Positive visualization of implanted devices with susceptibility gradient mapping using the original resolution

Rapid variable flip angle positive susceptibility contrast imaging for clinical metal seeds

Positive susceptibility contrast imaging (PSCI) based on susceptibility mapping exhibits excellent efficacy for visualizing magnetic resonance (MR)-compatible metallic devices because of their high magnetic susceptibility compared to that of human tissues. However, the long-acquisition time required by the two-dimensional fast spin echo (2D FSE)-based PSCI approach, impedes its practical applications in 3D imaging. In this study, a three-dimensional (3D) susceptibility-based variable flip angle (vFA) FSE sequence was proposed to accelerate data acquisition in the clinical radiotherapy applications of ex vivo and in vivo rapid 3D PSCI for the imaging of metal seeds. Here, the proposed scheme applied a 3D modulated vFA technique for refocused imaging with an extended echo-train sequence for sampling data. The scheme integrated the projection-onto-dipole fields (PDF) to remove the background field and accelerate PSCI by using a compressive sensing framework with a variable-densitysampling mask. The experiments involved some gelatin phantoms, porcine tissues and patients with scapular tumors and brachytherapy seeds. All of the experimental results showed that the proposed scheme could accelerate data acquisition of 3D PSCI at the reduction factors of 2 ∼ 5 while accurately localizing the actual positions of the brachytherapy seeds in the ex vivo and in vivo applications. The results were compared with those of the existing methods, including susceptibility gradient mapping using the original resolution (SUMO) and gradient echo acquisition for superparamagnetic particle (GRASP).

Susceptibility-based MR Imaging of Nitinol Stent

Conventional MR techniques have difficulty to accurately localize the stent position and access the stent restenosis because of the effects of susceptibility and radiofrequency (RF) shielding artifacts caused by stent mesh. Previous studies have demonstrated that a susceptibility-based positive contrast MR method exhibits excellent efficacy for visualizing MR compatible metal devices by taking advantage of their high magnetic susceptibility. However, the method is not evaluated in the visualization of stents. Therefore, the purpose of this study is to prospectively assess whether the susceptibility-based positive contrast method can be used to visualize the nitinol stents, with the comparison of two typical MR positive contrast techniques, i.e., susceptibility gradient mapping using the original resolution (SUMO) and the gradient echo acquisition for super-paramagnetic particles with positive contrast (GRASP). The experiment results showed that the susceptibility-based method provided better visualization and more precise localization of the stent than SUMO and GRASP.

Positive visualization of MR-compatible nitinol stent using a susceptibility-based imaging technique

Background

MR-compatible metallic stents have been widely used for the treatment of arterial occlusive diseases. However, conventional MR techniques have difficulty in accurately localizing the stent position and access the stent restenosis because of the susceptibility and radiofrequency (RF) shielding artifacts caused by the stent mesh. Previous studies have demonstrated that a susceptibility-based positive contrast MR method exhibits excellent efficacy for visualizing MR compatible metal devices. However, the method had not been evaluated in the visualization of stents and for the assessment of stent restenosis.

Methods

The susceptibility-based positive contrast MR method was used to visualize the nitinol stents and assess the stent restenosis by comparing two typical MR positive contrast techniques, i.e., susceptibility gradient mapping using the original resolution (SUMO) and the gradient echo acquisition for super-paramagnetic particles (GRASP) with positive contrast.

Results

Three sets of experiments were respectively performed to investigate the influence of stent orientation and spatial resolution on the susceptibility-based method, and to demonstrate the feasibility of the susceptibility-based method in evaluating the stent restenosis comparing to the two typical MR positive contrast methods, GRASP and SUMO.

Conclusions

The susceptibility-based method provides better visualization and localization of the stent than SUMO and GRASP and has the capability of assessing the stent restenosis.

Differentiating platinum coated brachytherapy seeds and gold fiducial markers with varying off-resonant frequency offsets

PURPOSE

To develop an off-resonant frequency filtered method to selectively differentiate between implanted gold fiducial markers and platinum coated brachytherapy seeds.

MATERIALS AND METHODS

The magnetic susceptibilities for gold fiducial markers and brachytherapy seeds differ in magnitude and also in their signs, resulting in B₀-field inhomogeneity patterns with opposite main lobes. A pulse sequence used to localize brachytherapy seeds with positive contrast, centre-out radial sampling with off-resonance reception (co-RASOR), was used to reconstruct images with a range of off-resonant frequency offsets. The proposed method utilizes two frequency filters to selectively reconstruct maximum intensity projections through band-pass regions where each seed has its maximal localized hyperintensity. Seeds were simulated and then placed in gel and tissue phantoms to validate the technique using orthogonal 2D slices with seeds both parallel and perpendicular to the B₀-field.

