Fat suppression techniques in MRI: an update

Fast online spectral-spatial pulse design for subject-specific fat saturation in cervical spine and foot imaging at 1.5 T

OBJECTIVE

To compensate subject-specific field inhomogeneities and enhance fat pre-saturation with a fast online individual spectral-spatial (SPSP) single-channel pulse design.

METHODS

The RF shape is calculated online using subject-specific field maps and a predefined excitation k-space trajectory. Calculation acceleration options are explored to increase clinical viability. Four optimization configurations are compared to a standard Gaussian spectral selective pre-saturation pulse and to a Dixon acquisition using phantom and volunteer (N = 5) data at 1.5 T with a turbo spin echo (TSE) sequence. Measurements and simulations are conducted across various body parts and image orientations.

RESULTS

Phantom measurements demonstrate up to a 3.5-fold reduction in residual fat signal compared to Gaussian fat saturation. In vivo evaluations show improvements up to sixfold for dorsal subcutaneous fat in sagittal cervical spine acquisitions. The versatility of the tailored trajectory is confirmed through sagittal foot/ankle, coronal, and transversal cervical spine experiments. Additional measurements indicate that excitation field (B1) information can be disregarded at 1.5 T. Acceleration methods reduce computation time to a few seconds.

DISCUSSION

An individual pulse design that primarily compensates for main field (B0) inhomogeneities in fat pre-saturation is successfully implemented within an online "push-button" workflow. Both fat saturation homogeneity and the level of suppression are improved.

Reducing the ambiguity of field inhomogeneity and chemical shift effect for fat-water separation by field factor

PURPOSE

To reduce the ambiguity between chemical shift and field inhomogeneity with flexible TE combinations by introducing a variable (field factor).

THEORY AND METHODS

The ambiguity between chemical shift and field inhomogeneity can be eliminated directly from the multiple in-phase images acquired at different TEs; however, it is only applicable to few echo combinations. In this study, we accommodated such an implementation in flexible TE combinations by introducing a new variable (field factor). The effects of the chemical shift were removed from the field inhomogeneity in the candidate solutions, thus reducing the ambiguity problem. To validate this concept, multi-echo MRI data acquired from various anatomies with different imaging parameters were tested. The derived fat and water images were compared with those of the state-of-the-art fat-water separation algorithms.

RESULTS

Robust fat-water separation was achieved with the accurate solution of field inhomogeneity, and no apparent fat-water swap was observed. In addition to the good performance, the proposed method is applicable to various fat-water separation applications, including different sequence types and flexible TE choices.

CONCLUSION

We propose an algorithm to reduce the ambiguity of chemical shift and field inhomogeneity and achieved robust fat-water separation in various applications.

Clinician's guide to the basic principles of MRI

MRI is an important and widely used imaging modality for clinical diagnosis. This article provides a concise discussion of the basic principles of MRI physics for non-radiology clinicians, with a general explanation of the fundamentals of signal generation and image contrast mechanisms. Common pulse sequences, tissue suppression techniques and use of gadolinium contrast with relevant clinical applications are presented. Knowledge of these concepts would provide an appreciation of how MR images are acquired and interpreted to facilitate interdisciplinary understanding between radiologists and referring clinicians.

Short-T2 MRI: Principles and recent advances

Among current modalities of biomedical and diagnostic imaging, MRI stands out by virtue of its versatile contrast obtained without ionizing radiation. However, in various cases, e.g., water protons in tissues such as bone, tendon, and lung, MRI performance is limited by the rapid decay of resonance signals associated with short transverse relaxation times T₂ or T₂*. Efforts to address this shortcoming have led to a variety of specialized short-T₂ techniques. Recent progress in this field expands the choice of methods and prompts fresh considerations with regard to instrumentation, data acquisition, and signal processing. In this review, the current status of short-T₂ MRI is surveyed. In an attempt to structure the growing range of techniques, the presentation highlights overarching concepts and basic methodological options. The most frequently used approaches are described in detail, including acquisition strategies, image reconstruction, hardware requirements, means of introducing contrast, sources of artifacts, limitations, and applications.

Clinical experience with two-point mDixon turbo spin echo as an alternative to conventional turbo spin echo for magnetic resonance imaging of the pediatric knee

BACKGROUND

Two-point modified Dixon (mDixon) turbo spin-echo (TSE) sequence provides an efficient, robust method of fat suppression. In one mDixon acquisition, four image types can be generated: water-only, fat-only, in-phase and opposed-phase images.

OBJECTIVE

To determine whether PD mDixon TSE water-only and, by proxy, PD in-phase images generated by one acquisition can replace two conventional PD TSE sequences with and without fat suppression in routine clinical MR examination of the knee.

