Novel Ultrafast Spiral Head MR Angiography Compared to Standard MR and CT Angiography

Simultaneous brain and neck time-of-flight MRA using spiral multiband with localized quadratic encoding

PURPOSE

To develop a method that achieves simultaneous brain and neck time-of-flight (ToF) magnetic resonance angiography (MRA) within feasible scan timeframes.

METHODS

Localized quadratic (LQ) encoding is efficient for both signal-to-noise ratio (SNR) and in-flow enhancement. We proposed a spiral multiband LQ method to enable simultaneous intracranial and carotid ToF-MRA within a single scan. To address the venous signal contamination that becomes a challenge with multiband (MB) ToF, tilt-optimized non-saturated excitation (TONE) and partial-Fourier slice selection (PFSS) were further introduced in the LQ framework to mitigate the venous signal and improve artery contrast. A sequential spiral MB and LQ reconstruction pipeline was employed to obtain the brain-and-neck image volumes.

RESULTS

The proposed MB method was able to achieve simultaneous brain and neck ToF-MRA within a 2:50-min scan. The complementarily boosted SNR-efficiency by MB and LQ acquisitions allows for the increased spatial coverage without increase in scan time or noticeable compromise in SNR. The incorporation of both TONE and PFSS effectively alleviated the venous contamination with improved small vessel sensitivity. Selection of scan parameters such as the LQ factor and flip angle reflected the trade-off among SNR, blood contrast, and venous suppression.

CONCLUSIONS

A novel MB spiral LQ approach was proposed to enable fast intracranial and carotid ToF-MRA with minimized venous corruption. The method has shown promise in MRA applications where large spatial coverage is necessary.

New Perspectives in Radiological and Radiopharmaceutical Hybrid Imaging in Progressive Supranuclear Palsy: A Systematic Review

Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by four-repeat tau deposition in various cell types and anatomical regions, and can manifest as several clinical phenotypes, including the most common phenotype, Richardson's syndrome. The limited availability of biomarkers for PSP relates to the overlap of clinical features with other neurodegenerative disorders, but identification of a growing number of biomarkers from imaging is underway. One way to increase the reliability of imaging biomarkers is to combine different modalities for multimodal imaging. This review aimed to provide an overview of the current state of PSP hybrid imaging by combinations of positron emission tomography (PET) and magnetic resonance imaging (MRI). Specifically, combined PET and MRI studies in PSP highlight the potential of [18F]AV-1451 to detect tau, but also the challenge in differentiating PSP from other neurodegenerative diseases. Studies over the last years showed a reduced synaptic density in [11C]UCB-J PET, linked [11C]PK11195 and [18F]AV-1451 markers to disease progression, and suggested the potential role of [18F]RO948 PET for identifying tau pathology in subcortical regions. The integration of quantitative global and regional gray matter analysis by MRI may further guide the assessment of reduced cortical thickness or volume alterations, and diffusion MRI could provide insight into microstructural changes and structural connectivity in PSP. Challenges in radiopharmaceutical biomarkers and hybrid imaging require further research targeting markers for comprehensive PSP diagnosis.

Spiral inflow MRA with sliding-slice localized quadratic encoding

PURPOSE

This work proposes a 2D/3D hybrid inflow MRA technique for fast scanning and high SNR and contrast-to-noise (CNR) efficiencies.

METHODS

Localized quadratic (LQ) encoding was combined with a sliding-slice spiral acquisition. Inflow MRAs around the circle of Willis and the carotid bifurcations were collected on four healthy volunteers. Spiral images were deblurred without or with water-fat separation for sliding-slice LQ (ssLQ) out-of-phase (OP) and Dixon inflow MRAs, respectively. Results were compared to multiple overlapping thin slab acquisitions (MOTSA) and 2D OP inflow MRAs. Noise data were also acquired with RF and gradients turned off to compute maps of SNR and SNR efficiency. Quantitative assessment of relative contrast, CNR, and CNR efficiency for flow were performed in regions of interest.

RESULTS

The sliding-slice spiral technique alone reduces scan time by 10% to 40% compared with a standard spiral acquisition scheme. The proposed spiral ssLQ OP achieves 50% higher scan speed than the spiral MOTSA with comparable SNR and CNR efficiencies, which are ∼100% higher than the Cartesian MOTSA for intracranial inflow MRAs. Spiral ssLQ Dixon inflow MRA provides better visibility for vessels around the fat compared to spiral ssLQ OP inflow MRA, with a trade-off of scan speed. Spiral ssLQ MRA with thinner slice thickness is two to five times faster than the 2D Cartesian inflow neck MRA around the carotid bifurcations, while also achieving higher SNR efficiency.

