Tuning the optimal diffusion-weighted MRI parameters on a 0.35-T MR-Linac for clinical implementation: A phantom study

PURPOSE

This study aims to assess the quality of a new diffusion-weighted imaging (DWI) sequence implemented on an MR-Linac MRIdian system, evaluating and optimizing the acquisition parameters to explore the possibility of clinically implementing a DWI acquisition protocol in a 0.35-T MR-Linac.

MATERIALS AND METHODS

All the performed analyses have been carried out on two types of phantoms: a homogeneous 24-cm diameter polymethylmethacrylate (PMMA) sphere (SP) and a homemade phantom (HMP) constating in a PMMA cylinder filled with distilled water with empty sockets into which five cylindrical vials filled with five different concentrations of methylcellulose water solutions have been inserted. SP was used to evaluate the dependence of diffusion gradient inhomogeneity artifacts on gantry position. Four diffusion sequences with b-values of 500 s/mm2 and 3 averages have been acquired: three with diffusion gradients in the three main directions (phase direction, read direction, slice direction) and one with the diffusion gradients switched off. The dependence of diffusion image uniformity and SNR on the number of averages in the MR sequences was also investigated to determine the optimal number of averages. Finally, the ADC values of HMP have been computed and then compared between images acquired in the scanners at 0.35 and 1.5 T.

RESULTS

In order to acquire high-quality artifact-free DWI images, the "slice" gradient direction has been identified to be the optimal one and 0° to be the best gradient angle. Both the SNR ratio and the uniformity increase with the number of averages. A threshold value of 80 for SNR and 85% for uniformity was adopted to choose the best number of averages. By making a compromise between time and quality and limiting the number of b-values, it is possible to reduce the acquisition time to 78 s. The Passing-Bablok test showed that the two methods, with 0.35 and 1.5 T scanners, led to similar results.

CONCLUSION

The quality of the DWI has been accurately evaluated in relation to different sequence parameters, and optimal parameters have been identified to select a clinical protocol for the acquisition of ADC maps sustainable in the workflow of a hybrid radiotherapy system with a 0.35-T MRI scanner.

Quantitative diffusion MRI of the abdomen and pelvis

Diffusion MRI has enormous potential and utility in the evaluation of various abdominal and pelvic disease processes including cancer and noncancer imaging of the liver, prostate, and other organs. Quantitative diffusion MRI is based on acquisitions with multiple diffusion encodings followed by quantitative mapping of diffusion parameters that are sensitive to tissue microstructure. Compared to qualitative diffusion-weighted MRI, quantitative diffusion MRI can improve standardization of tissue characterization as needed for disease detection, staging, and treatment monitoring. However, similar to many other quantitative MRI methods, diffusion MRI faces multiple challenges including acquisition artifacts, signal modeling limitations, and biological variability. In abdominal and pelvic diffusion MRI, technical acquisition challenges include physiologic motion (respiratory, peristaltic, and pulsatile), image distortions, and low signal-to-noise ratio. If unaddressed, these challenges lead to poor technical performance (bias and precision) and clinical outcomes of quantitative diffusion MRI. Emerging and novel technical developments seek to address these challenges and may enable reliable quantitative diffusion MRI of the abdomen and pelvis. Through systematic validation in phantoms, volunteers, and patients, including multicenter studies to assess reproducibility, these emerging techniques may finally demonstrate the potential of quantitative diffusion MRI for abdominal and pelvic imaging applications.

MR cell size imaging with temporal diffusion spectroscopy

Cytological features such as cell size and intracellular morphology provide fundamental information on cell status and hence may provide specific information on changes that arise within biological tissues. Such information is usually obtained by invasive biopsy in current clinical practice, which suffers several well-known disadvantages. Recently, novel MRI methods such as IMPULSED (imaging microstructural parameters using limited spectrally edited diffusion) have been developed for direct measurements of mean cell size non-invasively. The IMPULSED protocol is based on using temporal diffusion spectroscopy (TDS) to combine measurements of water diffusion over a wide range of diffusion times to probe cellular microstructure over varying length scales. IMPULSED has been shown to provide rapid, robust, and reliable mapping of mean cell size and is suitable for clinical imaging. More recently, cell size distributions have also been derived by appropriate analyses of data acquired with IMPULSED or similar sequences, which thus provides MRI-cytometry. This review summarizes the basic principles, practical implementations, validations, and example applications of MR cell size imaging based on TDS and demonstrates how cytometric information can be used in various applications. In addition, the limitations and potential future directions of MR cytometry are identified including the diagnosis of nonalcoholic steatohepatitis of the liver and the assessment of treatment response of cancers.

