(31) P MR spectroscopic imaging combined with (1) H MR spectroscopic imaging in the human prostate using a double tuned endorectal coil at 7T

From strength to precision: A systematic review exploring the clinical utility of 7-Tesla magnetic resonance imaging in abdominal imaging

BACKGROUND

After approval for clinical use in 2017 early investigations of ultra-high-field abdominal magnetic resonance imaging (MRI) have demonstrated the feasibility as well as diagnostic capabilities of liver, kidney, and prostate MRI at 7-Tesla. However, the elevation of the field strength to 7-Tesla not only brought advantages to abdominal MRI but also presented considerable challenges and drawbacks, primarily stemming from heightened artifacts and limitations in Specific Absorption Rate, etc. Furthermore, evidence in the literature is relatively scarce concerning human studies in comparison to phantom/animal studies which necessitates an investigation into the evidence so far in humans and summarizing all relevant evidence.

AIM

To offer a comprehensive overview of current literature on clinical abdominal 7T MRI that emphasizes current trends, details relevant challenges, and provides a concise set of potential solutions.

METHODS

This systematic review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A PubMed search, utilizing Medical Subject Headings terms such as "7-Tesla" and organ-specific terms, was conducted for articles published between January 1, 1985, and July 25, 2023. Eligibility criteria included studies exploring 7T MRI for imaging human abdominal organs, encompassing various study types (in-vivo/ex-vivo, method development, reviews/meta-analyses). Exclusion criteria involved animal studies and those lacking extractable data. Study selection involved initial identification via title/abstract, followed by a full-text review by two researchers, with discrepancies resolved through discussion. Data extraction covered publication details, study design, population, sample size, 7T MRI protocol, image characteristics, endpoints, and conclusions.

RESULTS

The systematic review included a total of 21 studies. The distribution of clinical 7T abdominal imaging studies revealed a predominant focus on the prostate (n = 8), followed by the kidney (n = 6) and the hepatobiliary system (n = 5). Studies on these organs, and in the pancreas, demonstrated clear advantages at 7T. However, small bowel studies showed no significant improvements compared to traditional MRI at 1.5T. The majority of studies evaluated originated from Germany (n = 10), followed by the Netherlands (n = 5), the United States (n = 5), Austria (n = 2), the United Kingdom (n = 1), and Italy (n = 1).

CONCLUSION

Further increase of abdominal clinical MRI field strength to 7T demonstrated high imaging potential, yet also limitations mainly due to the inhomogeneous radiofrequency (RF) excitation field relative to lower field strengths. Hence, further optimization of dedicated RF coil elements and pulse sequences are expected to better optimize clinical imaging at high magnetic field strength.

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.

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.

A Crosstalk- and Interferent-Free Dual Electrode Amperometric Biosensor for the Simultaneous Determination of Choline and Phosphocholine

Choline (Ch) and phosphocholine (PCh) levels in tissues are associated to tissue growth and so to carcinogenesis. Till now, only highly sophisticated and expensive techniques like those based on NMR spectroscopy or GC/LC- high resolution mass spectrometry permitted Ch and PCh analysis but very few of them were capable of a simultaneous determination of these analytes. Thus, a never reported before amperometric biosensor for PCh analysis based on choline oxidase and alkaline phosphatase co-immobilized onto a Pt electrode by co-crosslinking has been developed. Coupling the developed biosensor with a parallel sensor but specific to Ch, a crosstalk-free dual electrode biosensor was also developed, permitting the simultaneous determination of Ch and PCh in flow injection analysis. This novel sensing device performed remarkably in terms of sensitivity, linear range, and limit of detection so to exceed in most cases the more complex analytical instrumentations. Further, electrode modification by overoxidized polypyrrole permitted the development of a fouling- and interferent-free dual electrode biosensor which appeared promising for the simultaneous determination of Ch and PCh in a real sample.

Introduction of the snake antenna array: Geometry optimization of a sinusoidal dipole antenna for 10.5T body imaging with lower peak SAR

Purpose

To improve imaging performance for body MRI with a local transmit array at 10.5T, the geometry of a dipole antenna was optimized to achieve lower peak specific absorption rate (SAR) levels and a more uniform transmit profile.

