Keyhole chemical exchange saturation transfer

Amide proton transfer-weighted imaging with a short acquisition time based on a self B0 correction using the turbo spin echo-Dixon method: A phantom study

PURPOSE

Conventional amide proton transfer (APT)-weighted imaging requires a chemical exchange saturation transfer (CEST) sequence with multiple saturation frequency offsets and a B0 correction sequence, plus a long acquisition time that can be reduced by applying the conventional method using CEST images with seven radiation pulses (i.e., the seven-points method). For a further reduction of acquisition times, we propose fast two-dimensional (2D) APT-weighted imaging based on a self B0 correction using the turbo spin echo (TSE)-Dixon method. We conducted a phantom study to investigate the accuracy of TSE-Dixon APT-weighted imaging.

METHODS

We prepared two types of phantoms with six samples for a concentrationdependent evaluation and a pH-dependent evaluation. APT-weighted images were acquired by the conventional, seven-points, and TSE-Dixon methods. Linear regression analyses assessed the dependence between each method's APT signal intensities (SIs) and the concentration or pH. We performed a one-way analysis of variance with Tukey's honestly significant difference post hoc test to compare the APT SIs among the three methods. The agreement of the APT SIs between the conventional and seven-points or TSE-Dixon methods was assessed by a Bland- Altman plot analysis.

RESULTS

The APT SIs of all three acquisition methods showed positive concentration dependence and pH dependence. No significant differences were observed in the APT SIs between the conventional and TSE-Dixon methods at each concentration. The Bland-Altman plot analyses showed that the APT SIs measured with the seven-points method resulted in 0.42% bias and narrow 95% limits of agreement (LOA) (0.93%-0.09%) compared to the conventional method. The APT SIs measured using the TSE-Dixon method showed 0.14% bias and similar 95% LOA (-0.33% to 0.61%) compared with the seven-points method. The APT SIs of all three methods showed positive pH dependence. At each pH, no significant differences in the APT SIs were observed among the methods. Bland-Altman plot analyses showed that the APT SIs measured with the seven-points method resulted in low bias (0.03%) and narrow 95% LOA (-0.30% to 0.36%) compared to the conventional method. The APT SIs measured by the TSE-Dixon method showed slightly larger bias (0.29%) and similar 95% LOA (from -0.15% to 0.72%) compared to those measured by the seven-points method.

CONCLUSION

These results demonstrated that our proposed method has the same concentration dependence and pH dependence as the conventional method and the seven-points method. We thus expect that APT-weighted imaging with less influence of motion can be obtained in clinical examinations.

Accelerating CEST imaging using a model-based deep neural network with synthetic training data

PURPOSE

To develop a model-based deep neural network for high-quality image reconstruction of undersampled multi-coil CEST data.

THEORY AND METHODS

Inspired by the variational network (VN), the CEST image reconstruction equation is unrolled into a deep neural network (CEST-VN) with a k-space data-sharing block that takes advantage of the inherent redundancy in adjacent CEST frames and 3D spatial-frequential convolution kernels that exploit correlations in the x-ω domain. Additionally, a new pipeline based on multiple-pool Bloch-McConnell simulations is devised to synthesize multi-coil CEST data from publicly available anatomical MRI data. The proposed network is trained on simulated data with a CEST-specific loss function that jointly measures the structural and CEST contrast. The performance of CEST-VN was evaluated on four healthy volunteers and five brain tumor patients using retrospectively or prospectively undersampled data with various acceleration factors, and then compared with other conventional and state-of-the-art reconstruction methods.

RESULTS

The proposed CEST-VN method generated high-quality CEST source images and amide proton transfer-weighted maps in healthy and brain tumor subjects, consistently outperforming GRAPPA, blind compressed sensing, and the original VN. With the acceleration factors increasing from 3 to 6, CEST-VN with the same hyperparameters yielded similar and accurate reconstruction without apparent loss of details or increase of artifacts. The ablation studies confirmed the effectiveness of the CEST-specific loss function and data-sharing block used.

CONCLUSIONS

The proposed CEST-VN method can offer high-quality CEST source images and amide proton transfer-weighted maps from highly undersampled multi-coil data by integrating the deep learning prior and multi-coil sensitivity encoding model.

Acquisition sequences and reconstruction methods for fast chemical exchange saturation transfer imaging

Chemical exchange saturation transfer (CEST) imaging is an emerging molecular magnetic resonance imaging (MRI) technique that has been developed and employed in numerous diseases. Based on the unique saturation transfer principle, a family of CEST-detectable biomolecules in vivo have been found capable of providing valuable diagnostic information. However, CEST MRI needs a relatively long scan time due to the common long saturation labeling module and typical acquisition of multiple frequency offsets and signal averages, limiting its widespread clinical applications. So far, a plethora of imaging schemes and techniques has been developed to accelerate CEST MRI. In this review, the key acquisition and reconstruction methods for fast CEST imaging are summarized from a practical and systematic point of view. The first acquisition sequence section describes the major development of saturation schemes, readout patterns, ultrafast z-spectroscopy, and saturation-editing techniques for rapid CEST imaging. The second reconstruction method section lists the important advances of parallel imaging, compressed sensing, sparsity in the z-spectrum, and algorithms beyond the Fourier transform for speeding up CEST MRI.

Joint K-space and Image-space Parallel Imaging (KIPI) for accelerated chemical exchange saturation transfer acquisition

PURPOSE

To develop an auto-calibrated technique by joint K-space and Image-space Parallel Imaging (KIPI) for accelerated CEST acquisition.

THEORY AND METHODS

The KIPI method selects a calibration frame with a low acceleration factor (AF) and auto-calibration signals (ACS) acquired, from which the coil sensitivity profiles and artifact correction maps are calculated after restoring the k-space by GRAPPA. Then the other frames with high AF and without ACS can be reconstructed by SENSE and artifact suppression. The signal leakage due to the T₂ -decay filtering in k-space compromises the SENSE reconstruction, which can be corrected by the artifact suppression algorithm of KIPI. The 2D and 3D imaging experiments were done on the phantom, healthy volunteer, and brain tumor patient with a 3T scanner.

RESULTS

The proposed KIPI method was evaluated by retrospectively undersampled data with variable AFs and compared against existing parallel imaging methods (SENSE/auto, GRAPPA, and ESPIRiT). KIPI enabled CEST frames with random AFs to achieve similar image quality, eliminated the strong aliasing artifacts, and generated significantly smaller errors than the other methods (p < 0.01). The KIPI method permitted an AF up to 12-fold in both phase-encoding and slice-encoding directions for 3D CEST source images, achieving an overall 8.2-fold speedup in scan time.

CONCLUSION

KIPI is a novel auto-calibrated parallel imaging method that enables variable AFs for different CEST frames, achieves a significant reduction in scan time, and does not compromise the accuracy of CEST maps.

