Feasibility of T2 -weighted turbo spin echo imaging of the human prostate at 7 tesla

Recent Developments in Speeding up Prostate MRI

The increasing incidence of prostate cancer cases worldwide has led to a tremendous demand for multiparametric MRI (mpMRI). In order to relieve the pressure on healthcare, reducing mpMRI scan time is necessary. This review focuses on recent techniques proposed for faster mpMRI acquisition, specifically shortening T2W and DWI sequences while adhering to the PI-RADS (Prostate Imaging Reporting and Data System) guidelines. Speeding up techniques in the reviewed studies rely on more efficient sampling of data, ranging from the acquisition of fewer averages or b-values to adjustment of the pulse sequence. Novel acquisition methods based on undersampling techniques are often followed by suitable reconstruction methods typically incorporating synthetic priori information. These reconstruction methods often use artificial intelligence for various tasks such as denoising, artifact correction, improvement of image quality, and in the case of DWI, for the generation of synthetic high b-value images or apparent diffusion coefficient maps. Reduction of mpMRI scan time is possible, but it is crucial to maintain diagnostic quality, confirmed through radiological evaluation, to integrate the proposed methods into the standard mpMRI protocol. Additionally, before clinical integration, prospective studies are recommended to validate undersampling techniques to avoid potentially inaccurate results demonstrated by retrospective analysis. This review provides an overview of recently proposed techniques, discussing their implementation, advantages, disadvantages, and diagnostic performance according to PI-RADS guidelines compared to conventional methods. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 3.

Improved 1 H body imaging at 10.5 T: Validation and VOP-enabled imaging in vivo with a 16-channel transceiver dipole array

PURPOSE

To increase the RF coil performance and RF management for body imaging at 10.5 T by validating and evaluating a high-density 16-channel transceiver array, implementing virtual observation points (VOPs), and demonstrating specific absorption rate (SAR) constrained imaging in vivo.

METHODS

The inaccuracy of the electromagnetic model of the array was quantified based on B1 + and SAR data. Inter-subject variability was estimated using a new approach based on the relative SAR deviation of different RF shims between human body models. The pTx performance of the 16-channel array was assessed in simulation by comparison to a previously demonstrated 10-channel array. In vivo imaging of the prostate was performed demonstrating SAR-constrained static RF shimming and acquisition modes optimized for refocused echoes (AMORE).

RESULTS

The model inaccuracy of 29% and the inter-subject variability of 85% resulted in a total safety factor of 1.91 for pelvis studies. For renal and cardiac imaging, inter-subject variabilities of 121% and 141% lead to total safety factors of 2.25 and 2.45, respectively. The shorter wavelength at 10.5 T supported the increased element density of the 16-channel array which in turn outperformed the 10-channel version for all investigated metrics. Peak 10 g local SAR reduction of more than 25% without a loss of image quality was achieved in vivo, allowing a theoretical improvement in measurement efficiency of up to 66%.

CONCLUSIONS

By validating and characterizing a 16-channel dipole transceiver array, this work demonstrates, for the first time, a VOP-enabled RF coil for human torso imaging enabling increased pTx performance at 10.5 T.

Ultra-high-field MR in Prostate cancer: Feasibility and Potential

Multiparametric MRI of the prostate at clinical magnetic field strengths (1.5/3 Tesla) has emerged as a reliable noninvasive imaging modality for identifying clinically significant cancer, enabling selective sampling of high-risk regions with MRI-targeted biopsies, and enabling minimally invasive focal treatment options. With increased sensitivity and spectral resolution, ultra-high-field (UHF) MRI (≥ 7 Tesla) holds the promise of imaging and spectroscopy of the prostate with unprecedented detail. However, exploiting the advantages of ultra-high magnetic field is challenging due to inhomogeneity of the radiofrequency field and high local specific absorption rates, raising local heating in the body as a safety concern. In this work, we review various coil designs and acquisition strategies to overcome these challenges and demonstrate the potential of UHF MRI in anatomical, functional and metabolic imaging of the prostate and pelvic lymph nodes. When difficulties with power deposition of many refocusing pulses are overcome and the full potential of metabolic spectroscopic imaging is used, UHF MR(S)I may aid in a better understanding of the development and progression of local prostate cancer. Together with large field-of-view and low-flip-angle anatomical 3D imaging, 7 T MRI can be used in its full strength to characterize different tumor stages and help explain the onset and spatial distribution of metastatic spread.