RESULTS

Dual-plane 2D co-RASOR sequences were reconstructed off-resonance with applied frequency filters to create two projections displaying each seed, which were then colour-coded to negative and positive frequencies. Phantom validation showed that each seed contains its maximal CNR in opposing frequency regions as predicted. Local maxima can also appear in both negative and positive frequency regions. The relative difference between the signal of each seed and these local maxima ranged from 1.19 to 3.73, and an image threshold was determined in all cases. Tissue validation showed the technique differentiates seeds correctly and is limited by the hyperintensity patterns observed in the co-RASOR method.

CONCLUSIONS

Dual-plane co-RASOR offers sub-millimetre positive contrast from implanted seeds that contain unique off-resonant frequency maxima, which frequency filters can selectively differentiate.

Resolution and registration in dual-plane co-RASOR MR

Magnetic resonance imaging (MRI) has superior soft tissue contrast and lower interobserver variability compared to computed tomography and advances in equipment and pseudo-CT estimation have allowed for MR-only radiation therapy planning. Dedicated MR sequences have been used to localize paramagnetic structures with positive contrast, and most implanted seeds are gold fiducial markers (GFMs). We used a fast, dual-plane co-RASOR sequence to localize implanted GFMs with positive contrast in phantom and tissue to assess their resolution and registration accuracy of registration to CT. Off-resonant reconstructions of co-RASOR images were able to resolve GFMs down to 5 mm apart at 12 cm FOV. No systematic biases were observed by comparing registration of co-RASOR and bSSFP to CT images in an MR-compatible Lego phantom with a set of highly visible known points. The standard deviations of the MR to CT distance errors were  <0.5 mm in all directions. We separated the component due to registration by comparing the two MR sequences, which had a maximum standard deviation of 0.36 mm in the SI-direction. Registration using the positive contrast points in a porcine sample phantom showed increased errors, but co-RASOR still performs acceptably with a target registration error of  <0.75 mm. The dual-plane co-RASOR sequence could then be used for both registration and image tracking when performing MR-only radiation therapy planning.

Effect of pulse sequence parameter selection on signal strength in positive-contrast MRI markers for MRI-based prostate postimplant assessment

PURPOSE

For postimplant dosimetric assessment, computed tomography (CT) is commonly used to identify prostate brachytherapy seeds, at the expense of accurate anatomical contouring. Magnetic resonance imaging (MRI) is superior to CT for anatomical delineation, but identification of the negative-contrast seeds is challenging. Positive-contrast MRI markers were proposed to replace spacers to assist seed localization on MRI images. Visualization of these markers under varying scan parameters was investigated.

METHODS

To simulate a clinical scenario, a prostate phantom was implanted with 66 markers and 86 seeds, and imaged on a 3.0T MRI scanner using a 3D fast radiofrequency-spoiled gradient recalled echo acquisition with various combinations of scan parameters. Scan parameters, including flip angle, number of excitations, bandwidth, field-of-view, slice thickness, and encoding steps were systematically varied to study their effects on signal, noise, scan time, image resolution, and artifacts.

RESULTS

The effects of pulse sequence parameter selection on the marker signal strength and image noise were characterized. The authors also examined the tradeoff between signal-to-noise ratio, scan time, and image artifacts, such as the wraparound artifact, susceptibility artifact, chemical shift artifact, and partial volume averaging artifact. Given reasonable scan time and managable artifacts, the authors recommended scan parameter combinations that can provide robust visualization of the MRI markers.

CONCLUSIONS

The recommended MRI pulse sequence protocol allows for consistent visualization of the markers to assist seed localization, potentially enabling MRI-only prostate postimplant dosimetry.

Positive Contrast MRI Techniques for Visualization of Iron-Loaded Hernia Mesh Implants in Patients

Object

In MRI, implants and devices can be delineated via susceptibility artefacts. To discriminate susceptibility voids from proton-free structures, different positive contrast techniques were implemented. The purpose of this study was to evaluate a pulse sequence-based positive contrast technique (PCSI) and a post-processing susceptibility gradient mapping algorithm (SGM) for visualization of iron loaded mesh implants in patients.

Material and Methods

Five patients with iron-loaded MR-visible inguinal hernia mesh implants were examined at 1.5 Tesla. A gradient echo sequence (GRE; parameters: TR: 8.3ms; TE: 4.3ms; NSA:2; FA:20°; FOV:350mm²) and a PCSI sequence (parameters: TR: 25ms; TE: 4.6ms; NSA:4; FA:20°; FOV:350mm²) with on-resonant proton suppression were performed. SGM maps were calculated using two algorithms. Image quality and mesh delineation were independently evaluated by three radiologists.

