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Mouchoux J, Meyer-Marcotty P, Sojka F, Dechent P, Klenke D, Wiechens B, Quast A. Reliability of landmark identification for analysis of the temporomandibular joint in real-time MRI. Head Face Med 2024; 20:10. [PMID: 38365709 PMCID: PMC10874088 DOI: 10.1186/s13005-024-00411-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/22/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Real-time magnetic resonance imaging (rtMRI) is essential for diagnosing and comprehending temporomandibular joint (TMJ) movements. Current methods for tracking and analysis require manual landmark placement on each acquisition frame. Therefore, our study aimed to assess the inter- and intra-rater reliability of placing cephalometric landmarks in frames from a dynamic real-time TMJ MRI. MATERIAL AND METHODS Four real-time MRIs of the right TMJ were taken during mandibular movement at ten frames per second. Seven dentists identified ten landmarks on two frames (intercuspal position-ICP-and maximum mouth opening-MMO) twice at a two-week interval, yielding 112 tracings. Six typical cephalometric measurements (angles and distances) were derived from these landmarks. The reliabilities of landmarks and measurements were evaluated using distance-based (dbICC), linear mixed effect model intraclass correlation (lmeICC), and standard ICC. RESULTS The average inter-rater reliability for the landmarks stood at 0.92 (dbICC) and 0.93 (lmeICC). The intra-rater reliability scores were 0.97 and 0.98. Over 80% of the landmarks showed an ICC greater than 0.98 (inter-rater) and over 0.99 (intra-rater). The lowest landmark ICC was observed for the orbitale and the oblique ridge of the mandibular ramus. However, the cephalometric angle and distance measurements derived from these landmarks showed only moderate to good reliability, whereas the reliability in the frames with ICP was better than those with MMO. Measurements performed in the ICP frame were more reliable than measurements in the MMO frame. CONCLUSION While dentists reliably localize isolated landmarks in real-time MRIs, the cephalometric measurements derived from them remain inconsistent. The better results in ICP than MMO are probably due to a more familiar jaw position. The higher error rate of the TMJ measurements in MMO could be associated with a lack of training in real-time MRI analysis in dentistry.
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Affiliation(s)
- Jérémy Mouchoux
- Poliklinik Für Kieferorthopädie, Universitätmedizin Göttingen (UMG), Göttingen, Germany.
| | | | - Florian Sojka
- Poliklinik Für Kieferorthopädie, Universitätmedizin Göttingen (UMG), Göttingen, Germany
| | - Peter Dechent
- Institut Für Kognitive Neurologie, Universitätmedizin Göttingen (UMG), Göttingen, Germany
| | - Daniela Klenke
- Poliklinik Für Kieferorthopädie, Universitätmedizin Göttingen (UMG), Göttingen, Germany
| | - Bernhard Wiechens
- Poliklinik Für Kieferorthopädie, Universitätmedizin Göttingen (UMG), Göttingen, Germany
| | - Anja Quast
- Poliklinik Für Kieferorthopädie, Universitätmedizin Göttingen (UMG), Göttingen, Germany
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2
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Biggemann L, Uhlig J, Streit U, Al-Bourini O, Wedi E, Amanzada A, Ellenrieder V, Rühlmann F, Ghadimi M, Frahm J, Uecker M, Seif Amir Hosseini A. Visualization of deglutition and gastroesophageal reflux using real-time MRI: a standardized approach to image acquisition and assessment. Sci Rep 2023; 13:22854. [PMID: 38129469 PMCID: PMC10739804 DOI: 10.1038/s41598-023-49776-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
This study aims to develop a standardized algorithm for gastroesophageal image acquisition and diagnostic assessment using real-time MRI. Patients with GERD symptoms undergoing real-time MRI of the esophagus and esophagogastric junction between 2015 and 2018 were included. A 10 ml bolus of pineapple juice served as an oral contrast agent. Patients performed Valsalva maneuver to provoke reflux and hiatal hernia. Systematic MRI assessment included visual presence of achalasia, fundoplication failure in patients with previous surgical fundoplication, gastroesophageal reflux, and hiatal hernia. A total of 184 patients (n = 92 female [50%], mean age 52.7 ± 15.8 years) completed MRI studies without adverse events at a mean examination time of 15 min. Gastroesophageal reflux was evident in n = 117 (63.6%), hiatal hernia in n = 95 (52.5%), and achalasia in 4 patients (2.2%). Hiatal hernia was observed more frequently in patients with reflux at rest (n = 67 vs. n = 6, p < 0.01) and during Valsalva maneuver (n = 87 vs. n = 8, p < 0.01). Real-time MRI visualized a morphologic correlate for recurring GERD symptoms in 20/22 patients (90%) after fundoplication procedure. In a large-scale single-center cohort of patients with GERD symptoms undergoing real-time MRI, visual correlates for clinical symptoms were evident in most cases. The proposed assessment algorithm could aid in wider-spread utilization of real-time MRI and provides a comprehensive approach to this novel imaging modality.
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Affiliation(s)
- Lorenz Biggemann
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany.
| | - Johannes Uhlig
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Ulrike Streit
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, München, Germany
| | - Omar Al-Bourini
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Edris Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Göttingen, Germany
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Ahmad Amanzada
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Felix Rühlmann
- Department of General, Visceral, and Paediatric Surgery, University Medical Center, Göttingen, Germany
| | - Michael Ghadimi
- Department of General, Visceral, and Paediatric Surgery, University Medical Center, Göttingen, Germany
| | - Jens Frahm
- Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Martin Uecker
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
- Institute of Biomedical Imaging, Graz University of Technology, Graz, Austria
- Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany
| | - Ali Seif Amir Hosseini
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
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3
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Röwer LM, Radke KL, Hußmann J, Malik H, Eichinger M, Voit D, Wielpütz MO, Frahm J, Klee D, Pillekamp F. First experience with real-time magnetic resonance imaging-based investigation of respiratory influence on cardiac function in pediatric congenital heart disease patients with chronic right ventricular volume overload. Pediatr Radiol 2023; 53:2608-2621. [PMID: 37794175 PMCID: PMC10698081 DOI: 10.1007/s00247-023-05765-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) is often associated with chronic right ventricular (RV) volume overload. Real-time magnetic resonance imaging (MRI) enables the analysis of cardiac function during free breathing. OBJECTIVE To evaluate the influence of respiration in pediatric patients with CHD and chronic RV volume overload. METHODS AND MATERIALS RV volume overload patients (n=6) and controls (n=6) were recruited for cardiac real-time MRI at 1.5 tesla during free breathing. Breathing curves from regions of interest reflecting the position of the diaphragm served for binning images in four different tidal volume classes, each in inspiration and expiration. Tidal volumes were estimated from these curves by data previously obtained by magnetic resonance-compatible spirometry. Ventricular volumes indexed to body surface area and Frank-Starling relationships referenced to the typical tidal volume indexed to body height (TTVi) were compared. RESULTS Indexed RV end-diastolic volume (RV-EDVi) and indexed RV stroke volume (RV-SVi) increased during inspiration (RV-EDVi/TTVi: RV load: + 16 ± 4%; controls: + 22 ± 13%; RV-SVi/TTVi: RV load: + 21 ± 6%; controls: + 35 ± 17%; non-significant for comparison). The increase in RV ejection fraction during inspiration was significantly lower in RV load patients (RV load: + 1.1 ± 2.2%; controls: + 6.1 ± 1.5%; P=0.01). The Frank-Starling relationship of the RV provided a significantly reduced slope estimate in RV load patients (inspiration: RV load: 0.75 ± 0.11; controls: 0.92 ± 0.02; P=0.02). CONCLUSION In pediatric patients with CHD and chronic RV volume overload, cardiac real-time MRI during free breathing in combination with respiratory-based binning indicates an impaired Frank-Starling relationship of the RV.