MATERIALS AND METHODS

This is a retrospective study of 50 consecutive pediatric knee MR examinations. PD mDixon TSE water-only and PD fat-saturated TSE sequences (acquired in the sagittal plane with identical spatial resolution) were reviewed independently by two pediatric radiologists for homogeneity of fat suppression and detection of intra-articular pathology. Thirteen of the 50 patients underwent arthroscopy, and we used the arthroscopic results as a reference standard for the proton-density fat-saturated and proton-density mDixon results. We used the Kruskal-Wallis rank test to assess difference in fat suppression between the proton-density mDixon and proton-density fat-saturated techniques. We used kappa statistics to compare the agreement of detection of intra-articular pathology between readers and techniques. We also calculated sensitivity, specificity and accuracy between arthroscopy and MR interpretations.

RESULTS

Proton-density mDixon water-only imaging showed significant improvement with the fat suppression compared with proton-density fat-saturated sequence (P=0.02). Each observer demonstrated near-perfect agreement between both techniques for detecting meniscal and ligamentous pathology and fair to substantial agreement for bone contusions, and chondral and osteochondral lesions.

CONCLUSION

Two-point mDixon water-only imaging can replace conventional proton-density fat-saturated sequence. When same-plane proton-density fat-saturated and non-fat-saturated sequences are required, proton-density water-only and proton-density in-phase image types acquired in the same acquisition shorten the overall examination time while maintaining excellent intra-articular lesion conspicuity.

Is there an association between enhanced choline and β-catenin pathway in breast cancer? A pilot study by MR Spectroscopy and ELISA

Total choline (tCho) was documented as a biomarker for breast cancer diagnosis by in vivo MRS. To understand the molecular mechanisms behind elevated tCho in breast cancer, an association of tCho with β-catenin and cyclin D1 was evaluated. Hundred fractions from 20 malignant, 10 benign and 20 non-involved breast tissues were isolated. Cytosolic and nuclear expressions of β-catenin and cyclin D1 were estimated using ELISA. Higher tCho was seen in malignant compared to benign tissues. Malignant tissues showed higher cytosolic and nuclear β-catenin expressions than benign and non-involved tissues. Within malignant tissues, β-catenin and cyclin D1 expressions were higher in the nucleus than cytosol. Cyclin D1 expression was higher in the cytosolic fractions of benign and non-involved than malignant tissues. Furthermore, in malignant tissues, tCho showed a positive correlation with the cytosolic and nuclear expression of β-catenin and cyclin D1 and also a correlation between nuclear expressions of both these proteins was seen. Higher cytosolic β-catenin expression was seen in progesterone receptor negative than positive patients. Results provide an evidence of correlation between non-invasive biomarker, tCho and the Wnt/β-catenin pathway. The findings explain the molecular mechanism of tCho elevation which may facilitate exploration of additional therapeutic targets for breast cancer.

Spectrally-Presaturated Modulation (SPM): An efficient fat suppression technique for STEAM-based cardiac imaging sequences

Stimulated-echo acquisition mode (STEAM) is a key pulse sequences in MRI in general, and in cardiac imaging in particular. Fat suppression is an important feature in cardiac imaging to improve visualization and eliminate off-resonance and chemical-shift artifacts. Nevertheless, fat suppression comes at the expense of reduced temporal resolution and signal-to-noise ratio (SNR). The purpose of this study is to develop an efficient fat suppression method (Spectrally-Presaturated Modulation) for STEAM-based sequences to enable imaging with high temporal-resolution, high SNR, and no increase in scan time. The developed method is based on saturating the fat magnetization prior to applying STEAM modulation; therefore, only the water-content of the tissues is modulated by the sequence, resulting in fat-suppressed images without the need to run the fat suppression module during image acquisition. The potential significance of the proposed method is presented in two STEAM-based cardiac MRI applications: complementary spatial-modulation of magnetization (CSPAMM), and black-blood cine imaging. Phantom and in vivo experiments are conducted to evaluate the developed technique and compare it to the commonly implemented chemical-shift selective (CHESS) and water-excitation using spectral-spatial selective pulses (SSSP) fat suppression techniques. The results from the phantom and in vivo experiments show superior performance of the proposed method compared to the CHESS and SSSP techniques in terms of temporal resolution and SNR. In conclusion, the developed fat suppression technique results in enhanced image quality of STEAM-based images, especially in cardiac applications, where high temporal-resolution is imperative for accurate measurement of functional parameters and improved performance of image analysis algorithms.

