Constraining the initial phase in water-fat separation

Estimation of field inhomogeneity map following magnitude-based ambiguity-resolved water-fat separation

Magnitude-based PDFF (Proton Density Fat Fraction) and R2∗ mapping with resolved water-fat ambiguity is extended to calculate field inhomogeneity (field map) using the phase images. The estimation is formulated in matrix form, resolving the field map in a least-squares sense. PDFF and R2∗ from magnitude fitting may be updated using the estimated field maps. The limits of quantification of our voxel-independent implementation were assessed. Bland-Altman was used to compare PDFF and field maps from our method against a reference complex-based method on 152 UK Biobank subjects (1.5 T Siemens). A separate acquisition (3 T Siemens) presenting field inhomogeneities was also used. The proposed field mapping was accurate beyond double the complex-based limit range. High agreement was obtained between the proposed method and the reference in UK. Robust field mapping was observed at 3 T, for inhomogeneities over 400 Hz including rapid variation across edges. Field mapping following unambiguous magnitude-based water-fat separation was demonstrated in-vivo and showed potential at 3 T.

Confounder-corrected T1 mapping in the liver through simultaneous estimation of T1 , PDFF, R 2 * , and B 1 + in a single breath-hold acquisition

PURPOSE

Quantitative volumetric T₁ mapping in the liver has the potential to aid in the detection, diagnosis, and quantification of liver fibrosis, inflammation, and spatially resolved liver function. However, accurate measurement of hepatic T₁ is confounded by the presence of fat and inhomogeneous B 1 + $$ {B}_1^{+} $$ excitation. Furthermore, scan time constraints related to respiratory motion require tradeoffs of reduced volumetric coverage and/or increased acquisition time. This work presents a novel 3D acquisition and estimation method for confounder-corrected T₁ measurement over the entire liver within a single breath-hold through simultaneous estimation of T₁ , fat and B 1 + $$ {B}_1^{+} $$ .

THEORY AND METHODS

The proposed method combines chemical shift encoded MRI and variable flip angle MRI with a B 1 + $$ {B}_1^{+} $$ mapping technique to enable confounder-corrected T₁ mapping. The method was evaluated theoretically and demonstrated in both phantom and in vivo acquisitions at 1.5 and 3.0T. At 1.5T, the method was evaluated both pre- and post- contrast enhancement in healthy volunteers.

RESULTS

The proposed method demonstrated excellent linear agreement with reference inversion-recovery spin-echo based T₁ in phantom acquisitions at both 1.5 and 3.0T, with minimal bias (5.2 and 45 ms, respectively) over T₁ ranging from 200-1200 ms. In vivo results were in general agreement with reference saturation-recovery based 2D T₁ maps (SMART₁ Map, GE Healthcare).

CONCLUSION

The proposed 3D T₁ mapping method accounts for fat and B 1 + $$ {B}_1^{+} $$ confounders through simultaneous estimation of T₁ , B 1 + $$ {B}_1^{+} $$ , PDFF and R 2 * $$ {R}_2^{\ast } $$ . It demonstrates strong linear agreement with reference T₁ measurements, with low bias and high precision, and can achieve full liver coverage in a single breath-hold.

Addressing concomitant gradient phase errors in time-interleaved chemical shift-encoded MRI fat fraction and R2 * mapping with a pass-specific phase fitting method

PURPOSE

Concomitant gradients induce phase errors that increase quadratically with distance from isocenter. This work proposes a complex-based fitting method that addresses concomitant gradient phase errors in chemical shift encoded (CSE) MRI estimation of proton density fat fraction (PDFF) and R₂ ^* through joint estimation of pass-specific phase terms. This method is applicable to time-interleaved multi-echo gradient-echo acquisitions (i.e., multi-pass acquisitions) and does not require prior knowledge of gradient waveforms typically needed to address concomitant gradient phase errors.

THEORY AND METHODS

A CSE-MRI spoiled gradient echo signal model, with pass-specific phase terms, is introduced for non-linear least squares estimation of PDFF and R₂ ^* in the presence of concomitant gradient phase errors. Cramér-Rao lower bound analysis was used to determine noise performance tradeoffs of the proposed fitting method, which was then validated in both phantom and in vivo experiments.

RESULTS

The proposed fitting method removed PDFF and R₂ ^* estimation errors up to 12% and 10 s^-1 , respectively, at ±12 cm off isocenter (S/I) in a water phantom. In healthy volunteers, PDFF and R₂ ^* bias was reduced by ~10% (12 cm off-isocenter) and ~30 s^-1 (16 cm off-isocenter), respectively. An evaluation in 29 clinical liver datasets demonstrated reduced PDFF bias and variability (8.4% improvement in the coefficient of variation), even with the imaging volume centered at isocenter.