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Affiliation(s)
- Lena Maria Röwer
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Karl Ludger Radke
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Janina Hußmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Halima Malik
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Monika Eichinger
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Dirk Voit
- Biomedical NMR, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Mark Oliver Wielpütz
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Jens Frahm
- Biomedical NMR, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Dirk Klee
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Frank Pillekamp
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
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Hirsch FW, Frahm J, Sorge I, Klee D, Prenzel F, Krause M, Lacher M, Voit D, Gräfe D. Real-time MRI: a new tool of radiologic imaging in small children. Eur J Pediatr 2023; 182:3405-3417. [PMID: 37249681 PMCID: PMC10460313 DOI: 10.1007/s00431-023-04996-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/31/2023]
Abstract
Real-time MRI (rt-MRI) in children is a new imaging technique that combines the advantages of US - at frame rates of up to 50 images per second - with the quality and features of MRI. Although still subject of research, it has become a standard tool in the diagnostic portfolio of two pediatric radiology departments in Germany. Based on ultrashort acquisition times, any detrimental effects of macroscopic movements of the child and the physiological movements of the organs are negligible. Especially in pediatric brain imaging, rt-MRI has already proven its value. With suitable indications, rt-MRI can reduce anesthesia and sedation examinations in children below 6 years of age by 40% due to its very short examination time and its robustness to motion. There is a high level of acceptance among parents and referrers when diagnostic possibilities and limitations are communicated correctly. CONCLUSION Completely new diagnostic possibilities arise in the imaging of the moving lung, the beating heart, joint movements, and speaking and swallowing, as demonstrated in this video-backed review. WHAT IS KNOWN • MRI in moving children has been burdened with severe artifacts. • Gross motion usually has to be handled by sedation and periodic motion of the heart and lungs has to be compensated with time-consuming techniques until now. WHAT IS NEW • Real-time MRI allows image acquisition with up to 50 frames per second similar to ultrasound frame rate. • Real-time MRI proofs to be very promising for imaging children, reducing examination time and sedation rate drastically.
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Affiliation(s)
| | - Jens Frahm
- Biomedical NMR, Max Planck Institute for Multidisciplinary Sciences, Gottingen, Germany
| | - Ina Sorge
- Department of Pediatric Radiology, University Hospital, Leipzig, Germany
| | - Dirk Klee
- Department of Radiology, University Hospital, Dusseldorf, Germany
| | - Freerk Prenzel
- Department of Pediatrics, University Hospital, Leipzig, Germany
| | - Matthias Krause
- Department of Neurosurgery, University Hospital, Leipzig, Germany
| | - Martin Lacher
- Department of Pediatrics Surgery, University Hospital, Leipzig, Germany
| | - Dirk Voit
- Biomedical NMR, Max Planck Institute for Multidisciplinary Sciences, Gottingen, Germany
| | - Daniel Gräfe
- Department of Pediatric Radiology, University Hospital, Leipzig, Germany
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5
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Feng L. 4D Golden-Angle Radial MRI at Subsecond Temporal Resolution. NMR IN BIOMEDICINE 2023; 36:e4844. [PMID: 36259951 PMCID: PMC9845193 DOI: 10.1002/nbm.4844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/29/2022] [Accepted: 10/13/2022] [Indexed: 05/14/2023]
Abstract
Intraframe motion blurring, as a major challenge in free-breathing dynamic MRI, can be reduced if high temporal resolution can be achieved. To address this challenge, this work proposes a highly accelerated 4D (3D + time) dynamic MRI framework with subsecond temporal resolution that does not require explicit motion compensation. The method combines standard stack-of-stars golden-angle radial sampling and tailored GRASP-Pro (Golden-angle RAdial Sparse Parallel imaging with imProved performance) reconstruction. Specifically, 4D dynamic MRI acquisition is performed continuously without motion gating or sorting. The k-space centers in stack-of-stars radial data are organized to guide estimation of a temporal basis, with which GRASP-Pro reconstruction is employed to enforce joint low-rank subspace and sparsity constraints. This new basis estimation strategy is the new feature proposed for subspace-based reconstruction in this work to achieve high temporal resolution (e.g., subsecond/3D volume). It does not require sequence modification to acquire additional navigation data, it is compatible with commercially available stack-of-stars sequences, and it does not need an intermediate reconstruction step. The proposed 4D dynamic MRI approach was tested in abdominal motion phantom, free-breathing abdominal MRI, and dynamic contrast-enhanced MRI (DCE-MRI). Our results have shown that GRASP-Pro reconstruction with the new basis estimation strategy enables highly-accelerated 4D dynamic imaging at subsecond temporal resolution (with five spokes or less for each dynamic frame per image slice) for both free-breathing non-DCE-MRI and DCE-MRI. In the abdominal phantom, better image quality with lower root mean square error and higher structural similarity index was achieved using GRASP-Pro compared with standard GRASP. With the ability to acquire each 3D image in less than 1 s, intraframe respiratory blurring can be intrinsically reduced for body applications with our approach, which eliminates the need for explicit motion detection and motion compensation.
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Affiliation(s)
- Li Feng
- Biomedical Engineering and Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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6
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Gräfe D, Lacher M, Martynov I, Hirsch FW, Voit D, Frahm J, Busse H, Sesia SB, Krämer S, Zimmermann P. Pectus excavatum in motion: dynamic evaluation using real-time MRI. Eur Radiol 2023; 33:2128-2135. [PMID: 36307555 PMCID: PMC9935721 DOI: 10.1007/s00330-022-09197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The breathing phase for the determination of thoracic indices in patients with pectus excavatum is not standardized. The aim of this study was to identify the best period for reliable assessments of morphologic indices by dynamic observations of the chest wall using real-time MRI. METHODS In this prospective study, patients with pectus excavatum underwent morphologic evaluation by real-time MRI at 3 T between January 2020 and June 2021. The Haller index (HI), correction index (CI), modified asymmetry index (AI), and modified eccentricity index (EI) were determined during free, quiet, and forced breathing respectively. Breathing-related differences in the thoracic indices were analyzed with the Wilcoxon signed-rank test. Motion of the anterior chest wall was analyzed as well. RESULTS A total of 56 patients (11 females and 45 males, median age 15.4 years, interquartile range 14.3-16.9) were included. In quiet expiration, the median HI in the cohort equaled 5.7 (4.5-7.2). The median absolute differences (Δ) in the thoracic indices between peak inspiration and peak expiration were ΔHI = 1.1 (0.7-1.6, p < .001), ΔCI = 4.8% (1.3-7.5%, p < .001), ΔAI = 3.0% (1.0-5.0%, p < .001), and ΔEI = 8.0% (3.0-14.0%, p < .05). The indices varied significantly during different inspiratory phases, but not during expiration (p > .05 each). Furthermore, the dynamic evaluation revealed three distinctive movement patterns of the funnel chest. CONCLUSIONS Real-time MRI reveals patterns of chest wall motion and indicate that thoracic indices of pectus excavatum should be assessed in the end-expiratory phase of quiet expiration. KEY POINTS • The thoracic indices in patients with pectus excavatum depend on the breathing phase. • Quiet expiration represents the best breathing phase for determining thoracic indices. • Real-time MRI can identify different chest wall motion patterns in pectus excavatum.
