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Lavrova A, Mishra S, Richardson J, Masotti M, Kurokawa R, Kurokawa M, Itriago-Leon P, Gulani V, McCracken B, Wright K, Hussain HK, Moritani T, Seiberlich N. Quality assessment of routine brain imaging at 0.55 T: initial experience in a clinical workflow. NMR IN BIOMEDICINE 2024; 37:e5017. [PMID: 37654047 DOI: 10.1002/nbm.5017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/20/2023] [Accepted: 07/16/2023] [Indexed: 09/02/2023]
Abstract
The purpose of this study was to assess the quality of clinical brain imaging in healthy subjects and patients on an FDA-approved commercial 0.55 T MRI scanner, and to provide information about the feasibility of using this scanner in a clinical workflow. In this IRB-approved study, brain examinations on the scanner were prospectively performed in 10 healthy subjects (February-April 2022) and retrospectively derived from 44 patients (February-July 2022). Images collected using the following pulse sequences were available for assessment: axial DWI (diffusion-weighted imaging), apparent diffusion coefficient maps, 2D axial fluid-attenuated inversion recovery images, axial susceptibility-weighted images (both magnitude and phase), sagittal T1-weighted (T1w) Sampling Perfection with Application Optimized Contrast images, sagittal T1w MPRAGE (magnetization prepared rapid gradient echo) with contrast enhancement, axial T1w turbo spin echo (TSE) with and without contrast enhancement, and axial T2-weighted TSE. Two readers retrospectively and independently evaluated image quality and specific anatomical features in a blinded fashion on a four-point Likert scale, with a score of 1 being unacceptable and 4 being excellent, and determined the ability to answer the clinical question in patients. For each category of image sequences, the mean, standard deviation, and percentage of unacceptable quality images (<2) were calculated. Acceptable (rating ≥ 2) image quality was achieved at 0.55 T in all sequences for patients and 85% of the sequences for healthy subjects. Radiologists were able to answer the clinical question in all patients scanned. In total, 50% of the sequences used in patients and about 60% of the sequences used in healthy subjects exhibited good (rating ≥ 3) image quality. Based on these findings, we conclude that diagnostic quality clinical brain images can be successfully collected on this commercial 0.55 T scanner, indicating that the routine brain imaging protocol may be deployed on this system in the clinical workflow.
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Affiliation(s)
- Anna Lavrova
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Shruti Mishra
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jacob Richardson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Maria Masotti
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryo Kurokawa
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariko Kurokawa
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Vikas Gulani
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Brendan McCracken
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Katherine Wright
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Hero K Hussain
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Toshio Moritani
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicole Seiberlich
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
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Samardzija A, Selvaganesan K, Zhang HZ, Sun H, Sun C, Ha Y, Galiana G, Constable RT. Low-Field, Low-Cost, Point-of-Care Magnetic Resonance Imaging. Annu Rev Biomed Eng 2024; 26:67-91. [PMID: 38211326 DOI: 10.1146/annurev-bioeng-110122-022903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Low-field magnetic resonance imaging (MRI) has recently experienced a renaissance that is largely attributable to the numerous technological advancements made in MRI, including optimized pulse sequences, parallel receive and compressed sensing, improved calibrations and reconstruction algorithms, and the adoption of machine learning for image postprocessing. This new attention on low-field MRI originates from a lack of accessibility to traditional MRI and the need for affordable imaging. Low-field MRI provides a viable option due to its lack of reliance on radio-frequency shielding rooms, expensive liquid helium, and cryogen quench pipes. Moreover, its relatively small size and weight allow for easy and affordable installation in most settings. Rather than replacing conventional MRI, low-field MRI will provide new opportunities for imaging both in developing and developed countries. This article discusses the history of low-field MRI, low-field MRI hardware and software, current devices on the market, advantages and disadvantages, and low-field MRI's global potential.
