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Ozcan HN, Ozer G, Dogan HS, Karakaya J, Oguz B, Tekgul S, Haliloglu M. Zero-echo time MRI: an alternative method for the diagnosis of urinary stones in children. Eur Radiol 2024:10.1007/s00330-024-10950-x. [PMID: 38992108 DOI: 10.1007/s00330-024-10950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/01/2024] [Accepted: 06/21/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES To evaluate the potential of zero-echo time-magnetic resonance imaging (ZTE-MRI) in the assessment of urolithiasis and compare ZTE-MRI with computed tomography (CT) in pediatric patients. MATERIALS AND METHODS This was a single-center, prospective cross-sectional study conducted between April 2023 and December 2023. 23 patients (12 girls, 11 boys; mean age: 12.3, range 1-18) with urinary tract stones detected on non-enhanced abdominal CT were enrolled. The images were evaluated independently by two radiologists for the presence, and number of stones in the kidneys, ureters, and bladder. In the second session, two radiologists evaluated whether urinary tract stones could be detected by MRI compared to CT, and the maximum diameter of the stones was measured. The CT and MRI results were compared with the Wilcoxon test. The agreement between the results of the observers was examined using Spearman's rho correlation coefficient and the intraclass correlation coefficient. RESULTS A total of 58 urinary tract stones were detected by CT and 39 of these were detected by MRI. Most of the stones that MRI could not detect were < 5 mm and the detection sensitivity of MRI increased in correlation with stone size (p < 0.001). There was poor intermodality agreement for stones < 5 mm, substantial agreement for stones 5-10 mm, and almost perfect agreement for stones > 10 mm. Interobserver agreement for stone detection on MRI was almost perfect for stones > 10 mm and 5-10 mm and was substantial for stones < 5 mm. CONCLUSION ZTE-MRI is a promising modality for detecting urinary stones without radiation exposure in children. CLINICAL RELEVANCE STATEMENT Zero-echo time-magnetic resonance imaging is a potential method for identifying urinary stones in children and other populations who are particularly sensitive to radiation. KEY POINTS Urinary system stone disease in children is increasing and imaging is needed for managing urolithiasis. Zero-echo time-magnetic resonance imaging (ZTE-MRI) had an accuracy of 81.8% and 93.7% for stones larger than 5 mm and 10 mm, respectively. ZTE-MRI is a potential non-irradiating method for the diagnosis and management of urolithiasis.
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Affiliation(s)
- H Nursun Ozcan
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
| | - Gozde Ozer
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Berna Oguz
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mithat Haliloglu
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Csore J, Karmonik C, Wilhoit K, Buckner L, Roy TL. Automatic Classification of Magnetic Resonance Histology of Peripheral Arterial Chronic Total Occlusions Using a Variational Autoencoder: A Feasibility Study. Diagnostics (Basel) 2023; 13:diagnostics13111925. [PMID: 37296778 DOI: 10.3390/diagnostics13111925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
The novel approach of our study consists in adapting and in evaluating a custom-made variational autoencoder (VAE) using two-dimensional (2D) convolutional neural networks (CNNs) on magnetic resonance imaging (MRI) images for differentiate soft vs. hard plaque components in peripheral arterial disease (PAD). Five amputated lower extremities were imaged at a clinical ultra-high field 7 Tesla MRI. Ultrashort echo time (UTE), T1-weighted (T1w) and T2-weighted (T2w) datasets were acquired. Multiplanar reconstruction (MPR) images were obtained from one lesion per limb. Images were aligned to each other and pseudo-color red-green-blue images were created. Four areas in latent space were defined corresponding to the sorted images reconstructed by the VAE. Images were classified from their position in latent space and scored using tissue score (TS) as following: (1) lumen patent, TS:0; (2) partially patent, TS:1; (3) mostly occluded with soft tissue, TS:3; (4) mostly occluded with hard tissue, TS:5. Average and relative percentage of TS was calculated per lesion defined as the sum of the tissue score for each image divided by the total number of images. In total, 2390 MPR reconstructed images were included in the analysis. Relative percentage of average tissue score varied from only patent (lesion #1) to presence of all four classes. Lesions #2, #3 and #5 were classified to contain tissues except mostly occluded with hard tissue while lesion #4 contained all (ranges (I): 0.2-100%, (II): 46.3-75.9%, (III): 18-33.5%, (IV): 20%). Training the VAE was successful as images with soft/hard tissues in PAD lesions were satisfactory separated in latent space. Using VAE may assist in rapid classification of MRI histology images acquired in a clinical setup for facilitating endovascular procedures.