The role of novel imaging in prostate cancer focal therapy: treatment and follow-up

PURPOSE OF REVIEW

Multiparametric magnetic resonance imaging (mpMRI) has fundamentally changed how intraprostatic lesions are visualized, serving as a highly sensitive means for detecting clinically significant prostate cancer (csPCa) via image-targeted biopsy. However, limitations associated with mpMRI have led to the development of new imaging technologies with the goal of better characterizing intraprostatic disease burden to more accurately guide treatment planning and surveillance for prostate cancer focal therapy. Herein, we review several novel imaging modalities with an emphasis on clinical data reported within the past two years.

RECENT FINDINGS

7T MRI, artificial intelligence applied to mpMRI, positron emission tomography combined with either computerized tomography or MRI, contrast-enhanced ultrasound, and micro-ultrasound are novel imaging modalities with the potential to further improve intraprostatic lesion localization for applications in focal therapy for prostate cancer. Many of these technologies have demonstrated equivalent or favorable diagnostic accuracy compared to contemporary mpMRI for identifying csPCa and some have even shown improved capabilities to define lesion borders, to provide volumetric estimates of lesions, and to assess the adequacy of focal ablation of planned treatment zones.

SUMMARY

Novel imaging modalities with capabilities to better characterize intraprostatic lesions have the potential to improve accuracy in treatment planning, real-time assessment of the ablation zone, and posttreatment surveillance; however, many of these technologies require further validation to determine their clinical utility.

Future perspective of focal therapy for localized prostate cancer

Objective

To summarize the recent literature discussing focal therapy for localized prostate cancer.

Methods

A thorough literature review was performed using PubMed to identify recent studies involving focal therapy for the treatment of localized prostate cancer.

Results

In an effort to decrease the morbidity associated with prostate cancer treatment, many urologists are turning to focal therapy as an alternative treatment option. With this approach, the cancer bearing portion of the prostate is targeted while leaving the benign tissue untouched. Multiparametric magnetic resonance imaging remains the gold standard for visualization during focal therapy, but new imaging modalities such as prostate specific membrane antigen/positron emission tomography and contrast enhanced ultrasound are being investigated. Furthermore, several biomarkers, such as prostate cancer antigen 3 and prostate health index, are used in conjunction with imaging to improve risk stratification prior to focal therapy. Lastly, there are several novel technologies such as nanoparticles and transurethral devices that are under investigation for use in focal therapy.

Conclusion

Focal therapy is proving to be a promising option for the treatment of localized prostate cancer. However, further study is needed to determine the true efficacy of these exciting new technologies.

7 Tesla and Beyond: Advanced Methods and Clinical Applications in Magnetic Resonance Imaging

ABSTRACT

Ultrahigh magnetic fields offer significantly higher signal-to-noise ratio, and several magnetic resonance applications additionally benefit from a higher contrast-to-noise ratio, with static magnetic field strengths of B0 ≥ 7 T currently being referred to as ultrahigh fields (UHFs). The advantages of UHF can be used to resolve structures more precisely or to visualize physiological/pathophysiological effects that would be difficult or even impossible to detect at lower field strengths. However, with these advantages also come challenges, such as inhomogeneities applying standard radiofrequency excitation techniques, higher energy deposition in the human body, and enhanced B0 field inhomogeneities. The advantages but also the challenges of UHF as well as promising advanced methodological developments and clinical applications that particularly benefit from UHF are discussed in this review article.

Progress in Imaging the Human Torso at the Ultrahigh Fields of 7 and 10.5 T

Especially after the launch of 7 T, the ultrahigh magnetic field (UHF) imaging community achieved critically important strides in our understanding of the physics of radiofrequency interactions in the human body, which in turn has led to solutions for the challenges posed by such UHFs. As a result, the originally obtained poor image quality has progressed to the high-quality and high-resolution images obtained at 7 T and now at 10.5 T in the human torso. Despite these tremendous advances, work still remains to further improve the image quality and fully capitalize on the potential advantages UHF has to offer.

First in-vivo human imaging at 10.5T: Imaging the body at 447 MHz

PURPOSE

To investigate the feasibility of imaging the human torso and to evaluate the performance of several radiofrequency (RF) management strategies at 10.5T.

