053 ± 0.019, 0.047 ± 0.022, and 0.033 ± 0.017 ( P < 0.05). The f values of the four groups were 0.208 ± 0.09, 0.341 ± 0.12, 0.373 ± 0.15, and 0.461 ± 0.17 ( P < 0.05). Both the D and D* values correlated negatively with CRCC grading ( r = -0.677 and -0.693, P < 0.05). The f values correlated positively with CRCC grading (r = 0.699, P < 0.05). The areas of the D, D*, and f values under the ROC curves to diagnose low and high CRCC grades were 0.934, 0.837, and 0.793, respectively. The cutoff values of D, D*, and f were 1.13, 0.056, and 0.376, respectively; the diagnostic performance for low and high CRCC grading had a sensitivity of 82.0%, 80.7%, and 83.2% and a specificity of 90.8%, 86.3%, and 82.6%. Conclusion IVIM may provide information for differentiating CRCC grades.

Technical Note: Diffusion-weighted MRI with minimal distortion in head-and-neck radiotherapy using a turbo spin echo acquisition method

PURPOSE

Diffusion-weighted (DW) MRI, showing high contrast between tumor and background tissue, is a promising technique in radiotherapy for tumor delineation. However, its use for head-and-neck patients is hampered by poor geometric accuracy in conventional echo planar imaging (EPI) DW-MRI. An alternative turbo spin echo sequence, DW-SPLICE, is implemented and demonstrated in patients.

METHODS

The DW-SPLICE sequence was implemented on a 3.0 T system and evaluated in 10 patients. The patients were scanned in treatment position, using a customized head support and immobilization mask. Image distortions were quantified at the gross tumor volume (GTV) using field map analysis. The apparent diffusion coefficient (ADC) was evaluated using an ice water phantom.

RESULTS

The DW images acquired by DW-SPLICE showed no image distortions. Field map analysis at the gross tumor volumes resulted in a median distortion of 0.2 mm for DW-SPLICE, whereas for the conventional method this was 7.2 mm. ADC values, measured using an ice water phantom were in accordance with literature values.

CONCLUSIONS

The implementation of DW-SPLICE allows for diffusion-weighted imaging of patients in treatment position with excellent geometrical accuracy. The images can be used to facilitate target volume delineation in RT treatment planning.

Comparison of Turbo Spin Echo and Echo Planar Imaging for intravoxel incoherent motion and diffusion tensor imaging of the kidney at 3Tesla

Echo Planar Imaging (EPI) is most commonly applied to acquire diffusion-weighted MR-images. EPI is able to capture an entire image in very short time, but is prone to distortions and artifacts. In diffusion-weighted EPI of the kidney severe distortions may occur due to intestinal gas. Turbo Spin Echo (TSE) is robust against distortions and artifacts, but needs more time to acquire an entire image compared to EPI. Therefore, TSE is more sensitive to motion during the readout. In this study we compare diffusion-weighted TSE and EPI of the human kidney with regard to intravoxel incoherent motion (IVIM) and diffusion tensor imaging (DTI). Images were acquired with b-values between 0 and 750s/mm² with TSE and EPI. Distortions were observed with the EPI readout in all volunteers, while the TSE images were virtually distortion-free. Fractional anisotropy of the diffusion tensor was significantly lower for TSE than for EPI. All other parameters of DTI and IVIM were comparable for TSE and EPI. Especially the main diffusion directions yielded by TSE and EPI were similar. The results demonstrate that TSE is a worthwhile distortion-free alternative to EPI for diffusion-weighted imaging of the kidney at 3Tesla.

Evaluation of renal oxygenation change under the influence of carbogen breathing using a dynamic R2 , R2 ' and R2 * quantification approach

The purpose of this study is to demonstrate the feasibility of dynamic renal R₂ /R₂ '/R₂ * measurements based on a method, denoted psMASE-ME, in which a periodic 180° pulse-shifting multi-echo asymmetric spin echo (psMASE) sequence, combined with a moving estimation (ME) strategy, is adopted. Following approval by the institutional animal care and use committee, a block design of respiratory challenge with interleaved air and carbogen (97% O₂ , 3% CO₂ ) breathing was employed in nine rabbits. Parametrical R₂ /R₂ '/R₂ * maps were computed and average R₂ /R₂ '/R₂ * values were measured in regions of interest in the renal medulla and cortex. Bland-Altman plots showed good agreement between the proposed method and reference standards of multi-echo spin echo and multi-echo gradient echo sequences. Renal R₂ , R₂ ' and R₂ * decreased significantly from 16.2 ± 4.4 s^-1 , 9.8 ± 5.2 s^-1 and 25.9 ± 5.0 s^-1 to 14.9 ± 4.4 s^-1 (p < 0.05), 8.5 ± 4.1 s^-1 (p < 0.05) and 23.4 ± 4.8 s^-1 (p < 0.05) in the cortex when switching the gas mixture from room air to carbogen. In the renal medulla, R₂ , R₂ ' and R₂ * also decreased significantly from 12.9 ± 4.7 s^-1 , 15.1 ± 5.8 s^-1 and 27.9 ± 5.3 s^-1 to 11.8 ± 4.5 s^-1 (p < 0.05), 14.2 ± 4.2 s^-1 (p < 0.05) and 25.8 ± 5.1 s^-1 (p < 0.05). No statistically significant differences in relative R₂ , R₂ ' and R₂ * changes were observed between the cortex and medulla (p = 0.72 for R₂ , p = 0.39 for R₂ ' and p = 0.61 for R₂ *). The psMASE-ME method for dynamic renal R₂ /R₂ '/R₂ * measurements, together with the respiratory challenge, has potential use in the evaluation of renal oxygenation in many renal diseases.