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Affiliation(s)
- Anja Samardzija
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA;
| | - Kartiga Selvaganesan
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA;
| | - Horace Z Zhang
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA;
| | - Heng Sun
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA;
| | - Chenhao Sun
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Yonghyun Ha
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gigi Galiana
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA;
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - R Todd Constable
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA;
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
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3
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Ariyasingha NM, Chowdhury MRH, Samoilenko A, Salnikov OG, Chukanov NV, Kovtunova LM, Bukhtiyarov VI, Shi Z, Luo K, Tan S, Koptyug IV, Goodson BM, Chekmenev EY. Toward Lung Ventilation Imaging Using Hyperpolarized Diethyl Ether Gas Contrast Agent. Chemistry 2024; 30:e202304071. [PMID: 38381807 PMCID: PMC11065616 DOI: 10.1002/chem.202304071] [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: 12/13/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 02/23/2024]
Abstract
Hyperpolarized 129Xe gas was FDA-approved as an inhalable contrast agent for magnetic resonance imaging of a wide range of pulmonary diseases in December 2022. Despite the remarkable success in clinical research settings, the widespread clinical translation of HP 129Xe gas faces two critical challenges: the high cost of the relatively low-throughput hyperpolarization equipment and the lack of 129Xe imaging capability on clinical MRI scanners, which have narrow-bandwidth electronics designed only for proton (1H) imaging. To solve this translational grand challenge of gaseous hyperpolarized MRI contrast agents, here we demonstrate the utility of batch-mode production of proton-hyperpolarized diethyl ether gas via heterogeneous pairwise addition of parahydrogen to ethyl vinyl ether. An approximately 0.1-liter bolus of hyperpolarized diethyl ether gas was produced in 1 second and injected in excised rabbit lungs. Lung ventilation imaging was performed using sub-second 2D MRI with up to 2×2 mm2 in-plane resolution using a clinical 0.35 T MRI scanner without any modifications. This feasibility demonstration paves the way for the use of inhalable diethyl ether as a gaseous contrast agent for pulmonary MRI applications using any clinical MRI scanner.
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Affiliation(s)
- Nuwandi M Ariyasingha
- Department of Chemistry, Karmanos Cancer Institute (KCI), Department of Pediatrics, Wayne State University, Detroit, MI-48202, USA
| | - Md Raduanul H Chowdhury
- Department of Chemistry, Karmanos Cancer Institute (KCI), Department of Pediatrics, Wayne State University, Detroit, MI-48202, USA
| | - Anna Samoilenko
- Department of Chemistry, Karmanos Cancer Institute (KCI), Department of Pediatrics, Wayne State University, Detroit, MI-48202, USA
| | - Oleg G Salnikov
- International Tomography Center SB RAS, 3 A Institutskaya Street, Novosibirsk, 630090, Russia
| | - Nikita V Chukanov
- International Tomography Center SB RAS, 3 A Institutskaya Street, Novosibirsk, 630090, Russia
| | - Larisa M Kovtunova
- International Tomography Center SB RAS, 3 A Institutskaya Street, Novosibirsk, 630090, Russia
- Boreskov Institute of Catalysis SB RAS, 5 Acad. Lavrentiev Pr, Novosibirsk, 630090, Russia
| | - Valerii I Bukhtiyarov
- Boreskov Institute of Catalysis SB RAS, 5 Acad. Lavrentiev Pr, Novosibirsk, 630090, Russia
| | - Zhongjie Shi
- Department of Chemistry, Karmanos Cancer Institute (KCI), Department of Pediatrics, Wayne State University, Detroit, MI-48202, USA
| | - Kehuan Luo
- Department of Chemistry, Karmanos Cancer Institute (KCI), Department of Pediatrics, Wayne State University, Detroit, MI-48202, USA
| | - Sidhartha Tan
- Department of Chemistry, Karmanos Cancer Institute (KCI), Department of Pediatrics, Wayne State University, Detroit, MI-48202, USA
| | - Igor V Koptyug
- International Tomography Center SB RAS, 3 A Institutskaya Street, Novosibirsk, 630090, Russia
| | - Boyd M Goodson
- School of Chemical and Biomolecular Sciences, Southern Illinois University, Carbondale, IL-62901, USA
| | - Eduard Y Chekmenev
- Department of Chemistry, Karmanos Cancer Institute (KCI), Department of Pediatrics, Wayne State University, Detroit, MI-48202, USA
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4