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Affiliation(s)
- Daniel Gräfe
- Department of Pediatric Radiology, University Hospital, Leipzig, Germany.
| | - Martin Lacher
- Department of Pediatric Surgery, University Hospital, Leipzig, Germany
| | - Illya Martynov
- Department of Pediatric Surgery, University Hospital, Leipzig, Germany
| | | | - Dirk Voit
- Biomedizinische NMR, Max-Planck-Institut für Biophysikalische Chemie, Göttingen, Germany
| | - Jens Frahm
- Biomedizinische NMR, Max-Planck-Institut für Biophysikalische Chemie, Göttingen, Germany
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, University Hospital, Leipzig, Germany
| | - Sergio Bruno Sesia
- Division of General Thoracic Surgery, Bern University Hospital, Bern, Switzerland
| | - Sebastian Krämer
- Division of General Thoracic Surgery, Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital, Leipzig, Germany
| | - Peter Zimmermann
- Department of Pediatric Surgery, University Hospital, Leipzig, Germany
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7
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Hirsch FW, Sorge I, Voit D, Frahm J, Prenzel F, Wachowiak R, Anders R, Roth C, Gräfe D. Chest examinations in children with real-time magnetic resonance imaging: first clinical experience. Pediatr Radiol 2023; 53:12-20. [PMID: 35836015 PMCID: PMC9816257 DOI: 10.1007/s00247-022-05421-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/04/2022] [Accepted: 06/02/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Real-time magnetic resonance imaging (MRI) based on a fast low-angle shot technique 2.0 (FLASH 2.0) is highly effective against artifacts caused due to the bulk and pulmonary and cardiac motions of the patient. However, to date, there are no reports on the application of this innovative technique to pediatric lung MRI. OBJECTIVE This study aimed to identify the limits of resolution and image quality of real-time lung MRI in children and to assess the types and minimal size of lesions with these new sequences. MATERIALS AND METHODS In this retrospective study, pathological lung findings in 87 children were classified into 6 subgroups, as detected on conventional MRI: metastases and tumors, consolidation, scars, hyperinflation, interstitial pathology and bronchiectasis. Subsequently, the findings were grouped according to size (4-6 mm, 7-9 mm and ≥ 10 mm) and evaluated for visual delineation of the findings (0 = not visible, 1 = hardly visible and 2 = well visualized). RESULTS Real-time MRI allows for diagnostic, artifact-free thorax images to be obtained, regardless of patient movements. The delineation of findings strongly correlates with the size of the pathology. Metastases, consolidation and scars were visible at 100% when larger than 9 mm. In the 7-9 mm subgroup, the visibility was 83% for metastases, 88% for consolidation and 100% for scars in T2/T1 weighting. Though often visible, smaller pathological lesions of 4-6 mm in size did not regularly meet the expected diagnostic confidence: The visibility of metastases was 18%, consolidation was 64% and scars was 71%. Diffuse interstitial lung changes and hyperinflation, known as "MR-minus pathologies," were not accessible to real-time MRI. CONCLUSION The method provides motion robust images of the lung and thorax. However, the lower sensitivity for small lung lesions is a major limitation for routine use of this technique. Currently, the method is adequate for diagnosing inflammatory lung diseases, atelectasis, effusions and lung scarring in children with irregular breathing patterns or bulk motion on sedation-free MRI. A medium-term goal is to improve the diagnostic accuracy of small nodules and interstitial lesions.
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Affiliation(s)
- Franz Wolfgang Hirsch
- Department of Pediatric Radiology, University Hospital, Liebigstraße 20a, 04107, Leipzig, Germany.
| | - Ina Sorge
- Department of Pediatric Radiology, University Hospital, Liebigstraße 20a, 04107 Leipzig, Germany
| | - Dirk Voit
- Biomedical NMR, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Jens Frahm
- Biomedical NMR, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Freerk Prenzel
- Department of Pediatrics, University Hospital, Leipzig, Germany
| | - Robin Wachowiak
- Department of Pediatric Surgery, University Hospital, Leipzig, Germany
| | - Rebecca Anders
- Department of Pediatric Radiology, University Hospital, Liebigstraße 20a, 04107 Leipzig, Germany
| | - Christian Roth
- Department of Pediatric Radiology, University Hospital, Liebigstraße 20a, 04107 Leipzig, Germany
| | - Daniel Gräfe
- Department of Pediatric Radiology, University Hospital, Liebigstraße 20a, 04107 Leipzig, Germany
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8
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Hu H, Huang H, Li M, Gao X, Yin L, Qi R, Wu RS, Chen X, Ma Y, Shi K, Li C, Maus TM, Huang B, Lu C, Lin M, Zhou S, Lou Z, Gu Y, Chen Y, Lei Y, Wang X, Wang R, Yue W, Yang X, Bian Y, Mu J, Park G, Xiang S, Cai S, Corey PW, Wang J, Xu S. A wearable cardiac ultrasound imager. Nature 2023; 613:667-675. [PMID: 36697864 PMCID: PMC9876798 DOI: 10.1038/s41586-022-05498-z] [Citation(s) in RCA: 84] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/31/2022] [Indexed: 01/26/2023]
Abstract
Continuous imaging of cardiac functions is highly desirable for the assessment of long-term cardiovascular health, detection of acute cardiac dysfunction and clinical management of critically ill or surgical patients1-4. However, conventional non-invasive approaches to image the cardiac function cannot provide continuous measurements owing to device bulkiness5-11, and existing wearable cardiac devices can only capture signals on the skin12-16. Here we report a wearable ultrasonic device for continuous, real-time and direct cardiac function assessment. We introduce innovations in device design and material fabrication that improve the mechanical coupling between the device and human skin, allowing the left ventricle to be examined from different views during motion. We also develop a deep learning model that automatically extracts the left ventricular volume from the continuous image recording, yielding waveforms of key cardiac performance indices such as stroke volume, cardiac output and ejection fraction. This technology enables dynamic wearable monitoring of cardiac performance with substantially improved accuracy in various environments.
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Affiliation(s)
- Hongjie Hu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Hao Huang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Mohan Li
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Xiaoxiang Gao
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Lu Yin
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Ruixiang Qi
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA
| | - Ray S Wu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Xiangjun Chen
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Yuxiang Ma
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Keren Shi
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
- Materials Science and Engineering Program, University of California, Riverside, CA, USA
| | - Chenghai Li
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, CA, USA
| | - Timothy M Maus
- Department of Anesthesiology, University of California, San Diego Health Sulpizio Cardiovascular Center, La Jolla, CA, USA
| | - Brady Huang
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Chengchangfeng Lu
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Muyang Lin
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Sai Zhou
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Zhiyuan Lou
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yue Gu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
- Department of Neurosurgery, Yale University, New Haven, CT, USA
| | - Yimu Chen
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yusheng Lei
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Xinyu Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Ruotao Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Wentong Yue
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Xinyi Yang
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Yizhou Bian
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Jing Mu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Geonho Park
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Shu Xiang
- Softsonics, Inc., San Diego, CA, USA
| | - Shengqiang Cai
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, CA, USA
| | - Paul W Corey
- Department of Anesthesiology, Sharp Memorial Hospital, San Diego, CA, USA
| | - Joseph Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Sheng Xu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA.
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA.
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA.
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA.
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.
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9
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Brisson NM, Krämer M, Krahl LA, Schill A, Duda GN, Reichenbach JR. A novel multipurpose device for guided knee motion and loading during dynamic magnetic resonance imaging. Z Med Phys 2022; 32:500-513. [PMID: 35221155 PMCID: PMC9948850 DOI: 10.1016/j.zemedi.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/21/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This work aimed to develop a novel multipurpose device for guided knee flexion-extension, both passively using a motorized pneumatic system and actively (muscle-driven) with the joint unloaded or loaded during dynamic MRI. Secondary objectives were to characterize the participant experience during device use, and present preliminary dynamic MRI data to demonstrate the different device capabilities. MATERIAL AND METHODS Self-reported outcomes were used to characterize the pain, physical exertion and discomfort levels experienced by 10 healthy male participants during four different active knee motion and loading protocols using the novel device. Knee angular data were recorded during the protocols to determine the maximum knee range of motion achievable. Dynamic MRI was acquired for three healthy volunteers during passive, unloaded knee motion using 2D Cartesian TSE, 2D radial GRE and 3D UTE sequences; and during active, unloaded and loaded knee motion using 2D radial GRE imaging. Because of the different MRI sequences used, spatial resolution was inherently lower for active knee motion than for passive motion acquisitions. RESULTS Depending on the protocol, some participants reported slight pain, mild discomfort and varying levels of physical exertion. On average, participants achieved ∼40° of knee flexion; loaded conditions can create knee moments up to 27Nm. High quality imaging data were obtained during different motion and loading conditions. Dynamic 3D data allowed to retrospectively extract arbitrarily oriented slices. CONCLUSION A novel multipurpose device for guided, physiologically relevant knee motion and loading during dynamic MRI was developed. Device use was well tolerated and suitable for acquiring high quality images during different motion and loading conditions. Different bone positions between loaded and unloaded conditions were likely due to out-of-plane motion, particularly because image registration was not performed. Ultimately, this device could be used to advance our understanding of physiological and pathological joint mechanics.
