7 Tesla quantitative hip MRI: a comparison between TESS and CPMG for T2 mapping

Cartilage compositional MRI-a narrative review of technical development and clinical applications over the past three decades

Articular cartilage damage and degeneration are among hallmark manifestations of joint injuries and arthritis, classically osteoarthritis. Cartilage compositional MRI (Cart-C MRI), a quantitative technique, which aims to detect early-stage cartilage matrix changes that precede macroscopic alterations, began development in the 1990s. However, despite the significant advancements over the past three decades, Cart-C MRI remains predominantly a research tool, hindered by various technical and clinical hurdles. This paper will review the technical evolution of Cart-C MRI, delve into its clinical applications, and conclude by identifying the existing gaps and challenges that need to be addressed to enable even broader clinical application of Cart-C MRI.

Multi-parametric MRI for radiotherapy simulation

Magnetic resonance imaging (MRI) has become an important imaging modality in the field of radiotherapy (RT) in the past decade, especially with the development of various novel MRI and image-guidance techniques. In this review article, we will describe recent developments and discuss the applications of multi-parametric MRI (mpMRI) in RT simulation. In this review, mpMRI refers to a general and loose definition which includes various multi-contrast MRI techniques. Specifically, we will focus on the implementation, challenges, and future directions of mpMRI techniques for RT simulation.

Current and Future Advanced Imaging Modalities for the Diagnosis of Early Osteoarthritis of the Hip

Hip osteoarthritis (OA) can be idiopathic or develop secondary to structural joint abnormalities of the hip joint (alteration of normal anatomy) and/or due to a systemic condition with joint involvement. Early osteoarthritic changes to the hip can be completely asymptomatic or may cause the development hip symptomatology without evidence of OA on radiographs. Delaying the progression of hip OA is critical due to the significant impact of this condition on the patient’s quality of life. Pre-OA of the hip is a newly established term that is often described as the development of signs and symptoms of degenerative hip disease but no radiographic evidence of OA. Advanced imaging methods can help to diagnose pre-OA of the hip in patients with hip pain and normal radiographs or aid in the surveillance of asymptomatic patients with an underlying hip diagnosis that is known to increase the risk of early OA of the hip. These methods include the delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC), quantitative magnetic resonance imaging (qMRI- T1rho, T2, and T2* relaxation time mapping), 7-Tesla MRI, computed tomography (CT), and optical coherence tomography (OCT). dGEMRIC proved to be a reliable and accurate modality though it is limited by the significant time necessary for contrast washout between scans. This disadvantage is potentially overcome by T2 weighted MRIs, which do not require contrast. 7-Tesla MRI is a promising development for enhanced imaging resolution compared to 1.5 and 3T MRIs. This technique does require additional optimization and development prior to widespread clinical use. The purpose of this review was to summarize the results of translational and clinical studies investigating the utilization of the above-mentioned imaging modalities to diagnose hip pre-OA, with special focus on recent research evaluating their implementation into clinical practice.

Musculoskeletal MR Imaging Applications at Ultra-High (7T) Field Strength

Regulatory approval of ultrahigh field (UHF) MR imaging scanners for clinical use has opened new opportunities for musculoskeletal imaging applications. UHF MR imaging has unique advantages in terms of signal-to-noise ratio, contrast-to-noise ratio, spectral resolution, and multinuclear applications, thus providing unique information not available at lower field strengths. But UHF also comes with a set of technical challenges that are yet to be resolved and may not be suitable for all imaging applications. This review focuses on the latest research in musculoskeletal MR imaging applications at UHF including morphologic imaging, T₂, T₂∗, and T_1ρ mapping, chemical exchange saturation transfer, sodium imaging, and phosphorus spectroscopy imaging applications.

Musculoskeletal MRI at 7 T: do we need more or is it more than enough?

Ultra-high field magnetic resonance imaging (UHF-MRI) provides important diagnostic improvements in musculoskeletal imaging. The higher signal-to-noise ratio leads to higher spatial and temporal resolution which results in improved anatomic detail and higher diagnostic confidence. Several methods, such as T2, T2*, T1rho mapping, delayed gadolinium-enhanced, diffusion, chemical exchange saturation transfer, and magnetisation transfer techniques, permit a better tissue characterisation. Furthermore, UHF-MRI enables in vivo measurements by low-γ nuclei (²³Na, ³¹P, ¹³C, and ³⁹K) and the evaluation of different tissue metabolic pathways. European Union and Food and Drug Administration approvals for clinical imaging at UHF have been the first step towards a more routinely use of this technology, but some drawbacks are still present limiting its widespread clinical application. This review aims to provide a clinically oriented overview about the application of UHF-MRI in the different anatomical districts and tissues of musculoskeletal system and its pros and cons. Further studies are needed to consolidate the added value of the use of UHF-MRI in the routine clinical practice and promising efforts in technology development are already in progress.