An intravoxel oriented flow model for diffusion-weighted imaging of the kidney

By combining intravoxel incoherent motion (IVIM) and diffusion tensor imaging (DTI) we introduce a new diffusion model called intravoxel oriented flow (IVOF) that accounts for anisotropy of diffusion and the flow-related signal. An IVOF model using a simplified apparent flow fraction tensor (IVOFf ) is applied to diffusion-weighted imaging of human kidneys. The kidneys of 13 healthy volunteers were examined on a 3 T scanner. Diffusion-weighted images were acquired with six b values between 0 and 800 s/mm(2) and 30 diffusion directions. Diffusivity and flow fraction were calculated for different diffusion models. The Akaike information criterion was used to compare the model fit of the proposed IVOFf model to IVIM and DTI. In the majority of voxels the proposed IVOFf model with a simplified apparent flow fraction tensor performs better than IVIM and DTI. Mean diffusivity is significantly higher in DTI compared with models that account for the flow-related signal. The fractional anisotropy of diffusion is significantly reduced when flow fraction is considered to be anisotropic. Anisotropy of the apparent flow fraction tensor is significantly higher in the renal medulla than in the cortex region. The IVOFf model describes diffusion-weighted data in the human kidney more accurately than IVIM or DTI. The apparent flow fraction in the kidney proved to be anisotropic.

Diffusion-weighted imaging outside the brain: Consensus statement from an ISMRM-sponsored workshop

The significant advances in magnetic resonance imaging (MRI) hardware and software, sequence design, and postprocessing methods have made diffusion-weighted imaging (DWI) an important part of body MRI protocols and have fueled extensive research on quantitative diffusion outside the brain, particularly in the oncologic setting. In this review, we summarize the most up-to-date information on DWI acquisition and clinical applications outside the brain, as discussed in an ISMRM-sponsored symposium held in April 2015. We first introduce recent advances in acquisition, processing, and quality control; then review scientific evidence in major organ systems; and finally describe future directions. J. Magn. Reson. Imaging 2016;44:521-540.

Multi-institutional validation of a novel textural analysis tool for preoperative stratification of suspected thyroid tumors on diffusion-weighted MRI

PURPOSE

Ultrasound-guided fine needle aspirate cytology fails to diagnose many malignant thyroid nodules; consequently, patients may undergo diagnostic lobectomy. This study assessed whether textural analysis (TA) could noninvasively stratify thyroid nodules accurately using diffusion-weighted MRI (DW-MRI).

METHODS

This multi-institutional study examined 3T DW-MRI images obtained with spin echo echo planar imaging sequences. The training data set included 26 patients from Cambridge, United Kingdom, and the test data set included 18 thyroid cancer patients from Memorial Sloan Kettering Cancer Center (New York, New York, USA). Apparent diffusion coefficients (ADCs) were compared over regions of interest (ROIs) defined on thyroid nodules. TA, linear discriminant analysis (LDA), and feature reduction were performed using the 21 MaZda-generated texture parameters that best distinguished benign and malignant ROIs.

RESULTS

Training data set mean ADC values were significantly different for benign and malignant nodules (P = 0.02) with a sensitivity and specificity of 70% and 63%, respectively, and a receiver operator characteristic (ROC) area under the curve (AUC) of 0.73. The LDA model of the top 21 textural features correctly classified 89/94 DW-MRI ROIs with 92% sensitivity, 96% specificity, and an AUC of 0.97. This algorithm correctly classified 16/18 (89%) patients in the independently obtained test set of thyroid DW-MRI scans.

CONCLUSION

TA classifies thyroid nodules with high sensitivity and specificity on multi-institutional DW-MRI data sets. This method requires further validation in a larger prospective study. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance.

High-resolution diffusion-weighted imaging of the breast with multiband 2D radiofrequency pulses and a generalized parallel imaging reconstruction

PURPOSE

To develop a technique for high-resolution diffusion-weighted imaging (DWI) and to compare it with standard DWI methods.