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Cavion CC, Altmayer S, Forte GC, Feijó Andrade RG, Hochhegger DQDR, Zaguini Francisco M, Camargo C, Patel P, Hochhegger B. Diagnostic Performance of MRI for the Detection of Pulmonary Nodules: A Systematic Review and Meta-Analysis. Radiol Cardiothorac Imaging 2024; 6:e230241. [PMID: 38634743 PMCID: PMC11056753 DOI: 10.1148/ryct.230241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 02/18/2024] [Accepted: 03/07/2024] [Indexed: 04/19/2024]
Abstract
Purpose To perform a meta-analysis of the diagnostic performance of MRI for the detection of pulmonary nodules, with use of CT as the reference standard. Materials and Methods PubMed, Embase, Scopus, and other databases were systematically searched for studies published from January 2000 to March 2023 evaluating the performance of MRI for diagnosis of lung nodules measuring 4 mm or larger, with CT as reference. Studies including micronodules, nodules without size stratification, or those from which data for contingency tables could not be extracted were excluded. Primary outcomes were the per-lesion sensitivity of MRI and the rate of false-positive nodules per patient (FPP). Subgroup analysis by size and meta-regression with other covariates were performed. The study protocol was registered in the International Prospective Register of Systematic Reviews, or PROSPERO (no. CRD42023437509). Results Ten studies met inclusion criteria (1354 patients and 2062 CT-detected nodules). Overall, per-lesion sensitivity of MRI for nodules measuring 4 mm or larger was 87.7% (95% CI: 81.1, 92.2), while the FPP rate was 12.4% (95% CI: 7.0, 21.1). Subgroup analyses demonstrated that MRI sensitivity was 98.5% (95% CI: 90.4, 99.8) for nodules measuring at least 8-10 mm and 80.5% (95% CI: 71.5, 87.1) for nodules less than 8 mm. Conclusion MRI demonstrated a good overall performance for detection of pulmonary nodules measuring 4 mm or larger and almost equal performance to CT for nodules measuring at least 8-10 mm, with a low rate of FPP. Systematic review registry no. CRD42023437509 Keywords: Lung Nodule, Lung Cancer, Lung Cancer Screening, MRI, CT Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- César Campagnolo Cavion
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Stephan Altmayer
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Gabriele Carra Forte
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Rubens Gabriel Feijó Andrade
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Daniela Quinto dos Reis Hochhegger
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Martina Zaguini Francisco
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Capitulino Camargo
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Pratik Patel
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Bruno Hochhegger
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
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Hinsen M, Nagel AM, May MS, Wiesmueller M, Uder M, Heiss R. Lung Nodule Detection With Modern Low-Field MRI (0.55 T) in Comparison to CT. Invest Radiol 2024; 59:215-222. [PMID: 37490031 DOI: 10.1097/rli.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the accuracy of modern low-field magnetic resonance imaging (MRI) for lung nodule detection and to correlate nodule size measurement with computed tomography (CT) as reference. MATERIALS AND METHODS Between November 2020 and July 2021, a prospective clinical trial using low-field MRI at 0.55 T was performed in patients with known pulmonary nodules from a single academic medical center. Every patient underwent MRI and CT imaging on the same day. The primary aim was to evaluate the detection accuracy of pulmonary nodules using MRI with transversal periodically rotated overlapping parallel lines with enhanced reconstruction in combination with coronal half-Fourier acquired single-shot turbo spin-echo MRI sequences. The secondary outcome was the correlation of the mean lung nodule diameter with CT as reference according to the Lung Imaging Reporting and Data System. Nonparametric Mann-Whitney U test, Spearman rank correlation coefficient, and Bland-Altman analysis were applied to analyze the results. RESULTS A total of 46 participants (mean age ± SD, 66 ± 11 years; 26 women) were included. In a blinded analysis of 964 lung nodules, the detection accuracy was 100% for those ≥6 mm (126/126), 80% (159/200) for those ≥4-<6 mm, and 23% (147/638) for those <4 mm in MRI compared with reference CT. Spearman correlation coefficient of MRI and CT size measurement was r = 0.87 ( P < 0.001), and the mean difference was 0.16 ± 0.9 mm. CONCLUSIONS Modern low-field MRI shows excellent accuracy in lesion detection for lung nodules ≥6 mm and a very strong correlation with CT imaging for size measurement, but could not compete with CT in the detection of small nodules.
