Improving the robustness of 3D turbo spin echo imaging to involuntary motion

Modern acceleration in musculoskeletal MRI: applications, implications, and challenges

Magnetic resonance imaging (MRI) is crucial for accurately diagnosing a wide spectrum of musculoskeletal conditions due to its superior soft tissue contrast resolution. However, the long acquisition times of traditional two-dimensional (2D) and three-dimensional (3D) fast and turbo spin-echo (TSE) pulse sequences can limit patient access and comfort. Recent technical advancements have introduced acceleration techniques that significantly reduce MRI times for musculoskeletal examinations. Key acceleration methods include parallel imaging (PI), simultaneous multi-slice acquisition (SMS), and compressed sensing (CS), enabling up to eightfold faster scans while maintaining image quality, resolution, and safety standards. These innovations now allow for 3- to 6-fold accelerated clinical musculoskeletal MRI exams, reducing scan times to 4 to 6 min for joints and spine imaging. Evolving deep learning-based image reconstruction promises even faster scans without compromising quality. Current research indicates that combining acceleration techniques, deep learning image reconstruction, and superresolution algorithms will eventually facilitate tenfold accelerated musculoskeletal MRI in routine clinical practice. Such rapid MRI protocols can drastically reduce scan times by 80-90% compared to conventional methods. Implementing these rapid imaging protocols does impact workflow, indirect costs, and workload for MRI technologists and radiologists, which requires careful management. However, the shift from conventional to accelerated, deep learning-based MRI enhances the value of musculoskeletal MRI by improving patient access and comfort and promoting sustainable imaging practices. This article offers a comprehensive overview of the technical aspects, benefits, and challenges of modern accelerated musculoskeletal MRI, guiding radiologists and researchers in this evolving field.

Intracranial vessel wall imaging framework - Data acquisition, processing, and visualization

OBJECTIVE

Assessment of vessel walls is an integral part in diagnosis and disease monitoring of vascular diseases such as vasculitis. Vessel wall imaging (VWI), in particular of intracranial arteries, is the domain of Magnetic Resonance Imaging (MRI) - but still remains a challenge. The tortuous anatomy of intracranial arteries and the need for high resolution within clinically acceptable scan times require special technical conditions regarding the hardware and software environments.

MATERIALS AND METHODS

In this work a dedicated framework for intracranial VWI is presented offering an optimized, black-blood 3D T1-weighted post-contrast Compressed Sensing (CS)-accelerated MRI sequence prototype combined with dedicated 3D-GUI supported post-processing tool for the CPR visualization of tortuous arbitrary vessel structures.

RESULTS

Using CS accelerated MRI sequence, the scanning time for high-resolution 3D black-blood CS-space data could be reduced to under 10 min. These data are adequate for a further processing to extract straightened visualizations (curved planar reformats - CPR). First patient data sets could be acquired in clinical environment.

CONCLUSION

A highly versatile framework for VWI visualization was demonstrated utilizing a post-processing tool to extract CPR reformats from high-resolution 3D black-blood CS-SPACE data, enabling simplified and optimized assessment of intracranial arteries in intracranial vascular disorders, especially in suspected intracranial vasculitis, by stretching their tortuous course. The processing time from about 15-20 min per patient (data acquisition and further processing) allows the integration into clinical routine.

Comparison of Compressed Sensing and Gradient and Spin-Echo in Breath-Hold 3D MR Cholangiopancreatography: Qualitative and Quantitative Analysis

While magnetic resonance cholangiopancreatography (MRCP) is routinely used, compressed sensing MRCP (CS-MRCP) and gradient and spin-echo MRCP (GRASE-MRCP) with breath-holding (BH) may allow sufficient image quality with shorter acquisition times. This study qualitatively and quantitatively compared BH-CS-MRCP and BH-GRASE-MRCP and evaluated their clinical effectiveness. Data from 59 consecutive patients who underwent both BH-CS-MRCP and BH-GRASE-MRCP were qualitatively analyzed using a five-point Likert-type scale. The signal-to-noise ratio (SNR) of the common bile duct (CBD), contrast-to-noise ratio (CNR) of the CBD and liver, and contrast ratio between periductal tissue and the CBD were measured. Paired t-test, Wilcoxon signed-rank test, and McNemar’s test were used for statistical analysis. No significant differences were found in overall image quality or duct visualization of the CBD, right and left 1st level intrahepatic duct (IHD), cystic duct, and proximal pancreatic duct (PD). BH-CS-MRCP demonstrated higher background suppression and better visualization of right (p = 0.004) and left 2nd level IHD (p < 0.001), mid PD (p = 0.003), and distal PD (p = 0.041). Image quality degradation was less with BH-GRASE-MRCP than BH-CS-MRCP (p = 0.025). Of 24 patients with communication between a cyst and the PD, 21 (87.5%) and 15 patients (62.5%) demonstrated such communication on BH-CS-MRCP and BH-GRASE-MRCP, respectively. SNR, contrast ratio, and CNR of BH-CS-MRCP were higher than BH-GRASE-MRCP (p < 0.001). Both BH-CS-MRCP and BH-GRASE-MRCP are useful imaging methods with sufficient image quality. Each method has advantages, such as better visualization of small ducts with BH-CS-MRCP and greater time saving with BH-GRASE-MRCP. These differences allow diverse choices for visualization of the pancreaticobiliary tree in clinical practice.