METHODS

Healthy volunteers were imaged on a 10.5T whole-body scanner in multiple target anatomies, including the prostate, hip, kidney, liver, and heart. Phase-only shimming and spoke pulses were used to demonstrate their performance in managing the B 1 + inhomogeneity present at 447 MHz. Imaging protocols included both qualitative and quantitative acquisitions to show the feasibility of imaging with different contrasts.

RESULTS

High-quality images were acquired and demonstrated excellent overall contrast and signal-to-noise ratio. The experimental results matched well with predictions and suggested good translational capabilities of the RF management strategies previously developed at 7T. Phase-only shimming provided increased efficiency, but showed pronounced limitations in homogeneity, demonstrating the need for the increased degrees of freedom made possible through single- and multispoke RF pulse design.

CONCLUSION

The first in-vivo human imaging was successfully performed at 10.5T using previously developed RF management strategies. Further improvement in RF coils, transmit chain, and full integration of parallel transmit functionality are needed to fully realize the benefits of 10.5T.

A multitransmit external body array combined with a 1 H and 31 P endorectal coil to enable a multiparametric and multimetabolic MRI examination of the prostate at 7T

Purpose

In vivo¹H and ³¹P magnetic resonance spectroscopic imaging (MRSI) provide complementary information on the biology of prostate cancer. In this work we demonstrate the feasibility of performing multiparametric imaging (mpMRI) and ¹H and ³¹P spectroscopic imaging of the prostate using a ³¹P and ¹H endorectal radiofrequency coil (ERC) in combination with a multitransmit body array at 7 Tesla (T).

Methods

An ERC with a ³¹P transceiver loop coil and ¹H receive (Rx) asymmetric microstrip (³¹P/¹H ERC) was designed, constructed and tested in combination with an external 8‐channel ¹H transceiver body array coil (8CH). Electromagnetic field simulations and measurements and in vivo temperature measurements of the ERC were performed for safety validation. In addition, the signal‐to‐noise (SNR) benefit of the ¹H microstrip with respect to the 8CH was evaluated. Finally, the feasibility of the setup was tested in one volunteer and three patients with prostate cancer by performing T₂‐weighted and diffusion‐weighted imaging in combination with ¹H and ³¹P spectroscopic imaging.

Results

Electromagnetic field simulations of the ³¹P loop coil showed no differences in the E‐ and B‐fields of the ³¹P/¹H ERC compared with a previously safety validated ERC without ¹H microstrip. The hotspot of the specific absorption rate (SAR) at the feed point of the ³¹P/¹H ERC loop coil was 9.42 W/kg when transmitting on ³¹P at 1 W. Additional in vivo measurements showed a maximum temperature increase at the SAR hotspot of 0.7°C over 6 min on ³¹P at 1.9 W transmit (Tx) power, indicating safe maximum power levels. When transmitting with the external ¹H body array at 40W for 2:30 min, the temperature increase around the ERC was < 0.3°C. Up to 3.5 cm into the prostate the ¹H microstrip of the ERC provided higher SNR than the 8CH. The total coil combination allowed acquisition of an mpMRI protocol and the assessment of ³¹P and ¹H metabolites of the prostate in all test subjects.

Conclusion

We developed a setup with a ³¹P transceiver and ¹H Rx endorectal coil in combination with an 8‐channel transceiver external body array coil and demonstrated its safety and feasibility for obtaining multiparametric imaging and ¹H and ³¹P MRSI at 7T in patients with prostate cancer within one MR examination.

Evolution of UHF Body Imaging in the Human Torso at 7T: Technology, Applications, and Future Directions

The potential value of ultrahigh field (UHF) magnetic resonance imaging (MRI) and spectroscopy to biomedical research and in clinical applications drives the development of technologies to overcome its many challenges. The increased difficulties of imaging the human torso compared with the head include its overall size, the dimensions and location of its anatomic targets, the increased prevalence and magnitude of physiologic effects, the limited availability of tailored RF coils, and the necessary transmit chain hardware. Tackling these issues involves addressing notoriously inhomogeneous transmit B1 (B1) fields, limitations in peak B1, larger spatial variations of the static magnetic field B0, and patient safety issues related to implants and local RF power deposition. However, as research institutions and vendors continue to innovate, the potential gains are beginning to be realized. Solutions overcoming the unique challenges associated with imaging the human torso are reviewed as are current studies capitalizing on the benefits of UHF in several anatomies and applications. As the field progresses, strategies associated with the RF system architecture, calibration methods, RF pulse optimization, and power monitoring need to be further integrated into the MRI systems making what are currently complex processes more streamlined. Meanwhile, the UHF MRI community must seize the opportunity to build upon what have been so far proof of principle and feasibility studies and begin to further explore the true impact in both research and the clinic.