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Affiliation(s)
- Nicholas M. Brisson
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Germany,Corresponding author: Nicholas Brisson, Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Philippstrasse 13, Haus 11, Raum 2.18, 10115 Berlin, Germany, Tel.: +49 (0)30 2093 46122; fax: +49 (0)30 450 55996.
| | - Martin Krämer
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, Germany,Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Leonie A.N. Krahl
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Germany
| | - Alexander Schill
- Research Workshop, Charité – Universitätsmedizin Berlin, Germany
| | - Georg N. Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Germany
| | - Jürgen R. Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, Germany
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10
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Kollmeier JM, Gürbüz-Reiss L, Sahoo P, Badura S, Ellebracht B, Keck M, Gärtner J, Ludwig HC, Frahm J, Dreha-Kulaczewski S. Deep breathing couples CSF and venous flow dynamics. Sci Rep 2022; 12:2568. [PMID: 35173200 PMCID: PMC8850447 DOI: 10.1038/s41598-022-06361-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
Venous system pathologies have increasingly been linked to clinically relevant disorders of CSF circulation whereas the exact coupling mechanisms still remain unknown. In this work, flow dynamics of both systems were studied using real-time phase-contrast flow MRI in 16 healthy subjects during normal and forced breathing. Flow evaluations in the aqueduct, at cervical level C3 and lumbar level L3 for both the CSF and venous fluid systems reveal temporal modulations by forced respiration. During normal breathing cardiac-related flow modulations prevailed, while forced breathing shifted the dominant frequency of both CSF and venous flow spectra towards the respiratory component and prompted a correlation between CSF and venous flow in the large vessels. The average of flow magnitude of CSF was increased during forced breathing at all spinal and intracranial positions. Venous flow in the large vessels of the upper body decreased and in the lower body increased during forced breathing. Deep respiration couples interdependent venous and brain fluid flow—most likely mediated by intrathoracic and intraabdominal pressure changes. Further insights into the driving forces of CSF and venous circulation and their correlation will facilitate our understanding how the venous system links to intracranial pressure regulation and of related forms of hydrocephalus.
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Affiliation(s)
- Jost M Kollmeier
- Biomedizinische NMR, Max-Planck-Institut für multidisziplinäre Naturwissenschaften, 37077, Göttingen, Germany
| | - Lukas Gürbüz-Reiss
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Prativa Sahoo
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Simon Badura
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Ben Ellebracht
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Mathilda Keck
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Jutta Gärtner
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Hans-Christoph Ludwig
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Jens Frahm
- Biomedizinische NMR, Max-Planck-Institut für multidisziplinäre Naturwissenschaften, 37077, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Göttingen, Germany
| | - Steffi Dreha-Kulaczewski
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075, Göttingen, Germany.
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11
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He Z, Zhu YN, Qiu S, Wang T, Zhang C, Sun B, Zhang X, Feng Y. Low-Rank and Framelet Based Sparsity Decomposition for Interventional MRI Reconstruction. IEEE Trans Biomed Eng 2022; 69:2294-2304. [PMID: 35015631 DOI: 10.1109/tbme.2022.3142129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Interventional MRI (i-MRI) is crucial for MR image-guided therapy. Current image reconstruction methods for dynamic MR imaging are mostly retrospective that may not be suitable for i-MRI in real-time. Therefore, an algorithm to reconstruct images without a temporal pattern as in dynamic imaging is needed for i-MRI. METHODS We proposed a low-rank and sparsity (LS) decomposition algorithm with framelet transform to reconstruct the interventional feature with a high temporal resolution. Different from the existing LS based algorithm, the spatial sparsity of both the low-rank and sparsity components was used. We also used a primal dual fixed point (PDFP) method for optimization of the objective function to avoid solving sub-problems. Intervention experiments with gelatin and brain phantoms were carried out for validation. RESULTS The LS decomposition with framelet transform and PDFP could provide the best reconstruction performance compared with those without. Satisfying reconstruction results were obtained with only 10 radial spokes for a temporal resolution of 60 ms. CONCLUSION AND SIGNIFICANCE The proposed method has the potential for i-MRI in many different application scenarios.
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12
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Röwer LM, Radke KL, Hußmann J, Malik H, Uelwer T, Voit D, Frahm J, Wittsack HJ, Harmeling S, Pillekamp F, Klee D. Comparison of cardiac volumetry using real-time MRI during free-breathing with standard cine MRI during breath-hold in children. Pediatr Radiol 2022; 52:1462-1475. [PMID: 35353211 PMCID: PMC9271116 DOI: 10.1007/s00247-022-05327-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/13/2022] [Accepted: 02/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cardiac real-time magnetic resonance imaging (RT-MRI) provides high-quality images even during free-breathing. Difficulties in post-processing impede its use in clinical routine. OBJECTIVE To demonstrate the feasibility of quantitative analysis of cardiac free-breathing RT-MRI and to compare image quality and volumetry during free-breathing RT-MRI in pediatric patients to standard breath-hold cine MRI. MATERIALS AND METHODS Pediatric patients (n = 22) received cardiac RT-MRI volumetry during free breathing (1.5 T; short axis; 30 frames per s) in addition to standard breath-hold cine imaging in end-expiration. Real-time images were binned retrospectively based on electrocardiography and respiratory bellows. Image quality and volumetry were compared using the European Cardiovascular Magnetic Resonance registry score, structure visibility rating, linear regression and Bland-Altman analyses. RESULTS Additional time for binning of real-time images was 2 min. For both techniques, image quality was rated good to excellent. RT-MRI was significantly more robust against artifacts (P < 0.01). Linear regression revealed good correlations for the ventricular volumes. Bland-Altman plots showed a good limit of agreement (LoA) for end-diastolic volume (left ventricle [LV]: LoA -0.1 ± 2.7 ml/m2, right ventricle [RV]: LoA -1.9 ± 3.4 ml/m2), end-systolic volume (LV: LoA 0.4 ± 1.9 ml/m2, RV: LoA 0.6 ± 2.0 ml/m2), stroke volume (LV: LoA -0.5 ± 2.3 ml/m2, RV: LoA -2.6 ± 3.3 ml/m2) and ejection fraction (LV: LoA -0.5 ± 1.6%, RV: LoA -2.1 ± 2.8%). CONCLUSION Compared to standard cine MRI with breath hold, RT-MRI during free breathing with retrospective respiratory binning offers good image quality, reduced image artifacts enabling fast quantitative evaluations of ventricular volumes in clinical practice under physiological conditions.
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Affiliation(s)
- Lena Maria Röwer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Moorenstr. 5, 40225, Dusseldorf, Germany.