Chemical Exchange Saturation Transfer MRI: What Neuro-Oncology Clinicians Need To Know

Chemical exchange saturation transfer (CEST) is a relatively novel magnetic resonance imaging (MRI) technique with an image contrast designed for in vivo measurement of certain endogenous molecules with protons that are exchangeable with water protons, such as amide proton transfer commonly used for neuro-oncology applications. Recent technological advances have made it feasible to implement CEST on clinical grade scanners within practical acquisition times, creating new opportunities to integrate CEST in clinical workflow. In addition, the majority of CEST applications used in neuro-oncology are performed without the use gadolinium-based contrast agents which are another appealing feature of this technique. This review is written for clinicians involved in neuro-oncologic care (nonphysicists) as the target audience explaining what they need to know as CEST makes its way into practice. The purpose of this article is to (1) review the basic physics and technical principles of CEST MRI, and (2) review the practical applications of CEST in neuro-oncology.

Rapid analytical CEST spectroscopy of competitive host-guest interactions using spatial parallelization with a combined approach of variable flip angle, keyhole and averaging (CAVKA)

A serious limitation of high resolution ¹²⁹Xe chemical exchange saturation transfer (CEST) NMR spectroscopy for comparing competitive host-guest interactions from different samples is the long acquisition time due to step-wise encoding of the chemical shift dimension. A method of optimized use of ¹²⁹Xe spin magnetization to enable the accelerated and simultaneous acquisition of CEST spectra from multiple samples or regions in a setup is described. The method is applied to investigate the host-guest system of commercially available cucurbit[7]uril (CB7) and xenon with competing guests: cis-1,4-bis(aminomethyl)cyclohexane, cadaverine, and putrescine. Interactions with the different guests prove that the observed CEST signal is from a CB6 impurity and that CB7 itself does not produce a CEST signal. Instead, rapid interactions between xenon and CB7 manifest in the spectrum as a broad saturation response that could be suppressed by cis-1,4-bis(aminomethyl)cyclohexane. This guest prevents interactions at the CB7 portals. The suggested method represents a type of spectroscopic imaging that is capable of capturing the exchange kinetics information of systems that otherwise suffer from shortened T₂ times and yields multiple spectra for comparing exchange conditions with a reduction of >95% in acquisition time. The spectral quality is sufficient to perform quantitative analysis and quantifications relative to a CB6 standard as well as relative to a known blocker concentration (putrescine) that both reveal an unexpectedly high CB6 impurity of ca. 8%.

Review and consensus recommendations on clinical APT-weighted imaging approaches at 3T: Application to brain tumors

Amide proton transfer-weighted (APTw) MR imaging shows promise as a biomarker of brain tumor status. Currently used APTw MRI pulse sequences and protocols vary substantially among different institutes, and there are no agreed-on standards in the imaging community. Therefore, the results acquired from different research centers are difficult to compare, which hampers uniform clinical application and interpretation. This paper reviews current clinical APTw imaging approaches and provides a rationale for optimized APTw brain tumor imaging at 3 T, including specific recommendations for pulse sequences, acquisition protocols, and data processing methods. We expect that these consensus recommendations will become the first broadly accepted guidelines for APTw imaging of brain tumors on 3 T MRI systems from different vendors. This will allow more medical centers to use the same or comparable APTw MRI techniques for the detection, characterization, and monitoring of brain tumors, enabling multi-center trials in larger patient cohorts and, ultimately, routine clinical use.

A fast and novel method for amide proton transfer-chemical exchange saturation transfer multislice imaging

Amide proton transfer-chemical exchange saturation transfer (APT-CEST) imaging provides important information for the diagnosis and monitoring of tumors. For such analysis, complete coverage of the brain is advantageous, especially when registration is performed with other magnetic resonance (MR) modalities, such as MR spectroscopy (MRS). However, the acquisition of Z-spectra across several slices via multislice imaging may be time-consuming. Therefore, in this paper, we present a new approach for fast multislice imaging, allowing us to acquire 16 slices per frequency offset within 8 s. The proposed fast CEST-EPI sequence employs a presaturation module, which drives the magnetization into the steady-state equilibrium for the first frequency offset. A second module, consisting of a single CEST pulse (for maintaining the steady-state) followed by an EPI acquisition, passes through a loop to acquire multiple slices and adjacent frequency offsets. Thus, the whole Z-spectrum can be recorded much faster than the conventional saturation scheme, which employs a presaturation for each single frequency offset. The validation of the CEST sequence parameters was performed by using the conventional saturation scheme. Subsequently, the proposed and a modified version of the conventional CEST sequence were compared in vitro on a phantom with different T1 times and in vivo on a brain tumor patient. No significant differences between both sequences could be found in vitro. The in vivo data yielded almost identical MTR_asym contrasts for the white and gray matter as well as for tumor tissue. Our results show that the proposed fast CEST-EPI sequence allows for rapid data acquisition and provides similar CEST contrasts as the modified conventional scheme while reducing the scanning time by approximately 50%.

A fast multislice sequence for 3D MRI-CEST pH imaging

Purpose

Chemical exchange saturation transfer MRI can provide accurate pH images, but the slow scan time (due to long saturation periods and multiple offsets sampling) reduce both the volume coverage and spatial resolution capability, hence the possibility to interrogate the heterogeneity in tumors and organs. To overcome these limitations, we propose a fast multislice CEST‐MRI sequence with high pH accuracy and spatial resolution.

Methods

The sequence first uses a long saturation pulse to induce the steady‐state CEST contrast and a second short saturation pulse repeated after each image acquisition to compensate for signal losses based on an uneven irradiation scheme combined with a single‐shot rapid acquisition with refocusing echoes readout. Sequence sensitivity and accuracy in measuring pH was optimized by simulation and assessed by in vitro studies in pH‐varying phantoms. In vivo validation was performed in two applications by acquiring multislice pH images covering the whole tumors and kidneys after iopamidol injection.

Results

Simulated and in vivo data showed comparable contrast efficiency and pH responsiveness by reducing saturation time. The experimental data from a homogeneous, pH‐varying, iopamidol‐containing phantom show that the sequence produced a uniform CEST contrast across slices and accurate values across slices in less than 10 minutes. In vivo measurements allowed us to quantify the 3D pH gradients of tumors and kidneys, with pH ranges comparable with the literature.

Conclusion

The proposed fast multislice CEST‐MRI sequence allows volumetric acquisitions with good pH sensitivity, accuracy, and spatial resolution for several in vivo pH imaging applications.