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Affiliation(s)
- Judit Csore
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122 Budapest, Hungary
| | - Christof Karmonik
- MRI Core, Translational Imaging Center, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, 77030 TX, USA
| | - Kayla Wilhoit
- MRI Core, Translational Imaging Center, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, 77030 TX, USA
| | - Lily Buckner
- MRI Core, Translational Imaging Center, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, 77030 TX, USA
| | - Trisha L Roy
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA
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Takahashi M, Takehara Y, Fujisaki K, Okuaki T, Fukuma Y, Tooyama N, Ichijo K, Amano T, Goshima S, Naganawa S. Three Dimensional Ultra-short Echo Time MRI Can Depict Cholesterol Components of Gallstones Bright. Magn Reson Med Sci 2020; 20:359-370. [PMID: 33390560 PMCID: PMC8922345 DOI: 10.2463/mrms.mp.2020-0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose Non-calcified cholesterol stones that are small in size are hard to be depicted on CT or magnetic resonance cholangiopancreatography. This institutional review board (IRB)-approved retrospective in vitro study aims to characterize contrast behaviors of 3 main components of the gallstones, i.e., cholesterol component (CC), bilirubin calcium component (BC) and CaCO3 (CO) on 3D radial scan with ultrashort TE (UTE) MRI, and to test the capability of depicting CC of gallstones as bright signals as compared to background saline. Methods Fourteen representative gallstones from 14 patients, including 15 CC, 6 BC and 4 CO, were enrolled. The gallstones underwent MRI including fat-saturated T1-weighted image (fs-T1WI) and UTE MRI with dual echoes. The contrast-to-noise ratio (CNR) and the chemical analysis for the 25 portions of the stones were compared. Results BC was bright on fs-T1WI, which did not change dramatically on UTE MRI and the signal did not remain on UTE subtraction image between dual echoes. Whereas the CC was negative or faintly positive signal on fs-T1WI, bright signal on UTE MRI and the contrast remained even higher on the UTE subtraction, which reflected their short T2 values. Median CNRs and standard errors of the segments on each imaging were as follows: on fs-T1WI, −10.2 ± 4.2 for CC, 149.7 ± 27.6 for BC and 37.9 ± 14.3 for CO; on UTE MRI first echo, 16.7 ± 3.3 for CC, 74.9 ± 21.3 for BC and 17.7 ± 8.4 for CO; on UTE subtraction image, 30.2 ±2.0 for CC, −11.2 ± 5.4 for BC and 17.8 ± 10.7 for CO. Linear correlations between CNRs and cholesterol concentrations were observed on fs-T1WI with r = −0.885, (P < 0.0001), UTE MRI first echo r = −0.524 (P = 0.0072) and UTE subtraction with r = 0.598 (P = 0.0016). Conclusion UTE MRI and UTE subtraction can depict CC bright.
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Affiliation(s)
| | - Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine
| | | | | | | | | | | | - Tomoyasu Amano
- Department of Radiological Technology, Seirei Mikatahara General Hospital
| | - Satoshi Goshima
- Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University School of Medicine
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine
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Shamir SB, Peng Q, Schoenfeld AH, Drzewiecki BA, Liszewski MC. CT, US and MRI of xanthine urinary stones: in-vitro and in-vivo analyses. BMC Urol 2020; 20:157. [PMID: 33046039 PMCID: PMC7552601 DOI: 10.1186/s12894-020-00736-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Xanthine urinary stones are a rare entity that may occur in patients with Lesch-Nyhan syndrome receiving allopurinol. There is little literature describing imaging characteristics of these stones, and the most appropriate approach to imaging these stones is therefore unclear. We performed in-vitro and in-vivo analyses of xanthine stones using computed tomography (CT) at different energy levels, ultrasound (US), and magnetic resonance imaging (MRI). METHODS Five pure xanthine stones from a child with Lesch-Nyhan were imaged in-vitro and in-vivo. CT of the stones was performed at 80 kVp, 100 kVp, 120 kVp and 140 kVp and CT numbers of the stones were recorded in Hounsfield units (HU). US of the stones was performed and echogenicity, acoustic shadowing and twinkle artifact were assessed. MRI of the stones was performed and included T2-weighted, ultrashort echo-time-weighted and T2/T1-weighted 3D bFFE sequences and signal was assessed. RESULTS In-vitro analysis on CT demonstrated that xanthine stones were radiodense and the average attenuation coefficient did not differ with varying kVp, measuring 331.0 ± 51.7 HU at 80 kVp, 321.4 ± 63.4 HU at 100 kVp, 329.7 ± 54.2 HU at 120 kVp and 328.4 ± 61.1 HU at 140 kVp. In-vivo analysis on CT resulted in an average attenuation of 354 ± 35 HU. On US, xanthine stones where echogenic with acoustic shadowing and twinkle artifact. On MRI, stones lacked signal on all tested sequences. CONCLUSION Xanthine stone analyses, both in-vitro and in-vivo, demonstrate imaging characteristics typical of most urinary stones: dense on CT, echogenic on US, and lacking signal on MRI. Therefore, the approach to imaging xanthine stones should be comparable to that of other urinary stones.