Sample size estimation: Current practice and considerations for original investigations in MRI technical development studies

PURPOSE

To investigate and to provide guidance for sample size selection based on the current practice in MR technical development studies in which healthy volunteers are examined.

METHODS

All original articles published in Magnetic Resonance in Medicine between 2017 and 2019 were investigated and categorized according to technique, anatomical region, and magnetic field strength. The number of examined healthy volunteers (ie, the sample size) was collected and evaluated, whereas the number of patients was not considered. Papers solely measuring patients, animals, phantoms, specimens, or studies using existing data, for example, from an open databank, or consisting only of theoretical work or simulations were excluded.

RESULTS

The median sample size of the 882 included studies was 6. There were some peaks in the sample size distribution (eg, 1, 5, and 10). In 49.9%, 82.1%, and 95.6% of the studies, the sample size was smaller or equal to 5, 10, and 20, respectively.

CONCLUSION

We observed a large variance in sample sizes reflecting the variety of studies published in Magnetic Resonance in Medicine. Therefore, it can be concluded that it is current practice to balance the need for statistical power with the demand to minimize experiments involving healthy humans, often by choosing small sample sizes between 1 and 10. Naturally, this observation does not release an investigator from ensuring that sufficient data are acquired to reach statistical conclusions.

Mapping hepatocyte size in vivo using temporal diffusion spectroscopy MRI

PURPOSE

The goal of this study is to implement a noninvasive method for in vivo mapping of hepatocyte size. This method will have a broad range of clinical and preclinical applications, as pathological changes in hepatocyte sizes are relevant for the accurate diagnosis and assessments of treatment response of liver diseases.

METHODS

Building on the concepts of temporal diffusion spectroscopy in MRI, a clinically feasible imaging protocol named IMPULSED (Imaging Microstructural Parameters Using Limited Spectrally Edited Diffusion) has been developed, which is able to report measurements of cell sizes noninvasively. This protocol acquires a selected set of diffusion imaging data and fits them to a model of water compartments in tissues to derive robust estimates of the cellular structures that restrict free diffusion. Here, we adapt and further develop this approach to measure hepatocyte sizes in vivo. We validated IMPULSED in livers of mice and rats and implemented it to image healthy human subjects using a clinical 3T MRI scanner.

RESULTS

The IMPULSED-derived mean hepatocyte sizes for rats and mice are about 15-20 µm and agree well with histological findings. Maps of mean hepatocyte size for humans can be achieved in less than 15 minutes, a clinically feasible scan time.

CONCLUSION

Our results suggest that this method has potential to overcome major limitations of liver biopsy and provide noninvasive mapping of hepatocyte sizes in clinical applications.

Motion-robust and blood-suppressed M1-optimized diffusion MR imaging of the liver

PURPOSE

To develop motion-robust, blood-suppressed diffusion-weighted imaging (DWI) of the liver with optimized diffusion encoding waveforms and evaluate the accuracy and reproducibility of quantitative apparent diffusion coefficient (ADC) measurements.

METHODS

A novel approach for the design of diffusion weighting waveforms, termed M1-optimized diffusion imaging (MODI), is proposed. MODI includes an echo time-optimized motion-robust diffusion weighting gradient waveform design, with a small nonzero first-moment motion sensitivity (M1) value to enable blood signal suppression. Experiments were performed in eight healthy volunteers and five patient volunteers. In each case, DW images and ADC maps were compared between acquisitions using standard monopolar waveforms, motion moment-nulled (M1-nulled and M1-M2-nulled) waveforms, and the proposed MODI approach.

RESULTS

Healthy volunteer experiments using MODI showed no significant ADC bias in the left lobe relative to the right lobe (p < .05) demonstrating robustness to cardiac motion, and no significant ADC bias with respect to monopolar-based ADC measured in the right lobe (p < .05), demonstrating blood signal suppression. In contrast, monopolar-based ADC showed significant bias in the left lobe relative to the right lobe (p < .01) due to its sensitivity to motion, and both M1-nulled and M1-M2-nulled-based ADC showed significant bias (p < .01) due to the lack of blood suppression. Preliminary patient results also suggest MODI may enable improved visualization and quantitative assessment of lesions throughout the entire liver.