Accelerating CEST MRI in the mouse brain at 9.4 T by exploiting sparsity in the Z-spectrum domain

PURPOSE

Chemical exchange saturation transfer (CEST) is an MR contrast modality offering an enhanced sensitivity for the detection of dilute metabolites with exchangeable protons. Quantitative analysis requires the acquisition of a number of images (usually between 20 and 50 RF offsets) per Z-spectrum, leading to long acquisition times of the order of 5-40 min in practice. In this work, we explore the possibility of employing sparsity in the Z-spectrum domain (irradiation offset dimension) to provide an accelerated acquisition scheme without compromising the quality of reconstructed CEST spectra.

METHOD AND THEORY

Ex vivo and in vivo data were acquired on an experimental, small animal 9.4 T system. Three different reconstruction methods were tested: k-Z SPARSE, k-Z SLR and k-Z principal component analysis (PCA) using retrospective undersampling with net acceleration factors R = 2, 3, 5. The quality of the reconstructed data was compared with respect to CEST spectra and full magnetization transfer ratio (MTR) asymmetry maps.

RESULTS

In both phantom and in vivo data, CEST spectra and the resulting MTR asymmetry maps were reconstructed without significant deterioration in data quality. For a low acceleration factor (R = 2, 3) all applied methods resulted in similar data quality, while for high acceleration factor (R = 5) only k-Z PCA and k-Z SLR could be used. Loss in spatial resolution was observed in reconstruction with k-Z PCA for all acceleration factors. An example of prospective undersampling with acceleration factor R = 3 and k-Z PCA reconstruction demonstrates improved CEST maps when compared with fully sampled data acquisition with either three times longer scan duration or threefold prolonged acquisition window per frequency offset.

CONCLUSION

The acquisition time of CEST spectra can be significantly accelerated by exploiting the sparsity of the Z-domain. For prospective and retrospective analysis using k-Z PCA, an acceleration factor of up to R = 3 can be used without significant loss in data quality.

Optimization of Keyhole Imaging Parameters for Glutamate Chemical Exchange Saturation Transfer MRI at 7.0 T

PURPOSE

To evaluate the effects of a reference image and keyhole factor (K_f) selections for high-frequency substitution on keyhole imaging technique for applications in glutamate chemical exchange saturation transfer (GluCEST) imaging.

PROCEDURES

The CEST data were obtained using a 7.0 T MRI scanner. We used varied K_f ranges that constituted from 16.67 to 75 % of the full k-space. The reference image was respectively selected for - 3 and + 3 ppm images that associated with the GluCEST calculation and the unsaturated image. The zero-padding algorithm was applied for the missing k-space lines in the low-frequency data collected to compare the results obtained from using the keyhole imaging technique. All the techniques were evaluated using a healthy rat group and extended to the status epilepticus rat group to explore their applicability and usability.

RESULTS

The calculated GluCEST signals and visually inspected results from the reconstructed GluCEST maps indicated that the combination of unsaturated image as a reference image, and over 50 % of K_f showed consistent signals and image quality compared with the fully sampled CEST data.

CONCLUSIONS

Combining the keyhole imaging technique with GluCEST imaging enables stable image reconstruction and quantitative evaluation, and this approach is potentially applicable in various CEST imaging applications.

Fast 3D chemical exchange saturation transfer imaging with variably-accelerated sensitivity encoding (vSENSE)

PURPOSE

To extend the variably-accelerated sensitivity encoding (vSENSE) method from 2D to 3D for fast chemical exchange saturation transfer (CEST) imaging, and prospectively implement it for clinical MRI.

METHODS

The CEST scans were acquired from 7 normal volunteers and 15 brain tumor patients using a 3T clinical scanner. The 2D and 3D "artifact suppression" (AS) vSENSE algorithms were applied to generate sensitivity maps from a first scan acquired with conventional SENSE-accelerated 2D and 3D CEST data. The AS sensitivity maps were then applied to reconstruct the other CEST frames at higher acceleration factors. Both retrospective and prospective acceleration in phase-encoding and slice-encoding dimensions were implemented.

RESULTS

Applying the 2D AS vSENSE algorithm to a 2-fold undersampled 3.5-ppm CEST frame halved the scan time of conventional SENSE, while generating essentially identical reconstruction errors (p ≈ 1.0). The 3D AS vSENSE algorithm permitted prospective acceleration by up to 8-fold, in total, from phase-encoding and slice-encoding directions for individual source CEST images, and an overall speed-up in scan time of 5-fold. The resulting vSENSE-accelerated amide proton transfer-weighted images agreed with conventional 2-fold-accelerated SENSE CEST results in brain tumor patients and healthy volunteers. Importantly, the vSENSE method eliminated unfolding artifacts in the slice-encoding direction that compromised conventional SENSE CEST scans.

CONCLUSION

The vSENSE method can be extended to 3D CEST imaging to provide higher acceleration factors than conventional SENSE without compromising accuracy.

Prospective acceleration of parallel RF transmission-based 3D chemical exchange saturation transfer imaging with compressed sensing

PURPOSE

To develop prospectively accelerated 3D CEST imaging using compressed sensing (CS), combined with a saturation scheme based on time-interleaved parallel transmission.

METHODS

A variable density pseudo-random sampling pattern with a centric elliptical k-space ordering was used for CS acceleration in 3D. Retrospective CS studies were performed with CEST phantoms to test the reconstruction scheme. Prospectively CS-accelerated 3D-CEST images were acquired in 10 healthy volunteers and 6 brain tumor patients with an acceleration factor (R_CS ) of 4 and compared with conventional SENSE reconstructed images. Amide proton transfer weighted (APTw) signals under varied RF saturation powers were compared with varied acceleration factors.

RESULTS

The APTw signals obtained from the CS with acceleration factor of 4 were well-preserved as compared with the reference image (SENSE R = 2) both in retrospective phantom and prospective healthy volunteer studies. In the patient study, the APTw signals were significantly higher in the tumor region (gadolinium [Gd]-enhancing tumor core) than in the normal tissue (p < .001). There was no significant APTw difference between the CS-accelerated images and the reference image. The scan time of CS-accelerated 3D APTw imaging was dramatically reduced to 2:10 minutes (in-plane spatial resolution of 1.8 × 1.8 mm² ; 15 slices with 4-mm slice thickness) as compared with SENSE (4:07 minutes).

CONCLUSION

Compressed sensing acceleration was successfully extended to 3D-CEST imaging without compromising CEST image quality and quantification. The CS-based CEST imaging can easily be integrated into clinical protocols and would be beneficial for a wide range of applications.