Results

On GRE, the iron-loaded meshes generated distinct susceptibility-induced signal voids. PCSI exhibited susceptibility differences including the meshes as hyperintense signals. SGM exhibited susceptibility differences with positive contrast. Visually, the different algorithms presented no significant differences. Overall, the diagnostic value was rated best in GRE whereas PCSI and SGM were barely “sufficient”.

Conclusion

Both “positive contrast” techniques depicted implanted meshes with hyperintense signal. SGM comes without additional acquisition time and can therefore be utilized in every patient.

Quantification of susceptibility change at high-concentrated SPIO-labeled target by characteristic phase gradient recognition

Phase map cross-correlation detection and quantification may produce highlighted signal at superparamagnetic iron oxide nanoparticles, and distinguish them from other hypointensities. The method may quantify susceptibility change by performing least squares analysis between a theoretically generated magnetic field template and an experimentally scanned phase image. Because characteristic phase recognition requires the removal of phase wrap and phase background, additional steps of phase unwrapping and filtering may increase the chance of computing error and enlarge the inconsistence among algorithms. To solve problem, phase gradient cross-correlation and quantification method is developed by recognizing characteristic phase gradient pattern instead of phase image because phase gradient operation inherently includes unwrapping and filtering functions. However, few studies have mentioned the detectable limit of currently used phase gradient calculation algorithms. The limit may lead to an underestimation of large magnetic susceptibility change caused by high-concentrated iron accumulation. In this study, mathematical derivation points out the value of maximum detectable phase gradient calculated by differential chain algorithm in both spatial and Fourier domain. To break through the limit, a modified quantification method is proposed by using unwrapped forward differentiation for phase gradient generation. The method enlarges the detectable range of phase gradient measurement and avoids the underestimation of magnetic susceptibility. Simulation and phantom experiments were used to quantitatively compare different methods. In vivo application performs MRI scanning on nude mice implanted by iron-labeled human cancer cells. Results validate the limit of detectable phase gradient and the consequent susceptibility underestimation. Results also demonstrate the advantage of unwrapped forward differentiation compared with differential chain algorithms for susceptibility quantification at high-concentrated iron accumulation.

Radiotherapy planning using MRI

The use of magnetic resonance imaging (MRI) in radiotherapy (RT) planning is rapidly expanding. We review the wide range of image contrast mechanisms available to MRI and the way they are exploited for RT planning. However a number of challenges are also considered: the requirements that MR images are acquired in the RT treatment position, that they are geometrically accurate, that effects of patient motion during the scan are minimized, that tissue markers are clearly demonstrated, that an estimate of electron density can be obtained. These issues are discussed in detail, prior to the consideration of a number of specific clinical applications. This is followed by a brief discussion on the development of real-time MRI-guided RT.

Imaging and localizing interventional devices by susceptibility mapping using MRI

MRI has been used for imaging interventional procedures with devices such as brachytherapy seeds, biopsy needles, markers, and stents. However, the high susceptibility of these devices leads to signal loss and distortion in the MRI images. Previously, we proposed a method to generate positive contrast of the brachytherapy seeds using a regularized L1 minimization algorithm. In this paper, we further developed and tested the method to image larger interventional devices based on susceptibility mapping. Computer simulations and experiments were performed using phantoms made of platinum wires and titanium needles. The results show that the proposed method provide positive contrast images of devices, therefore improves the visualization and localization of the devices.

A biodistribution and toxicity study of cobalt dichloride-N-acetyl cysteine in an implantable MRI marker for prostate cancer treatment

PURPOSE

C4, a cobalt dichloride-N-acetyl cysteine complex, is being developed as a positive-signal magnetic resonance imaging (MRI) marker to localize implanted radioactive seeds in prostate brachytherapy. We evaluated the toxicity and biodistribution of C4 in rats with the goal of simulating the systemic effects of potential leakage from C4 MRI markers within the prostate.

METHODS AND MATERIALS

9-μL doses (equivalent to leakage from 120 markers in a human) of control solution (0.9% sodium chloride), 1% (proposed for clinical use), and 10% C4 solution were injected into the prostates of male Sprague-Dawley rats via laparotomy. Organ toxicity and cobalt disposition in plasma, tissues, feces, and urine were evaluated.

RESULTS

No C4-related morbidity or mortality was observed in the biodistribution arm (60 rats). Biodistribution was measurable after 10% C4 injection: cobalt was cleared rapidly from periprostatic tissue; mean concentrations in prostate were 163 μg/g and 268 μg/g at 5 and 30 minutes but were undetectable by 60 minutes. Expected dual renal-hepatic elimination was observed, with percentages of injected dose recovered in tissues of 39.0 ± 5.6% (liver), >11.8 ± 6.5% (prostate), and >5.3 ± 0.9% (kidney), with low plasma concentrations detected up to 1 hour (1.40 μg/mL at 5-60 minutes). Excretion in urine was 13.1 ± 4.6%, with 3.1 ± 0.54% recovered in feces by 24 hours. In the toxicity arm, 3 animals died in the control group and 1 each in the 1% and 10% groups from surgical or anesthesia-related complications; all others survived to scheduled termination at 14 days. No C4-related adverse clinical signs or organ toxicity were observed.