CONCLUSIONS

This novel method for diffusion gradient waveform design enables DWI of the liver with high robustness to motion and suppression of blood signals, overcoming the limitations of conventional monopolar waveforms and moment-nulled waveforms, respectively.

Water/fat separation for distortion-free EPI with point spread function encoding

PURPOSE

Effective removal of chemical-shift artifacts in echo-planar imaging (EPI) is a challenging problem especially with severe field inhomogeneity. This study aims to develop a reliable water/fat separation technique for point spread function (PSF) encoded EPI (PSF-EPI) by using its intrinsic multiple echo-shifted images.

THEORY AND METHODS

EPI with PSF encoding can achieve distortion-free imaging and can be highly accelerated using the tilted-CAIPI technique. In this study, the chemical-shift encoding existing in the intermediate images with different time shifts of PSF-EPI is used for water/fat separation, which is conducted with latest water/fat separation algorithms. The method was tested in T1-weighted, T2-weighted, and diffusion weighted imaging in healthy volunteers.

RESULTS

The ability of the proposed method to separate water/fat using intrinsic PSF-EPI signals without extra scans was demonstrated through in vivo T1-weighted, T2-weighted, and diffusion weighted imaging experiments. By exploring different imaging contrasts and regions, the results show that this PSF-EPI based method can separate water/fat and remove fat residues robustly.

CONCLUSION

By using the intrinsic signals of PSF-EPI for water/fat separation, fat signals can be effectively suppressed in EPI even with severe field inhomogeneity. This water/fat separation method for EPI can be extended to multiple image contrasts. The distortion-free PSF-EPI technique, thus, has the potential to provide anatomical and functional images with high-fidelity and practical acquisition efficiency.

Improved stimulated echo in diffusion magnetic resonance imaging: introducing a π pulse for SNR enhancement

PURPOSE

Anomalous diffusion in biological tissues can be examined by diffusion MRI for various applications, including tumor diagnosis and measurement of brain fiber pathways. However, the measurement of anomalous diffusion requires high b-values for the diffusion gradient in MRI, and current MRI methods cannot provide a high SNR. This study aimed to improve on the standard stimulated echo (STE) to enhance the SNR in diffusion MRI with high b-values.

METHODS

Because of hardware limitations and human safety considerations, prolonging the diffusion time (Δ) is 1 of the few methods available to realize high b-values. Here, we propose a new echo mechanism for diffusion MRI to enhance SNRs under long Δ. By introducing a π pulse at the midpoint between 2nd and 3rd π/2 pulses of STE, we refocus the magnetic moment vectors in the longitudinal plane before the third π/2 pulse is applied, which preserves the full echo signals. This sequence was compared with STE and spin echo (SE). Nine Δs were tested in a phantom. Multi b-values with 2 Δs were tested in a mouse liver, brain, and tumor.

RESULTS

Compared with STE and SE, the proposed improved STE (ISTE) exhibited an improved SNR in the phantom experiment and improved performance in the in vivo experiments.

CONCLUSION

By using the proposed echo mechanism in diffusion MRI, we enhanced the SNR of the images, which enables us to investigate diffusion behavior at higher b-values and further facilitates the development of quantitative diffusion MRI and radiomics.

Diffusion-weighted MRI of the lung at 3T evaluated using echo-planar-based and single-shot turbo spin-echo-based acquisition techniques for radiotherapy applications

Purpose

To compare single‐shot echo‐planar (SS‐EPI)‐based and turbo spin‐echo (SS‐TSE)‐based diffusion‐weighted imaging (DWI) in Non‐Small Cell Lung Cancer (NSCLC) patients and to characterize the distributions of apparent diffusion coefficient (ADC) values generated by the two techniques.

Methods

Ten NSCLC patients were enrolled in a prospective IRB‐approved study to compare and optimize DWI using EPI and TSE‐based techniques for radiotherapy planning. The imaging protocol included axial T2w, EPI‐based DWI and TSE‐based DWI on a 3 T Philips scanner. Both EPI‐based and TSE‐based DWI sequences used three b values (0, 400, and 800 s/mm²). The acquisition times for EPI‐based and TSE‐based DWI were 5 and 8 min, respectively. DW‐MR images were manually coregistered with axial T2w images, and tumor volume contoured on T2w images were mapped onto the DWI scans. A pixel‐by‐pixel fit of tumor ADC was calculated based on monoexponential signal behavior. Tumor ADC mean, standard deviation, kurtosis, and skewness were calculated and compared between EPI and TSE‐based DWI. Image distortion and ADC values between the two techniques were also quantified using fieldmap analysis and a NIST traceable ice‐water diffusion phantom, respectively.