Methods

Electromagnetic simulations on a phantom were used to evaluate the SAR and B1+‐performance of different dipole antenna geometries. The best performing antenna (the snake antenna) was simulated on human models in a 12‐channel array configuration for safety assessment and for comparison to a previous antenna design. This 12‐channel array was constructed after which electromagnetic simulations were validated by B1+‐maps and temperature measurements. After obtaining approval by the Food and Drug Administration to scan with the snake antenna array, in vivo imaging was performed on 2 volunteers.

Results

Simulation results on a phantom indicate a lower SAR and a higher transmit efficiency for the snake antenna compared to the fractionated dipole array. Similar results are found on a human body model: when comparing the trade‐off between uniformity and peak SAR, the snake antenna performs better for all imaging targets. Simulations and measurements are in good agreement. Preliminary imaging result were acquired in 2 volunteers with the 12‐channel snake antenna array.

Conclusion

By optimizing the geometry of a dipole antenna, peak SAR levels were lowered while achieving a more uniform transmit field as demonstrated in simulations on a phantom and a human body model. The array was constructed, validated, and successfully used to image 2 individuals at 10.5T.

A 32-channel parallel transmit system add-on for 7T MRI

PURPOSE

A 32-channel parallel transmit (pTx) add-on for 7 Tesla whole-body imaging is presented. First results are shown for phantom and in-vivo imaging.

METHODS

The add-on system consists of a large number of hardware components, including modulators, amplifiers, SAR supervision, peripheral devices, a control computer, and an integrated 32-channel transmit/receive body array. B1+ maps in a phantom as well as B1+ maps and structural images in large volunteers are acquired to demonstrate the functionality of the system. EM simulations are used to ensure safe operation.

RESULTS

Good agreement between simulation and experiment is shown. Phantom and in-vivo acquisitions show a field of view of up to 50 cm in z-direction. Selective excitation with 100 kHz sampling rate is possible. The add-on system does not affect the quality of the original single-channel system.

CONCLUSION

The presented 32-channel parallel transmit system shows promising performance for ultra-high field whole-body imaging.

Beyond T2 and 3T: New MRI techniques for clinicians

Technological advances in Magnetic Resonance Imaging (MRI) in terms of field strength and hybrid MR systems have led to improvements in tumor imaging in terms of anatomy and functionality. This review paper discusses the applications of such advances in the field of radiation oncology with regards to treatment planning, therapy guidance and monitoring tumor response and predicting outcome.

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.

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.

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.

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.

(31)P CSI of the human brain in healthy subjects and tumor patients at 9.4 T with a three-layered multi-nuclear coil: initial results

OBJECTIVE

Investigation of the feasibility and performance of phosphorus ((31)P) magnetic resonance spectroscopic imaging (MRSI) at 9.4 T with a three-layered phosphorus/proton coil in human normal brain tissue and tumor.

MATERIALS AND METHODS

A multi-channel (31)P coil was designed to enable MRSI of the entire human brain. The performance of the coil was evaluated by means of electromagnetic field simulations and actual measurements. A 3D chemical shift imaging approach with a variable repetition time and flip angle was used to increase the achievable signal-to-noise ratio of the acquired (31)P spectra. The impact of the resulting k-space modulation was investigated by simulations. Three tumor patients and three healthy volunteers were scanned and differences between spectra from healthy and cancerous tissue were evaluated qualitatively.

RESULTS

The high sensitivity provided by the 27-channel (31)P coil allowed acquiring CSI data in 22 min with a nominal voxel size of 15 × 15 × 15 mm(3). Shimming and anatomical localization could be performed with the integrated four-channel proton dipole array. The amplitudes of the phosphodiesters and phosphoethanolamine appeared reduced in tumorous tissue for all three patients. A neutral or slightly alkaline pH was measured within the brain lesions.

CONCLUSION

These initial results demonstrate that (31)P 3D CSI is feasible at 9.4 T and could be performed successfully in healthy subjects and tumor patients in under 30 min.