Whole-body magnetic resonance imaging featuring moving table continuous data acquisition with high-precision position feedback

[Prognostic value of cardiovascular MRI in diabetics]

CLINICAL/METHODICAL ISSUE

Despite an increased cardiovascular risk in patients with diabetes mellitus they are a heterogeneous population with very different individual manifestation of diseases; therefore, a profound stratification is recommended.

STANDARD METHODS

Clinical examinations and blood biomarkers are typically used in diabetic patients to determine the risk for developing cardio-cerebrovascular events.

METHODICAL INNOVATIONS

Cardiac as well as whole-body magnetic resonance imaging (MRI) including cardiovascular sequences are established methods for clinical diagnostics. Their significance in predicting the outcome and the corresponding risk stratification for patients with diabetes is becoming increasingly more important based on recent study results.

PERFORMANCE

Late gadolinium enhancement (LGE) in cardiac MRI detects silent myocardial ischemia in up to 30% of diabetic patients, which is associated with a hazard ratio of 3-6 for cardiovascular events. Regional left ventricular wall motion abnormalities and decreased ejection fraction also have a prognostic value in diabetics. Based on whole-body MRI, the vessel score as well as carotid artery stenosis have been evaluated as additional predictors for cardio-cerebrovascular events.

ACHIEVEMENTS

The MRI-based predictors have independent and incremental prognostic value beyond traditional risk stratification for cardio-cerebrovascular events; however, only the comprehensive assessment of whole-body MRI including angiography allows the identification of patients who remain free of cardio-cerebrovascular events over a period of 6 years.

PRACTICAL RECOMMENDATIONS

Cardiac MRI, particularly the detection of LGE, can be recommended for risk stratification of patients with diabetes mellitus. The clinical relevance of the added prognostic value of whole-body MRI needs to be clarified in further studies.

Whole-Body MR Imaging in the German National Cohort: Rationale, Design, and Technical Background

PURPOSE

To detail the rationale, design, and future perspective of implementing whole-body magnetic resonance (MR) imaging in the German National Cohort, a large multicentric population-based study.

MATERIALS AND METHODS

All institutional review boards approved the study, and informed consent is obtained before study enrollment. Participants are enrolled from a random sample of the general population at five dedicated imaging sites among 18 recruitment centers. MR imaging facilities are equipped with identical 3.0-T imager technology and use uniform MR protocols. Imager-specific hardware and software settings remained constant over the study period. On-site and centralized measures of image quality enable monitoring of completeness of the acquisitions and quality of each of the MR sequences. Certified radiologists read all MR imaging studies for presence of incidental findings according to predefined algorithms.

RESULTS

Over a 4-year period, six participants per day are examined at each center, totaling a final imaging cohort of approximately 30 000 participants. The MR imaging protocol is identical for each site and comprises a set of 12 native series to cover neurologic, cardiovascular, thoracoabdominal, and musculoskeletal imaging phenotypes totaling approximately 1 hour of imaging time. A dedicated analysis platform as part of a central imaging core incorporates a thin client-based integrative and modular data handling platform to enable multicentric off-site image reading for incidental findings. Scientific analysis will be pursued on a per-project hypothesis-driven basis.

CONCLUSION

Population-based whole-body MR imaging as part of the German National Cohort will serve to compile a comprehensive image repository, will provide insight into physiologic variants and subclinical disease burden, and has the potential to enable identification of novel imaging biomarkers of risk.

Comparison of a new whole-body continuous-table-movement protocol versus a standard whole-body MR protocol for the assessment of multiple myeloma

OBJECTIVES

To evaluate a whole body (WB) continuous-table-movement (CTM) MR protocol for the assessment of multiple myeloma (MM) in comparison to a step-by-step WB protocol.