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany.
| | - Karl Ludger Radke
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Janina Hußmann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Moorenstr. 5, 40225, Dusseldorf, Germany
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Halima Malik
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Moorenstr. 5, 40225, Dusseldorf, Germany
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Tobias Uelwer
- Department of Computer Science, Heinrich Heine University, Dusseldorf, Germany
| | - Dirk Voit
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Göttingen, Germany
| | - Jens Frahm
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Göttingen, Germany
| | - Hans-Joerg Wittsack
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Stefan Harmeling
- Department of Computer Science, Heinrich Heine University, Dusseldorf, Germany
| | - Frank Pillekamp
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Dirk Klee
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
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13
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Wech T, Ankenbrand MJ, Bley TA, Heidenreich JF. A data-driven semantic segmentation model for direct cardiac functional analysis based on undersampled radial MR cine series. Magn Reson Med 2021; 87:972-983. [PMID: 34609026 DOI: 10.1002/mrm.29017] [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: 07/15/2021] [Revised: 08/06/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE Image acquisition and subsequent manual analysis of cardiac cine MRI is time-consuming. The purpose of this study was to train and evaluate a 3D artificial neural network for semantic segmentation of radially undersampled cardiac MRI to accelerate both scan time and postprocessing. METHODS A database of Cartesian short-axis MR images of the heart (148,500 images, 484 examinations) was assembled from an openly accessible database and radial undersampling was simulated. A 3D U-Net architecture was pretrained for segmentation of undersampled spatiotemporal cine MRI. Transfer learning was then performed using samples from a second database, comprising 108 non-Cartesian radial cine series of the midventricular myocardium to optimize the performance for authentic data. The performance was evaluated for different levels of undersampling by the Dice similarity coefficient (DSC) with respect to reference labels, as well as by deriving ventricular volumes and myocardial masses. RESULTS Without transfer learning, the pretrained model performed moderately on true radial data [maximum number of projections tested, P = 196; DSC = 0.87 (left ventricle), DSC = 0.76 (myocardium), and DSC =0.64 (right ventricle)]. After transfer learning with authentic data, the predictions achieved human level even for high undersampling rates (P = 33, DSC = 0.95, 0.87, and 0.93) without significant difference compared with segmentations derived from fully sampled data. CONCLUSION A 3D U-Net architecture can be used for semantic segmentation of radially undersampled cine acquisitions, achieving a performance comparable with human experts in fully sampled data. This approach can jointly accelerate time-consuming cine image acquisition and cumbersome manual image analysis.
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Affiliation(s)
- Tobias Wech
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Markus Johannes Ankenbrand
- Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany.,Center for Computational and Theoretical Biology, University of Würzburg, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
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14
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Xiong X, Ye Z, Tang H, Wei Y, Nie L, Wei X, Liu Y, Song B. MRI of Temporomandibular Joint Disorders: Recent Advances and Future Directions. J Magn Reson Imaging 2021; 54:1039-1052. [PMID: 32869470 DOI: 10.1002/jmri.27338] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 02/05/2023] Open
Abstract
Temporomandibular joint disorders (TMDs) are a prevalent disease covering pain and dysfunction of temporomandibular joints and masticatory muscles, which can be detrimental to quality of life. Magnetic resonance imaging (MRI) is a powerful and noninvasive tool for the imaging and understanding of TMD. With the recent technical development of dynamic and quantitative MRI techniques, including diffusion-weighted imaging, T2 mapping, and ultrashort/zero echo time, it is now feasible in TMD imaging and has been preliminarily investigated with promising results. In this review we will discuss the recent advances of MRI techniques in TMD and its future directions, and hope to highlight the scientific potential and clinical value of novel MRI techniques in diagnosing and treating TMD. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Xin Xiong
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zheng Ye
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hehan Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Wei
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | | | | | - Yang Liu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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15
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Jaubert O, Montalt‐Tordera J, Knight D, Coghlan GJ, Arridge S, Steeden JA, Muthurangu V. Real-time deep artifact suppression using recurrent U-Nets for low-latency cardiac MRI. Magn Reson Med 2021; 86:1904-1916. [PMID: 34032308 PMCID: PMC8613539 DOI: 10.1002/mrm.28834] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/22/2021] [Accepted: 04/17/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Real-time low latency MRI is performed to guide various cardiac interventions. Real-time acquisitions often require iterative image reconstruction strategies, which lead to long reconstruction times. In this study, we aim to reconstruct highly undersampled radial real-time data with low latency using deep learning. METHODS A 2D U-Net with convolutional long short-term memory layers is proposed to exploit spatial and preceding temporal information to reconstruct highly accelerated tiny golden radial data with low latency. The network was trained using a dataset of breath-hold CINE data (including 770 time series from 7 different orientations). Synthetic paired data were created by retrospectively undersampling the magnitude images, and the network was trained to recover the target images. In the spirit of interventional imaging, the network was trained and tested for varying acceleration rates and orientations. Data were prospectively acquired and reconstructed in real time in 1 healthy subject interactively and in 3 patients who underwent catheterization. Images were visually compared to sliding window and compressed sensing reconstructions and a conventional Cartesian real-time sequence. RESULTS The proposed network generalized well to different acceleration rates and unseen orientations for all considered metrics in simulated data (less than 4% reduction in structural similarity index compared to similar acceleration and orientation-specific networks). The proposed reconstruction was demonstrated interactively, successfully depicting catheters in vivo with low latency (39 ms, including 19 ms for deep artifact suppression) and an image quality comparing favorably to other reconstructions. CONCLUSION Deep artifact suppression was successfully demonstrated in the time-critical application of non-Cartesian real-time interventional cardiac MR.
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Affiliation(s)
- Olivier Jaubert
- Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Javier Montalt‐Tordera
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Dan Knight
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Gerry J. Coghlan
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Simon Arridge
- Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
| | - Jennifer A. Steeden
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Vivek Muthurangu
- UCL Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
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16
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Vachha B, Huang SY. MRI with ultrahigh field strength and high-performance gradients: challenges and opportunities for clinical neuroimaging at 7 T and beyond. Eur Radiol Exp 2021; 5:35. [PMID: 34435246 PMCID: PMC8387544 DOI: 10.1186/s41747-021-00216-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
Research in ultrahigh magnetic field strength combined with ultrahigh and ultrafast gradient technology has provided enormous gains in sensitivity, resolution, and contrast for neuroimaging. This article provides an overview of the technical advantages and challenges of performing clinical neuroimaging studies at ultrahigh magnetic field strength combined with ultrahigh and ultrafast gradient technology. Emerging clinical applications of 7-T MRI and state-of-the-art gradient systems equipped with up to 300 mT/m gradient strength are reviewed, and the impact and benefits of such advances to anatomical, structural and functional MRI are discussed in a variety of neurological conditions. Finally, an outlook and future directions for ultrahigh field MRI combined with ultrahigh and ultrafast gradient technology in neuroimaging are examined.
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Affiliation(s)
- Behroze Vachha
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Susie Y Huang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, 149 13th Street, Room 2301, Charlestown, MA, 02129, USA.
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17
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Ludwig HC, Bock HC, Gärtner J, Schiller S, Frahm J, Dreha-Kulaczewski S. Hydrocephalus Revisited: New Insights into Dynamics of Neurofluids on Macro- and Microscales. Neuropediatrics 2021; 52:233-241. [PMID: 34192788 DOI: 10.1055/s-0041-1731981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
New experimental and clinical findings question the historic view of hydrocephalus and its 100-year-old classification. In particular, real-time magnetic resonance imaging (MRI) evaluation of cerebrospinal fluid (CSF) flow and detailed insights into brain water regulation on the molecular scale indicate the existence of at least three main mechanisms that determine the dynamics of neurofluids: (1) inspiration is a major driving force; (2) adequate filling of brain ventricles by balanced CSF upsurge is sensed by cilia; and (3) the perivascular glial network connects the ependymal surface to the pericapillary Virchow-Robin spaces. Hitherto, these aspects have not been considered a common physiologic framework, improving knowledge and therapy for severe disorders of normal-pressure and posthemorrhagic hydrocephalus, spontaneous intracranial hypotension, and spaceflight disease.