APT-weighted MRI: Techniques, current neuro applications, and challenging issues

Amide proton transfer-weighted (APTw) imaging is a molecular MRI technique that generates image contrast based predominantly on the amide protons in mobile cellular proteins and peptides that are endogenous in tissue. This technique, the most studied type of chemical exchange saturation transfer imaging, has been used successfully for imaging of protein content and pH, the latter being possible due to the strong dependence of the amide proton exchange rate on pH. In this article we briefly review the basic principles and recent technical advances of APTw imaging, which is showing promise clinically, especially for characterizing brain tumors and distinguishing recurrent tumor from treatment effects. Early applications of this approach to stroke, Alzheimer's disease, Parkinson's disease, multiple sclerosis, and traumatic brain injury are also illustrated. Finally, we outline the technical challenges for clinical APT-based imaging and discuss several controversies regarding the origin of APTw imaging signals in vivo. Level of Evidence: 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:347-364.

Real-time simultaneous shim and motion measurement and correction in glycoCEST MRI using double volumetric navigators (DvNavs)

PURPOSE

CEST MRI allows for indirect detection of molecules with exchangeable protons, measured as a reduction in water signal because of continuous transfer of saturated protons. CEST requires saturation pulses on the order of a second, as well as repeated acquisitions at different offset frequencies. The resulting extended scan time makes CEST susceptible to subject motion, which introduces field inhomogeneity, shifting offset frequencies and causing distortions in CEST spectra that resemble true CEST effects. This is a particular problem for molecules that resonate close to water, such as hydroxyl group in glycogen. To address this, a technique for real-time measurement and correction of motion and field inhomogeneity is proposed.

METHODS

A CEST sequence was modified to include double volumetric navigators (DvNavs) for real-time simultaneous motion and shim correction. Phantom tests were conducted to investigate the effects of motion and shim changes on CEST quantification and to validate the accuracy of DvNav motion and shim estimates. To evaluate DvNav shim and motion correction in vivo, acquisitions including 5 experimental conditions were performed in the calf muscle of 2 volunteers.

RESULTS

Phantom data show that DvNav-CEST accurately estimates frequency and linear gradient changes because of motion and corrects resulting image distortions. In addition, DvNav-CEST improves CEST quantification in vivo in the presence of motion.

CONCLUSION

The proposed technique allows for real-time simultaneous motion and shim correction with no additional scanning time, enabling accurate CEST quantification even in the presence of motion and field inhomogeneity.

Presaturation Power Adjusted Pulsed CEST: A Method to Increase Independence of Target CEST Signals

Chemical exchange saturation transfer (CEST) imaging has been demonstrated to discuss the concentration changes of amide proton, glutamate, creatine, or glucose measured at 3.5, 3.0, 2.0, and 1.0-1.2 ppm. However, these peaks in z-spectra are quite broad and overlap with each other, and thus, the independence of a CEST signal on any specific metabolite is still open to question. Here, we described whether there was interference among the CEST signals and how these CEST signals behave when the power of the presaturation pulse was changed. Based on these results, further experiments were designed to investigate a method to increase the independence of the CEST signal in both phantoms and animals. The result illustrates a clear interference among CEST signals. A presaturation power adjusted pulsed- (PPAP-) CEST method which was designed based on the exchange rates of the metabolites can be used to remove contributions from other exchanging species in the same sample. Further, the method was shown to improve the independence of the glutamate signal in vivo in the renal medulla in mice. The PPAP-CEST method has the potential to increase the independence of any target CEST signals in vivo by choosing the appropriate combination of pulse amplitudes and durations.

Flip-angle based ratiometric approach for pulsed CEST-MRI pH imaging

Several molecules have been exploited for developing MRI pH sensors based on the chemical exchange saturation transfer (CEST) technique. A ratiometric approach, based on the saturation of two exchanging pools at the same saturation power, or by varying the saturation power levels on the same pool, is usually needed to rule out the concentration term from the pH measurement. However, all these methods have been demonstrated by using a continuous wave saturation scheme that limits its translation to clinical scanners. This study shows a new ratiometric CEST-MRI pH-mapping approach based on a pulsed CEST saturation scheme for a radiographic contrast agent (iodixanol) possessing a single chemical exchange site. This approach is based on the ratio of the CEST contrast effects at two different flip angles combinations (180°/360° and 180°/720°), keeping constant the mean irradiation RF power (B_{avg power}). The proposed ratiometric approach index is concentration independent and it showed good pH sensitivity and accuracy in the physiological range between 6.0 and 7.4.

Clinical applications of chemical exchange saturation transfer (CEST) MRI

Chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) has been developed and employed in multiple clinical imaging research centers worldwide. Selective radiofrequency (RF) saturation pulses with standard 2D and 3D MRI acquisition schemes are now routinely performed, and CEST MRI can produce semiquantitative results using magnetization transfer ratio asymmetry (MTR_asym ) analysis while accounting for B₀ inhomogeneity. Faster clinical CEST MRI acquisition methods and more quantitative acquisition and analysis routines are under development. Endogenous biomolecules with amide, amine, and hydroxyl groups have been detected during clinical CEST MRI studies, and exogenous CEST agents have also been administered to patients. These CEST MRI tools show promise for contributing to assessments of cerebral ischemia, neurological disorders, lymphedema, osteoarthritis, muscle physiology, and solid tumors. This review summarizes the salient features of clinical CEST MRI protocols and critically evaluates the utility of CEST MRI for these clinical imaging applications.

LEVEL OF EVIDENCE

5 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:11-27.

Investigating hydroxyl chemical exchange using a variable saturation power chemical exchange saturation transfer (vCEST) method at 3 T

PURPOSE

To develop a chemical exchange saturation transfer (CEST) scheme sensitive to hydroxyl protons at 3 T. Clinical imaging of hydroxyl moieties can have an impact on osteoarthritis, neuropsychiatric disorders, and cancer.

THEORY

By varying saturation amplitude linearly with frequency offset, the direct water saturation component of the Z-spectrum is flattened and can be subtracted to produce a magnetization transfer ratio difference spectrum (MTRdiff ) that isolates solute resonances. Variable saturation power allows for near optimization of hydroxyl and amine/amide moieties in one Z-spectrum.

METHODS

Phantom studies were used to test vCEST performance in two environments: (1) aqueous single-solute (glycogen, glucose); (2) aqueous multiple solute (glycogen with bovine serum albumin). In vivo vCEST imaging of glycosaminoglycan content in patellar-femoral cartilage was performed in a subject with history of cartilage transplant.

RESULTS

In solutions with overlapping resonances, vCEST resolves separate hydroxyl and amine/amide peaks. CEST hydroxyl signal in cartilage is negligible, but with vCEST, hydroxyl signal ranged from 2 to 5% ppm and showed distinct contrast between lesions and normal appearing cartilage.

CONCLUSION

Introduced a variable saturation amplitude CEST (vCEST) scheme to improve sensitivity to exchangeable hydroxyl moieties at 3 T resulting in detection of hydroxyl in the presence of multiple solutes with overlapping resonances. Magn Reson Med 76:826-837, 2016. © 2015 Wiley Periodicals, Inc.