METHODS

Eighteen patients with MM were examined at 1.5T using a WB CTM protocol (axial T2-w fs BLADE, T1-w GRE sequence) and a step-by-step WB protocol including coronal/sagittal T1-w SE and STIR sequences as reference. Protocol time was assessed. Image quality, artefacts, liver/spleen assessability, and the ability to depict bone marrow lesions less than or greater than 1 cm as well as diffuse infiltration and soft tissue lesions were rated. Potential changes in the Durie and Salmon Plus stage and the detectability of complications were assessed.

RESULTS

Mean protocol time was 6:38 min (CTM) compared to 24:32 min (standard). Image quality was comparable. Artefacts were more prominent using the CTM protocol (P = 0.0039). Organ assessability was better using the CTM protocol (P < 0.001). Depiction of bone marrow and soft tissue lesions was identical without a staging shift. Vertebral fractures were not detected using the CTM protocol.

CONCLUSIONS

The new protocol allows a higher patient throughput and facilitates the depiction of extramedullary lesions. However, as long as vertebral fractures are not detectable, the protocol cannot be safely used for clinical routine without the acquisition of an additional sagittal sequence.

Whole body MR imaging in diabetes

Diabetes mellitus is a major cardiovascular risk factor and one of the major causes for morbidity and mortality worldwide. Diabetic complications have not only major impact on the quality of life of diabetic patients, but are also potentially life-threatening. Therefore prevention, diagnosis and therapy of these long-term complications are of high importance. However, diagnosis of the variety of complications from diabetes mellitus remains a diagnostic challenge and usually several diagnostic steps are necessary to diagnose or exclude these complications. In the last years whole body magnetic resonance imaging (WB-MRI) including whole body magnetic resonance angiography (WB-MRA) has been introduced for cardiovascular imaging and is now increasingly applied in clinical routine for the workup of patients with cardiovascular disease and for cardiovascular screening. The article summarizes rationales for WB-MRI in diabetes mellitus, technical concepts of disease specific cardiovascular WB-MRI in diabetes mellitus and discusses potential clinical consequences.

Fast dixon-based multisequence and multiplanar MRI for whole-body detection of cancer metastases

PURPOSE

To develop and demonstrate the feasibility of multisequence and multiplanar MRI for whole-body cancer detection.

MATERIALS AND METHODS

Two fast Dixon-based sequences and a diffusion-weighted sequence were used on a commercially available 1.5 T scanner for whole-body cancer detection. The study enrolled 19 breast cancer patients with known metastases and in multistations acquired whole-body axial diffusion-weighted, coronal T2-weighted, axial/sagittal pre- and postcontrast T1-weighted, as well as triphasic abdomen images. Three radiologists subjectively scored Dixon images of each series for overall image quality and fat suppression uniformity on a 4-point scale (1 = poor, 2 = fair, 3 = good, and 4 = excellent).

RESULTS

Eighteen of the 19 patients completed the whole-body MRI successfully. The mean acquisition time and overall patient table time were 46 +/- 3 and 69 +/- 5 minutes, respectively. The average radiologists' scores for overall image quality and fat suppression uniformity were both 3.4 +/- 0.5. The image quality was consistent between patients and all completed whole-body examinations were diagnostically adequate.

CONCLUSION

Whole-body MRI offering essentially all the most optimal tumor-imaging sequences in a typical 1-hour time slot can potentially become an appealing "one-stop-shop" for whole-body cancer imaging.

Whole-body imaging of the musculoskeletal system: the value of MR imaging

In clinical practice various modalities are used for whole-body imaging of the musculoskeletal system, including radiography, bone scintigraphy, computed tomography, magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET-CT). Multislice CT is far more sensitive than radiographs in the assessment of trabecular and cortical bone destruction and allows for evaluation of fracture risk. The introduction of combined PET-CT scanners has markedly increased diagnostic accuracy for the detection of skeletal metastases compared with PET alone. The unique soft-tissue contrast of MRI enables for precise assessment of bone marrow infiltration and adjacent soft tissue structures so that alterations within the bone marrow may be detected before osseous destruction becomes apparent in CT or metabolic changes occur on bone scintigraphy or PET scan. Improvements in hard- and software, including parallel image acquisition acceleration, have made high resolution whole-body MRI clinically feasible. Whole-body MRI has successfully been applied for bone marrow screening of metastasis and systemic primary bone malignancies, like multiple myeloma. Furthermore, it has recently been proposed for the assessment of systemic bone diseases predisposing for malignancy (e.g., multiple cartilaginous exostoses) and muscle disease (e.g., muscle dystrophy). The following article gives an overview on state-of-the-art whole-body imaging of the musculoskeletal system and highlights present and potential future applications, especially in the field of whole-body MRI.