CONCLUSION

Concomitant gradient induced phase errors in multi-pass CSE-MRI acquisitions can result in PDFF and R₂ ^* estimation biases away from isocenter. The proposed fitting method enables accurate PDFF and R₂ ^* quantification in the presence of concomitant gradient phase errors without knowledge of imaging gradient waveforms.

Development, validation, qualification, and dissemination of quantitative MR methods: Overview and recommendations by the ISMRM quantitative MR study group

On behalf of the International Society for Magnetic Resonance in Medicine (ISMRM) Quantitative MR Study Group, this article provides an overview of considerations for the development, validation, qualification, and dissemination of quantitative MR (qMR) methods. This process is framed in terms of two central technical performance properties, i.e., bias and precision. Although qMR is confounded by undesired effects, methods with low bias and high precision can be iteratively developed and validated. For illustration, two distinct qMR methods are discussed throughout the manuscript: quantification of liver proton-density fat fraction, and cardiac T₁ . These examples demonstrate the expansion of qMR methods from research centers toward widespread clinical dissemination. The overall goal of this article is to provide trainees, researchers, and clinicians with essential guidelines for the development and validation of qMR methods, as well as an understanding of necessary steps and potential pitfalls for the dissemination of quantitative MR in research and in the clinic.

Intravoxel incoherent motion diffusion-weighted MRI for the characterization of inflammation in chronic liver disease

OBJECTIVE

To evaluate the diagnostic performance of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) for grading hepatic inflammation.

METHODS

In this retrospective cross-sectional dual-center study, 91 patients with chronic liver disease were recruited between September 2014 and September 2018. Patients underwent 3.0-T MRI examinations within 6 weeks from a liver biopsy. IVIM parameters, perfusion fraction (f), diffusion coefficient (D), and pseudo-diffusion coefficient (D*), were estimated using a voxel-wise nonlinear regression on DWI series (10 b-values from 0 to 800 s/mm²). The reference standard was histopathological analysis of hepatic inflammation grade, steatosis grade, and fibrosis stage. Intraclass correlation coefficients (ICC), univariate and multivariate correlation analyses, and areas under receiver operating characteristic curves (AUC) were assessed.

RESULTS

Parameters f, D, and D* had ICCs of 0.860, 0.839, and 0.916, respectively. Correlations of f, D, and D* with inflammation grade were ρ = - 0.70, p < 0.0001; ρ = 0.10, p = 0.35; and ρ = - 0.27, p = 0.010, respectively. When adjusting for fibrosis and steatosis, the correlation between f and inflammation (p < 0.0001) remained, and that between f and fibrosis was also significant to a lesser extent (p = 0.002). AUCs of f, D, and D* for distinguishing inflammation grades 0 vs. ≥ 1 were 0.84, 0.53, and 0.70; ≤ 1 vs. ≥ 2 were 0.88, 0.57, and 0.60; and ≤ 2 vs. 3 were 0.86, 0.54, and 0.65, respectively.

CONCLUSION

Perfusion fraction f strongly correlated, D very weakly correlated, and D* weakly correlated with inflammation. Among all IVIM parameters, f accurately graded inflammation and showed promise as a biomarker of hepatic inflammation.

KEY POINTS

• IVIM parameters derived from DWI series with 10 b-values are reproducible for liver tissue characterization. • This retrospective two-center study showed that perfusion fraction provided good diagnostic performance for distinguishing dichotomized grades of inflammation. • Fibrosis is a significant confounder on the association between inflammation and perfusion fraction.

Generalized parameter estimation in multi-echo gradient-echo-based chemical species separation

To develop a generalized formulation for multi-echo gradient-echo-based chemical species separation for all MR signal models described by a weighted sum of complex exponentials with phases linear in the echo time. Constraints between estimation parameters in the signal model were abstracted into a matrix formulation of a generic parameter gradient. The signal model gradient was used in a parameter estimation algorithm and the Fisher information matrix. The general formulation was tested in numerical simulations and against literature and in vivo results. The proposed gradient-based parameter estimation and experimental design framework is universally applicable over the whole class of signal models using the matrix abstraction of the signal model-specific parameter constraints as input. Several previous results in magnetic-field mapping and water-fat imaging with different models could successfully be replicated with the same framework and only different input matrices. A framework for generalized parameter estimation in multi-echo gradient-echo MR signal models of multiple chemical species was developed and validated and its software version is freely available online.