Chemical exchange saturation transfer (CEST) imaging with fast variably-accelerated sensitivity encoding (vSENSE)

PURPOSE

The widespread clinical use of chemical exchange saturation transfer (CEST) imaging is hampered by relatively long scan times due to its requirement that multiple saturation-offset image frames be acquired. Here, a novel variably-accelerated sensitivity encoding (vSENSE) method is proposed that provides faster CEST acquisition than conventional SENSE.

THEORY AND METHODS

The vSENSE method fully samples one CEST saturation frame, then undersamples the other frames variably. The fully-sampled frame, in conjunction with newly proposed incoherence absorption and artifact suppression strategies, improves the accuracy of sensitivity maps and permits higher acceleration factors for the other undersampled frames than regular SENSE. vSENSE is validated in a phantom, a normal volunteer and eight brain tumor patients at 3 Tesla.

RESULTS

vSENSE with an acceleration factor of four generated a 3-6 times smaller error on average than conventional SENSE (P ≤ 0.02), with acceleration factors of 2-4, as compared with full k-space reconstruction. vSENSE permitted four-fold acceleration for amide proton transfer-weighted images, while regular SENSE could only provide a factor of two. When conventional SENSE is used with vSENSE's variable undersampling pattern, erroneous (∼9%) z-spectra result.

CONCLUSION

The vSENSE method enabled twice the acceleration and generated more accurate images than conventional SENSE. Magn Reson Med 77:2225-2238, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

UCEPR: Ultrafast localized CEST-spectroscopy with PRESS in phantoms and in vivo

PURPOSE

Chemical exchange saturation transfer (CEST) is a contrast mechanism enhancing low-concentration molecules through saturation transfer from their exchangeable protons to bulk water. Often many scans are acquired to form a Z-spectrum, making the CEST method time-consuming. Here, an ultrafast localized CEST-spectroscopy with PRESS (UCEPR) is proposed to obtain the entire Z-spectrum of a voxel using only two scans, significantly accelerating CEST.

THEORY AND METHODS

The approach combines ultrafast nonlocalized CEST spectroscopy with localization using PRESS. A field gradient is applied concurrently with the saturation pulse producing simultaneous saturation of all Z-spectrum frequencies that are also spatially encoded. A readout gradient during data acquisition resolves the spatial dependence of the CEST responses into frequency. UCEPR was tested on a 3T scanner both in phantoms and in vivo.

RESULTS

In phantoms, a fast Z-spectroscopy acquisition of multiple pH-variant iopamidol samples was achieved with four- to seven-fold acceleration as compared to the conventional CEST methods. In vivo, amide proton transfer (APT) in white matter of healthy human brain was measured rapidly in 48 s and with high frequency resolution (≤ 0.2 ppm).

CONCLUSION

Compared with conventional CEST methods, UCEPR has the advantage of rapidly acquiring high-resolution Z-spectra. Potential in vivo applications include ultrafast localized Z-spectroscopy, quantitative, or dynamic CEST studies.

Accelerating chemical exchange saturation transfer (CEST) MRI by combining compressed sensing and sensitivity encoding techniques

PURPOSE

To evaluate the feasibility of accelerated chemical-exchange-saturation-transfer (CEST) imaging using a combination of compressed sensing (CS) and sensitivity encoding (SENSE) at 3 Tesla.

THEORY AND METHODS

Two healthy volunteers and six high-grade glioma patients were recruited. Raw CEST image k-space data were acquired (with varied radiofrequency saturation power levels for the healthy volunteer study), and a sequential CS and SENSE reconstruction (CS-SENSE) was assessed. The MTR_asym (3.5 ppm) signals were compared with varied CS-SENSE acceleration factors.

RESULTS

In the healthy volunteer study, a CS-SENSE acceleration factor of R = 2 × 2 (CS × SENSE) was achieved without compromising the reconstructed MTR_asym (3.5 ppm) image quality. The MTR_asym (3.5 ppm) signals obtained from the CS-SENSE reconstruction with R = 2 × 2 were well preserved compared with the reference image (R = 2 for only SENSE). In the glioma patient study, the MTR_asym (3.5 ppm) signals were significantly higher in the tumor region (Gd-enhancing tumor core) than in the normal-appearing white matter (P < 0.001). There was no significant MTR_asym (3.5 ppm) difference between the reference image and CS-SENSE-reconstructed image in the acceleration factor of R = 2 × 2.

CONCLUSION

Combining the SENSE technique with CS (R = 2 × 2) enables considerable acceleration of CEST image acquisition and potentially has a wide range of clinical applications. Magn Reson Med 77:779-786, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Investigating GluCEST and its specificity for pH mapping at low temperatures

Chemical exchange saturation transfer (CEST) from glutamate to water (GluCEST) is a powerful tool for mapping glutamate concentration and intracellular pH. GluCEST could also be helpful to understand the physiology of lower aquatic vertebrates and invertebrates. Therefore, this study aimed to investigate the GluCEST effect and the exchange rate ksw from amine protons of glutamate to water in a broad range of temperatures (1-37°C) and pH (5.5-8.0). Z-spectra were measured from glutamate solutions at different pH values and temperatures and analysed by numerically solving the Bloch-McConnell equation. As expected, a strong dependence of the GluCEST effect and the determined ksw values on pH and temperature was observed. In addition, a strong dependence of the GluCEST effect on phosphate buffer concentration was confirmed. The in vitro data show that GluCEST is detectable in the whole temperature range, even at 1°C. An interpolation function for the exchange rate ksw was determined for the considered range of temperatures and pH values, showing a bijective relation between the exchange rate and pH at a given temperature. To investigate the specificity of GluCEST imaging at low temperatures, the CEST effect was investigated for several metabolites relevant for CEST imaging of the brain. As an example, the contribution of GluCEST to the total CEST effect at 3 ppm was estimated for zebrafish (Danio rerio). It is shown that also at lower temperatures glutamate is the major contributor to the total CEST effect, particularly if the experimental parameters are optimized.

Highly accelerated chemical exchange saturation transfer (CEST) measurements with linear algebraic modeling

PURPOSE

In clinical studies, compartmental average chemical exchange saturation transfer (CEST) measurements rather than voxel-by-voxel CEST images may suffice for evaluating its diagnostic value. A recently developed method-spectroscopy with linear algebraic modeling, or SLAM-could directly provide compartmental measures with dramatically reduced scan time and optimal signal-to-noise ratios. Here, we test whether SLAM can be adapted to significantly accelerate CEST acquisitions.

THEORY AND METHODS

Conventional anatomical images and raw CEST image k-space data were acquired from seven brain tumor patients. SLAM was applied to the CEST data using acceleration factors of R = 1-45, after segmenting compartments from co-registered images. SLAM-CEST measures were compared with average values from the identical compartments obtained by conventional Fourier transform (FT) CEST.