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Affiliation(s)
- Hans C Ludwig
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Hans C Bock
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Jutta Gärtner
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Stina Schiller
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Jens Frahm
- Biomedical NMR, Max Planck Institute for Biophysical Chemistry, Göttingen, Germany
| | - Steffi Dreha-Kulaczewski
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
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18
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Sartoretti E, Sartoretti T, van Smoorenburg L, Sartoretti-Schefer S, Wyss M, Binkert CA. Qualitative and Quantitative Analysis of a Spiral Gradient Echo Sequence for Contrast-Enhanced Fat-Suppressed T1-Weighted Spine Magnetic Resonance Imaging. Invest Radiol 2021; 56:517-524. [PMID: 33653993 DOI: 10.1097/rli.0000000000000770] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pulse sequences with non-Cartesian k-space sampling enable improved imaging in anatomical areas with high degrees of motion artifacts. We analyzed a novel spiral 3-dimensional (3D) gradient echo (GRE) magnetic resonance imaging (MRI) sequence ("spiral," 114.7 ± 11 seconds) and compared it with a radial 3D GRE ("vane," 216.7 ± 2 seconds) and a conventional Cartesian 2D turbo spin echo (TSE) sequence ("TSE," 266.7 ± 82 seconds) for contrast-enhanced fat-suppressed T1-weighted spine imaging. MATERIALS AND METHODS Forty consecutive patients referred for contrast-enhanced MRI were prospectively scanned with all 3 sequences. A qualitative analysis was performed by 3 readers using 4- or 5-point Likert scales to independently grade images in terms of overall image quality, occurrence of artifacts, lesion conspicuity, and conspicuity of nerve roots. The numbers of visible nerve roots per sequence and patient were counted in consensus. Coefficient of variation measurements were performed for the paravertebral musculature (CVPM) and the spinal cord (CVSC). RESULTS Spiral (median [interquartile range], 5 [4-5]) exhibited improved overall image quality in comparison to TSE (3 [3-4]) and vane (4 [4-5]; both P < 0.001). Vane surpassed TSE in terms of overall image quality (P < 0.001). Spiral (4 [3.75-4]) and vane (3.5 [3-4]) presented with less artifacts than TSE (3 [2.75-3.25]; both P < 0.001). Spiral (4 [4-5]) outperformed vane (4 [3-5]; P = 0.01) and TSE (4 [3-4]; P = 0.04) in terms of lesion conspicuity. Conspicuity of nerve roots was superior on spiral (3 [3-4]) and vane (4 [3-4]) when compared with TSE (1.5 [1-2]; both P < 0.001). Readers discerned significantly more nerve roots on spiral (4 [2.75-8]) and vane (4 [3.75-7.25]) images when compared with TSE (2 [0-4]; both P < 0.001). Interreader agreement ranged from moderate (α = 0.639) to almost perfect (α = 0.967). CVPM and CVSC were significantly lower on spiral as compared with vane and TSE (P < 0.001, P = 0.04). Vane exhibited lower CVPM and CVSC than TSE (P < 0.001, P = 0.01). CONCLUSIONS A novel spiral 3D GRE sequence improves contrast-enhanced fat-suppressed T1-weighted spinal imaging qualitatively and quantitatively in comparison with a conventional Cartesian 2D TSE sequence and to a lesser extent with a radial 3D GRE sequence at shorter scan times.
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Affiliation(s)
| | | | - Luuk van Smoorenburg
- From the Institute of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Sabine Sartoretti-Schefer
- From the Institute of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | | | - Christoph A Binkert
- From the Institute of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
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Röwer LM, Uelwer T, Hußmann J, Malik H, Eichinger M, Voit D, Wielpütz MO, Frahm J, Harmeling S, Klee D, Pillekamp F. Spirometry-based reconstruction of real-time cardiac MRI: Motion control and quantification of heart-lung interactions. Magn Reson Med 2021; 86:2692-2702. [PMID: 34272760 DOI: 10.1002/mrm.28892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/13/2021] [Accepted: 05/31/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To test the feasibility of cardiac real-time MRI in combination with retrospective gating by MR-compatible spirometry, to improve motion control, and to allow quantification of respiratory-induced changes during free-breathing. METHODS Cross-sectional real-time MRI (1.5T; 30 frames/s) using steady-state free precession contrast during free-breathing was combined with MR-compatible spirometry in healthy adult volunteers (n = 4). Retrospective binning assigned images to classes that were defined by electrocardiogram and spirometry. Left ventricular eccentricity index as an indicator of septal position and ventricular volumes in different respiratory phases were calculated to assess heart-lung interactions. RESULTS Real-time MRI with MR-compatible spirometry is feasible and well tolerated. Spirometry-based binning improved motion control significantly. The end-diastolic epicardial eccentricity index increased significantly during inspiration (1.04 ± 0.04 to 1.19 ± 0.05; P < .05). During inspiration, right ventricular end-diastolic volume (79 ± 17 mL/m2 to 98 ± 18 mL/m2 ), stroke volume (41 ± 8 mL/m2 to 59 ± 11 mL/m2 ) and ejection fraction (53 ± 3% to 60 ± 1%) increased significantly, whereas the end-systolic volume remained almost unchanged. Left ventricular end-diastolic volume, left ventricular stroke volume, and left ventricular ejection fraction decreased during inspiration, whereas the left ventricular end-systolic volume increased. The relationship between stroke volume and end-diastolic volume (Frank-Starling relationship) based on changes induced by respiration allowed for a slope estimate of the Frank-Starling curve to be 0.9 to 1.1. CONCLUSION Real-time MRI during free-breathing combined with MR-compatible spirometry and retrospective binning improves image stabilization, allows quantitative image analysis, and importantly, offers unique opportunities to judge heart-lung interactions.
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Affiliation(s)
- Lena Maria Röwer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany.,Department of Diagnostic and Interventional Radiology, Heinrich Heine University, Düsseldorf, Germany
| | - Tobias Uelwer
- Department of Computer Science, Heinrich Heine University, Düsseldorf, Germany
| | - Janina Hußmann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany.,Department of Diagnostic and Interventional Radiology, Heinrich Heine University, Düsseldorf, Germany
| | - Halima Malik
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany.,Department of Diagnostic and Interventional Radiology, Heinrich Heine University, Düsseldorf, Germany
| | - Monika Eichinger
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Dirk Voit
- Biomedizinische NMR, Max-Planck Institute for Biophysical Chemistry, Göttingen, Germany
| | - Mark Oliver Wielpütz
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Jens Frahm
- Biomedizinische NMR, Max-Planck Institute for Biophysical Chemistry, Göttingen, Germany.,Partner Site Göttingen, German Centre for Cardiovascular Research, Berlin, Germany
| | - Stefan Harmeling
- Department of Computer Science, Heinrich Heine University, Düsseldorf, Germany
| | - Dirk Klee
- Department of Diagnostic and Interventional Radiology, Heinrich Heine University, Düsseldorf, Germany
| | - Frank Pillekamp
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
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20
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Unger M, Berger J, Melzer A. Robot-Assisted Image-Guided Interventions. Front Robot AI 2021; 8:664622. [PMID: 34322519 PMCID: PMC8312560 DOI: 10.3389/frobt.2021.664622] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/01/2021] [Indexed: 12/23/2022] Open
Abstract
Image guidance is a common methodology of minimally invasive procedures. Depending on the type of intervention, various imaging modalities are available. Common imaging modalities are computed tomography, magnetic resonance tomography, and ultrasound. Robotic systems have been developed to enable and improve the procedures using these imaging techniques. Spatial and technological constraints limit the development of versatile robotic systems. This paper offers a brief overview of the developments of robotic systems for image-guided interventions since 2015 and includes samples of our current research in this field.