MRI sequences for the detection of individual lymph nodes in regional breast radiotherapy planning

OBJECTIVE

In regional radiotherapy (RT) for patients with breast cancer, lymph node (LN) targets are delineated on CT, defined by anatomical boundaries. By identifying individual LNs, MRI-based delineations may reduce target volumes and thereby toxicity. We optimized MRI sequences for this purpose. Our aim was to evaluate the techniques for LN delineation in RT planning.

METHODS

Supine MRI was explored at 1.5 T in RT position (arms in abduction). 5 MRI techniques were optimized in 10 and evaluated in 12 healthy female volunteers. The scans included one T1 weighted (T1w), three T2 weighted (T2w) and a diffusion-weighted imaging (DWI) technique. Quantitative evaluation was performed by scoring LN numbers per volunteer and per scan. Qualitatively, scans were assessed on seven aspects, including LN contrast, anatomical information and insensitivity to motion during acquisition.

RESULTS

Two T2w fast spin-echo (FSE) methods showed the highest LN numbers (median 24 axillary), high contrast, excellent fat suppression and relative insensitivity to motion during acquisition. A third T2w sequence and DWI showed significantly fewer LNs (14 and 10) and proved unsuitable due to motion sensitivity and geometrical uncertainties. T1w MRI showed an intermediate number of LNs (17), provided valuable anatomical information, but lacked LN contrast.

CONCLUSION

Explicit LN imaging was achieved, in supine RT position, using MRI. Two T2w FSE techniques had the highest detection rates and were motion insensitive. T1w MRI showed anatomical information. MRI enables direct delineation of individual LNs.

ADVANCES IN KNOWLEDGE

Our optimized MRI scans enable accurate target definition in MRI-guided regional breast RT and development of personalized treatments.

Trunk Muscle Size and Composition Assessment in Older Adults with Chronic Low Back Pain: An Intra-Examiner and Inter-Examiner Reliability Study

OBJECTIVE

To evaluate intra- and inter-examiner reliability for the assessment of relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area, i.e., total cross-sectional area minus intramuscular fat, from T1-weighted magnetic resonance images obtained in older adults with chronic low back pain.

DESIGN

Reliability study.

SUBJECTS

n = 13 (69.3 ± 8.2 years old)

METHODS

After lumbar magnetic resonance imaging, two examiners produced relative cross-sectional area measurements of multifidi, erector spinae, psoas, and quadratus lumborum by tracing regions of interest just inside fascial borders. Pixel-intensity summaries were used to determine muscle-to-fat infiltration indices; relative muscle cross-sectional area was calculated. Intraclass correlation coefficients were used to estimate intra- and inter-examiner reliability; standard error of measurement was calculated.

RESULTS

Intra-examiner intraclass correlation coefficient point estimates for relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area were excellent for multifidi and erector spinae across levels L2-L5 (ICC = 0.77-0.99). At L3, intra-examiner reliability was excellent for relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area for both psoas and quadratus lumborum (ICC = 0.81-0.99). Inter-examiner intraclass correlation coefficients ranged from poor to excellent for relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area.

CONCLUSIONS

Assessment of relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area in older adults with chronic low back pain can be reliably determined by one examiner from T1-weighted images. Such assessments provide valuable information, as muscle-to-fat infiltration indices and relative muscle cross-sectional area indicate that a substantial amount of relative cross-sectional area may be magnetic resonance-visible intramuscular fat in older adults with chronic low back pain.

Improved frequency selective fat suppression in the posterior neck with tissue susceptibility matched pyrolytic graphite foam

PURPOSE

To demonstrate improved frequency selective fat suppression in MRI using a magnetic susceptibility matching foam by reducing B0 inhomogeneities induced within the body by air-tissue interfaces.

MATERIALS AND METHODS

Flexible pyrolytic graphite (PG) composite foam was tailored to match the magnetic susceptibility of human tissue and was shaped to surround the cervical spine region. Field maps and frequency selective fat suppressed T1 -weighted FLASH images were acquired at 3 Tesla in both phantoms and six healthy necks.

RESULTS

B0 field uniformity was shimmed to a target critical threshold of 1 ppm for fat suppression. The percentage of voxels in the phantom that did not achieve the critical threshold was reduced from 64% without the PG foam to only 1% with the foam. A similar decrease from 16% to 2% was observed in the in vivo region of interest.

CONCLUSION

PG foam improved B0 field uniformity by moving air-tissue field gradients outside of the neck where they cannot cause MRI artifacts. The PG foams consistently mitigated signal dropout, improved overall SNR, and enabled more robust frequency selective fat suppression.