Whole-body magnetic resonance imaging and positron emission tomography-computed tomography in oncology

The advent of positron emission tomography-computed tomography (PET-CT) and whole-body magnetic resonance imaging (WB-MRI) has introduced tumor imaging with a systemic and functional approach compared with established sequential, multimodal diagnostic algorithms.Whole-body PET with [18F]-fluoro-2-desoxy-glucose is a useful imaging procedure for tumor staging and monitoring that can visualize active tumor tissue by detecting pathological glucose metabolism. The combination of PET with the detailed anatomical information of multislice computed tomography as dual-modality scanners has markedly increased lesion localization and diagnostic accuracy compared with both modalities as standalone applications.Hardware innovations, such as the introduction of multi-receiver channel whole-body MRI scanners at 1.5 and, recently, 3 T, combined with acquisition acceleration techniques, have made high-resolution WB-MRI clinically feasible. Now, a dedicated assessment of individual organs with various soft tissue contrast, spatial resolution, and contrast media dynamics can be combined with whole-body anatomical coverage in a multiplanar imaging approach. More flexible protocols (eg, T1-weighted turbo spin-echo and short inversion recovery imaging, dedicated lung imaging or dynamic contrast-enhanced studies of the abdomen) can be performed within 45 minutes.Whole-body magnetic resonance imaging has recently been proposed for tumor screening of asymptomatic individuals, and potentially life-changing diagnoses, such as formerly unknown malignancy, have been reported. However, larger patient cohort studies will have to show the cost efficiency and the clinical effectiveness of such an approach.For initial tumor staging, PET-CT has proved more accurate for the definition of T-stage and lymph node assessment, mainly because of the missing metabolic information in WB-MRI. However, new applications, such as magnetic resonance whole-body diffusion-weighted imaging or lymphotropic contrast agents, may significantly increase sensitivity in near future. Whole-body magnetic resonance imaging has shown advantages for the detection of distant metastatic disease, especially from tumors frequently spreading to the liver or brain and as a whole-body bone marrow screening application. Within this context, WB-MRI is highly accurate for the detection of skeletal metastases and staging of multiple myeloma. This article summarizes recent developments of CT/PET-CT and WB-MRI and highlights their performance within the scope of systemic oncological imaging.

Perspectives for preventive screening with total body MRI

Radiology has started to increasingly recognise its potential for screening with the advent of "whole-body" imaging techniques. This article briefly reviews prerequisites for successful screening, presents a quick summary of single-organ screening with magnetic resonance (MR) imaging, and introduces how this knowledge can be integrated into whole-body MR (wb-MR) screening. MR colonography has demonstrated its potential for screening. Wb-MR in the form of wb-MR angiography has already entered both clinical and screening settings; also, the search for metastases with wb-MR has been evaluated and has performed well when compared with other imaging modalities. But screening a group of healthy subjects requires more than feasibility and high accuracy of the screening test; thus, technical and ethical considerations are also presented. Wb-MR is only at its beginning and will in the near future certainly inspire many new research activities as well as transform the radiological market.