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Affiliation(s)
- Michael Unger
- Innovation Center Computer Assisted Surgery, Leipzig, Germany
| | - Johann Berger
- Innovation Center Computer Assisted Surgery, Leipzig, Germany
| | - Andreas Melzer
- Innovation Center Computer Assisted Surgery, Leipzig, Germany.,Institute for Medical Science and Technology, IMSaT, University Dundee, Dundee, United Kingdom
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21
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Spiral 3-Dimensional T1-Weighted Turbo Field Echo: Increased Speed for Magnetization-Prepared Gradient Echo Brain Magnetic Resonance Imaging. Invest Radiol 2021; 55:775-784. [PMID: 32816415 DOI: 10.1097/rli.0000000000000705] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Spiral magnetic resonance imaging acquisition may enable improved image quality and higher scan speeds than Cartesian trajectories. We tested the performance of four 3D T1-weighted (T1w) TFE sequences (magnetization-prepared gradient echo magnetic resonance sequence) with isotropic spatial resolution for brain imaging at 1.5 T in a clinical patient cohort based on qualitative and quantitative image quality metrics. Two prototypical spiral TFE sequences (spiral 1.0 and spiral 0.85) and a Cartesian compressed sensing technology accelerated TFE sequence (CS 2.5; acceleration factor of 2.5) were compared with a conventional (reference standard) Cartesian parallel imaging accelerated TFE sequence (SENSE; acceleration factor of 1.8). MATERIALS AND METHODS The SENSE (5:52 minutes), CS 2.5 (3:17 minutes), and spiral 1.0 (2:16 minutes) sequences all had identical spatial resolutions (1.0 mm). The spiral 0.85 (3:47 minutes) had a higher spatial resolution (0.85 mm). The 4 TFE sequences were acquired in 41 patients (20 with and 21 without contrast media). Three readers rated qualitative image quality (12 categories) and selected their preferred sequence for each patient. Two readers performed quantitative analysis whereby 6 metrics were derived: contrast-to-noise ratio for white and gray matter (CNRWM/GM), contrast ratio for gray matter-CSF (CRGM/CSF), and white matter-CSF (CRWM/CSF); and coefficient of variations for gray matter (CVGM), white matter (CVWM), and CSF (CVCSF). Friedman tests with post hoc Nemenyi tests, exact binomial tests, analysis of variance with post hoc Dunnett tests, and Krippendorff alphas were computed. RESULTS Concerning qualitative analysis, the CS 2.5 sequence significantly outperformed the SENSE in 4/1 (with/without contrast) categories, whereas the spiral 1.0 and spiral 0.85 showed significantly improved scores in 10/9and 7/7 categories, respectively (P's < 0.001-0.039). The spiral 1.0 was most frequently selected as the preferred sequence (reader 1, 10/15 times; reader 2, 9/12 times; reader 3, 11/13times [with/without contrast]). Interreader agreement ranged from substantial to almost perfect (alpha = 0.615-0.997). Concerning quantitative analysis, compared with the SENSE, the CS 2.5 had significantly better scores in 2 categories (CVWM, CVCSF) and worse scores in 2 categories (CRGM/CSF, CRWM/CSF), the spiral 1.0 had significantly improved scores in 4 categories (CNRWM/GM, CRGM/CSF, CRWM/CSF, CVWM), and the spiral 0.85 had significantly better scores in 2 categories (CRGM/CSF, CRWM/CSF). CONCLUSIONS Spiral T1w TFE sequences may deliver high-quality clinical brain imaging, thus matching the performance of conventional parallel imaging accelerated T1w TFEs. Imaging can be performed at scan times as short as 2:16 minutes per sequence (61.4% scan time reduction compared with SENSE). Optionally, spiral imaging enables increased spatial resolution while maintaining the scan time of a Cartesian-based acquisition schema.
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22
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Affiliation(s)
- Val M Runge
- From the Department of Diagnostic, Interventional, and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
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23
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Hirsch FW, Frahm J, Sorge I, Roth C, Voit D, Gräfe D. Real-time magnetic resonance imaging in pediatric radiology - new approach to movement and moving children. Pediatr Radiol 2021; 51:840-846. [PMID: 33566125 PMCID: PMC8055638 DOI: 10.1007/s00247-020-04828-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/17/2020] [Accepted: 08/23/2020] [Indexed: 11/30/2022]
Abstract
The recent development of highly undersampled radial gradient echo sequences in combination with nonlinear inverse image reconstruction now allows for MRI examinations in real time. Image acquisition times as short as 20 ms yield MRI videos with rates of up to 50 frames per second with spin density, T1- and T2-type contrast. The addition of an initial 180° inversion pulse achieves accurate T1 mapping within only 4 s. These technical advances promise specific advantages for studies of infants and young children by eliminating the need for sedation or anesthesia. Our preliminary data demonstrate new diagnostic opportunities ranging from dynamic studies of speech and swallowing processes and body movements to a rapid volumetric assessment of brain cerebrospinal fluid spaces in only few seconds. Real-time MRI of the heart and blood flow can be performed without electrocardiogram gating and under free breathing. The present findings support the idea that real-time MRI will complement existing methods by providing long-awaited diagnostic options for patients in early childhood. Major advantages are the avoidance of sedation or anesthesia and the yet unexplored potential to gain insights into arbitrary body functions.
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Affiliation(s)
- Franz Wolfgang Hirsch
- Department of Pediatric Radiology, University of Leipzig, Liebigstraße 20a 04103 Leipzig, Germany
| | - Jens Frahm
- Biomedizinische NMR, Max-Planck-Institut für Biophysikalische Chemie, Göttingen, Germany
| | - Ina Sorge
- Department of Pediatric Radiology, University of Leipzig, Liebigstraße 20a 04103 Leipzig, Germany
| | - Christian Roth
- Department of Pediatric Radiology, University of Leipzig, Liebigstraße 20a 04103 Leipzig, Germany
| | - Dirk Voit
- Biomedizinische NMR, Max-Planck-Institut für Biophysikalische Chemie, Göttingen, Germany
| | - Daniel Gräfe
- Department of Pediatric Radiology, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany.
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24
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Temporomandibular joint imaging: current clinical applications, biochemical comparison with the intervertebral disc and knee meniscus, and opportunities for advancement. Skeletal Radiol 2020; 49:1183-1193. [PMID: 32162049 DOI: 10.1007/s00256-020-03412-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/01/2020] [Accepted: 03/01/2020] [Indexed: 02/02/2023]
Abstract
Temporomandibular disorders encompass multiple pathologies of the temporomandibular joint that manifest as middle/inner ear symptoms, headache, and/or localized TMJ symptoms. There is an important although somewhat limited role of imaging in the diagnostic evaluation of temporomandibular disorders. In this manuscript, we provide a comprehensive review of TMJ anatomy, outline potentially important features of TMJ disc ultrastructure and biochemistry in comparison with the intervertebral disc and knee meniscus, and provide imaging examples of the TMJ abnormalities currently evaluable with MRI and CT. In addition, we provide an overview of emerging and investigational TMJ imaging techniques in order to encourage further imaging research based on the biomechanical alterations of the TMJ disc.
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25
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Hellwig S, Grittner U, Elgeti M, Wyschkon S, Nagel SN, Fiebach JB, Krause T, Herm J, Scheitz JF, Endres M, Nolte CH, Haeusler KG, Elgeti T. Evaluation of left ventricular function in patients with acute ischaemic stroke using cine cardiovascular magnetic resonance imaging. ESC Heart Fail 2020; 7:2572-2580. [PMID: 32667736 PMCID: PMC7524103 DOI: 10.1002/ehf2.12833] [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] [Received: 02/24/2020] [Revised: 05/05/2020] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
Aims Heart failure (HF) is frequent in patients with acute ischaemic stroke (AIS) and associated with higher morbidity and mortality. Assessment of cardiac function in AIS patients using cardiovascular MRI (CMR) may help to detect HF. We report the rate of systolic and diastolic dysfunction in a cohort of patients with AIS using CMR and compare cine real‐time (CRT) sequences with the reference of segmented cine steady‐state free precession sequences. Methods and results Patients with AIS without known atrial fibrillation were prospectively enrolled in the HEart and BRain Interfaces in Acute Ischemic Stroke (HEBRAS) study (NCT 02142413) and underwent CMR at 3 Tesla within 7 days after AIS. Validity of CRT sequences was determined in 50 patients. A total of 229 patients were included in the analysis (mean age 66 years; 35% women; HF 2%). Evaluation of cardiac function was successful in 172 (75%) patients. Median time from stroke onset to CMR was 82 h (interquartile range 56–111) and 54 h (interquartile range 31–78) from cerebral MRI to CMR. Systolic dysfunction was observed in 43 (25%) and diastolic dysfunction in 102 (59%) patients. Diagnostic yield was similar using CRT or segmented cine imaging (no significant difference in left ventricular ejection fraction, myocardial mass, time to peak filling rate, and peak filling rate ratio E/A). Intraobserver and interobserver agreement was high (κ = 0.78–1.0 for all modalities). Conclusions Cardiovascular MRI at 3 Tesla is an appropriate method for the evaluation of cardiac function in a selected cohort of patients with AIS. Systolic and diastolic dysfunction is frequent in these patients. CRT imaging allows reliable assessment of systolic and diastolic function.