Strategies to improve intratrain prospective motion correction for turbo spin-echo sequences with constant flip angles

PURPOSE

To investigate the effects of prospective motion correction on turbo spin echo sequences and optimize motion correction approaches, mitigating signal dropout artifacts caused by the imperfections of motion tracking data.

METHODS

Signal dropout artifacts caused by undesired phase deviations introduced by tracking errors are analyzed theoretically. To reduce the adverse effect of such deviations, two approaches are proposed: (1) freezing the correction for example, for even-numbered or higher number of echoes and (2) shifting the correction event prior to the left crusher gradient preceding the refocusing pulse. A comprehensive analysis is presented, including both signal simulations and experimental verifications in phantoms and in vivo. Performance of the proposed approach is validated in two healthy volunteers imaged under two types of motion conditions simulating inadvertent fast motions associated with discomfort and continuous large motions.

RESULTS

The results show that the proposed optimization is able to efficiently correct for the motion artifacts and at the same time avoid signal dropout artifacts. Specifically, performing correction every 4^th echo prior to the left crusher gradient was shown to improve image quality.

CONCLUSION

An optimization approach is proposed to exploit the potential of external tracking for intra-echo-train motion artifact correction for turbo spin echo sequences.

Comparison between 2D and 3D MEDIC for human cervical spinal cord MRI at 3T

INTRODUCTION

High-resolution magnetic resonance imaging (MRI) of the cervical spinal cord is important to provide accurate diagnosis and pathological assessment of injuries. MEDIC (Multiple Echo Data Image Combination) sequences have been used in clinical MRI; however, a comparison of the performance of 2D and 3D MEDIC for cervical spinal cord imaging has not been reported. The aim of this study is to compare axial 2D and 3D MEDIC for the visualisation of the grey matter (GM) and white matter (WM) of the human cervical spinal cord.

METHODS

Eight healthy participants were scanned using Siemens Prismafit 3T MRI. T2*-weighted gradient spoiled 2D and 3D MEDIC sequences were acquired at 0.4 × 0.4 × 3.0 and 0.3 × 0.3 × 3.0 mm resolutions, with the acquisition times of 6 and 7 min, respectively. Quantitative analyses of the images were made based on the image signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and non-uniformity (NU). Two independent radiologists (CS and FN), each provided Likert scoring assessments of anatomical visibility of the GM and WM structures and image clarity for all samples.

RESULTS

Quantitative evaluation showed that 3D MEDIC provided higher SNR, higher CNR and lower NU than 2D MEDIC. However, 2D MEDIC provided better anatomical visibility for the GM, WM and CSF, and higher image clarity (lower artefacts) compared to 3D MEDIC.

CONCLUSIONS

2D MEDIC provides better information for depicting the internal structures of the cervical spinal cord compared to 3D MEDIC.

Optimized Breath-Hold Compressed-Sensing 3D MR Cholangiopancreatography at 3T: Image Quality Analysis and Clinical Feasibility Assessment

Magnetic resonance cholangiopancreatography (MRCP) has been widely used in clinical practice, and recently developed compressed-sensing accelerated MRCP (CS-MRCP) has shown great potential in shortening the acquisition time. The purpose of this prospective study was to evaluate the clinical feasibility and image quality of optimized breath-hold CS-MRCP (BH-CS-MRCP) and conventional navigator-triggered MRCP. Data from 124 consecutive patients with suspected pancreaticobiliary diseases were analyzed by two radiologists using a five-point Likert-type scale. Communication between a cyst and the pancreatic duct (PD) was analyzed. Signal-to-noise ratio (SNR) of the common bile duct (CBD), contrast ratio between the CBD and periductal tissue, and contrast-to-noise ratio (CNR) of the CBD and liver were measured. Optimized BH-CS-MRCP showed significantly fewer artifacts with better background suppression and overall image quality. Optimized BH-CS-MRCP demonstrated communication between a cyst and the PD better than conventional MRCP (96.7% vs. 76.7%, p = 0.048). SNR, contrast ratio, and CNR were significantly higher with optimized BH-CS-MRCP (p < 0.001). Optimized BH-CS-MRCP showed comparable or even better image quality than conventional MRCP, with improved visualization of communication between a cyst and the PD.