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Affiliation(s)
- Maximilian Hinsen
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany (M.H., A.M.N., M.S.M., M.W., M.U., R.H.); and Division of Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany (A.M.N.)
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Ramachandran A, Hussain HK, Gulani V, Kelsey L, Mendiratta-Lala M, Richardson J, Masotti M, Dudek N, Morehouse J, Panagis KR, Wright K, Seiberlich N. Abdominal MRI on a Commercial 0.55T System: Initial Evaluation and Comparison to Higher Field Strengths. Acad Radiol 2024:S1076-6332(24)00018-7. [PMID: 38320946 DOI: 10.1016/j.acra.2024.01.018] [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: 10/17/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/08/2024]
Abstract
RATIONALE AND OBJECTIVES This study aims to assess the quality of abdominal MR images acquired on a commercial 0.55T scanner and compare these images with those acquired on conventional 1.5T/3T scanners in both healthy subjects and patients. MATERIALS AND METHODS Fifteen healthy subjects and 52 patients underwent abdominal Magnetic Resonance Imaging at 0.55T. Images were also collected in healthy subjects at 1.5T, and comparison 1.5/3T images identified for 28 of the 52 patients. Image quality was rated by two radiologists on a 4-point Likert scale. Readers were asked whether they could answer the clinical question for patient studies. Wilcoxon signed-rank test was used to test for significant differences in image ratings and acquisition times, and inter-reader reliability was computed. RESULTS The overall image quality of all sequences at 0.55T were rated as acceptable in healthy subjects. Sequences were modified to improve signal-to-noise ratio and reduce artifacts and deployed for clinical use; 52 patients were enrolled in this study. Radiologists were able to answer the clinical question in 52 (reader 1) and 46 (reader 2) of the patient cases. Average image quality was considered to be diagnostic (>3) for all sequences except arterial phase FS 3D T1w gradient echo (GRE) and 3D magnetic resonance cholangiopancreatography for one reader. In comparison to higher field images, significantly lower scores were given to 0.55T IP 2D GRE and arterial phase FS 3D T1w GRE, and significantly higher scores to diffusion-weighted echo planar imaging at 0.55T; other sequences were equivalent. The average scan time at 0.55T was 54 ± 10 minutes vs 36 ± 11 minutes at higher field strengths (P < .001). CONCLUSION Diagnostic-quality abdominal MR images can be obtained on a commercial 0.55T scanner at a longer overall acquisition time compared to higher field systems, although some sequences may benefit from additional optimization.
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Affiliation(s)
| | - Hero K Hussain
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109
| | - Vikas Gulani
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109
| | - Lauren Kelsey
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109
| | | | - Jacob Richardson
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109
| | - Maria Masotti
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Nancy Dudek
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109
| | - Joel Morehouse
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109
| | | | - Katherine Wright
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109
| | - Nicole Seiberlich
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109.
