Diffusion-weighted double-echo steady-state with a three-dimensional cones trajectory for non-contrast-enhanced breast MRI

Rapid whole brain 3D T2 mapping respiratory-resolved Double-Echo Steady State (DESS) sequence with improved repeatability

PURPOSE

To propose a quantitative 3D double-echo steady-state (DESS) sequence that offers rapid and repeatable T2 mapping of the human brain using different encoding schemes that account for respiratory B0 variation.

METHODS

A retrospective self-gating module was firstly implemented into the standard DESS sequence in order to suppress the respiratory artifact via data binning. A compressed-sensing trajectory (CS-DESS) was then optimized to accelerate the acquisition. Finally, a spiral Cartesian encoding (SPICCS-DESS) was incorporated to further disrupt the coherent respiratory artifact. These different versions were compared to a standard DESS sequence (fully DESS) by assessing the T2 distribution and repeatability in different brain regions of eight volunteers at 3 T.

RESULTS

The respiratory artifact correction was determined to be optimal when the data was binned into seven respiratory phases. Compared to the fully DESS, T2 distribution was improved for the CS-DESS and SPICCS-DESS with interquartile ranges reduced significantly by a factor ranging from 2 to 12 in the caudate, putamen, and thalamus regions. In the gray and white matter areas, average absolute test-retest T2 differences across all volunteers were respectively 3.5 ± 2% and 3.1 ± 2.1% for the SPICCS-DESS, 4.6 ± 4.6% and 4.9 ± 5.1% for the CS-DESS, and 15% ± 13% and 7.3 ± 5.6% for the fully DESS. The SPICCS-DESS sequence's acquisition time could be reduced by half (<4 min) while maintaining its efficient T2 mapping.

CONCLUSION

The respiratory-resolved SPICCS-DESS sequence offers rapid, robust, and repeatable 3D T2 mapping of the human brain, which can be especially effective for longitudinal monitoring of cerebral pathologies.

Estimation of effective b-value for a diffusion-weighted double-echo steady-state sequence with bipolar gradients

Diffusion-weighted double-echo steady-state (dwDESS) MRI with bipolar diffusion gradients is a promising candidate to obtain diffusion weighted images (DWI) free of geometric distortions and with low motion sensitivity. However, a wider clinical application of dwDESS is currently hindered as no method is reported to explicitly calculate the effective b-value of the obtained DWI from the diffusion-gradients applied in the sequence. To this end, a previously described signal model was adapted for dwDESS with bipolar diffusion gradients, which allows to estimate an effective b-value, dubbed b'. Evaluation in phantom examinations was performed on a clinical 1.5 T MR system. Experimental results were compared with theoretical predictions, including the apparent diffusion coefficient (ADC) based on b-values from a standard EPI-DWI sequence and ADC' based on the effective b' from the dwDESS sequence. The adapted signal model was able to describe the experimental results, and the obtained values of ADC' were in line with conventional ADC measurements.

Diffusion Tensor Imaging of Peripheral Nerves: Current Status and New Developments

Diffusion tensor imaging (DTI) is an emerging technique for peripheral nerve imaging that can provide information about the microstructural organization and connectivity of these nerves and complement the information gained from anatomical magnetic resonance imaging (MRI) sequences. With DTI it is possible to reconstruct nerve pathways and visualize the three-dimensional trajectory of nerve fibers, as in nerve tractography. More importantly, DTI allows for quantitative evaluation of peripheral nerves by the calculation of several important parameters that offer insight into the functional status of a nerve. Thus DTI has a high potential to add value to the work-up of peripheral nerve pathologies, although it is more technically demanding. Peripheral nerves pose specific challenges to DTI due to their small diameter and DTI's spatial resolution, contrast, location, and inherent field inhomogeneities when imaging certain anatomical locations. Numerous efforts are underway to resolve these technical challenges and thus enable wider acceptance of DTI in peripheral nerve MRI.

Multishot Diffusion-Weighted MRI of the Breasts in the Supine vs. Prone Position

BACKGROUND

Diffusion-weighted imaging (DWI) may allow for breast cancer screening MRI without a contrast injection. Multishot methods improve prone DWI of the breasts but face different challenges in the supine position.

PURPOSE

To establish a multishot DWI (msDWI) protocol for supine breast MRI and to evaluate the performance of supine vs. prone msDWI.

STUDY TYPE

Prospective.

POPULATION

Protocol optimization: 10 healthy women (ages 22-56), supine vs. prone: 24 healthy women (ages 22-62) and five women (ages 29-61) with breast tumors.

FIELD STRENGTH/SEQUENCE

3-T, protocol optimization msDWI: free-breathing (FB) 2-shots, FB 4-shots, respiratory-triggered (RT) 2-shots, RT 4-shots, supine vs. prone: RT 4-shot msDWI, T2-weighted fast-spin echo.

ASSESSMENT

Protocol optimization and supine vs. prone: three observers performed an image quality assessment of sharpness, aliasing, distortion (vs. T2), perceived SNR, and overall image quality (scale of 1-5). Apparent diffusion coefficients (ADCs) in fibroglandular tissue (FGT) and breast tumors were measured.