CONCLUSION

The proposed spiral ssLQ is a fast and flexible MRA method with improved SNR and CNR efficiencies over traditional Cartesian inflow MRAs.

Spiral gradient echo versus cartesian turbo spin echo imaging for sagittal contrast-enhanced fat-suppressed T1 weighted spine MRI: an inter-individual comparison study

OBJECTIVES

To compare a novel 3D spiral gradient echo (GRE) sequence with a conventional 2D cartesian turbo spin echo (TSE) sequence for sagittal contrast-enhanced (CE) fat-suppressed (FS) T1 weighted (T1W) spine MRI.

METHODS

In this inter-individual comparison study, 128 patients prospectively underwent sagittal CE FS T1W spine MRI with either a 2D cartesian TSE ("TSE", 285 s, 64 patients) or a 3D spiral GRE sequence ("Spiral", 93 s, 64 patients). Between both groups, patients were matched in terms of anatomical region (cervical/thoracic/lumbar spine and sacrum). Three readers used 4-point Likert scales to assess images qualitatively in terms of overall image quality, presence of artifacts, spinal cord visualization, lesion conspicuity and quality of fat suppression.

RESULTS

Spiral achieved a 67.4% scan time reduction compared to TSE. Interreader agreement was high (alpha=0.868-1). Overall image quality (4;[3,4] vs 3;[3,4], p<0.001 - p=0.002 for all readers), presence of artifacts (4;[3,4] vs 3;[3,4] p=0.027 - p=0.046 for all readers), spinal cord visualization (4;[4,4] vs 4;[3,4], p<0.001 for all readers), lesion conspicuity (4;[4,4] vs 4;[4,4], p=0.016 for all readers) and quality of fat suppression (4;[4,4] vs 4;[4,4], p=0.027 - p=0.033 for all readers), were all deemed significantly improved by all three readers on Spiral images as compared to TSE images.

CONCLUSION

We demonstrate the feasibility of a novel 3D spiral GRE sequence for improved and rapid sagittal CE FS T1W spine MRI.

ADVANCES IN KNOWLEDGE

A 3D spiral GRE sequence allows for improved sagittal CE FS T1W spine MRI at very short scan times.

Usefulness of silent magnetic resonance angiography (MRA) for the diagnosis of atherosclerosis of the internal carotid artery siphon in comparison with time-of-flight MRA

Background and purpose

Flow visualization in 3D time-of-flight MRA (3D-TOF MRA) may be limited for internal carotid artery siphon owing to turbulent artifact. The purpose of this study was to compare the usefulness of Silent MRA and 3D-TOF MRA to assess atherosclerosis of the internal carotid artery siphon.

Material and methods

A total of 106 patients with suspected cerebrovascular disease were included. All patients were scanned with Silent MRA and 3D-TOF MRA sequences and also underwent DSA examination. Two observers independently assessed the TOF MRA and Silent MRA images of atherosclerosis of the internal carotid artery siphon. The diagnostic efficacy of two MRA methods in evaluating atherosclerosis of the carotid siphon was performed by using receiver operating characteristic (ROC) curve analysis. Interobserver reliability was also assessed using weighted kappa statistics.

Results

Image of Silent MRA sequence had higher subjective evaluation scores and significantly high CNR between the carotid siphon and the background tissues than the image of 3D-TOF MRA sequence (P < 0.05). The AUC was 0.928 (95% CI 0.909–0.986) for Silent MRA, which was significantly higher than that of 3D-TOF MRA (0.671, 95% CI 0.610–0.801, P < 0.05). Silent MRA had high sensitivity, specificity and accuracy than 3D-TOF MRA for visualization of the carotid siphon.

Conclusions

Silent MRA as a new angiographic modality is superior to 3D-TOF MRA for visualization of the carotid siphon, and maybe an alternative to 3D-TOF MRA in the diagnosis of atherosclerosis of the carotid siphon.

Spiral 3D time-of-flight MR angiography for rapid non-contrast carotid artery imaging: Clinical feasibility and protocol optimization

PURPOSE

To assess the clinical feasibility of spiral 3D Time-Of-Flight (TOF) MR Angiography (MRA) sequence variants for rapid non-contrast carotid artery imaging.

METHODS

Nine different 3D TOF MRA sequences were acquired in nine healthy volunteers on a standard clinical 1.5 T scanner. Three cartesian sequences (fully sampled (10:15 min), accelerated with SENSE (05:08 min), accelerated with Compressed SENSE (03:32 min)) and six different spiral sequences were acquired (spiral acquisition windows ranging from 10 to 5 ms (01:32 min-03:05 min)). Three readers graded the images qualitatively in terms of overall image quality, vessel sharpness, inhomogeneous intraluminal signal, background noise, visualization of large and small vessels and overall impression of the number of visible vessels. Cross-sectional areas of the vessel lumen were measured and vessel sharpness was quantified.