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Affiliation(s)
- Simon Hellwig
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Matthias Elgeti
- Jules Stein Eye Institute and Department for Chemistry and Biochemistry, University of California, Los Angeles, CA, USA
| | - Sebastian Wyschkon
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian N Nagel
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Krause
- Department of Neurology, Jüdisches Krankenhaus Berlin, Berlin, Germany
| | - Juliane Herm
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan F Scheitz
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Centre for Cardiovascular Diseases (DZHK), partner site Berlin, Berlin, Germany
| | - Matthias Endres
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Centre for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany.,German Centre for Cardiovascular Diseases (DZHK), partner site Berlin, Berlin, Germany
| | - Christian H Nolte
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Centre for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany.,German Centre for Cardiovascular Diseases (DZHK), partner site Berlin, Berlin, Germany
| | | | - Thomas Elgeti
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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26
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Needle Heating During Interventional Magnetic Resonance Imaging at 1.5- and 3.0-T Field Strengths. Invest Radiol 2020; 55:396-404. [DOI: 10.1097/rli.0000000000000649] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Garetier M, Borotikar B, Makki K, Brochard S, Rousseau F, Ben Salem D. Dynamic MRI for articulating joint evaluation on 1.5 T and 3.0 T scanners: setup, protocols, and real-time sequences. Insights Imaging 2020; 11:66. [PMID: 32430739 PMCID: PMC7237553 DOI: 10.1186/s13244-020-00868-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 04/02/2020] [Indexed: 01/31/2023] Open
Abstract
Dynamic magnetic resonance imaging (MRI) is a non-invasive method that can be used to increase the understanding of the pathomechanics of joints. Various types of real-time gradient echo sequences used for dynamic MRI acquisition of joints include balanced steady-state free precession sequence, radiofrequency-spoiled sequence, and ultra-fast gradient echo sequence. Due to their short repetition time and echo time, these sequences provide high temporal resolution, a good signal-to-noise ratio and spatial resolution, and soft tissue contrast. The prerequisites of the evaluation of joints with dynamic MRI include suitable patient installation and optimal positioning of the joint in the coil to allow joint movement, sometimes with dedicated coil support. There are currently few recommendations in the literature regarding appropriate protocol, sequence standardizations, and diagnostic criteria for the use of real-time dynamic MRI to evaluate joints. This article summarizes the technical parameters of these sequences from various manufacturers on 1.5 T and 3.0 T MRI scanners. We have reviewed pertinent details of the patient and coil positioning for dynamic MRI of various joints. The indications and limitations of dynamic MRI of joints are discussed.
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Affiliation(s)
- Marc Garetier
- Department of Radiology, Military Teaching Hospital Clermont-Tonnerre, Rue du colonel Fonferrier, 29240, Brest, Cedex 9, France. .,Department of Radiology, University Hospital Morvan, Brest, France. .,Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.
| | - Bhushan Borotikar
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,University of Western Brittany (UBO), Brest, France.,University Hospital, Brest, France
| | - Karim Makki
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,IMT Atlantique, UBL, Brest, France
| | - Sylvain Brochard
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,University of Western Brittany (UBO), Brest, France.,Department of Physical and Medical Rehabilitation, University Hospital Morvan, Brest, France.,Department of Paediatric Physical and Medical Rehabilitation, Fondation Ildys, Brest, France
| | - François Rousseau
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,IMT Atlantique, UBL, Brest, France
| | - Douraïed Ben Salem
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,University of Western Brittany (UBO), Brest, France.,Department of Radiology, University Hospital La Cavale Blanche, Brest, France
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28
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Joseph AA, Voit D, Frahm J. Inferior vena cava revisited - Real-time flow MRI of respiratory maneuvers. NMR IN BIOMEDICINE 2020; 33:e4232. [PMID: 31913551 DOI: 10.1002/nbm.4232] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
Recent MRI studies of blood flow in the inferior vena cava (IVC) resulted in findings which are inconsistent with earlier observations by invasive procedures - most likely because ECG-gated MRI techniques are unable to resolve dynamic adjustments due to respiration. The purpose of this work was to apply real-time phase-contrast MRI at 50 ms resolution to re-evaluate IVC flow in response to normal and deep breathing as well as breath holding and Valsalva maneuver (11 young healthy subjects). Real-time flow MRI relied on highly undersampled radial gradient-echo sequences and a model-based nonlinear inverse reconstruction. A frequency analysis of the predominant pulsatility classified IVC flow in individual subjects as "cardiac", "respiratory" or "mixed" type. Peak flow velocities during free breathing ranged from 30 to 58 cm s-1 , while flow rates varied from 15 to 37 ml s-1 . The subject-specific IVC flow pattern persists during deep breathing although the enhanced respiratory influence may shift subjects form "cardiac" to "mixed" or from "mixed" to "respiratory" type. Peak velocities increased relative to normal breathing but led to similar flow rates of 16 to 34 ml s-1 . Inspiration during deep breathing elicited brief periods of flow reversal in all subjects with mean peak velocities of -21 cm s-1 . The observation of only mildly flattened parabolic velocity distributions within the IVC indicated mostly laminar flow. Breath holding reduced blood flow velocities and rates by more than 40% on average, while Valsalva maneuvers completely abolished venous return. In conclusion, IVC blood flow is dominated by the acquired respiratory behavior of individual subjects and its pressure-induced alterations relative to cardiac pulsation. The responses to breath holding and Valsalva maneuver are in full agreement with previous invasive observations of reduced or even ceased flow, respectively.
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Affiliation(s)
- Arun A Joseph
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Dirk Voit
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Jens Frahm
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany
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29
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Voit D, Kalentev O, van Zalk M, Joseph AA, Frahm J. Rapid and motion-robust volume coverage using cross-sectional real-time MRI. Magn Reson Med 2019; 83:1652-1658. [PMID: 31670850 DOI: 10.1002/mrm.28029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE To develop a rapid and motion-robust technique for volumetric MRI, which is based on cross-sectional real-time MRI acquisitions with automatic advancement of the slice position. METHODS Real-time MRI with a frame-by-frame moving cross-section is performed with use of highly undersampled radial gradient-echo sequences offering spin density, T1 , or T2 /T1 contrast. Joint reconstructions of serial images and coil sensitivity maps from spatially overlapping sections are accomplished by nonlinear inversion with regularization to the preceding section-formally identical to dynamic real-time MRI. Shifting each frame by 20% to 25% of the section thickness ensures 75% to 80% overlap of successive sections. Acquisition times of 40 to 67 ms allow for rates of 15 to 25 sections per second, while volumes are defined by the number of cross-sections times the section shift. RESULTS Preliminary realizations at 3T comprise studies of the human brain, carotid arteries, liver, and prostate. Typically, coverage of a 90- to 180-mm volume at 0.8- to 1.2-mm in-plane resolution, 4- to 6-mm section thickness, and 0.8- to 1.5-mm section shift is accomplished within total measuring times of 4 to 6 seconds and a section speed of 15 to 37.5 mm per second. However, spatiotemporal resolution, contrast including options such as fat saturation and total measuring time are highly variable and may be adjusted to clinical needs. Promising volumetric applications range from fetal MRI to dynamic contrast-enhanced MRI. CONCLUSION The proposed method allows for rapid and motion-robust volume coverage in a variety of imaging scenarios.
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Affiliation(s)
- Dirk Voit
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Oleksandr Kalentev
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Maaike van Zalk
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Arun A Joseph
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Jens Frahm
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
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