Constraints in estimating the proton density fat fraction

The study evaluates four physically motivated constraints in the estimation of the proton density fat fraction (PDFF). Least squares approaches were developed for constraining the parameters in PDFF quantification based on the physics of magnetic resonance imaging. These were smooth fieldmap, smooth initial phase, nonnegative proton density and moderate R₂^∗ values. The constraints were evaluated in terms of their influence on the bias and standard deviation of the estimated parameters using numerical simulations and in vivo data acquired at 0.35 T. Results show that unconstrained least squares estimation is noisy and biased and that constraints can be effective at reducing both the standard deviation and bias.

Dynamic water/fat separation and B 0 inhomogeneity mapping-joint estimation using undersampled triple-echo multi-spoke radial FLASH

PURPOSE

To achieve dynamic water/fat separation and B 0 field inhomogeneity mapping via model-based reconstructions of undersampled triple-echo multi-spoke radial FLASH acquisitions.

METHODS

This work introduces an undersampled triple-echo multi-spoke radial FLASH sequence, which uses (i) complementary radial spokes per echo train for faster spatial encoding, (ii) asymmetric echoes for flexible and nonuniform echo spacing, and (iii) a golden angle increment across frames for optimal k-space coverage. Joint estimation of water, fat, B 0 inhomogeneity, and coil sensitivity maps from undersampled triple-echo data poses a nonlinear and non-convex inverse problem which is solved by a model-based reconstruction with suitable regularization. The developed methods are validated using phantom experiments with different degrees of undersampling. Real-time MRI studies of the knee, liver, and heart are conducted without prospective gating or retrospective data sorting at temporal resolutions of 70, 158, and 40 ms, respectively.

RESULTS

Up to 18-fold undersampling is achieved in this work. Even in the presence of rapid physiological motion, large B 0 field inhomogeneities, and phase wrapping, the model-based reconstruction yields reliably separated water/fat maps in conjunction with spatially smooth inhomogeneity maps.

CONCLUSIONS

The combination of a triple-echo acquisition and joint reconstruction technique provides a practical solution to time-resolved and motion robust water/fat separation at high spatial and temporal resolution.

Time-resolved contrast-enhanced MR angiography with single-echo Dixon fat suppression

PURPOSE

Dixon-based fat suppression has recently gained interest for dynamic contrast-enhanced MRI, but multi-echo techniques require longer scan times and reduce temporal resolution compared to single-echo alternatives without fat suppression. The purpose of this work is to demonstrate accelerated single-echo Dixon imaging with high spatial and temporal resolution.

THEORY AND METHODS

Real-valued water and fat images can be obtained from a single measurement if the shared initial phase and that due to ΔB0 are assumed known a priori. An expression for simultaneous sensitivity encoding (SENSE) unfolding and fat-water separation is derived for the general undersampling case, and simplified under the special case of uniform Cartesian undersampling. In vivo experiments were performed in extremities and brain with SENSE acceleration factors of up to R = 8.

RESULTS

Single-echo Dixon reconstruction of highly undersampled data was successfully demonstrated. Dynamic contrast-enhanced water and fat images provided high spatial and temporal resolution dynamic images with image update times shorter than previous single-echo Dixon work.

CONCLUSION

Time-resolved contrast-enhanced MRI with single-echo Dixon fat suppression shows high image quality, improved vessel delineation, and reduced sensitivity to motion when compared to time-subtraction methods.

Noise properties of proton density fat fraction estimated using chemical shift-encoded MRI

PURPOSE

The purpose of this work is to characterize the noise distribution of proton density fat fraction (PDFF) measured using chemical shift-encoded MRI, and to provide alternative strategies to reduce bias in PDFF estimation.

THEORY

We derived the probability density function for PDFF estimated using chemical shift-encoded MRI, and found it to exhibit an asymmetric noise distribution that contributes to signal-to-noise-ratio dependent bias.

METHODS

To study PDFF noise bias, we performed (at 1.5 T) numerical simulations, phantom acquisitions, and a retrospective in vivo experiment. In each experiment, we compared the performance of three statistics (mean, median, and maximum likelihood estimator) in estimating the PDFF in a region of interest.

RESULTS

We demonstrated the presence of the asymmetric noise distribution in simulations, phantoms, and in vivo. In each experiment we demonstrated that both the median and proposed maximum likelihood estimator statistics outperformed the mean statistic in mitigating noise-related bias for low signal-to-noise-ratio acquisitions.