Assessment of global cardiac function

High-resolution magnetic resonance cine imaging (cine-MRI) allows for a non-invasive assessment of ventricular function and mass in normal mice and in genetically and surgically modified mouse models of cardiac disease. The assessment of myocardial mass and function by cine-MRI does not rely on geometric assumptions, as the hearts are covered from the base to the apex, typically by a stack of two-dimensional images. The MR data acquisition is then followed by image segmentation of specific cine frames in each slice to obtain geometric and functional parameters, such as end-diastolic volume (EDV), end-systolic volume (ESV) or ejection fraction (EF). This technique has been well established in clinical routine application and it is now also becoming the reference method in experimental cardiovascular MRI. The cine images are typically acquired in short- and long-axis orientations of the heart to facilitate an accurate assessment of cardiac functional parameters. These views can be difficult to identify, particularly in animals with diseased hearts. Furthermore, data analysis can be the source of a systematic error, mainly for myocardial mass measurement. We have established protocols that allow for a quick and reproducible way of obtaining the relevant cardiac views for cine-MRI, and for accurate image analysis.

[Comparison of fat suppression techniques of bilateral breast dynamic sequence at 3.0 T: utility of three-point DIXON technique]

The purposes of this study were to determine optimum flip angles (FAs) and to compare the effectiveness of fat suppression and signal homogeneity among three techniques, spectral attenuated with inversion recovery (SPAIR), principle of selective excitation technique (PROSET), and three-point DIXON technique (DIXON), of the bilateral breast dynamic sequence acquired using the optimum FA at 3.0 T. Using a homemade phantom that represented a tumor, fat, and a mammary gland, the optimum FAs were determined from the change of fat signal intensity, signal-to-noise ratio (SNR) of the mammary gland, and contrast ratio (CR) between the tumor and mammary gland. The effectiveness of fat suppression and signal homogeneity were compared in ten breast cancer cases, using the CR between fat and pectoralis muscle signal intensities and the standard deviation (SD) of fat signal intensity, respectively. The optimum FAs for SPAIR, PROSET, and DIXON were 10, 20, and 20 degrees, respectively. The mean CR between fat and pectoralis muscle signal intensities achieved using SPAIR, PROSET, and DIXON were 0.19, 0.30 and 0.40, respectively, and the mean SDs of the fat signal intensities were 90.2, 103.1, and 30.5, respectively. The DIXON technique provided better fat suppression and signal homogeneity than the other two techniques. The results of this study suggest the possible application of the DIXON technique in combination with the optimum FA setting as an effective fat suppression technique for the bilateral breast dynamic sequence at 3.0 T.

Pyrolytic graphite foam: a passive magnetic susceptibility matching material

PURPOSE

To evaluate a novel soft, lightweight cushion that can match the magnetic susceptibility of human tissue. The magnetic susceptibility difference between air and tissue produces field inhomogeneities in the B(0) field, which leads to susceptibility artifacts in magnetic resonance imaging (MRI) studies.

MATERIALS AND METHODS

Pyrolytic graphite (PG) microparticles were uniformly embedded into a foam cushion to reduce or eliminate field inhomogeneities at accessible air and tissue interfaces. 3T MR images and field maps of an air/water/PG foam phantom were acquired. Q measurements on a 4T tuned head coil and pulse sequence heating tests at 3T were also performed.

RESULTS

The PG foam improved susceptibility matching, reduced the field perturbations in phantoms, does not heat, and is nonconductive.

CONCLUSION

The susceptibility matched PG foam is lightweight, safe for patient use, adds no noise or MRI artifacts, is compatible with radiofrequency coil arrays, and improves B(0) homogeneity, which enables more robust MR studies.

PERFIDI filters to suppress and/or quantify relaxation time components in multi-component systems: an example for fat-water systems

Parametrically Enabled Relaxation FIlters with Double and multiple Inversion (PERFIDI) is an experimental NMR/MRI technique devised to analyze samples/voxels characterized by multi-exponential longitudinal relaxation. It is based on a linear combination of NMR sequences with suitable preambles composed of inversion pulses. Given any standard NMR/MRI sequence, it permits one to modify it in a way which will attenuate, in a predictable manner and before data acquisition, signals arising from components with different r rates (r=1/T1). Consequently, it is possible to define relatively simple protocols to suppress and/or to quantify signals of different components. This article describes a simple way to construct low-pass, high-pass and band-pass PERFIDI filters. Experimental data are presented in which the method has been used to separate fat and water proton signals. We also present a novel protocol for very fast determination of the ratio between the fat signal and the total signal which avoids any time-consuming magnetization recovery multi-array data acquisition. The method has been validated also for MRI, producing well T1-contrasted images.