RESULTS

The SENSE and Compressed SENSE accelerated cartesian sequences and the Spiral 6 ms and 5 ms sequences were deemed comparable to the fully sampled cartesian sequence in most qualitative categories (p > 0.05) based on exact binomial tests. The Spiral 6 ms and 5 ms sequences achieved a scan time reduction of 75.3% and 69.9% respectively compared to the fully sampled cartesian sequence. The spiral sequences (generally) exhibited improved subjective vessel sharpness (p < 0.01-p = 0.13) but increased background noise (p = 0.03-p = 0.25). Cross-sectional area measurements were similar between all sequences (Krippendorff's alpha: 0.955-0.982). Quantitative vessel sharpness was increased for all spiral sequences compared to all cartesian sequences (p = 0.004).

CONCLUSIONS

Spiral 3D TOF MRA sequences with a spiral acquisition window of 5 ms or 6 ms may be used for accurate, rapid, clinical non-contrast carotid artery imaging.

Spiral 2D T2-Weighted TSE Brain MR Imaging: Initial Clinical Experience

BACKGROUND AND PURPOSE

Spiral MR imaging may enable improved image quality and higher scan speeds than Cartesian trajectories. We sought to compare a novel spiral 2D T2-weighted TSE sequence with a conventional Cartesian and an artifact-robust, non-Cartesian sequence named MultiVane for routine clinical brain MR imaging.

MATERIALS AND METHODS

Thirty-one patients were scanned with all 3 sequences (Cartesian, 4 minutes 14 seconds; MultiVane, 2 minutes 49 seconds; spiral, 2 minutes 12 seconds) on a standard clinical 1.5T MR scanner. Three readers described the presence and location of abnormalities and lesions and graded images qualitatively in terms of overall image quality, the presence of motion and pulsation artifacts, gray-white matter differentiation, lesion conspicuity, and subjective preference. Image quality was objectivized by measuring the SNR and the coefficients of variation for CSF, GM, and WM.

RESULTS

Spiral achieved a scan time reduction of 51.9% and 21.9% compared with Cartesian and MultiVane, respectively. The number and location of lesions were identical among all sequences. As for the qualitative analysis, interreader agreement was high (Krippendorff α > .75). Spiral and MultiVane both outperformed the Cartesian sequence in terms of overall image quality, the presence of motion artifacts, and subjective preference (P < .001). In terms of the presence of pulsation artifacts, gray-white matter differentiation, and lesion conspicuity, all 3 sequences performed similarly well (P > .15). Spiral and MultiVane outperformed the Cartesian sequence in coefficient of variation WM and SNR (P < .01).

CONCLUSIONS

Spiral 2D T2WI TSE is feasible for routine structural brain MR imaging and offers high-quality, artifact-robust brain imaging in short scan times.

What's Hot in Breast MRI

Several articles in the literature have demonstrated a promising role for breast MRI techniques that are more economic in total exam time than others when used as supplement to mammography for detection and diagnosis of breast cancer. There are many technical factors that must be considered in the shortened breast MRI protocols to cut down time of standard ones, including using optimal fat suppression, gadolinium-chelates intravascular contrast administrations for dynamic imaging with post processing subtractions and maximum intensity projections (MIP) high spatial and temporal resolution among others. Multiparametric breast MRI that includes both gadolinium-dependent, i.e., dynamic contrast-enhanced (DCE-MRI) and gadolinium-free techniques, i.e., diffusion-weighted/diffusion-tensor magnetic resonance imaging (DWI/DTI) are shown by several investigators that can provide extremely high sensitivity and specificity for detection of breast cancer. This article provides an overview of the proven indications for breast MRI including breast cancer screening for higher than average risk, determining chemotherapy induced tumor response, detecting residual tumor after incomplete surgical excision, detecting occult cancer in patients presenting with axillary node metastasis, detecting residual tumor after incomplete breast cancer surgical excision, detecting cancer when results of conventional imaging are equivocal, as well patients suspicious of having breast implant rupture. Despite having the highest sensitivity for breast cancer detection, there are pitfalls, however, secondary to false positive and false negative contrast enhancement and contrast-free MRI techniques. Awareness of the strengths and limitations of different approaches to obtain state of the art MR images of the breast will facilitate the work-up of patients with suspicious breast lesions.

Qualitative and Quantitative Analysis of a Spiral Gradient Echo Sequence for Contrast-Enhanced Fat-Suppressed T1-Weighted Spine Magnetic Resonance Imaging

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.