Comparing signal-to-noise ratio for prostate imaging at 7T and 3T

BACKGROUND

In MRI, the signal-to-noise ratio (SNR) theoretically increases with B0 field strength. However, because of attenuation of the radiofrequency (RF) fields at 7T, it is not certain if this SNR gain can be realized for prostate imaging.

PURPOSE/HYPOTHESIS

To investigate the SNR gain in prostate imaging at 7T as compared with 3T. It is expected that SNR will improve for prostate imaging at 7T compared with 3T.

STUDY TYPE

Prospective.

SUBJECTS

Four healthy volunteers and one prostate cancer patient.

FIELD STRENGTH/SEQUENCE

All subjects were scanned at 3T and at 7T using optimal coil setups for both field strengths. For all volunteers, proton density-weighted images were acquired for SNR analysis and actual flip angle imaging (AFI) B 1 + | maps were acquired for correction of measured SNR values. In the patient, a T2 -weighted (T2 w) image was acquired at 3T and at 7T.

ASSESSMENT

SNR was calculated in the prostate region for all volunteers. SNR was normalized for flip angle, receiver bandwidth, and voxel volume. SNR was also calculated for different sensitivity encoding (SENSE) acceleration factors.

STATISTICAL TESTING

SNR values are represented as the arithmetic mean of SNR values in the prostate. Estimated SNR in the T2 w image is calculated as the arithmetic mean of the signal intensity (SI) divided by the standard deviation of the SI in a specified zone. Tumor-to-tissue contrast is calculated as (SItumor +SIzone )/( SItumor -SIzone ).

RESULTS

An increase in SNR ranging from 1.7-fold to 2.8-fold was measured in the prostate at 7T in comparison to 3T for four volunteers. At 7T, it is possible to achieve a 4-fold SENSE acceleration in the left-right direction with similar SNR to a nonaccelerated 3T image. T2 w imaging was done at 3T and 7T in one patient, where improved tumor-to-tissue contrast was demonstrated at 7T.

DATA CONCLUSION

SNR improves for prostate imaging at 7T as compared with 3T.

LEVEL OF EVIDENCE

2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:1446-1455.

Homogeneous B1+ for bilateral breast imaging at 7 T using a five dipole transmit array merged with a high density receive loop array

To explore the use of five meandering dipole antennas in a multi-transmit setup, combined with a high density receive array for breast imaging at 7 T for improved penetration depth and more homogeneous B₁ field. Five meandering dipole antennas and 30 receiver loops were positioned on two cups around the breasts. Finite difference time domain simulations were performed to evaluate RF safety limits of the transmit setup. Scattering parameters of the transmit setup and coupling between the antennas and the detuned loops were measured. In vivo parallel imaging performance was investigated for various acceleration factors. After RF shimming, a B₁ map, a T₁ -weighted image, and a T₂ -weighted image were acquired to assess B₁ efficiency, uniformity in contrast weighting, and imaging performance in clinical applications. The maximum achievable local SAR_10g value was 7.0 W/kg for 5 × 1 W accepted power. The dipoles were tuned and matched to a maximum reflection of -11.8 dB, and a maximum inter-element coupling of -14.2 dB. The maximum coupling between the antennas and the receive loops was -18.2 dB and the mean noise correlation for the 30 receive loops 7.83 ± 8.69%. In vivo measurements showed an increased field of view, which reached to the axilla, and a high transmit efficiency. This coil enabled the acquisition of T₁ -weighted images with a high spatial resolution of 0.7 mm³ isotropic and T₂ -weighted spin echo images with uniformly weighted contrast.