Results

The mean ADC for EPI and TSE‐based DWI were 1.282 ± 0.42 × 10⁻³ and 1.211 ± 0.31 × 10⁻³ mm²/s. The average skewness and kurtosis were 0.14 ± 0.4 and 2.43 ± 0.40 for DWI‐EPI and −0.06 ± 0.69 and 2.89 ± 0.62 for DWI‐TSE. Fieldmap analysis showed a mean distortion of 13.72 ± 8.12 mm for GTV for DWI‐EPI and 0.61 ± 0.4 mm for DWI‐TSE. ADC values obtained using the diffusion phantom for the two techniques were within 0.03 × 10⁻³ mm²/s with respect to each other as well as the established values.

Conclusions

Diffusion‐weighted turbo spin‐echo shows better geometrical accuracy compared to DWI‐EPI. Mean ADC values were similar with both acquisitions but the shape of the histograms was different based on the skewness and kurtosis values. The impact of differences in respiratory technique on ADC values requires further investigation.

Optimized Diffusion-Weighting Gradient Waveform Design (ODGD) formulation for motion compensation and concomitant gradient nulling

PURPOSE

To present a novel Optimized Diffusion-weighting Gradient waveform Design (ODGD) method for the design of minimum echo time (TE), bulk motion-compensated, and concomitant gradient (CG)-nulling waveforms for diffusion MRI.

METHODS

ODGD motion-compensated waveforms were designed for various moment-nullings M_n (n = 0, 1, 2), for a range of b-values, and spatial resolutions, both without (ODGD-M_n ) and with CG-nulling (ODGD-M_n -CG). Phantom and in-vivo (brain and liver) experiments were conducted with various ODGD waveforms to compare motion robustness, signal-to-noise ratio (SNR), and apparent diffusion coefficient (ADC) maps with state-of-the-art waveforms.

RESULTS

ODGD-M_n and ODGD-M_n -CG waveforms reduced the TE of state-of-the-art waveforms. This TE reduction resulted in significantly higher SNR (P < 0.05) in both phantom and in-vivo experiments. ODGD-M₁ improved the SNR of BIPOLAR (42.8 ± 5.3 vs. 32.9 ± 3.3) in the brain, and ODGD-M₂ the SNR of motion-compensated (MOCO) and Convex Optimized Diffusion Encoding-M₂ (CODE-M₂ ) (12.3 ± 3.6 vs. 9.7 ± 2.9 and 10.2 ± 3.4, respectively) in the liver. Further, ODGD-M₂ also showed excellent motion robustness in the liver. ODGD-M_n -CG waveforms reduced the CG-related dephasing effects of non CG-nulling waveforms in phantom and in-vivo experiments, resulting in accurate ADC maps.

CONCLUSIONS

ODGD waveforms enable motion-robust diffusion MRI with reduced TEs, increased SNR, and reduced ADC bias compared to state-of-the-art waveforms in theoretical results, simulations, phantoms and in-vivo experiments.

Stimulated echo based mapping (STEM) of T1 , T2 , and apparent diffusion coefficient: validation and protocol optimization

PURPOSE

To present a stimulated-echo based mapping (STEM) approach for simultaneous T₁ , T₂ , and ADC mapping.

METHODS

Diffusion-weighted stimulated-echo images with various combinations of mixing time (TM), TE, and b-value were acquired to enable simultaneous mapping of T₁ , T₂ , and ADC. The proposed STEM method was performed by densely sampling the TM-TE-b space in a phantom and in brain and prostate of healthy volunteers. T₁ , T₂ , and ADC from STEM were compared to reference mapping methods. Additionally, protocol optimization was performed to enable rapid STEM acquisition within 2 min by sparsely sampling the TM-TE-b space. The T₁ , T₂ , and ADC measurements from rapid acquisitions were compared to the densely sampled STEM for evaluation. Finally, a patient with biopsy-proven high-risk prostate cancer was imaged to demonstrate the ability of STEM to differentiate cancer and healthy tissues.