Characterization of NAPL source zone architecture and dissolution kinetics in heterogeneous porous media using magnetic resonance imaging

A direct visualization method using magnetic resonance imaging (MRI) was developed to characterize sand grain size distribution, nonaqueous phase liquid (NAPL) source zone architecture, and aqueous flowpaths in a three-dimensional (3-D) flowcell (26.5 cm x 10.5 cm x 10.5 cm) packed with a heterogeneous distribution of five different sand fractions. All images were acquired at a resolution of 0.1875 cm x 0.1875 cm x 0.225 cm. A 1H image of pore water resolved the heterogeneous permeability field; grain size differences as small as 0.1 mm could be distinguished. A time series of 1H images of water doped with the paramagnetic tracer MnCl2 were acquired and used to obtain voxel-scale breakthrough curves. Water preferentially flowed through coarse sands before NAPL release. After NAPL release, the flow bypassed NAPLzones, and bypassing was more evident for high NAPL saturation zones. A time series of 19F images of NAPL were acquired and used to determine voxel-scale NAPL saturation (Sn) during dissolution. Results show that 93% of NAPL mass was in the coarsest sand, most NAPL was trapped as pools and not as residual ganglia, NAPL saturation increased with depth, and the NAPL dissolution front moved vertically from the top to the bottom of the flowcell during the first 170 pore volumes of waterflushed. NAPL component effluent concentrations initially increased due to the development of flow in zones with decreasing NAPL saturation. Flowpath images suggest that this occurs as NAPL transitions from pools (Sn > 0.15) to residual ganglia. The results highlight the importance of flow bypassing and provide the opportunity to develop more accurate NAPL dissolution models.

DEVELOPMENT OF A WHOLE BODY MAGNETIC RESONANCE IMAGING PROTOCOL IN NORMAL DOGS AND CANINE CANCER PATIENTS

Whole body magnetic resonance imaging (whole body MR imaging) could potentially provide accurate cancer staging as a single imaging modality. This study was done to develop a whole body MR imaging protocol for a 1.5T MR instrument using four normal Beagle dogs (Phase 1) and then to assess the protocol's feasibility in cancer-bearing dogs (Phase II). In Phase I, anesthetized dogs were placed in dorsal recumbency with limbs flexed along the torso. T1, T2, and short tau inversion recovery sequences were acquired by spin echo or fast spin echo, and also using the more rapid single shot fast spin echo and gradient echo pulse sequences. Three large overlapping fields of view (FOV) were used to visualize the entire body and the sagittal and dorsal imaging planes were compared. Relative examination time, image quality, organ visibility and signal intensity were evaluated. Phase I results were used to establish a protocol that balanced image quality with examination time. In Phase II, whole body MR imaging was done on 10 dogs with cancer. Examination times were 60-75 min. Image quality was sufficient for all known lesions to be visualized, including mass lesions, pulmonary infiltrate, and lymphadenomegaly. Skeletal detail was sufficient to visualize known neoplastic lesions of the appendicular skeleton, yet it was suboptimal because of the large FOV and use of the body coil. Additional modifications of a whole body MR imaging protocol and continued technological improvements in MR imaging will further increase its potential for veterinary cancer staging.

Peripheral Vascular Disease: Comparison of Continuous MR Angiography and Conventional MR Angiography—Pilot Study

The aim of this study was to prospectively assess the accuracy of three-dimensional magnetic resonance (MR) angiography for evaluation of stenosis in the peripheral arterial system with a continuous moving table technique, with conventional MR angiography as reference. This study was approved by the local institutional review board; informed consent was obtained. Five healthy male volunteers (mean age, 27 years; range, 24-35 years) and four men and one woman (mean age, 63 years; range, 46-78 years) with peripheral arterial occlusive disease were examined. Images obtained with both techniques showed excellent concordance (Cohen kappa = 0.75). Images obtained with a conventional protocol had higher quality compared with those obtained with the continuous technique (mean, 1.07 +/- 0.25 [standard deviation] vs 1.58 +/- 0.6; P < .05); small vessels appeared sharper on them. For detection of significant stenosis and occlusion, accuracy, sensitivity, and specificity of the continuous technique were 92.8%, 100%, and 89.2%, respectively.