Pros and cons of ultra-high-field MRI/MRS for human application

Magnetic resonance imaging and spectroscopic techniques are widely used in humans both for clinical diagnostic applications and in basic research areas such as cognitive neuroimaging. In recent years, new human MR systems have become available operating at static magnetic fields of 7 T or higher (≥300 MHz proton frequency). Imaging human-sized objects at such high frequencies presents several challenges including non-uniform radiofrequency fields, enhanced susceptibility artifacts, and higher radiofrequency energy deposition in the tissue. On the other side of the scale are gains in signal-to-noise or contrast-to-noise ratio that allow finer structures to be visualized and smaller physiological effects to be detected. This review presents an overview of some of the latest methodological developments in human ultra-high field MRI/MRS as well as associated clinical and scientific applications. Emphasis is given to techniques that particularly benefit from the changing physical characteristics at high magnetic fields, including susceptibility-weighted imaging and phase-contrast techniques, imaging with X-nuclei, MR spectroscopy, CEST imaging, as well as functional MRI. In addition, more general methodological developments such as parallel transmission and motion correction will be discussed that are required to leverage the full potential of higher magnetic fields, and an overview of relevant physiological considerations of human high magnetic field exposure is provided.

Design of a forward view antenna for prostate imaging at 7 T

PURPOSE

To design a forward view antenna for prostate imaging at 7 T, which is placed between the legs of the subject in addition to a dipole array.

MATERIALS AND METHODS

The forward view antenna is realized by placing a cross-dipole antenna at the end of a small rectangular waveguide. Quadrature drive of the cross-dipole can excite a circularly polarized wave propagating along the axial direction to and from the prostate region. Functioning of the forward view antenna is validated by comparing measurements and simulations. Antenna performance is evaluated by numerical simulations and measurements at 7 T.

RESULTS

Simulations of B₁⁺ on a phantom are in good correspondence with measurements. Simulations on a human model indicate that the signal-to-noise ratio (SNR), specific absorption rate (SAR) efficiency and SAR increase when adding the forward view antenna to a previously published dipole array. The SNR increases by up to 18% when adding the forward view antenna as a receive antenna to an eight-channel dipole array in vivo.

CONCLUSIONS

A design for a forward view antenna is presented and evaluated. SNR improvements up to 18% are demonstrated when adding the forward view antenna to a dipole array.

Focal therapy for prostate cancer: concepts and future directions

PURPOSE OF REVIEW

To present a perspective on the current status and future directions of focal therapy for prostate cancer (PCa).

RECENT FINDINGS

Focal therapy for localized PCa is a rapidly evolving field. Various recent concepts - the index lesion driving prognosis, the enhanced detection of clinically significant PCa using multiparametric MRI and targeted biopsy, improved risk-stratification using novel blood/tissue biomarkers, the recognition that reducing radical treatment-related morbidity (along with reducing pathologic progression) is a clinically meaningful end-point - have all led to a growing interest in focal therapy. Novel focal therapy modalities are being investigated, mostly in phase 1 and 2 studies. Recently, level I prospective randomized data comparing partial gland ablation with a standard-of-care treatment became available from one study. Recent developments in imaging, including 7-T MRI, functional imaging, radiomics and contrast-enhanced ultrasound show early promise. We also discuss emerging concepts in patient selection for focal therapy.

SUMMARY

PCa focal therapy has evolved considerably in the recent few years. Overall, these novel focal therapy treatments demonstrate safety and feasibility, low treatment-related toxicity and acceptable short-term and in some cases medium-term oncologic outcomes. As imaging techniques evolve, patient selection, detection of clinically significant PCa and noninvasive assessment of therapeutic efficacy will be further optimized. The aspirational goal of achieving oncologic control while reducing radical treatment-related morbidity will drive further innovation in the field.

Feasibility of Multiparametric Magnetic Resonance Imaging of the Prostate at 7 T

OBJECTIVES

The aim of this study was to evaluate the technical feasibility of prostate multiparametric magnetic resonance imaging (mpMRI) at a magnetic field strength of 7 T.

MATERIALS AND METHODS

In this prospective institutional review board-approved study, 14 patients with biopsy-proven prostate cancer (mean age, 65.2 years; median prostate-specific antigen [PSA], 6.2 ng/mL), all providing signed informed consent, underwent 7 T mpMRI with an external 8-channel body-array transmit coil and an endorectal receive coil between September 2013 and October 2014. Image and spectral quality of high-resolution T2-weighted (T2W) imaging (0.3 × 0.3 × 2 mm), diffusion-weighted imaging (DWI; 1.4 × 1.4 × 2 mm or 1.75 × 1.75 × 2 mm), and (H) MR spectroscopic imaging (MRSI; real voxel size, 0.6 mm in 7:16 minutes) were rated on a 5-point scale by 2 radiologists and a spectroscopist.