Magnetic Resonance Imaging of the Musculoskeletal System at 7T: Morphological Imaging and Beyond

In 2017, a whole-body 7T magnetic resonance imaging (MRI) device was given regulatory approval for clinical use in both the EU and United States for neuro and musculoskeletal applications. As 7 Tesla allows for higher signal-to-noise , which results in higher resolution images than those obtained on lower-field-strength scanners, it has attracted considerable attention from the musculoskeletal field, as evidenced by the increasing number of publications in the last decade. Besides morphological imaging, the quantitative MR methods, such as T₂, T₂∗, T_1ρ mapping, sodium imaging, chemical-exchange saturation transfer, and spectroscopy, substantially benefit from ultrahigh field scanning. In this review, we provide technical considerations for the individual techniques and an overview of (mostly) clinical applications for the assessment of cartilage, tendon, meniscus, and muscle. The first part of the review is dedicated to morphological applications at 7T, and the second part describes the most recent developments in quantitative MRI at 7T.

Measurement of T1 and T2 relaxation times of the pancreas at 7 T using a multi-transmit system

Objective

To determine T₁ and T₂ relaxation times of healthy pancreas parenchyma at 7 T using a multi-transmit system.

Materials and methods

Twenty-six healthy subjects were scanned with a 7 T MR system using eight parallel transceiver antennas, each with two additional receive loops. A Look-Locker sequence was used to obtain images for T₁ determination, while T₂ was obtained from spin-echo images and magnetic resonance spectroscopy measurements with different echo times. T₁ and T₂ times were calculated using a mono-exponential fit of the average magnitude signal from a region of interest in the pancreas and were tested for correlation with age.

Results

The age range of the included subjects was 21–72 years. Average T₁ and T₂ relaxation times in healthy pancreas were 896 ± 149 ms, and 26.7 ± 5.3 ms, respectively. No correlation with age was found.

Conclusion

T₁ and T₂ relaxation times of the healthy pancreas were reported for 7 T, which can be used for image acquisition optimization. No significant correlations were found between age and T₁ or T₂ relaxation times of the pancreas. Considering their low standard deviation and no observable age dependence, these values may be used as a baseline to study potentially pancreatic tissue affected by disease.

Radiofrequency Coils for 7 Tesla MRI

Radiofrequency (RF) coils are an essential part of the magnetic resonance (MR) system. To exploit the inherently higher signal-to-noise ratio at ultrahigh magnetic fields (UHF), research sites were forced to build up expertise in RF coil development, as the number of commercially available RF coils were limited. In addition, an integrated transmit body RF coil, which is well-established at MR systems of lower field strength, is still missing at UHF due to technical and physical constraints. This review article provides a brief recapitulation of RF characteristics and RF coils in general to introduce terminology and RF-related parameters, and will then provide an extensive overview of current state-of-the-art RF coils used for MRI from head to toe at 7 Tesla. Finally, a section on RF safety will briefly discuss challenges in performing a safety assessment for custom-designed RF coils, and issues arising from the interaction of the RF field and potentially implanted medical devices.

Diffusion effect on T2 relaxometry in triple-echo steady state free precession sequence

PURPOSE

The purpose of this study is to evaluate the effect of diffusion on SSFP (Steady-state Free Precession) signals in triple-echo steady state (TESS) sequence and ultimately on the accuracy of T2 relaxometry.

METHODS

The extended phase graph (EPG) algorithm was used to study the effect of diffusion on SSFP signals and T2 relaxometry. The simulation results were verified by a commercial phantom and in vivo studies. Based on the simulation results, a correction scheme was proposed to correct the estimated T2 values.

RESULTS

T2 underestimation in TESS was evident in case of small flip angle and large unbalanced gradient moment on objects with large T2 and D values. The T2 underestimation mainly originated from the diffusion sensitivity of SSFP-echo. It was also observed that SSFP-FID (Free Induction Decay) signals increased with increasing diffusion weighting under some specific conditions. The proposed correction scheme corrected the T2 underestimation, which verified that the underestimation was due to the neglect of diffusion effect. For clinical practice of TESS in tissues with short T2 such as cartilage and muscle, the diffusion effect of TESS is negligible.

CONCLUSION

The effect of diffusion cannot be neglected during TESS T2 quantification as it is the main source of T2 underestimation when small flip angle and large unbalanced gradient moment is used, especially for objects with large T2 and D values.

Quantitative techniques for musculoskeletal MRI at 7 Tesla

Whole-body 7 Tesla MRI scanners have been approved solely for research since they appeared on the market over 10 years ago, but may soon be approved for selected clinical neurological and musculoskeletal applications in both the EU and the United States. There has been considerable research work on musculoskeletal applications at 7 Tesla over the past decade, including techniques for ultra-high resolution morphological imaging, 3D T2 and T2* mapping, ultra-short TE applications, diffusion tensor imaging of cartilage, and several techniques for assessing proteoglycan content in cartilage. Most of this work has been done in the knee or other extremities, due to technical difficulties associated with scanning areas such as the hip and torso at 7 Tesla. In this manuscript, we first provide some technical context for 7 Tesla imaging, including challenges and potential advantages. We then review the major quantitative MRI techniques being applied to musculoskeletal applications on 7 Tesla whole-body systems.