RESULTS

SLAM generated compartmental average CEST z-spectra that were indistinguishable from conventional FT-CEST for R ≤ 45. SLAM-CEST z-spectra at ±3.5 ppm were highly correlated with FT-CEST measures (r(2)  ≥ 0.98 for R ≤ 9; r ≥ 0.995 for R ≤ 45). The average error of SLAM-CEST versus FT-CEST measures was ≤10% for R ≤ 45, in acquisitions requiring as few as a single k-space phase-encoding step.

CONCLUSION

Applied to patients with brain tumors, SLAM-CEST can yield results that are quantitatively equivalent to conventional CEST up to 45 times faster, which could prove enabling in clinical settings where scan time is limiting. Magn Reson Med 76:136-144, 2016. © 2015 Wiley Periodicals, Inc.

Glycosaminoglycan chemical exchange saturation transfer of lumbar intervertebral discs in patients with spondyloarthritis

PURPOSE

To assess glycosaminoglycan (GAG) content of lumbar intervertebral discs (IVD) in patients with spondyloarthritis (SpA) using glycosaminoglycan chemical exchange saturation transfer (gagCEST).

MATERIALS AND METHODS

Ninety lumbar intervertebral discs of nine patients with SpA and nine age-matched healthy controls (eight patients with ankylosing spondylitis; one patient with spondylitis related to inflammatory bowel disease; mean age: 44.1 ± 14.0 years; range: 27-72 years) were examined with a 3T magnetic resonance imaging (MRI) scanner in this prospective study. The MRI protocol included standard morphological, sagittal T2 -weighted (T2 w) images to assess Pfirrmann score of the five lumbar IVDs (L1 to S1) and biochemical imaging with gagCEST to calculate a region of interest analysis of nucleus pulposus (NP) and annulus fibrosus (AF). Prior to statistical testing of gagCEST effects (MTRasym values in percent) in patients and controls, IVDs were classified according to the Pfirrmann score.

RESULTS

Significantly lower gagCEST values of NP and AF were found in SpA patients compared with healthy volunteers (NP: 1.41% ± 0.41%, P = 0.001; 95% confidence interval, CI [0.600%-2.226%]; AF: 1.19% ± 0.32%, P < 0.001; CI [0.560%-1.822%]) by comparing the differences of the means. Pooled nondegenerative IVDs (Pfirrmann 1 and 2) had significantly lower gagCEST effects in patients suffering from SpA compared with healthy controls in NP (P < 0.001; CI [1.176%-2.337%]) and AF (P < 0.001; CI [0.858%-1.779%]). No significant difference of MTRasym values was found in degenerative IVDs between patients and controls in NP (P = 0.204; CI [-0.504%-2.170%]).

CONCLUSION

GagCEST analysis of morphologically nondegenerative IVDs (Pfirrmann score 1 and 2) in T2 w images demonstrated significantly lower GAG values in patients with spondyloarthritis in NP and AF, possibly representing a depletion of GAG in spondyloarthritis in the absence of morphologic degeneration.

A review of optimization and quantification techniques for chemical exchange saturation transfer MRI toward sensitive in vivo imaging

Chemical exchange saturation transfer (CEST) MRI is a versatile imaging method that probes the chemical exchange between bulk water and exchangeable protons. CEST imaging indirectly detects dilute labile protons via bulk water signal changes following selective saturation of exchangeable protons, which offers substantial sensitivity enhancement and has sparked numerous biomedical applications. Over the past decade, CEST imaging techniques have rapidly evolved owing to contributions from multiple domains, including the development of CEST mathematical models, innovative contrast agent designs, sensitive data acquisition schemes, efficient field inhomogeneity correction algorithms, and quantitative CEST (qCEST) analysis. The CEST system that underlies the apparent CEST-weighted effect, however, is complex. The experimentally measurable CEST effect depends not only on parameters such as CEST agent concentration, pH and temperature, but also on relaxation rate, magnetic field strength and more importantly, experimental parameters including repetition time, RF irradiation amplitude and scheme, and image readout. Thorough understanding of the underlying CEST system using qCEST analysis may augment the diagnostic capability of conventional imaging. In this review, we provide a concise explanation of CEST acquisition methods and processing algorithms, including their advantages and limitations, for optimization and quantification of CEST MRI experiments.

Comparison of biochemical cartilage imaging techniques at 3 T MRI

OBJECTIVE

To prospectively compare chemical-exchange saturation-transfer (CEST) with delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T2 mapping to assess the biochemical cartilage properties of the knee.

METHOD

Sixty-nine subjects were prospectively included (median age, 42 years; male/female = 32/37) in three cohorts: 10 healthy volunteers, 40 patients with clinically suspected cartilage lesions, and 19 patients about 1 year after microfracture therapy. T2 mapping, dGEMRIC, and CEST were performed at a 3 T MRI unit using a 15-channel knee coil. Parameter maps were evaluated using region-of-interest analysis of healthy cartilage, areas of chondromalacia and repair tissue. Differentiation of damaged from healthy cartilage was assessed using receiver-operating characteristic (ROC) analysis.

RESULTS

Chondromalacia grade 2-3 had significantly higher CEST values (P = 0.001), lower dGEMRIC (T1-) values (P < 0.001) and higher T2 values (P < 0.001) when compared to the normal appearing cartilage. dGEMRIC and T2 mapping correlated moderately negative (Spearman coefficient r = -0.56, P = 0.0018) and T2 mapping and CEST moderately positive (r = 0.5, P = 0.007), while dGEMRIC and CEST did not significantly correlate (r = -0.311, P = 0.07). The repair tissue revealed lower dGEMRIC values (P < 0.001) and higher CEST values (P < 0.001) with a significant negative correlation (r = -0.589, P = 0.01), whereas T2 values were not different (P = 0.54). In healthy volunteers' cartilage, CEST and dGEMRIC showed moderate positive correlation (r = 0.56), however not reaching significance (P = 0.09). ROC-analysis demonstrated non-significant differences of T2 mapping vs CEST (P = 0.14), CEST vs dGEMRIC (P = 0.89), and T2 mapping vs dGEMRIC (P = 0.12).

CONCLUSION

CEST is able to detect normal and damaged cartilage and is non-inferior in distinguishing both when compared to dGEMRIC and T2 mapping.