RESULTS

Prostate mpMRI including at least 2 of 3 MR techniques was obtained at 7 T in 13 patients in 65 ± 12 minutes. Overall T2W and DWI image quality at 7 T was scored as fair (38% and 17%, respectively) to good or very good (55% and 83%, respectively). The main artifacts for T2W imaging were motion and areas of low signal-to-noise ratio, the latter possibly caused by radiofrequency field inhomogeneities. For DWI, the primary artifact was ghosting of the rectal wall in the readout direction. Magnetic resonance spectroscopic imaging quality was rated fair or good in 56% of the acquisitions and was mainly limited by lipid contamination.

CONCLUSIONS

Multiparametric MRI of the prostate at 7 T is feasible at unprecedented spatial resolutions for T2W imaging and DWI and within clinically acceptable acquisition times for high-resolution MRSI, using the combination of an external 8-channel body-array transmit coil and an endorectal receive coil. The higher spatial resolutions can yield improved delineation of prostate anatomy, but the robustness of the techniques needs to be improved before clinical adoption of 7 T mpMRI.

Clinical applications at ultrahigh field (7 T). Where does it make the difference?

Presently, three major MR vendors provide commercial 7-T units for clinical research under ethical permission, with the number of operating 7-T systems having increased to over 50. This rapid increase indicates the growing interest in ultrahigh-field MRI because of improved clinical results with regard to morphological as well as functional and metabolic capabilities. As the signal-to-noise ratio scales linearly with the field strength (B0 ) of the scanner, the most obvious application at 7 T is to obtain higher spatial resolution in the brain, musculoskeletal system and breast. Of specific clinical interest for neuro-applications is the cerebral cortex at 7 T, for the detection of changes in cortical structure as a sign of early dementia, as well as for the visualization of cortical microinfarcts and cortical plaques in multiple sclerosis. In the imaging of the hippocampus, even subfields of the internal hippocampal anatomy and pathology can be visualized with excellent resolution. The dynamic and static blood oxygenation level-dependent contrast increases linearly with the field strength, which significantly improves the pre-surgical evaluation of eloquent areas before tumor removal. Using susceptibility-weighted imaging, the plaque-vessel relationship and iron accumulation in multiple sclerosis can be visualized for the first time. Multi-nuclear clinical applications, such as sodium imaging for the evaluation of repair tissue quality after cartilage transplantation and (31) P spectroscopy for the differentiation between non-alcoholic benign liver disease and potentially progressive steatohepatitis, are only possible at ultrahigh fields. Although neuro- and musculoskeletal imaging have already demonstrated the clinical superiority of ultrahigh fields, whole-body clinical applications at 7 T are still limited, mainly because of the lack of suitable coils. The purpose of this article was therefore to review the clinical studies that have been performed thus far at 7 T, compared with 3 T, as well as those studies performed at 7 T that cannot be routinely performed at 3 T. Copyright © 2015 John Wiley & Sons, Ltd.

Parallel transmission for ultrahigh-field imaging

The development of MRI systems operating at or above 7 T has provided researchers with a new window into the human body, yielding improved imaging speed, resolution and signal-to-noise ratio. In order to fully realise the potential of ultrahigh-field MRI, a range of technical hurdles must be overcome. The non-uniformity of the transmit field is one of such issues, as it leads to non-uniform images with spatially varying contrast. Parallel transmission (i.e. the use of multiple independent transmission channels) provides previously unavailable degrees of freedom that allow full spatial and temporal control of the radiofrequency (RF) fields. This review discusses the many ways in which these degrees of freedom can be used, ranging from making more uniform transmit fields to the design of subject-tailored RF pulses for both uniform excitation and spatial selection, and also the control of the specific absorption rate. © 2015 The Authors. NMR in Biomedicine published by John Wiley & Sons Ltd.