CONCLUSIONS

Characterization of the noise distribution of PDFF estimated using chemical shift-encoded MRI enabled new strategies based on median and maximum likelihood estimator statistics to mitigate noise-related bias for accurate PDFF measurement from a region of interest. Such strategies are important for quantitative chemical shift-encoded MRI applications that typically operate in low signal-to-noise-ratio regimes. Magn Reson Med 80:685-695, 2018. © 2018 International Society for Magnetic Resonance in Medicine.

Robust and efficient pharmacokinetic parameter non-linear least squares estimation for dynamic contrast enhanced MRI of the prostate

PURPOSE

To describe an efficient numerical optimization technique using non-linear least squares to estimate perfusion parameters for the Tofts and extended Tofts models from dynamic contrast enhanced (DCE) MRI data and apply the technique to prostate cancer.

METHODS

Parameters were estimated by fitting the two Tofts-based perfusion models to the acquired data via non-linear least squares. We apply Variable Projection (VP) to convert the fitting problem from a multi-dimensional to a one-dimensional line search to improve computational efficiency and robustness. Using simulation and DCE-MRI studies in twenty patients with suspected prostate cancer, the VP-based solver was compared against the traditional Levenberg-Marquardt (LM) strategy for accuracy, noise amplification, robustness to converge, and computation time.

RESULTS

The simulation demonstrated that VP and LM were both accurate in that the medians closely matched assumed values across typical signal to noise ratio (SNR) levels for both Tofts models. VP and LM showed similar noise sensitivity. Studies using the patient data showed that the VP method reliably converged and matched results from LM with approximate 3× and 2× reductions in computation time for the standard (two-parameter) and extended (three-parameter) Tofts models. While LM failed to converge in 14% of the patient data, VP converged in the ideal 100%.

CONCLUSION

The VP-based method for non-linear least squares estimation of perfusion parameters for prostate MRI is equivalent in accuracy and robustness to noise, while being more reliably (100%) convergent and computationally about 3× (TM) and 2× (ETM) faster than the LM-based method.

Technical Aspects of Contrast-enhanced MR Angiography: Current Status and New Applications

This article is based on a presentation at the meeting of the Japanese Society of Magnetic Resonance in Medicine in September 2016. The purpose is to review the technical developments which have contributed to the current status of contrast-enhanced magnetic resonance angiography (CE-MRA) and to indicate related emerging areas of study. Technical developments include MRI physics-based innovations as well as improvements in MRI engineering. These have collectively addressed not only early issues of timing and venous suppression but more importantly have led to an improvement in spatiotemporal resolution of CE-MRA of more than two orders of magnitude compared to early results. This has allowed CE-MRA to be successfully performed in virtually all vascular territories of the body. Contemporary technical areas of study include improvements in implementation of high rate acceleration, extension of high performance first-pass CE-MRA across multiple imaging stations, expanded use of compressive sensing techniques, integration of Dixon-based fat suppression into CE-MRA sequences, and application of CE-MRA sequences to dynamic-contrast-enhanced perfusion imaging.

B1-insensitive T2 mapping of healthy thigh muscles using a T2-prepared 3D TSE sequence

Purpose

To propose a T2-prepared 3D turbo spin echo (T2prep 3D TSE) sequence for B1-insensitive skeletal muscle T2 mapping and compare its performance with 2D and 3D multi-echo spin echo (MESE) for T2 mapping in thigh muscles of healthy subjects.

Methods

The performance of 2D MESE, 3D MESE and the proposed T2prep 3D TSE in the presence of transmit B1 and B0 inhomogeneities was first simulated. The thigh muscles of ten young and healthy subjects were then scanned on a 3 T system and T2 mapping was performed using the three sequences. Transmit B1-maps and proton density fat fraction (PDFF) maps were also acquired. The subjects were scanned three times to assess reproducibility. T2 values were compared among sequences and their sensitivity to B1 inhomogeneities was compared to simulation results. Correlations were also determined between T2 values, PDFF and B1.

Results

The left rectus femoris muscle showed the largest B1 deviations from the nominal value (from 54.2% to 92.9%). Significant negative correlations between T2 values and B1 values were found in the left rectus femoris muscle for 3D MESE (r = -0.72, p<0.001) and 2D MESE (r = -0.71, p<0.001), but not for T2prep 3D TSE (r = -0.32, p = 0.09). Reproducibility of T2 expressed by root mean square coefficients of variation (RMSCVs) were equal to 3.5% in T2prep 3D TSE, 2.6% in 3D MESE and 2.4% in 2D MESE. Significant differences between T2 values of 3D sequences (T2prep 3D TSE and 3D MESE) and 2D MESE were found in all muscles with the highest values for 2D MESE (p<0.05). No significant correlations were found between PDFF and T2 values.