METHODS

Multiple in-plane bands of magnetization were simultaneously excited by identically phase modulating each subpulse of a two-dimensional (2D) RF pulse. Several excitations with the same multiband pattern progressively shifted in the phase-encode direction were used to cover the prescribed field of view (FOV). The phase-encoded FOV was limited to the width of a single band to reduce off-resonance-induced distortion and blurring. Parallel imaging (PI) techniques were used to resolve aliasing from the other bands and to combine the different excitations. Following validation in phantoms and healthy volunteers, a preliminary study in breast cancer patients (N=14) was performed to compare the proposed method to conventional DWI with PI and to reduced-FOV DWI.

RESULTS

The proposed method gave high-resolution diffusion-weighted images with minimal artifacts at the band intersections. Compared to PI alone, higher phase-encoded FOV-reduction factors and reduced noise amplification were obtained, which translated to higher resolution images than conventional (non-multiband) DWI. The same resolution and image quality achievable over targeted regions using existing reduced-FOV methods was obtained, but the proposed method also enables complete bilateral coverage.

CONCLUSION

We developed an in-plane multiband technique for high-resolution DWI and compared its performance with other standard DWI methods. Magn Reson Med 77:209-220, 2017. © 2016 Wiley Periodicals, Inc.

Quantitative functional MRI in a clinical orthotopic model of pancreatic cancer in immunocompetent Lewis rats

OBJECTIVE

To demonstrate feasibility of performing quantitative MRI measurements in an immuno-competent rat model of pancreatic cancer by comparing in vivo anatomic and quantitative imaging measurements to tumor dissemination observations and histologic assays at necropsy. Meterials and methods: Rat ductal pancreatic adenocarcinoma DSL-6A/C1 cell line and Lewis rats were used for these studies. 10(8) DSL-6A/C1 cells were injected subcutaneously into the right flank of donor rats. Donor tumors reaching 10 mm were excised, and 1 mm(3) tumor fragments were implanted within recipient rat pancreas during mini-laparotomy. T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced (DCE) MRI were performed using a Bruker 7.0T ClinScan. After MRI, all animals underwent autopsy. Primary tumor size was measured, and dissemination score was used to assess local invasion and distant metastasis. Primary tumor and all sites of metastases were harvested and fixed for H&E, Masson's trichrome, and rat anti-CD34 staining. Trichrome slides were scanned and digitized for measurement of fibrotic tissue areas. Anti-CD34 slides were used for microvessel density (MVD) measurements.

RESULTS

Primary tumors, local invasion, and distant metastases were confirmed for all rats. No significant differences were found between in vivo MRI measurements (48.7 ± 5.3 mm) and ex vivo caliper measurements (43.6 ± 3.6 mm) of primary tumor sizes (p > .05). Spleen, liver, diaphragm, peritoneum, and abdominal wall metastases were observed on MRI but smaller lung, mediastinum, omen, and mesentery metastases were only observed at necropsy. Contrast uptake observed during DCE measurements was significantly greater in both primary and metastatic tumor tissues compared to skeletal muscle and normal liver tissues. Both primary and metastatic tumors were hyper-intense in T2-weighted images and hypo-intense in T1-weighted images, but no differences were found between quantitative T2 measurements in primary tumors and that in metastases. Similarly, quantitative ADC measurements were similar for both primary tumor and liver metastases (1.13 ± 0.3 × 10(-3) and 1.24 ± 0.4 × 10(-3) mm(2)/s, respectively). Histologic fibrosis and MVD measurements were similar in primary tumors and metastases.

CONCLUSIONS

Anatomic and quantitative functional MRI measurements are feasible in orthotropic DSL rat model and will permit non-invasive monitoring of tumor responses during longitudinal studies intended to develop new interventional therapies for primary and metastatic disease.

High-resolution diffusion tensor imaging of the human kidneys using a free-breathing, multi-slice, targeted field of view approach

Fractional anisotropy (FA) obtained by diffusion tensor imaging (DTI) can be used to image the kidneys without any contrast media. FA of the medulla has been shown to correlate with kidney function. It is expected that higher spatial resolution would improve the depiction of small structures within the kidney. However, the achievement of high spatial resolution in renal DTI remains challenging as a result of respiratory motion and susceptibility to diffusion imaging artefacts. In this study, a targeted field of view (TFOV) method was used to obtain high-resolution FA maps and colour-coded diffusion tensor orientations, together with measures of the medullary and cortical FA, in 12 healthy subjects. Subjects were scanned with two implementations (dual and single kidney) of a TFOV DTI method. DTI scans were performed during free breathing with a navigator-triggered sequence. Results showed high consistency in the greyscale FA, colour-coded FA and diffusion tensors across subjects and between dual- and single-kidney scans, which have in-plane voxel sizes of 2 × 2 mm(2) and 1.2 × 1.2 mm(2) , respectively. The ability to acquire multiple contiguous slices allowed the medulla and cortical FA to be quantified over the entire kidney volume. The mean medulla and cortical FA values were 0.38 ± 0.017 and 0.21 ± 0.019, respectively, for the dual-kidney scan, and 0.35 ± 0.032 and 0.20 ± 0.014, respectively, for the single-kidney scan. The mean FA between the medulla and cortex was significantly different (p < 0.001) for both dual- and single-kidney implementations. High-spatial-resolution DTI shows promise for improving the characterization and non-invasive assessment of kidney function.