Amide proton transfer-weighted imaging of the head and neck at 3 T: a feasibility study on healthy human subjects and patients with head and neck cancer

The aim of this study was to explore the feasibility and repeatability of amide proton transfer-weighted (APTw) MRI for the head and neck on clinical MRI scanners. Six healthy volunteers and four patients with head and neck tumors underwent APTw MRI scanning at 3 T. The APTw signal was quantified by the asymmetric magnetization transfer ratio (MTRasym) at 3.5 ppm. Z spectra of normal tissues in the head and neck (masseter muscle, parotid glands, submandibular glands and thyroid glands) were analyzed in healthy volunteers. Inter-scan repeatability of APTw MRI was evaluated in six healthy volunteers. Z spectra of patients with head and neck tumors were produced and APTw signals in these tumors were analyzed. APTw MRI scanning was successful for all 10 subjects. The parotid glands showed the highest APTw signal (~7.6% average), whereas the APTw signals in other tissues were relatively moderate. The repeatability of APTw signals from the masseter muscle, parotid gland, submandibular gland and thyroid gland of healthy volunteers was established. Four head and neck tumors showed positive mean APTw ranging from 1.2% to 3.2%, distinguishable from surrounding normal tissues. APTw MRI was feasible for use in the head and neck regions at 3 T. The preliminary results on patients with head and neck tumors indicated the potential of APTw MRI for clinical applications.

Sensitivity enhancement of (Hyper-)CEST image series by exploiting redundancies in the spectral domain

CEST has proven to be a valuable technique for the detection of hyperpolarized xenon-based functionalized contrast agents. Additional information can be encoded in the spectral dimension, allowing the simultaneous detection of multiple different biosensors. However, owing to the low concentration of dissolved xenon in biological tissue, the signal-to-noise ratio (SNR) of Hyper-CEST data is still a critical issue. In this work, we present two techniques aiming to increase SNR by exploiting the typically high redundancy in spectral CEST image series: PCA-based post-processing and sub-sampled acquisition with low-rank reconstruction. Each of them yields a significant SNR enhancement, demonstrating the feasibility of the two approaches. While the first method is directly applicable to proton CEST experiments as well, the second one is particularly beneficial when dealing with hyperpolarized nuclei, since it distributes the non-renewable initial polarization more efficiently over the sampling points. The results obtained are a further step towards the detection of xenon biosensors with spectral Hyper-CEST imaging in vivo.

Ultrafast CEST imaging

We describe a new MR imaging method for the rapid characterization or screening of chemical exchange saturation transfer (CEST) contrast agents. It is based on encoding the chemical shift dimension with an additional gradient as proposed in previous ultrafast CEST spectroscopy approaches, but extends these with imaging capabilities. This allows us to investigate multiple compounds simultaneously with an arbitrary sample tube arrangement. The technique requires a fast multislice readout to ensure the saturation is not lost during data acquisition due to T1 relaxation. We therefore employ radial subsampling, acquiring only 10 projections per CEST image with a 128×128 matrix. To recover the images, we use a heuristic reconstruction algorithm that incorporates low rank and limited object support as prior knowledge. This way, we are able to acquire a spectral CEST data set consisting of 15 saturation offsets more than 16 times faster than compared with conventional CEST imaging.

Non-invasive temperature mapping using temperature-responsive water saturation shift referencing (T-WASSR) MRI

We present a non-invasive MRI approach for assessing the water proton resonance frequency (PRF) shifts associated with changes in temperature. This method is based on water saturation shift referencing (WASSR), a method first developed for assessing B0 field inhomogeneity. Temperature-induced water PRF shifts were determined by estimating the frequency of the minimum intensity of the water direct saturation spectrum at each temperature using Lorentzian line-shape fitting. The change in temperature was then calculated from the difference in water PRF shifts between temperatures. Optimal acquisition parameters were first estimated using simulations and later confirmed experimentally. Results in vitro and in vivo showed that the temperature changes measured using the temperature-responsive WASSR (T-WASSR) were in good agreement with those obtained with MR spectroscopy or phase-mapping-based water PRF measurement methods,. In addition, the feasibility of temperature mapping in fat-containing tissue is demonstrated in vitro. In conclusion, the T-WASSR approach provides an alternative for non-invasive temperature mapping by MRI, especially suitable for temperature measurements in fat-containing tissues.

Amide proton transfer imaging of adult diffuse gliomas: correlation with histopathological grades

BACKGROUND

Amide proton transfer (APT) imaging is a novel molecular MRI technique to detect endogenous mobile proteins and peptides through chemical exchange saturation transfer. We prospectively assessed the usefulness of APT imaging in predicting the histological grade of adult diffuse gliomas.

METHODS

Thirty-six consecutive patients with histopathologically proven diffuse glioma (48.1 ± 14.7 y old, 16 males and 20 females) were included in the study. APT MRI was conducted on a 3T clinical scanner and was obtained with 2 s saturation at 25 saturation frequency offsets ω = -6 to +6 ppm (step 0.5 ppm). δB0 maps were acquired separately for a point-by-point δB0 correction. APT signal intensity (SI) was defined as magnetization transfer asymmetry at 3.5 ppm: magnetization transfer ratio (MTR)asym = (S[-3.5 ppm] - S[+3.5 ppm])/S0. Regions of interest were carefully placed by 2 neuroradiologists in solid parts within brain tumors. The APT SI was compared with World Health Organization grade, Ki-67 labeling index (LI), and cell density.

RESULTS

The mean APT SI values were 2.1 ± 0.4% in grade II gliomas (n = 8), 3.2 ± 0.9% in grade III gliomas (n = 10), and 4.1 ± 1.0% in grade IV gliomas (n = 18). Significant differences in APT intensity were observed between grades II and III (P < .05) and grades III and IV (P < .05), as well as between grades II and IV (P < .001). There were positive correlations between APT SI and Ki-67 LI (P = .01, R = 0.43) and between APT SI and cell density (P < .05, R = 0.38). The gliomas with microscopic necrosis showed higher APT SI than those without necrosis (P < .001).

CONCLUSIONS

APT imaging can predict the histopathological grades of adult diffuse gliomas.

Slice-selective gradient-encoded CEST spectroscopy for monitoring dynamic parameters and high-throughput sample characterization

Chemical Exchange Saturation Transfer (CEST) NMR is an increasingly used technique for generating molecule or microenvironment specific signal contrast. To characterize CEST agents and to extract parameters such as temperature and pH, it is often required to resolve the spectral dimension. This is achieved by recording so called CEST- or z-spectra, where the spectral CEST information is conventionally acquired point by point, leading to long acquisition times. Here, we employ gradient-encoding to substantially accelerate the acquisition process of z-spectra in phantom experiments, reducing it to only two scans. This speedup allows us to monitor dynamic processes such as rapid temperature changes in a PARACEST sample that would be inaccessible with the conventional encoding. Furthermore, we combine the gradient-encoding approach with multi-slice selection, thus reserving one spatial dimension for the simultaneous investigation of heterogeneous PARACEST sample packages within one experiment. Hence, gradient-encoded CEST might be of great use for high-throughput screening of CEST contrast agents.