Conclusion

A strong influence of an inhomogeneous B1 field on the T2 values of 3D MESE and 2D MESE was shown, whereas the proposed T2prep 3D TSE gives B1-insensitive and reproducible thigh muscle T2 mapping.

Dual echo Dixon imaging with a constrained phase signal model and graph cuts reconstruction

PURPOSE

The purpose of this work is to derive and demonstrate constrained-phase dual-echo Dixon imaging within a maximum likelihood framework solved with a regularized graph-cuts-guided optimization.

THEORY AND METHODS

Dual-echo Dixon reconstruction is fundamentally underdetermined; however, adopting a constrained-phase signal model reduces the number of unknowns and the nonlinear problem can be solved under a maximum likelihood framework. Period shifts in the field map (manifesting as fat/water signal swaps) must also be corrected. Here, a regularized cost function promotes a smooth field map and is solved with a graph-cuts-guided greedy binary optimization. The reconstruction shown here is compared to two other prevalent Dixon reconstructions in experimental phantom and human studies.

RESULTS

Reconstructed images of the water and fat signal are shown for a phantom study, and in vivo studies of foot/ankle, pelvis, and CE-MRA of the thighs. The method shown here compared favorably with the other two methods. Large field inhomogeneities on the order of 20 ppm were resolved, thereby avoiding the fat and water signal swaps present in images reconstructed with the other methods.

CONCLUSION

Constrained-phase dual-echo Dixon imaging solved with a regularized graph-cuts-guided optimization has been derived and demonstrated to successfully separate water and fat images in the presence of large magnetic field inhomogeneities. Magn Reson Med 78:2203-2215, 2017. © 2017 International Society for Magnetic Resonance in Medicine.

Correction of phase errors in quantitative water-fat imaging using a monopolar time-interleaved multi-echo gradient echo sequence

PURPOSE

To propose a phase error correction scheme for monopolar time-interleaved multi-echo gradient echo water-fat imaging that allows accurate and robust complex-based quantification of the proton density fat fraction (PDFF).

METHODS

A three-step phase correction scheme is proposed to address a) a phase term induced by echo misalignments that can be measured with a reference scan using reversed readout polarity, b) a phase term induced by the concomitant gradient field that can be predicted from the gradient waveforms, and c) a phase offset between time-interleaved echo trains. Simulations were carried out to characterize the concomitant gradient field-induced PDFF bias and the performance estimating the phase offset between time-interleaved echo trains. Phantom experiments and in vivo liver and thigh imaging were performed to study the relevance of each of the three phase correction steps on PDFF accuracy and robustness.

RESULTS

The simulation, phantom, and in vivo results showed in agreement with the theory an echo time-dependent PDFF bias introduced by the three phase error sources. The proposed phase correction scheme was found to provide accurate PDFF estimation independent of the employed echo time combination.

CONCLUSION

Complex-based time-interleaved water-fat imaging was found to give accurate and robust PDFF measurements after applying the proposed phase error correction scheme. Magn Reson Med 78:984-996, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

On the R2⁎ relaxometry in complex multi-peak multi-Echo chemical shift-based water-fat quantification: Applications to the neuromuscular diseases

PURPOSE

Investigation of the feasibility of the R₂^⁎ mapping techniques by using latest theoretical models corrected for confounding factors and optimized for signal to noise ratio.

THEORY AND METHODS

The improvement of the performance of state of the art magnetic resonance imaging (MRI) relaxometry algorithms is challenging because of a non-negligible bias and still unresolved numerical instabilities. Here, R₂^⁎ mapping reconstructions, including complex fitting with multi-spectral fat-correction by using single-decay and double-decay formulation, are deeply studied in order to investigate and identify optimal configuration parameters and minimize the occurrence of numerical artifacts. The effects of echo number, echo spacing, and fat/water relaxation model type are evaluated through both simulated and in-vivo data. We also explore the stability and feasibility of the fat/water relaxation model by analyzing the impact of high percentage of fat infiltrations and local transverse relaxation differences among biological species.

RESULTS

The main limits of the MRI relaxometry are the presence of bias and the occurrence of artifacts, which significantly affect its accuracy. Chemical-shift complex R₂^⁎-correct single-decay reconstructions exhibit a large bias in presence of a significant difference in the relaxation rates of fat and water and with fat concentration larger than 30%. We find that for fat-dominated tissues or in patients affected by extensive iron deposition, MRI reconstructions accounting for multi-exponential relaxation time provide accurate R₂^⁎ measurements and are less prone to numerical artifacts.