STATISTICAL TESTS

Effect of study variables on dichotomized ratings (4/5 vs. 1/2/3) and FGT ADCs were assessed with mixed-effects logistic regression. Interobserver agreement utilized Gwet's agreement coefficient (AC). Lesion ADCs were assessed by Bland-Altman analysis and concordance correlation (ρc ). P value <0.05 was considered statistically significant.

RESULTS

Protocol optimization: 4-shots significantly improved sharpness and distortion; RT significantly improved sharpness, aliasing, perceived SNR, and overall image quality. FGT ADCs were not significantly different between shots (P = 0.812), FB vs. RT (P = 0.591), or side (P = 0.574). Supine vs. prone: supine images were rated significantly higher for sharpness, aliasing, and overall image quality. FGT ADCs were significantly higher supine; lesion ADCs were highly correlated (ρc  = 0.92).

DATA CONCLUSION

Based on image quality, supine msDWI outperformed prone msDWI. Lesion ADCs were highly correlated between the two positions, while FGT ADCs were higher in the supine position.

EVIDENCE LEVEL

2.

TECHNICAL EFFICACY

Stage 1.

Characterization of Effects of Compressed Sensing on High Spectral and Spatial Resolution (HiSS) MRI with Comparison to SENSE

High Spectral and Spatial resolution (HiSS) MRI shows high diagnostic performance in the breast. Acceleration methods based on k-space undersampling could allow stronger T2*-based image contrast and/or higher spectral resolution, potentially increasing diagnostic performance. An agar/oil phantom was prepared with water-fat boundaries perpendicular to the readout and phase encoding directions in a breast coil. HiSS MRI was acquired at 3T, at sensitivity encoding (SENSE) acceleration factors R of up to 10, and the R = 1 dataset was used to simulate corresponding compressed sensing (CS) accelerations. Image quality was evaluated by quantifying noise and artifact levels. Effective spatial resolution was determined via modulation transfer function analysis. Dispersion vs. absorption (DISPA) analysis and full width at half maximum (FWHM) quantified spectral lineshape changes. Noise levels remained constant with R for CS but amplified with SENSE. SENSE preserved the spatial resolution of HiSS MRI, while CS reduced it in the phase encoding direction. SENSE showed no effect on FWHM or DISPA markers, while CS increased FWHM. Thus, CS might perform better in noise-limited or geometrically constrained applications, but in geometric configurations specific to breast MRI, spectral analysis might be compromised, decreasing the diagnostic performance of HiSS MRI.

Diffusion Breast MRI: Current Standard and Emerging Techniques

The role of diffusion weighted imaging (DWI) as a biomarker has been the subject of active investigation in the field of breast radiology. By quantifying the random motion of water within a voxel of tissue, DWI provides indirect metrics that reveal cellularity and architectural features. Studies show that data obtained from DWI may provide information related to the characterization, prognosis, and treatment response of breast cancer. The incorporation of DWI in breast imaging demonstrates its potential to serve as a non-invasive tool to help guide diagnosis and treatment. In this review, current technical literature of diffusion-weighted breast imaging will be discussed, in addition to clinical applications, advanced techniques, and emerging use in the field of radiomics.

Inter-Reader Agreement of Diffusion-Weighted Magnetic Resonance Imaging for Breast Cancer Detection: A Multi-Reader Retrospective Study

PURPOSE

In order to evaluate the use of un-enhanced magnetic resonance imaging (MRI) for detecting breast cancer, we evaluated the accuracy and the agreement of diffusion-weighted imaging (DWI) through the inter-reader reproducibility between expert and non-expert readers.

MATERIAL AND METHODS

Consecutive breast MRI performed in a single centre were retrospectively evaluated by four radiologists with different levels of experience. The per-breast standard of reference was the histological diagnosis from needle biopsy or surgical excision, or at least one-year negative follow-up on imaging. The agreement across readers (by inter-reader reproducibility) was examined for each breast examined using Cohen's and Fleiss' kappa (κ) statistics. The Wald test was used to test the difference in inter-reader agreement between expert and non-expert readers.

RESULTS

Of 1131 examinations, according to our inclusion and exclusion criteria, 382 women were included (49.5 ± 12 years old), 40 of them with unilateral mastectomy, totaling 724 breasts. Overall inter-reader reproducibility was substantial (κ = 0.74) for expert readers and poor (κ = 0.37) for non- expert readers. Pairwise agreement between expert readers and non-expert readers was moderate (κ = 0.60) and showed a statistically superior agreement of the expert readers over the non-expert readers (p = 0.003).

CONCLUSIONS

DWI showed substantial inter-reader reproducibility among expert-level readers. Pairwise comparison showed superior agreement of the expert readers over the non-expert readers, with the expert readers having higher inter-reader reproducibility than the non-expert readers. These findings open new perspectives for prospective studies investigating the actual role of DWI as a stand-alone method for un-enhanced breast MRI.