Characterization of lung cancer by amide proton transfer (APT) imaging: an in-vivo study in an orthotopic mouse model

Amide proton transfer (APT) imaging is one of the chemical exchange saturation transfer (CEST) imaging methods which images the exchange between protons of free tissue water and the amide groups (−NH) of endogenous mobile proteins and peptides. Previous work suggested the ability of APT imaging for characterization of the tumoral grade in the brain tumor. In this study, we tested the feasibility of in-vivo APT imaging of lung tumor and investigated whether the method could differentiate the tumoral types on orthotopic tumor xenografts from two malignant lung cancer cell lines. The results revealed that APT imaging is feasible to quantify lung tumors in the moving lung. The measured APT effect was higher in the tumor which exhibited more active proliferation than the other. The present study demonstrates that APT imaging has the potential to provide a characterization test to differentiate types or grade of lung cancer noninvasively, which may eventually reduce the need invasive needle biopsy or resection for lung cancer.

Osteoarthritis year 2013 in review: imaging

PURPOSE

To review recent original research publications related to imaging of osteoarthritis (OA) and identify emerging trends and significant advances.

METHODS

Relevant articles were identified through a search of the PubMed database using the query terms "OA" in combination with "imaging", "radiography", "MRI", "ultrasound", "computed tomography", and "nuclear medicine"; either published or in press between March 2012 and March 2013. Abstracts were reviewed to exclude review articles, case reports, and studies not focused on imaging using routine clinical imaging measures.

RESULTS

Initial query yielded 932 references, which were reduced to 328 citations following the initial review. MRI (118 references) and radiography (129 refs) remain the primary imaging modalities in OA studies, with fewer reports using computed tomography (CT) (35 refs) and ultrasound (23 refs). MRI parametric mapping techniques remain an active research area (33 refs) with growth in T2*- and T1-rho mapping publications compared to prior years. Although the knee is the major joint studied (210 refs) there is interest in the hip (106 refs) and hand (29 refs). Imaging continues to focus on evaluation of cartilage (173 refs) and bone (119 refs).

CONCLUSION

Imaging plays a major role in OA research with publications continuing along traditional lines of investigation. Translational and clinical research application of compositional MRI techniques is becoming more common driven in part by the availability of T2 mapping data from the Osteoarthritis Initiative (OAI). New imaging techniques continue to be developed with a goal of identifying methods with greater specificity and responsiveness to changes in the joint, and novel functional neuroimaging techniques to study central pain. Publications related to imaging of OA continue to be heavily focused on quantitative and semiquantitative MRI evaluation of the knee with increasing application of compositional MRI techniques in the hip.

Application of chemical exchange saturation transfer (CEST) MRI for endogenous contrast at 7 Tesla

Chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) indirectly images exchangeable solute protons resonating at frequencies different than bulk water. These solute protons are selectively saturated using low bandwidth RF irradiation and saturation is transferred to bulk water protons via chemical exchange, resulting in an attenuation of the measured water proton signal. CEST MRI is an advanced MRI technique with wide application potential due to the ability to examine complex molecular contributions. CEST MRI at high field (7 Tesla [7 T]) will improve the overall results due to increase in signal, T1 relaxation time, and chemical shift dispersion. Increased field strength translates to enhanced quantification of the metabolite of interest, allowing more fundamental studies on underlying pathophysiology. CEST contrast is affected by several tissue properties, such as the concentrations of exchange partners and their rate of proton exchange, whose effects have been examined and explored in this review. We have highlighted the background of CEST MRI, typical implementation strategy, and complications at 7 T.

Nuts and bolts of chemical exchange saturation transfer MRI

Chemical exchange saturation transfer (CEST) has emerged as a novel MRI contrast mechanism that is well suited for molecular imaging studies. This new mechanism can be used to detect small amounts of contrast agent through the saturation of rapidly exchanging protons on these agents, allowing a wide range of applications. CEST technology has a number of indispensable features, such as the possibility of simultaneous detection of multiple 'colors' of agents and of changes in their environment (e.g. pH, metabolites, etc.) through MR contrast. Currently, a large number of new imaging schemes and techniques are being developed to improve the temporal resolution and specificity and to correct for the influence of B0 and B1 inhomogeneities. In this review, the techniques developed over the last decade are summarized with the different imaging strategies and post-processing methods discussed from a practical point of view, including the description of their relative merits for the detection of CEST agents. The goal of the present work is to provide the reader with a fundamental understanding of the techniques developed, and to provide guidance to help refine future applications of this technology. This review is organized into three main sections ('Basics of CEST contrast', 'Implementation' and 'Post-processing'), and also includes a brief Introduction and Summary. The 'Basics of CEST contrast' section contains a description of the relevant background theory for saturation transfer and frequency-labeled transfer, and a brief discussion of methods to determine exchange rates. The 'Implementation' section contains a description of the practical considerations in conducting CEST MRI studies, including the choice of magnetic field, pulse sequence, saturation pulse, imaging scheme, and strategies to separate magnetization transfer and CEST. The 'Post-processing' section contains a description of the typical image processing employed for B0 /B1 correction, Z-spectral interpolation, frequency-selective detection and improvement of CEST contrast maps.

Chemical Exchange Saturation Transfer MR Imaging: Potential Clinical Applications

Chemical exchange saturation transfer (CEST) measurements hold great promise as the next step in magnetization transfer imaging and possibly allow for in vivo quantification of many clinically relevant parameters, including pH, temperature, and amide concentration. Therefore, it is a valuable method to add to the MR imaging toolbox. The aim of this article was to review the methods for the acquisition of CEST data and necessary postprocessing. CEST research is very much a field still in development, and initial explorations in clinical applications are shown to illustrate the potential of CEST as a new contrast mechanism.

CEST: from basic principles to applications, challenges and opportunities

Chemical Exchange Saturation Transfer (CEST) offers a new type of contrast for MRI that is molecule specific. In this approach, a slowly exchanging NMR active nucleus, typically a proton, possessing a chemical shift distinct from water is selectively saturated and the saturated spin is transferred to the bulk water via chemical exchange. Many molecules can act as CEST agents, both naturally occurring endogenous molecules and new types of exogenous agents. A large variety of molecules have been demonstrated as potential agents, including small diamagnetic molecules, complexes of paramagnetic ions, endogenous macromolecules, dendrimers and liposomes. In this review we described the basic principles of the CEST experiment, with emphasis on the similarity to earlier saturation transfer experiments described in the literature. Interest in quantitative CEST has also resulted in the development of new exchange-sensitive detection schemes. Some emerging clinical applications of CEST are described and the challenges and opportunities associated with translation of these methods to the clinical environment are discussed.