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Affiliation(s)
- Stephanie B Shamir
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East, 210th Street, Bronx, NY, 10467, USA.
| | - Qi Peng
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East, 210th Street, Bronx, NY, 10467, USA
| | - Alan H Schoenfeld
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East, 210th Street, Bronx, NY, 10467, USA
| | - Beth A Drzewiecki
- Division of Pediatric Urology, Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Ave, 5th Floor, Bronx, NY, 10467, USA
| | - Mark C Liszewski
- Division of Pediatric Radiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East, 210th Street, Bronx, NY, 10467, USA
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Abstract
Kidney stone imaging is an important diagnostic tool and initial step in deciding which therapeutic options to use for the management of kidney stones. Guidelines provided by the American College of Radiology, American Urological Association, and European Association of Urology differ regarding the optimal initial imaging modality to use to evaluate patients with suspected obstructive nephrolithiasis. Noncontrast CT of the abdomen and pelvis consistently provides the most accurate diagnosis but also exposes patients to ionizing radiation. Traditionally, ultrasonography has a lower sensitivity and specificity than CT, but does not require use of radiation. However, when these imaging modalities were compared in a randomized controlled trial they were found to have equivalent diagnostic accuracy within the emergency department. Both modalities have advantages and disadvantages. Kidney, ureter, bladder (KUB) plain film radiography is most helpful in evaluating for interval stone growth in patients with known stone disease, and is less useful in the setting of acute stones. MRI provides the possibility of 3D imaging without exposure to radiation, but it is costly and currently stones are difficult to visualize. Further developments are expected to enhance each imaging modality for the evaluation and treatment of kidney stones in the near future. A proposed algorithm for imaging patients with acute stones in light of the current guidelines and a randomized controlled trial could aid clinicians.
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Affiliation(s)
- Wayne Brisbane
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356510, Seattle, Washington 98195, USA
| | - Michael R Bailey
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 1013 NE 40th Street, Seattle, Washington 98105, USA
| | - Mathew D Sorensen
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356510, Seattle, Washington 98195, USA.,Division of Urology, Department of Veteran Affairs Medical Center, 1660S Columbian Way, Seattle, Washington 98108, USA
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Ibrahim ESH, Cernigliaro JG, Pooley RA, Bridges MD, Giesbrandt JG, Williams JC, Haley WE. Detection of different kidney stone types: an ex vivo comparison of ultrashort echo time MRI to reference standard CT. Clin Imaging 2015; 40:90-5. [PMID: 26526527 DOI: 10.1016/j.clinimag.2015.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/24/2015] [Accepted: 09/04/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE With the development of ultrashort echo time (UTE) sequences, it may now be possible to detect kidney stones by using magnetic resonance imaging (MRI). In this study, kidney stones of varying composition and sizes were imaged using both UTE MRI as well as the reference standard of computed tomography (CT), with different surrounding materials and scan setups. METHODS One hundred and fourteen kidney stones were inserted into agarose and urine phantoms and imaged both on a dual-energy CT (DECT) scanner using a standard renal stone imaging protocol and on an MRI scanner using the UTE sequence with both head and body surface coils. A subset of the stones representing all composition types and sizes was then inserted into the collecting system of porcine kidneys and imaged in vitro with both CT and MRI. RESULTS All of the stones were visible on both CT and MRI imaging. DECT was capable of differentiating between uric acid and nonuric acid stones. In MRI imaging, the choice of coil and large field of view (FOV) did not affect stone detection or image quality. The MRI images showed good visualization of the stones' shapes, and the stones' dimensions measured from MRI were in good agreement with the actual values (R(2)=0.886, 0.895, and 0.81 in the agarose phantom, urine phantom, and pig kidneys, respectively). The measured T2 relaxation times ranged from 4.2 to 7.5ms, but did not show significant differences among different stone composition types. CONCLUSIONS UTE MRI compared favorably with the reference standard CT for imaging stones of different composition types and sizes using body surface coil and large FOV, which suggests potential usefulness of UTE MRI in imaging kidney stones in vivo.
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Affiliation(s)
- El-Sayed H Ibrahim
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | | | - Robert A Pooley
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | | | | | - James C Williams
- Indiana University, 340 West 10th Street, Indianapolis, IN 46202, USA
| | - William E Haley
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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Ibrahim ESH, Pooley RA, Bridges MD, Cernigliaro JG, Haley WE. Kidney stone imaging with 3D ultra-short echo time (UTE) magnetic resonance imaging. A phantom study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:2356-9. [PMID: 25570462 DOI: 10.1109/embc.2014.6944094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Computed tomography (CT) is the current gold standard for imaging kidney stones, albeit at the cost of radiation exposure. Conventional magnetic resonance imaging (MRI) sequences are insensitive to detecting the stones because of their appearance as a signal void. With the development of 2D ultra-short echo-time (UTE) MRI sequences, it becomes possible to image kidney stones in vitro. In this work, we optimize and implement a modified 3D UTE MRI sequence for imaging kidney stones embedded in agarose phantoms mimicking the kidney tissue and in urine phantoms at 3.0T. The proposed technique is capable of imaging the stones with high spatial resolution in a short scan time.
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