W(h)ither human cardiac and body magnetic resonance at ultrahigh fields? technical advances, practical considerations, applications, and clinical opportunities

The objective of this study was to document and review advances and groundbreaking progress in cardiac and body MR at ultrahigh fields (UHF, B0 ≥ 7.0 T) with the goal to attract talent, clinical adopters, collaborations and resources to the biomedical and diagnostic imaging communities. This review surveys traits, advantages and challenges of cardiac and body MR at 7.0 T. The considerations run the gamut from technical advances to clinical opportunities. Key concepts, emerging technologies, practical considerations, frontier applications and future directions of UHF body and cardiac MR are provided. Examples of UHF cardiac and body imaging strategies are demonstrated. Their added value over the kindred counterparts at lower fields is explored along with an outline of research promises. The achievements of cardiac and body UHF-MR are powerful motivators and enablers, since extra speed, signal and imaging capabilities may be invested to overcome the fundamental constraints that continue to hamper traditional cardiac and body MR applications. If practical obstacles, concomitant physics effects and technical impediments can be overcome in equal measure, sophisticated cardiac and body UHF-MR will help to open the door to new MRI and MRS approaches for basic research and clinical science, with the lessons learned at 7.0 T being transferred into broad clinical use including diagnostics and therapy guiding at lower fields. Copyright © 2015 John Wiley & Sons, Ltd.

Novel methods for mapping the cavernous nerves during radical prostatectomy

The cavernous nerves, which course along the surface of the prostate gland, are responsible for erectile function. During radical prostatectomy, urologists are challenged in preserving these nerves and their function. Cavernous nerves are microscopic and show variable location in different patients; therefore, postoperative sexual potency rates are widely variable following radical prostatectomy. A variety of technologies, including electrical and optical nerve stimulation, dye-based optical fluorescence and microscopy, spectroscopy, ultrasound and magnetic resonance imaging have all been used to study cavernous nerve anatomy and physiology, and some of these methods are also potential intraoperative methods for identifying and preserving cavernous nerves. However, all of these technologies have inherent limitations, including slow or inconsistent nerve responses, poor image resolution, shallow image depth, slow image acquisition times and/or safety concerns. New and emerging technologies, as well as multimodal approaches combining existing methods, hold promise for improved postoperative sexual outcomes and patient quality of life following radical prostatectomy.

Non-enhanced magnetic resonance imaging of the small bowel at 7 Tesla in comparison to 1.5 Tesla: First steps towards clinical application

OBJECTIVE

To perform non-enhanced (NE) magnetic resonance imaging (MRI) of the small bowel at 7 Tesla (7T) and to compare it with 1.5 Tesla (1.5T).

MATERIAL AND METHODS

Twelve healthy subjects were prospectively examined using a 1.5T and 7T MRI system. Coronal and axial true fast imaging with steady-state precession (TrueFISP) imaging and a coronal T2-weighted (T2w) half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequence were acquired. Image analysis was performed by 1) visual evaluation of tissue contrast and detail detectability, 2) measurement and calculation of contrast ratios and 3) assessment of artifacts.

RESULTS

NE MRI of the small bowel at 7T was technically feasible. In the vast majority of the cases, tissue contrast and image details were equivalent at both field strengths. At 7T, two cases revealed better detail detectability in the TrueFISP, and better contrast in the HASTE. Susceptibility artifacts and B1 inhomogeneities were significantly increased at 7T.

CONCLUSION

This study provides first insights into NE ultra-high field MRI of the small bowel and may be considered an important step towards high quality T2w abdominal imaging at 7T MRI.

(1)H MR spectroscopic imaging of the prostate at 7T using spectral-spatial pulses

PURPOSE

To assess the feasibility of prostate (1)H MR spectroscopic imaging (MRSI) using low-power spectral-spatial (SPSP) pulses at 7T, exploiting accurate spectral selection and spatial selectivity simultaneously.

METHODS

A double spin-echo sequence was equipped with SPSP refocusing pulses with a spectral selectivity of 1 ppm. Three-dimensional prostate (1)H-MRSI at 7T was performed with the SPSP-MRSI sequence using an 8-channel transmit array coil and an endorectal receive coil in three patients with prostate cancer and in one healthy subject. No additional water or lipid suppression pulses were used.

RESULTS

Prostate (1)H-MRSI could be obtained well within specific absorption rate (SAR) limits in a clinically feasible time (10 min). Next to the common citrate signals, the prostate spectra exhibited high spermine signals concealing creatine and sometimes also choline. Residual lipid signals were observed at the edges of the prostate because of limitations in spectral and spatial selectivity.

CONCLUSION

It is possible to perform prostate (1)H-MRSI at 7T with a SPSP-MRSI sequence while using separate transmit and receive coils. This low-SAR MRSI concept provides the opportunity to increase spatial resolution of MRSI within reasonable scan times.