CONCLUSIONS

Complex fitting and fat-correction with multi-exponential decay formulation outperforms the conventional single-decay approximation in various diagnostic scenarios. Although it still lacks of numerical stability, which requires model enhancement and support from spectroscopy, it offers promising perspectives for the development of relaxometry as a reliable tool to improve tissue characterization and monitoring of neuromuscular disorders.

R2*-corrected water-fat imaging using compressed sensing and parallel imaging

PURPOSE

To demonstrate an approach to water-fat separation with R2* correction using compressed sensing and parallel imaging.

METHODS

Acquisition times for chemical shift based water-fat separation imaging are lengthy, and many applications rely on image acceleration techniques. In this study, we present an integrated compressed sensing, parallel imaging, R2* corrected water-fat separation technique for water-fat imaging of highly accelerated acquisitions. Reconstruction times are reduced using coil compression.

RESULTS

The proposed technique is demonstrated using a customized IDEAL-SPGR pulse sequence to acquire retrospectively and prospectively undersampled datasets of the liver, calf, knee, and abdominal cavity. This technique is shown to offer comparable image quality relative to fully sampled reference images for a range of acceleration factors. At high acceleration factors, this technique is shown to offer improved image quality over parallel imaging.

CONCLUSION

A technique is described that uses compressed sensing and parallel imaging to reconstruct R2*-corrected water and fat images from accelerated datasets. Acceleration factors as high as 7.0 are shown with excellent image quality. These high acceleration factors enable water-fat separation with higher resolution or greater anatomical coverage in breath-hold applications.

Correlations between quantitative fat-water magnetic resonance imaging and computed tomography in human subcutaneous white adipose tissue

Beyond estimation of depot volumes, quantitative analysis of adipose tissue properties could improve understanding of how adipose tissue correlates with metabolic risk factors. We investigated whether the fat signal fraction (FSF) derived from quantitative fat-water magnetic resonance imaging (MRI) scans at 3.0 T correlates to CT Hounsfield units (HU) of the same tissue. These measures were acquired in the subcutaneous white adipose tissue (WAT) at the umbilical level of 21 healthy adult subjects. A moderate correlation exists between MRI- and CT-derived WAT values for all subjects, [Formula: see text], [Formula: see text], with a slope of [Formula: see text], (95% CI [Formula: see text]), indicating that a decrease of 1 HU equals a mean increase of 0.38% FSF. We demonstrate that FSF estimates obtained using quantitative fat-water MRI techniques correlate with CT HU values in subcutaneous WAT, and therefore, MRI-based FSF could be used as an alternative to CT HU for assessing metabolic risk factors.

Total liver fat quantification using three-dimensional respiratory self-navigated MRI sequence

PURPOSE

MRI can produce quantitative liver fat fraction (FF) maps noninvasively, which can help to improve diagnoses of fatty liver diseases. However, most sequences acquire several two-dimensional (2D) slices during one or more breath-holds, which may be difficult for patients with limited breath-holding capacity. A whole-liver 3D FF map could also be obtained in a single acquisition by applying a reliable breathing-motion correction method. Several correction techniques are available for 3D imaging, but they use external devices, interrupt acquisition, or jeopardize the spatial resolution. To overcome these issues, a proof-of-concept study introducing a self-navigated 3D three-point Dixon sequence is presented here.

METHODS

A respiratory self-gating strategy acquiring a center k-space profile was integrated into a three-point Dixon sequence. We obtained 3D FF maps from a water-fat emulsions phantom and fifteen volunteers. This sequence was compared with multi-2D breath-hold and 3D free-breathing approaches.

RESULTS

Our 3D three-point Dixon self-navigated sequence could correct for respiratory-motion artifacts and provided more precise FF measurements than breath-hold multi-2D and 3D free-breathing techniques.

CONCLUSION

Our 3D respiratory self-gating fat quantification sequence could correct for respiratory motion artifacts and yield more-precise FF measurements. Magn Reson Med 76:1400-1409, 2016. © 2015 International Society for Magnetic Resonance in Medicine.

MRI-determined liver proton density fat fraction, with MRS validation: Comparison of regions of interest sampling methods in patients with type 2 diabetes

PURPOSE

To assess the agreement between published magnetic resonance imaging (MRI)-based regions of interest (ROI) sampling methods using liver mean proton density fat fraction (PDFF) as the reference standard.