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7
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Campbell-Washburn AE, Varghese J, Nayak KS, Ramasawmy R, Simonetti OP. Cardiac MRI at Low Field Strengths. J Magn Reson Imaging 2024; 59:412-430. [PMID: 37530545 PMCID: PMC10834858 DOI: 10.1002/jmri.28890] [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: 03/17/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 08/03/2023] Open
Abstract
Cardiac MR imaging is well established for assessment of cardiovascular structure and function, myocardial scar, quantitative flow, parametric mapping, and myocardial perfusion. Despite the clear evidence supporting the use of cardiac MRI for a wide range of indications, it is underutilized clinically. Recent developments in low-field MRI technology, including modern data acquisition and image reconstruction methods, are enabling high-quality low-field imaging that may improve the cost-benefit ratio for cardiac MRI. Studies to-date confirm that low-field MRI offers high measurement concordance and consistent interpretation with clinical imaging for several routine sequences. Moreover, low-field MRI may enable specific new clinical opportunities for cardiac imaging such as imaging near metal implants, MRI-guided interventions, combined cardiopulmonary assessment, and imaging of patients with severe obesity. In this review, we discuss the recent progress in low-field cardiac MRI with a focus on technical developments and early clinical validation studies. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Adrienne E Campbell-Washburn
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Juliet Varghese
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
- Alfred Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
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Tian Y, Nayak KS. New clinical opportunities of low-field MRI: heart, lung, body, and musculoskeletal. MAGMA (NEW YORK, N.Y.) 2024; 37:1-14. [PMID: 37902898 PMCID: PMC10876830 DOI: 10.1007/s10334-023-01123-w] [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: 05/26/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 11/01/2023]
Abstract
Contemporary whole-body low-field MRI scanners (< 1 T) present new and exciting opportunities for improved body imaging. The fundamental reason is that the reduced off-resonance and reduced SAR provide substantially increased flexibility in the design of MRI pulse sequences. Promising body applications include lung parenchyma imaging, imaging adjacent to metallic implants, cardiac imaging, and dynamic imaging in general. The lower cost of such systems may make MRI favorable for screening high-risk populations and population health research, and the more open configurations allowed may prove favorable for obese subjects and for pregnant women. This article summarizes promising body applications for contemporary whole-body low-field MRI systems, with a focus on new platforms developed within the past 5 years. This is an active area of research, and one can expect many improvements as MRI physicists fully explore the landscape of pulse sequences that are feasible, and as clinicians apply these to patient populations.
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Affiliation(s)
- Ye Tian
- Ming Hsieh Department of Electrical and Computer Engineering, Viterbi School of Engineering, University of Southern California, 3740 McClintock Ave, EEB 406, Los Angeles, CA, 90089-2564, USA.
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, Viterbi School of Engineering, University of Southern California, 3740 McClintock Ave, EEB 406, Los Angeles, CA, 90089-2564, USA
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9
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Shetty AS, Ludwig DR, Ippolito JE, Andrews TJ, Narra VR, Fraum TJ. Low-Field-Strength Body MRI: Challenges and Opportunities at 0.55 T. Radiographics 2023; 43:e230073. [PMID: 37917537 DOI: 10.1148/rg.230073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Advances in MRI technology have led to the development of low-field-strength (hereafter, "low-field") (0.55 T) MRI systems with lower weight, fewer shielding requirements, and lower cost than those of traditional (1.5-3 T) systems. The trade-offs of lower signal-to-noise ratio (SNR) at 0.55 T are partially offset by patient safety and potential comfort advantages (eg, lower specific absorption rate and a more cost-effective larger bore diameter) and physical advantages (eg, decreased T2* decay, shorter T1 relaxation times). Image reconstruction advances leveraging developing technologies (such as deep learning-based denoising) can be paired with traditional techniques (such as increasing the number of signal averages) to improve SNR. The overall image quality produced by low-field MRI systems, although perhaps somewhat inferior to 1.5-3 T MRI systems in terms of SNR, is nevertheless diagnostic for a broad variety of body imaging applications. Effective low-field body MRI requires (a) an understanding of the trade-offs resulting from lower field strengths, (b) an approach to modifying routine sequences to overcome SNR challenges, and (c) a workflow for carefully selecting appropriate patients. The authors describe the rationale, opportunities, and challenges of low-field body MRI; discuss important considerations for low-field imaging with common body MRI sequences; and delineate a variety of use cases for low-field body MRI. The authors also include lessons learned from their preliminary experience with a new low-field MRI system at a tertiary care center. Finally, they explore the future of low-field MRI, summarizing current limitations and potential future developments that may enhance the clinical adoption of this technology. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center. See the invited commentary by Venkatesh in this issue.