High-resolution Compressed-sensing T1 Black-blood MRI : A New Multipurpose Sequence in Vascular Neuroimaging?

BACKGROUND AND PURPOSE

In vasculopathies of the central nervous system, reliable and timely diagnosis is important against the background of significant morbidity and sequelae in cases of incorrect diagnosis or delayed treatment. Magnetic resonance imaging (MRI) plays a major role in the detection and monitoring of intracranial and extracranial vascular pathologies of different etiologies, in particular for evaluation of the vessel wall in addition to luminal information, thus allowing differentiation between various vasculopathies. Compressed-sensing black-blood MRI combines high image quality with relatively short acquisition time and offers promising potential in the context of neurovascular vessel wall imaging in clinical routine. This case review gives an overview of its application in the diagnosis of various intracranial and extracranial entities.

METHODS

An optimized high-resolution compressed-sensing black-blood 3D T1-weighted fast (turbo) spin echo technique (T1 CS-SPACE prototype) precontrast and postcontrast application at 3T was used for the evaluation of various vascular conditions in neuroradiology.

RESULTS

In this article seven cases of intracranial and extracranial arterial and venous vasculopathies with representative imaging findings in high-resolution compressed-sensing black-blood MRI are presented.

CONCLUSION

High-resolution 3D T1 CS-SPACE black-blood MRI is capable of imaging various vascular entities in high detail with whole head coverage and low susceptibility for motion artifacts and within acceptable scan times. It represents a highly versatile, non-invasive technique for the visualization and differentiation of a wide variety of neurovascular arterial and venous disorders.

Accelerated Internal Auditory Canal Screening Magnetic Resonance Imaging Protocol With Compressed Sensing 3-Dimensional T2-Weighted Sequence

BACKGROUND AND PURPOSE

High-resolution T2-weighted sequences are frequently used in magnetic resonance imaging (MRI) studies to assess the cerebellopontine angle and internal auditory canal (IAC) in sensorineural hearing loss patients but have low yield and lengthened examinations. Because image content in the Wavelet domain is sparse, compressed sensing (CS) that uses incoherent undersampling of k-space and iterative reconstruction can accelerate MRI acquisitions. We hypothesized that an accelerated CS T2 Sampling Perfection with Application optimized Contrasts using different flip angle Evolution (SPACE) sequence would produce acceptable diagnostic quality for IAC screening protocols.

MATERIAL AND METHODS

Seventy-six patients underwent 3 T MRI using conventional SPACE and a CS T2 SPACE prototype sequence for screening the IACs were identified retrospectively. Unilateral reconstructions for each sequence were separated, then placed into mixed folders for independent, blinded review by 3 neuroradiologists during 2 sessions 4 weeks apart. Radiologists reported if a lesion was present. Motion and visualization of specific structures were rated using ordinal scales. McNemar, Wilcoxon, Cohen κ, and Mann-Whitney U tests were performed for accuracy, equivalence, and interrater and intrarater reliability.

RESULTS

T2 SPACE using CS reconstruction reduced scan time by 80% to 50 seconds and provided 98.7% accuracy for IAC mass detection by 3 raters. Radiologists preferred conventional images (0.7-1.0 reduction on 5-point scale, P < 0.001), but rated CS SPACE acceptable. The 95% confidence for reduction in any cerebellopontine angle, IAC, or fluid-filled inner ear structure assessment with CS SPACE did not exceed 0.5.

CONCLUSIONS

Internal auditory canal screening MRI protocols can be performed using a 5-fold accelerated T2 SPACE sequence with compressed sensing while preserving diagnostic image quality and acceptable lesion detection rate.

Visualization of carotid vessel wall and atherosclerotic plaque: T1-SPACE vs. compressed sensing T1-SPACE

OBJECTIVES

To compare visualization of carotid plaques and vessel walls between 3D T1-fast spin echo imaging with conventional SPACE (T1-SPACE) and with a prototype compressed sensing T1-SPACE (CS-T1-SPACE) METHODS: This retrospective study was approved by the institutional review board. Participants comprised 43 patients (36 males, 7 females; mean age, 71 years) who underwent carotid MRI including T1-SPACE and CS-T1-SPACE. The quality of visualization for carotid plaques and vessel walls was evaluated using a 5-point scale, and signal intensity ratios (SRs) of the carotid plaques were measured and normalized to the adjacent sternomastoid muscle. Scores for the quality of visualization were compared between T1-SPACE and CS-T1-SPACE using the Wilcoxon signed-rank test. Statistical differences between SRs of plaques with T1-SPACE and CS-T1-SPACE were also evaluated using the Wilcoxon signed-rank test, and Spearman's correlation coefficient was calculated to investigate correlations.