Image quality and cancer visibility of T2-weighted magnetic resonance imaging of the prostate at 7 Tesla

OBJECTIVES

To assess the image quality of T2-weighted (T2w) magnetic resonance imaging of the prostate and the visibility of prostate cancer at 7 Tesla (T).

MATERIALS & METHODS

Seventeen prostate cancer patients underwent T2w imaging at 7T with only an external transmit/receive array coil. Three radiologists independently scored images for image quality, visibility of anatomical structures, and presence of artefacts. Krippendorff's alpha and weighted kappa statistics were used to assess inter-observer agreement. Visibility of prostate cancer lesions was assessed by directly linking the T2w images to the confirmed location of prostate cancer on histopathology.

RESULTS

T2w imaging at 7T was achievable with 'satisfactory' (3/5) to 'good' (4/5) quality. Visibility of anatomical structures was predominantly scored as 'satisfactory' (3/5) and 'good' (4/5). If artefacts were present, they were mostly motion artefacts and, to a lesser extent, aliasing artefacts and noise. Krippendorff's analysis revealed an α = 0.44 between three readers for the overall image quality scores. Clinically significant cancer lesions in both peripheral zone and transition zone were visible at 7T.

CONCLUSION

T2w imaging with satisfactory to good quality can be routinely acquired, and cancer lesions were visible in patients with prostate cancer at 7T using only an external transmit/receive body array coil.

KEY POINTS

• Satisfactory to good T2-weighted image quality of the prostate is achievable at 7T. • Periprostatic lipids appear hypo-intense compared to healthy peripheral zone tissue at 7T. • Prostate cancer is visible on T2-weighted MRI at 7T.

(31) P MR spectroscopic imaging of the human prostate at 7 T: T1 relaxation times, Nuclear Overhauser Effect, and spectral characterization

PURPOSE

Optimization of phosphorus ((31) P) MR spectroscopic imaging (MRSI) of the human prostate at 7 T by the evaluation of T1 relaxation times and the Nuclear Overhauser Effect (NOE) of phosphorus-containing metabolites.

METHODS

Twelve patients with prostate cancer and one healthy volunteer were scanned on a 7 T whole-body system using a (31) P endorectal coil combined with an eight-channel (1) H body array coil. T1 relaxation times were measured using progressive saturation in a two-dimensional localization sequence. (31) P MRSI was performed twice: once without NOE and once with NOE using low-power continuous wave (1) H irradiation to determine NOE enhancements.

RESULTS

T1 relaxation times of (31) P metabolites in the human prostate at 7 T varied between 3.0 and 8.3 s. Positive but variable NOE enhancements were measured for most metabolites. Remarkably, the (31) P MR spectra showed two peaks in chemical shift range of inorganic phosphate.

CONCLUSION

Knowledge of T1 relaxation times and NOE enhancements enables protocol optimization for (31) P MRSI of the prostate at 7 T. With a strongly reduced (31) P flip angle (≤ 45°), a (31) P MRSI dataset with optimal signal-to-noise ratio per unit time can be obtained within 15 minutes. The NOE enhancement can improve fitting accuracy, but its variability requires further investigation.

Magnetic resonance imaging at ultrahigh fields

Since the introduction of 4 T human systems in three academic laboratories circa 1990, rapid progress in imaging and spectroscopy studies in humans at 4 T and animal model systems at 9.4 T have led to the introduction of 7 T and higher magnetic fields for human investigation at about the turn of the century. Work conducted on these platforms has demonstrated the existence of significant advantages in SNR and biological information content at these ultrahigh fields, as well as the presence of numerous challenges. Primary difference from lower fields is the deviation from the near field regime; at the frequencies corresponding to hydrogen resonance conditions at ultrahigh fields, the RF is characterized by attenuated traveling waves in the human body, which leads to image nonuniformities for a given sample-coil configuration because of interferences. These nonuniformities were considered detrimental to the progress of imaging at high field strengths. However, they are advantageous for parallel imaging for signal reception and parallel transmission, two critical technologies that account, to a large extend, for the success of ultrahigh fields. With these technologies, and improvements in instrumentation and imaging methods, ultrahigh fields have provided unprecedented gains in imaging of brain function and anatomy, and started to make inroads into investigation of the human torso and extremities. As extensive as they are, these gains still constitute a prelude to what is to come given the increasingly larger effort committed to ultrahigh field research and development of ever better instrumentation and techniques.