CONCLUSION

C4-related toxicity was not observed at exposures at least 10-fold the exposure proposed for use in humans. These data demonstrating lack of systemic toxicity with dual routes of elimination in the event of in situ rupture suggest that C4 warrants further investigation as an MRI marker for prostate brachytherapy.

Selective depiction of susceptibility transitions using Laplace-filtered phase maps

In this work, we aim to demonstrate the ability of Laplace-filtered three-dimensional (3D) phase maps to selectively depict the susceptibility transitions in an object. To realize this goal, it is first shown that both the Laplace derivative of the z component of the static magnetic field in an object and the Laplacian of the corresponding phase distribution may be expected to be zero in regions of constant or linearly varying susceptibility and to be nonzero when there is an abrupt change in susceptibility, for instance, at a single point, a ridge, an interface, an edge or a boundary. Next, a method is presented by which the Laplace derivative of a 3D phase map can be directly extracted from the complex data, without the need for phase unwrapping or subtraction of a reference image. The validity of this approach and of the theory behind it is subsequently demonstrated by simulations and phantom experiments with exactly known susceptibility distributions. Finally, the potential of the Laplace derivative analysis is illustrated by simulations with a Shepp-Logan digital brain phantom and experiments with a gel phantom containing positive and negative focal susceptibility deviations.

Utilizing echo-shifts in k-space for generation of positive contrast in areas with marked susceptibility alterations

A technique for generation of positive contrast near susceptibility alterations utilizing echo-shifts in k-space is introduced, based on altered Larmor-frequencies and resulting phase-shifts accumulating during the echo-time at the site of local magnetic field gradients. 3D gradient-echo raw-data is acquired and weighted with an inverse Hanning filter. The filter partly suppresses central raw-data points, while maintaining outer areas. Reconstruction of the filtered raw-data results in images where pixels with apparent magnetic field gradients are highlighted against homogeneous pixels. Further processing steps are introduced to remove remaining intensities in the homogeneous parts of the filtered image. Feasibility is shown by an agar phantom containing magnetically labeled cells, with concentrations of 25, 50, 100, and 250 cells/μL, and by images of the human head. The technique allows detection of echo-shifted pixels with automatic suppression of magnetically homogeneous parts while keeping post-processing time short. Fewer than four labeled cells per pixel were clearly displayed with positive contrast. Application to the human head shows bright veins and complete suppression of homogeneous regions. The presented technique has high potential for specific detection of low concentrations of labeled cells or susceptibility altered regions in vivo with positive contrast, whereas areas with low spin density are not highlighted.

Monitoring of in vivo function of superparamagnetic iron oxide labelled murine dendritic cells during anti-tumour vaccination

Dendritic cells (DCs) generated in vitro to present tumour antigens have been injected in cancer patients to boost in vivo anti-tumour immune responses. This approach to cancer immunotherapy has had limited success. For anti-tumour therapy, delivery and subsequent migration of DCs to lymph nodes leading to effective stimulation of effector T cells is thought to be essential. The ability to non-invasively monitor the fate of adoptively transferred DCs in vivo using magnetic resonance imaging (MRI) is an important clinical tool to correlate their in vivo behavior with response to treatment. Previous reports of superparamagnetic iron oxides (SPIOs) labelling of different cell types, including DCs, have indicated varying detrimental effects on cell viability, migration, differentiation and immune function. Here we describe an optimised labelling procedure using a short incubation time and low concentration of clinically used SPIO Endorem to successfully track murine DC migration in vivo using MRI in a mouse tumour model. First, intracellular labelling of bone marrow derived DCs was monitored in vitro using electron microscopy and MRI relaxometry. Second, the in vitro characterisation of SPIO labelled DCs demonstrated that viability, phenotype and functions were comparable to unlabelled DCs. Third, ex vivo SPIO labelled DCs, when injected subcutaneously, allowed for the longitudinal monitoring by MR imaging of their migration in vivo. Fourth, the SPIO DCs induced the proliferation of adoptively transferred CD4⁺ T cells but, most importantly, they primed cytotoxic CD8⁺ T cell responses to protect against a B16-Ova tumour challenge. Finally, using anatomical information from the MR images, the immigration of DCs was confirmed by the increase in lymph node size post-DC injection. These results demonstrate that the SPIO labelling protocol developed in this study is not detrimental for DC function in vitro and in vivo has potential clinical application in monitoring therapeutic DCs in patients with cancer.