RESULTS

Visualization scores were significantly higher for CS-T1-SPACE than for T1-SPACE when evaluating carotid plaques (p = 0.0212) and vessel walls (p < 0.001). The SR of plaques did not differ significantly between T1-SPACE and CS-T1-SPACE (p = 0.5971). Spearman's correlation coefficient was significant (0.884; p < 0.0001).

CONCLUSIONS

CS-T1-SPACE allowed better visualization scores and sharpness compared with T1-SPACE in evaluating carotid plaques and vessel walls, with a 2.5-fold accelerated scan time with comparable image quality. CS-T1-SPACE appears promising as a method for investigating carotid vessel walls, offering better image quality with a shorter acquisition time.

KEY POINTS

• CS-T1-SPACE allowed better visualization compared with T1-SPACE in evaluating carotid plaques and vessel walls, with a 2.5-fold accelerated scan time with comparable image quality. • CS-T1-SPACE offers a promising method for investigating carotid vessel walls due to the better image quality with shorter acquisition time. • Physiological movements such as swallowing, arterial pulsations, and breathing induce motion artifacts in vessel wall imaging, and a shorter acquisition time can reduce artifacts from physiological movements.

Adaptive bulk motion exclusion for improved robustness of abdominal magnetic resonance imaging

Non-Cartesian magnetic resonance imaging (MRI) sequences have shown great promise for abdominal examination during free breathing, but break down in the presence of bulk patient motion (i.e. voluntary or involuntary patient movement resulting in translation, rotation or elastic deformations of the body). This work describes a data-consistency-driven image stabilization technique that detects and excludes bulk movements during data acquisition. Bulk motion is identified from changes in the signal intensity distribution across different elements of a multi-channel receive coil array. A short free induction decay signal is acquired after excitation and used as a measure to determine alterations in the load distribution. The technique has been implemented on a clinical MR scanner and evaluated in the abdomen. Six volunteers were scanned and two radiologists scored the reconstructions. To show the applicability to other body areas, additional neck and knee images were acquired. Data corrupted by bulk motion were successfully detected and excluded from image reconstruction. An overall increase in image sharpness and reduction of streaking and shine-through artifacts were seen in the volunteer study, as well as in the neck and knee scans. The proposed technique enables automatic real-time detection and exclusion of bulk motion during MR examinations without user interaction. It may help to improve the reliability of pediatric MRI examinations without the use of sedation.

Comparing an accelerated 3D fast spin-echo sequence (CS-SPACE) for knee 3-T magnetic resonance imaging with traditional 3D fast spin-echo (SPACE) and routine 2D sequences

PURPOSE

To compare a faster, new, high-resolution accelerated 3D-fast-spin-echo (3D-FSE) acquisition sequence (CS-SPACE) to traditional 2D and high-resolution 3D sequences for knee 3-T magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Twenty patients received knee MRIs that included routine 2D (T1, PD ± FS, T2-FS; 0.5 × 0.5 × 3 mm³; ∼10 min), traditional 3D FSE (SPACE-PD-FS; 0.5 × 0.5 × 0.5 mm³; ∼7.5 min), and accelerated 3D-FSE prototype (CS-SPACE-PD-FS; 0.5 × 0.5 × 0.5 mm³; ∼5 min) acquisitions on a 3-T MRI system (Siemens MAGNETOM Skyra). Three musculoskeletal radiologists (MSKRs) prospectively and independently reviewed the studies with graded surveys comparing image and diagnostic quality. Tissue-specific signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were also compared.

RESULTS

MSKR-perceived diagnostic quality of cartilage was significantly higher for CS-SPACE than for SPACE and 2D sequences (p < 0.001). Assessment of diagnostic quality of menisci and synovial fluid was higher for CS-SPACE than for SPACE (p < 0.001). CS-SPACE was not significantly different from SPACE but had lower assessments than 2D sequences for evaluation of bones, ligaments, muscles, and fat (p ≤ 0.004). 3D sequences had higher spatial resolution, but lower overall assessed contrast (p < 0.001). Overall image quality from CS-SPACE was assessed as higher than SPACE (p = 0.007), but lower than 2D sequences (p < 0.001). Compared to SPACE, CS-SPACE had higher fluid SNR and CNR against all other tissues (all p < 0.001).

CONCLUSIONS

The CS-SPACE prototype allows for faster isotropic acquisitions of knee MRIs over currently used protocols. High fluid-to-cartilage CNR and higher spatial resolution over routine 2D sequences may present a valuable role for CS-SPACE in the evaluation of cartilage and menisci.