MATERIALS AND METHODS

This retrospective, internal review board-approved study was conducted in 35 patients with type 2 diabetes. Liver PDFF was measured by magnetic resonance spectroscopy (MRS) using a stimulated-echo acquisition mode sequence and MRI using a multiecho spoiled gradient-recalled echo sequence at 3.0T. ROI sampling methods reported in the literature were reproduced and liver mean PDFF obtained by whole-liver segmentation was used as the reference standard. Intraclass correlation coefficients (ICCs), Bland-Altman analysis, repeated-measures analysis of variance (ANOVA), and paired t-tests were performed.

RESULTS

ICC between MRS and MRI-PDFF was 0.916. Bland-Altman analysis showed excellent intermethod agreement with a bias of -1.5 ± 2.8%. The repeated-measures ANOVA found no systematic variation of PDFF among the nine liver segments. The correlation between liver mean PDFF and ROI sampling methods was very good to excellent (0.873 to 0.975). Paired t-tests revealed significant differences (P < 0.05) with ROI sampling methods that exclusively or predominantly sampled the right lobe. Significant correlations with mean PDFF were found with sampling methods that included higher number of segments, total area equal or larger than 5 cm(2) , or sampled both lobes (P = 0.001, 0.023, and 0.002, respectively).

CONCLUSION

MRI-PDFF quantification methods should sample each liver segment in both lobes and include a total surface area equal or larger than 5 cm(2) to provide a close estimate of the liver mean PDFF.

Dixon-type and subtraction-type contrast-enhanced magnetic resonance angiography: A theoretical and experimental comparison of SNR and CNR

PURPOSE

The purpose of this work is to compare the behavior of the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in contrast-enhanced MR angiography with background suppression performed by either a Dixon-type or subtraction-type method.

THEORY AND METHODS

Theoretical expressions for the SNR and CNR for both background suppression techniques were derived. The theoretical Dixon:subtraction SNR and CNR ratios were compared to empirical ratios measured from phantom and in vivo studies for Dixon techniques utilizing one, two, and three echoes. Specifically, the SNR and CNR ratios were compared as the concentration of contrast material in the blood changed.

RESULTS

Empirical measurements of the SNR and CNR ratios compared favorably with the ratios predicted by theory. As the contrast concentration was reduced, the SNR advantage of the Dixon techniques increased asymptotically. In the ideal case, the SNR improvement over subtraction contrast-enhanced MR angiography was at least twofold for one- and two-echo Dixon techniques and at least a factor of 6 for the three-echo Dixon technique.

CONCLUSION

Expressions showing a contrast concentration-dependent SNR and CNR improvement of at least a factor of two when Dixon-type contrast-enhanced MR angiography is used in place of subtraction-type contrast-enhanced MR angiography were derived and validated with phantom and in vivo experiments. Magn Reson Med 74:81-92, 2015. © 2014 Wiley Periodicals, Inc.

Effect of hepatocyte-specific gadolinium-based contrast agents on hepatic fat-fraction and R2(⁎)

The purpose of this work was to investigate the effect of a hepatocyte-specific gadolinium based contrast agent (GBCA) on quantitative hepatic fat-fraction (FF) and R2* measurements. Fifty patients were imaged at 1.5T, using chemical-shift encoded water-fat MRI with low (5°) and high (15°) flip angles (FA), both before and after administration of a hepatocyte-specific GBCA (gadoxetic acid). Low and high FA, pre- and post-contrast FF and R2* values were measured for each subject. Available serum laboratory studies related to liver disease were also recorded. Linear regression and Bland-Altman analysis were performed to compare measurements. Hepatic FF was unaffected by GBCA at low FA (slope=1.02±0.02, p=0.32). FF was overestimated at high FA pre-contrast (slope=1.33±0.03, p<10(-10)), but underestimated post-contrast (slope=0.81±0.02, p<10(-10)). Hepatic R2* was unaffected by FA (mean difference±95% CI pre-contrast:2.2±4.9s(-1), post-contrast:2.8±3.6s(-1)), but increased post-contrast in patients with total bilirubin <2.5mg/dL (ΔR2*=13.4±12.7s(-1)). Regression analysis of serum values demonstrated a correlation of post-contrast change in R2* with total bilirubin (p<0.01) and model for end-stage liver disease (MELD) score (p≈0.01). In conclusion, GBCA has no effect on hepatic FF at low FA due to a lack of T1-weighting, potentially allowing flexibility for FF imaging with hepatobiliary imaging protocols. Hepatic R2* increased significantly after GBCA administration, particularly in the biliary tree. Therefore, R2* maps should be obtained prior to contrast administration.