Diagnosis of articular cartilage abnormalities of the knee: prospective clinical evaluation of a 3D water-excitation true FISP sequence

PURPOSE

To prospectively evaluate the accuracy of three-dimensional (3D) water-excitation true fast imaging with steady-state precession (FISP) in the assessment of cartilage abnormalities of the knee, by using surgery as the reference standard.

MATERIALS AND METHODS

The study was approved by the hospital institutional review board. Written informed consent was obtained from all patients. Twenty-nine patients (30 knees) with a mean age of 56 years (range, 18-86 years) were prospectively evaluated with a sagittal 3D true FISP magnetic resonance (MR) sequence. The mean interval between MR imaging and surgery was 1 day (range, 0-9 days). During surgery, the articular surfaces of the knee were evaluated by using a modified Noyes score. The MR images were evaluated by two blinded readers on two separate occasions. Diagnostic performance was evaluated by setting the cutoff for abnormality between grade 1 (intact cartilage surface) and grade 2 (cartilage defects). Statistical methods used included calculation of sensitivity, specificity, and accuracy, with 95% confidence intervals (Wilson score method) and calculation of kappa values with standard errors.

RESULTS

Overall sensitivity, specificity, and accuracy for the two readers and the two evaluations ranged from 56% to 66%, 78% to 93%, and 71% to 75%, respectively. Interobserver agreement was substantial for both the first (kappa = 0.73) and the second (kappa = 0.65) evaluation. Intraobserver agreement was almost perfect (kappa = 0.84) for reader 1 and moderate (kappa = 0.60) for reader 2.

CONCLUSION

The 3D water-excitation true FISP MR sequence allows assessment of the articular cartilage of the knee with moderate-to-high specificity and low-to-moderate sensitivity.

High-resolution continuously acquired peripheral MR angiography featuring partial parallel imaging GRAPPA

Continuously-moving-table MRI, in contrast to traditional multistation techniques, potentially can improve the scan time efficiency of whole-body applications and provide seamless images of an extended field of view (FOV). Contrast-enhanced MR angiography (CE-MRA) in particular requires high spatial resolution and at the same time has rigid scan time constraints due to the limited arterial contrast window. In this study a reconstruction method for continuously acquired 3D data sets during table movement was combined with a self-calibrated partial parallel imaging algorithm (generalized autocalibrating partially parallel acquisitions (GRAPPA)). The method was applied to peripheral CE-MRA and compared with a standard continuously-moving-table MRA protocol. The gain in scan time was used to increase the data acquisition matrix and decrease the slice thickness. The method was evaluated in five healthy volunteers and applied to one patient with peripheral arterial occlusive disease (PAOD). The protocols were intraindividually compared with respect to the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in selected vessel segments, as well as overall vessel depiction. The combination of the continuously-moving-table technique with parallel imaging enabled the acquisition of seamless peripheral 3D MRA with increased resolution and an overall crisper appearance.

Interactive continuously moving table (iCMT) large field-of-view real-time MRI

Continuously moving table (CMT) MRI is a new method that is capable of generating 3D, seamless, large field-of-view (FOV) images by acquiring readouts along the patient superior-inferior axis as the subject is translated through the scanner. For applications that require artifact-free images, such as arterial-phase contrast-enhanced (CE) angiography of the legs, a major challenge is to match the MR data acquisition and patient table motion with the dynamics of blood flow in the region of interest (ROI). Instead of restricting the CMT to predetermined constant table speeds, we adopted a more general approach in which the table motion is decoupled from the phase-encoding order. In our approach the table moves adaptively and in response to operator-provided feedback obtained from viewing real-time preview (or fluoroscopic) images. This interactivity is accomplished by integrating high temporal-spatial resolution encoding of the table position with real-time hybrid-space filling and image reconstruction. Experimental results obtained using our prototype interactive CMT (iCMT) system on a peripheral vascular phantom and five healthy volunteers demonstrate the feasibility of this robust and rapid imaging method for acquiring 3D large-FOV continuous images with patient-specific adaptive table motion profiles.