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Affiliation(s)
- Anup S Shetty
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| | - Daniel R Ludwig
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| | - Joseph E Ippolito
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| | - Trevor J Andrews
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| | - Vamsi R Narra
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| | - Tyler J Fraum
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
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10
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Lemberskiy G, Chandarana H, Bruno M, Ginocchio LA, Huang C, Tong A, Keerthivasan MB, Fieremans E, Novikov DS. Feasibility of Accelerated Prostate Diffusion-Weighted Imaging on 0.55 T MRI Enabled With Random Matrix Theory Denoising. Invest Radiol 2023; 58:720-729. [PMID: 37222526 PMCID: PMC10527232 DOI: 10.1097/rli.0000000000000979] [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] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Prostate cancer diffusion weighted imaging (DWI) MRI is typically performed at high-field strength (3.0 T) in order to overcome low signal-to-noise ratio (SNR). In this study, we demonstrate the feasibility of prostate DWI at low field enabled by random matrix theory (RMT)-based denoising, relying on the MP-PCA algorithm applied during image reconstruction from multiple coils. METHODS Twenty-one volunteers and 2 prostate cancer patients were imaged with a 6-channel pelvic surface array coil and an 18-channel spine array on a prototype 0.55 T system created by ramping down a commercial magnetic resonance imaging system (1.5 T MAGNETOM Aera Siemens Healthcare) with 45 mT/m gradients and 200 T/m/s slew rate. Diffusion-weighted images were acquired with 4 non-collinear directions, for which b = 50 s/mm 2 was used with 8 averages and b = 1000 s/mm 2 with 40 averages; 2 extra b = 50 s/mm 2 were used as part of the dynamic field correction. Standard and RMT-based reconstructions were applied on DWI over different ranges of averages. Accuracy/precision was evaluated using the apparent diffusion coefficient (ADC), and image quality was evaluated over 5 separate reconstructions by 3 radiologists with a 5-point Likert scale. For the 2 patients, we compare image quality and lesion visibility of the RMT reconstruction versus the standard one on 0.55 T and on clinical 3.0 T. RESULTS The RMT-based reconstruction in this study reduces the noise floor by a factor of 5.8, thereby alleviating the bias on prostate ADC. Moreover, the precision of the ADC in prostate tissue after RMT increases over a range of 30%-130%, with the increase in both signal-to-noise ratio and precision being more prominent for a low number of averages. Raters found that the images were consistently of moderate to good overall quality (3-4 on the Likert scale). Moreover, they determined that b = 1000 s/mm 2 images from a 1:55-minute scan with the RMT-based reconstruction were on par with the corresponding images from a 14:20-minute scan with standard reconstruction. Prostate cancer was visible on ADC and calculated b = 1500 images even with the abbreviated 1:55-minute scan reconstructed with RMT. CONCLUSIONS Prostate imaging using DWI is feasible at low field and can be performed more rapidly with noninferior image quality compared with standard reconstruction.