ISMRM workshop on fat-water separation: insights, applications and progress in MRI

Approximately 130 attendees convened on February 19-22, 2012 for the first ISMRM-sponsored workshop on water-fat imaging. The motivation to host this meeting was driven by the increasing number of research publications on this topic over the past decade. The scientific program included an historical perspective and a discussion of the clinical relevance of water-fat MRI, a technical description of multiecho pulse sequences, a review of data acquisition and reconstruction algorithms, a summary of the confounding factors that influence quantitative fat measurements and the importance of MRI-based biomarkers, a description of applications in the heart, liver, pancreas, abdomen, spine, pelvis, and muscles, an overview of the implications of fat in diabetes and obesity, a discussion on MR spectroscopy, a review of childhood obesity, the efficacy of lifestyle interventional studies, and the role of brown adipose tissue, and an outlook on federal funding opportunities from the National Institutes of Health.

Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease - MRI accurately quantifies hepatic steatosis in NAFLD

BACKGROUND

Conventional magnetic resonance imaging (MRI) techniques that measure hepatic steatosis are limited by T1 bias, T(2)* decay and multi-frequency signal-interference effects of protons in fat. Newer MR techniques such as the proton density-fat fraction (PDFF) that correct for these factors have not been specifically compared to liver biopsy in adult patients with non-alcoholic fatty liver disease (NAFLD).

AIM

To examine the association between MRI-determined PDFF and histology-determined steatosis grade, and their association with fibrosis.

METHODS

A total of 51 adult patients with biopsy-confirmed NAFLD underwent metabolic-biochemical profiling, MRI-determined PDFF measurement of hepatic steatosis and liver biopsy assessment according to NASH-CRN histological scoring system.

RESULTS

The average MRI-determined PDFF increased significantly with increasing histology-determined steatosis grade: 8.9% at grade-1, 16.3% at grade-2, and 25.0% at grade-3 with P ≤ 0.0001 (correlation: r(2) = 0.56, P < 0.0001). Patients with stage-4 fibrosis, when compared with patients with stage 0-3 fibrosis, had significantly lower hepatic steatosis by both MRI-determined PDFF (7.6% vs. 17.8%, P < 0.005) and histology-determined steatosis grade (1.4 vs. 2.2, P < 0.05). NAFLD patients with grade 1 steatosis were more likely to have characteristics of advanced liver disease including higher average AST:ALT (0.87 vs. 0.60, P < 0.02), GGT (140 vs. 67, P < 0.01), and INR (1.06 vs. 0.99, P < 0.01), higher stage of fibrosis and hepatocellular ballooning.

CONCLUSIONS

MRI-determined proton density-fat fraction correlates with histology-determined steatosis grade in adults with NAFLD. Steatosis is non-linearly related to fibrosis progression. In patients with NAFLD, a low amount of hepatic steatosis on imaging does not necessarily indicate mild disease.

Chemical shift-based water/fat separation in the presence of susceptibility-induced fat resonance shift

Chemical shift-based water/fat separation methods have been emerging due to the growing clinical need for fat quantification in different body organs. Accurate quantification of proton-density fat fraction requires the assessment of many confounding factors, including the need of modeling the presence of multiple peaks in the fat spectrum. Most recent quantitative chemical shift-based water/fat separation approaches rely on a multipeak fat spectrum with precalibrated peak locations and precalibrated or self-calibrated peak relative amplitudes. However, water/fat susceptibility differences can induce fat spectrum resonance shifts depending on the shape and orientation of the fatty inclusions. The effect is of particular interest in the skeletal muscle due to the anisotropic arrangement of extracellular lipids. In this work, the effect of susceptibility-induced fat resonance shift on the fat fraction is characterized in a conventional complex-based chemical shift-based water/fat separation approach that does not model the susceptibility-induced fat resonance shift. A novel algorithm is then proposed to quantify the resonance shift in a complex-based chemical shift-based water/fat separation approach that considers the fat resonance shift in the signal model, aiming to extract information about the orientation/geometry of lipids. The technique is validated in a phantom and preliminary in vivo results are shown in the calf musculature of healthy and diabetic subjects.

Robustness of fat quantification using chemical shift imaging

The purpose of this study was to investigate the effect of parameter changes that can potentially lead to unreliable measurements in fat quantification. Chemical shift imaging was performed using spoiled gradient echo sequences with systematic variations in the following: two-dimensional/three-dimensional sequence, number of echoes, delta echo time, fractional echo factor, slice thickness, repetition time, flip angle, bandwidth, matrix size, flow compensation and field strength. Results indicated no significant (or significant but small) changes in fat fraction with parameter. The significant changes can be attributed to the known effects of T1 bias and two forms of noise bias.