RESULTS

Relative to the reference measurements, densely sampled STEM provided accurate quantitative T₁ , T₂ , and ADC mapping in phantoms (R²  = 0.999, slope between 0.97-1.03), as well as in brain and prostate. Further, the T₁ , T₂ , and ADC measurements from the optimized rapid STEM acquisitions agreed closely with densely sampled STEM. Finally, STEM showed decreased T₂ and ADC in prostate cancer compared to healthy prostate tissue.

CONCLUSION

STEM provides accurate simultaneous mapping of T₁ , T₂ , and ADC. This method may enable rapid and accurate multi-parametric tissue characterization for clinical and research applications.

Diffusion-weighted imaging of the abdomen: Impact of b-values on texture analysis features

The purpose of this work was to systematically assess the impact of the b-value on texture analysis in MR diffusion-weighted imaging (DWI) of the abdomen. In eight healthy male volunteers, echo-planar DWI sequences at 16 b-values ranging between 0 and 1000 s/mm² were acquired at 3 T. Three different apparent diffusion coefficient (ADC) maps were computed (0, 750/100, 390, 750 s/mm² /all b-values). Texture analysis of rectangular regions of interest in the liver, kidney, spleen, pancreas, paraspinal muscle and subcutaneous fat was performed on DW images and the ADC maps, applying 19 features computed from the histogram, grey-level co-occurrence matrix (GLCM) and grey-level run-length matrix (GLRLM). Correlations between b-values and texture features were tested with a linear and an exponential model; the best fit was determined by the smallest sum of squared residuals. Differences between the ADC maps were assessed with an analysis of variance. A Bonferroni-corrected p-value less than 0.008 (=0.05/6) was considered statistically significant. Most GLCM and GLRLM-derived texture features (12-18 per organ) showed significant correlations with the b-value. Four texture features correlated significantly with changing b-values in all organs (p < 0.008). Correlation coefficients varied between 0.7 and 1.0. The best fit varied across different structures, with fat exhibiting mostly exponential (17 features), muscle mostly linear (12 features) and the parenchymatous organs mixed feature alterations. Two GLCM features showed significant variability in the different ADC maps. Several texture features vary systematically in healthy tissues at different b-values, which needs to be taken into account if DWI data with different b-values are analyzed. Histogram and GLRLM-derived texture features are stable on ADC maps computed from different b-values.

Comparison of T2, T1rho, and diffusion metrics in assessment of liver fibrosis in rats

PURPOSE

To evaluate the value of T₂ , T₁ rho, and diffusion metrics in assessment of liver fibrosis in rats.

MATERIALS AND METHODS

Liver fibrosis in a rat model (n = 72) was induced by injection of carbon tetrachloride (CCl₄ ) at 3T. T₂ , T₁ rho, and diffusion parameters (apparent diffusion coefficient (ADC), D_true ) via spin echo (SE) diffusion-weighted imaging (DWI) and stimulated echo acquisition mode (STEAM) DWI with three diffusion times (DT: 80, 106, 186 msec) were obtained in surviving rats with hepatic fibrosis (n = 52) and controls (n = 8). Liver fibrosis stage (F0-F6) was identified based on pathological results using the traditional liver fibrosis staging method for rodents. Nonparametric statistical methods and receiver operating characteristic (ROC) curve analysis were employed to determine the diagnostic accuracy.

RESULTS

Mean T₂ , T₁ rho, ADC, and D_true with DT = 186 msec correlated with the severity of fibrosis with r = 0.73, 0.83, -0.83, and -0.85 (all P < 0.001), respectively. The average areas under the ROC curve at different stages for T₁ rho and diffusion parameters (DT = 186 msec) were larger than those of T₂ and SE DWI (0.92, 0.92, and 0.92 vs. 0.86, 0.82, and 0.83). The corresponding average sensitivity and specificity for T₁ rho and diffusion parameters with a long DT were larger (89.35 and 88.90, 88.36 and 89.97, 90.16 and 87.13) than T₂ and SE DWI (90.28 and 79.93, 85.30 and 77.64, 78.21 and 82.41). The performances of T₁ rho and D_true (DT = 186 msec) were comparable (average AUC: 0.92 and 0.92).

CONCLUSION

Among the evaluated sequences, T₁ rho and STEAM DWI with a long DT may serve as superior imaging biomarkers for assessing liver fibrosis and monitoring disease severity.

LEVEL OF EVIDENCE

1 J. Magn. Reson. Imaging 2017;45:741-750.