Fat-free MRI based on magnetization exchange

An MRI technique is proposed for complete fat signal elimination. This approach exploits the fact that water rapidly exchanges magnetization with protons in protein and membrane phospholipid of tissue and cells but does not exchange magnetization with triglyceride or fat protons in the tissue. Saturation of the proton signal from protein and membrane phospholipid thus results in partial saturation of the water proton signal, allowing acquisition of an image including a portion of the water signal and the full fat signal. Subtraction of this image from the standard image, containing both water and fat signals, results in an image in which all fat signal is cancelled. This fat-free image is sensitive to magnetization transfer and to water density and relaxation time, providing the possibility of additional contrast. Unlike most fat suppression techniques, this method is not compromised by the static or radiofrequency field heterogeneity and is equally efficient for all fat resonances independent of their chemical shift frequency.

Algebraic decomposition of fat and water in MRI

The decomposition of magnetic resonance imaging (MRI) data to generate water and fat images has several applications in medical imaging, including fat suppression and quantification of visceral fat. We introduce a novel algorithm to overcome some of the problems associated with current analytical and iterative decomposition schemes. In contrast to traditional analytical schemes, our approach is general enough to accommodate any uniform echo-shift pattern, any number of metabolites and signal samples. In contrast to region-growing method that use a smooth field-map initialization to resolve the ambiguities with the IDEAL algorithm, we propose to use an explicit smoothness constraint on the final field-map estimate. Towards this end, we estimate the number of feasible solutions at all the voxels, prior to the evaluation of the roots. This approach enables the algorithm to evaluate all the feasible roots, thus avoiding the convergence to the wrong solution. The estimation procedure is based on a modification of the harmonic retrieval (HR) framework to account for the chemical shift dependence in the frequencies. In contrast to the standard linear HR framework, we obtain the frequency shift as the common root of a set of quadratic equations. On most of the pixels with multiple feasible solutions, the correct solution can be identified by a simple sorting of the solutions. We use a region-merging algorithm to resolve the remaining ambiguity and phase-wrapping. Experimental results indicate that the proposed algebraic scheme eliminates most of the difficulties with the current schemes, without compromising the noise performance. Moreover, the proposed algorithm is also computationally more efficient.

Novel rapid fat suppression strategy with spectrally selective pulses

Short repetition time gradient echo sequences are gaining popularity in clinical applications such as dynamic contrast enhancement imaging, cardiac imaging, and MR angiography. Performing fat suppression in these sequences is usually time consuming and often somewhat ineffective, due to the relatively short T(1) and long T(2) of fat. A novel rapid fat suppression strategy using spectrally selective pulses is introduced and compared with clinically popular sequences such as fat presaturated fast field echo (FFE) and turbo field echo (TFE) and binomial water-selective spatial-spectral excitation (SSE, or SPSP excitation) FFE. The new strategy combines fat presaturation with low-order binomial water-selective SSE pulses in a TFE sequence. This enables the use of a long echo train length to decrease exam time, but without creation of excess fat signal contamination of the resultant images. The fat nullification is also more reliable as fat signals in central k-space data are suppressed twice. An implementation of this strategy is compared with traditional methods in both phantom and human studies, confirming that the new technique provides strong fat suppression with few artifacts despite the short scan duration.

Fast, high-resolution in vivo cine magnetic resonance imaging in normal and failing mouse hearts on a vertical 11.7 T system

PURPOSE

To establish fast, high-resolution in vivo cine magnetic resonance imaging (cine-MRI) on a vertical 11.7-T MR system and to investigate the stability of normal and failing mouse hearts in the vertical position.

MATERIALS AND METHODS

To optimize the method on a high-field system, various MR-related parameters, such as relaxation times and the need for respiratory gating, were quantitatively investigated. High-resolution cine-MRI was applied to normal mice and to a murine heart failure model. Cardiac functional parameters were compared to matched mice imaged previously on a horizontal MR system.

RESULTS

A T(1) of 1.10 +/- 0.27 seconds and a T(2) of 18.5 +/- 3.9 msec were measured for murine myocardial tissue. A quantitative analysis also proved respiratory gating to be essential for obtaining artifact-free cine images in the vertical position at this field strength. Cardiac functional parameters of mice, obtained within one hour, agreed well with those from previous studies of mice in the horizontal position.

CONCLUSION

This work shows that MR systems with a vertical bore design can be used to accurately measure cardiac function in both normal and chronically failing mouse hearts within one hour. The increased signal-to-noise ratio (SNR) due to the higher field strength could be exploited to obtain higher temporal and spatial resolution compared to previous studies that were performed on horizontal systems with lower field strengths.