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Affiliation(s)
- Gregory Lemberskiy
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
| | - Hersh Chandarana
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
| | - Mary Bruno
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
| | - Luke A. Ginocchio
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
| | - Chenchan Huang
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
| | - Angela Tong
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
| | | | - Els Fieremans
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
| | - Dmitry S. Novikov
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine
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11
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Xu P, Meersmann T, Wang J, Wang C. Review of oxygen-enhanced lung mri: Pulse sequences for image acquisition and T 1 measurement. Med Phys 2023; 50:5987-6007. [PMID: 37345214 DOI: 10.1002/mp.16553] [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: 08/17/2021] [Revised: 03/23/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
Oxygen-enhanced MR imaging (OE-MRI) is a special proton imaging technique that can be performed without modifying the scanner hardware. Many fundamental studies have been conducted following the initial reporting of this technique in 1996, illustrating the high potential for its clinical application. This review aims to summarise and analyse current pulse sequences and T1 measurement methods for OE-MRI, including fundamental theories, existing pulse sequences applied to OE-MRI acquisition and T1 mapping. Wash-in and wash-out time identify lung function and are sensitive to ventilation; thus, dynamic OE-MRI is also discussed in this review. We compare OE-MRI with the primary competitive technique, hyperpolarised gas MRI. Finally, an overview of lower-field applications of OE-MRI is highlighted, as relatively recent publications demonstrated positive results. Lower-field OE-MRI, which is lower than 1.5 T, could be an alternative modality for detecting lung diseases. This educational review is aimed at researchers who want a quick summary of the steps needed to perform pulmonary OE-MRI with a particular focus on sequence design, settings, and quantification methods.
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Affiliation(s)
- Pengfei Xu
- Department of Electrical and Electronic Engineering, Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, China
| | - Thomas Meersmann
- Sir Peter Mansfield Magnetic Imaging Centre, University of Nottingham, Nottingham, UK
- Nottingham Ningbo China Beacons of Excellence Research and Innovation Institute, Ningbo, China
| | - Jing Wang
- Department of Electrical and Electronic Engineering, Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, China
- Nottingham Ningbo China Beacons of Excellence Research and Innovation Institute, Ningbo, China
| | - Chengbo Wang
- Department of Electrical and Electronic Engineering, Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, China
- Nottingham Ningbo China Beacons of Excellence Research and Innovation Institute, Ningbo, China
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12
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Salameh N, Lurie DJ, Ipek Ö, Cooley CZ, Campbell-Washburn AE. Exploring the foothills: benefits below 1 Tesla? MAGMA (NEW YORK, N.Y.) 2023; 36:329-333. [PMID: 37482583 DOI: 10.1007/s10334-023-01106-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Najat Salameh
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - David J Lurie
- Biomedical Physics, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Özlem Ipek
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Clarissa Zimmerman Cooley
- Department of Radiology, Massachusetts General Hospital, Athinoula A Martinos Center for Biomedical Imaging, Boston, MA, USA
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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13
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Zanette B, Greer MLC, Moraes TJ, Ratjen F, Santyr G. The argument for utilising magnetic resonance imaging as a tool for monitoring lung structure and function in pediatric patients. Expert Rev Respir Med 2023; 17:527-538. [PMID: 37491192 DOI: 10.1080/17476348.2023.2241355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Although historically challenging to perform in the lung, technological advancements have made Magnetic Resonance Imaging (MRI) increasingly applicable for pediatric pulmonary imaging. Furthermore, a wide array of functional imaging techniques has become available that may be leveraged alongside structural imaging for increasingly sensitive biomarkers, or as outcome measures in the evaluation of novel therapies. AREAS COVERED In this review, recent technical advancements and modern methodologies for structural and functional lung MRI are described. These include ultrashort echo time (UTE) MRI, free-breathing contrast agent-free, functional lung MRI, and hyperpolarized gas MRI, amongst other techniques. Specific examples of the application of these methods in children are provided, principally drawn from recent research in asthma, bronchopulmonary dysplasia, and cystic fibrosis. EXPERT OPINION Pediatric lung MRI is rapidly growing, and is well poised for clinical utilization, as well as continued research into early disease detection, disease processes, and novel treatments. Structure/function complementarity makes MRI especially attractive as a tool for increased adoption in the evaluation of pediatric lung disease. Looking toward the future, novel technologies, such as low-field MRI and artificial intelligence, mitigate some of the traditional drawbacks of lung MRI and will aid in improving access to MRI in general, potentially spurring increased adoption and demand for pulmonary MRI in children.