Reliable chemical exchange saturation transfer imaging of human lumbar intervertebral discs using reduced-field-of-view turbo spin echo at 3.0 T

The reduced field-of-view (rFOV) turbo-spin-echo (TSE) technique, which effectively suppresses bowel movement artifacts, is developed for the purpose of chemical exchange saturation transfer (CEST) imaging of the intervertebral disc (IVD) in vivo. Attempts to quantify IVD CEST signals in a clinical setting require high reliability and accuracy, which is often compromised in the conventionally used technique. The proposed rFOV TSE CEST method demonstrated significantly superior reproducibility when compared with the conventional technique on healthy volunteers, implying it is a more reliable measurement. Phantom study revealed a linear relation between CEST signal and glycosaminoglycan (GAG) concentration. The feasibility of detecting IVD degeneration was demonstrated on a healthy volunteer, indicating that the proposed method is a promising tool to quantify disc degeneration.

Grading of uterine cervical cancer by using the ADC difference value and its correlation with microvascular density and vascular endothelial growth factor

OBJECTIVE

To investigate the application value of the ADC(difference) value in evaluating the pathological grade of uterine cervical cancer and to analyse the correlations among microvascular density (MVD), vascular endothelial growth factor (VEGF) expression and maximum ADC(difference) value.

METHODS

Fifty-six patients with uterine cervical cancer were included in this prospective study. All underwent conventional MRI and DWI. MVD and VEGF were evaluated by immunohistochemical staining with anti-CD34 and anti-VEGF, respectively.

RESULTS

Maximum ADC(difference) value and MVD count showed statistical differences among different pathological grades (P < 0.001, P < 0.001). There was a significant positive linear correlation between the maximum ADC(difference) value and pathological tumour grade (P < 0.001), and also between MVD count and pathological tumour grade (P < 0.001). No significant differences were found between the level of VEGF expression and pathological tumour grade (P = 0.222). The maximum ADC(difference) value correlated positively with both the MVD count and the level of VEGF expression (P < 0.001, P < 0.001).

CONCLUSIONS

Quantitative analysis of maximum ADC(difference) value of uterine cervical cancer may represent the grade of tumour differentiation and provide valuable information on tumour microcirculation and perfusion, thus allowing a promising new method of non-invasively assessing the pathological grade, which could serve as a substitution for assessing tumour angiogenesis.

Diffusion-weighted MR imaging for detection of extrahepatic cholangiocarcinoma

OBJECTIVES

To measure the sensitivity of diffusion-weighted imaging (DWI) and determine the most appropriate b value for DWI; to explore the correlation between the apparent diffusion coefficient (ADC) value and the degree of extrahepatic cholangiocarcinoma differentiation.

METHODS

Preoperative diffusion-weighted imaging and magnetic resonance examinations were performed for 31 patients with extrahepatic cholangiocarcinoma. Tumor ADC values were measured, and the signal-to-noise ratio, contrast-to-noise ratio, and signal-intensity ratio between the diffusion-weighted images with various b values as well as the T2-weighted images were calculated. Pathologically confirmed patients were pathologically graded to compare the ADC value with different b values of tumor at different degrees of differentiation, and the results were statistically analyzed by using the Friedman test.

RESULTS

A total of 29 cases of extrahepatic cholangiocarcinoma were detected by DWI. As the b value increased, tumor signal-to-noise ratio and contrast-to-noise ratio between the tumor and normal liver gradually decreased, but the tumor signal-intensity ratio gradually increased. When b=800 s/mm2, contrast-to-noise ratio between tumor and normal liver, tumor signal-intensity ratio, and tumor signal-to-noise ratio of diffusion-weighted images were all higher than those of T2-weighted images; the differences were statistically significant (P<0.05). As the b value increased, the tumor ADC value gradually declined. As the degree of differentiation decreased, the tumor ADC value declined.

CONCLUSION

The b value of 800 s/mm2 was the best in DWI of extrahepatic cholangiocarcinoma; the lesion ADC value declined as the degree of cancerous tissue differentiation decreased.