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Affiliation(s)
- Brandon Zanette
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Theo J Moraes
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Felix Ratjen
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Giles Santyr
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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14
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Webb A, O'Reilly T. Tackling SNR at low-field: a review of hardware approaches for point-of-care systems. MAGMA (NEW YORK, N.Y.) 2023:10.1007/s10334-023-01100-3. [PMID: 37202656 PMCID: PMC10386948 DOI: 10.1007/s10334-023-01100-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To review the major hardware components of low-field point-of-care MRI systems which affect the overall sensitivity. METHODS Designs for the following components are reviewed and analyzed: magnet, RF coils, transmit/receive switches, preamplifiers, data acquisition system, and methods for grounding and mitigating electromagnetic interference. RESULTS High homogeneity magnets can be produced in a variety of different designs including C- and H-shaped as well as Halbach arrays. Using Litz wire for RF coil designs enables unloaded Q values of ~ 400 to be reached, with body loss representing about 35% of the total system resistance. There are a number of different schemes to tackle issues arising from the low coil bandwidth with respect to the imaging bandwidth. Finally, the effects of good RF shielding, proper electrical grounding, and effective electromagnetic interference reduction can lead to substantial increases in image signal-to-noise ratio. DISCUSSION There are many different magnet and RF coil designs in the literature, and to enable meaningful comparisons and optimizations to be performed it would be very helpful to determine a standardized set of sensitivity measures, irrespective of design.
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Affiliation(s)
- Andrew Webb
- Department of Radiology, C.J. Gorter MRI Center, Leiden University Medical Center, 2333 ZA, Leiden, The Netherlands.
| | - Thomas O'Reilly
- Department of Radiology, C.J. Gorter MRI Center, Leiden University Medical Center, 2333 ZA, Leiden, The Netherlands
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15
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Lyu M, Mei L, Huang S, Liu S, Li Y, Yang K, Liu Y, Dong Y, Dong L, Wu EX. M4Raw: A multi-contrast, multi-repetition, multi-channel MRI k-space dataset for low-field MRI research. Sci Data 2023; 10:264. [PMID: 37164976 PMCID: PMC10172399 DOI: 10.1038/s41597-023-02181-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/25/2023] [Indexed: 05/12/2023] Open
Abstract
Recently, low-field magnetic resonance imaging (MRI) has gained renewed interest to promote MRI accessibility and affordability worldwide. The presented M4Raw dataset aims to facilitate methodology development and reproducible research in this field. The dataset comprises multi-channel brain k-space data collected from 183 healthy volunteers using a 0.3 Tesla whole-body MRI system, and includes T1-weighted, T2-weighted, and fluid attenuated inversion recovery (FLAIR) images with in-plane resolution of ~1.2 mm and through-plane resolution of 5 mm. Importantly, each contrast contains multiple repetitions, which can be used individually or to form multi-repetition averaged images. After excluding motion-corrupted data, the partitioned training and validation subsets contain 1024 and 240 volumes, respectively. To demonstrate the potential utility of this dataset, we trained deep learning models for image denoising and parallel imaging tasks and compared their performance with traditional reconstruction methods. This M4Raw dataset will be valuable for the development of advanced data-driven methods specifically for low-field MRI. It can also serve as a benchmark dataset for general MRI reconstruction algorithms.
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Affiliation(s)
- Mengye Lyu
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China.
| | - Lifeng Mei
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China
| | - Shoujin Huang
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China
| | - Sixing Liu
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China
| | - Yi Li
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China
| | - Kexin Yang
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China
| | - Yilong Liu
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Key Laboratory of CNS Regeneration (Ministry of Education), Jinan University, Guangzhou, China
| | - Yu Dong
- Department of Neurosurgery, Shenzhen Samii Medical Center, Shenzhen, China
| | - Linzheng Dong
- Department of Neurosurgery, Shenzhen Samii Medical Center, Shenzhen, China
| | - Ed X Wu
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong, China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, China
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16
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Gräfe D, Prenzel F, Hirsch FW. Chest magnetic resonance imaging in cystic fibrosis: technique and clinical benefits. Pediatr Radiol 2023; 53:640-648. [PMID: 36372855 PMCID: PMC10027634 DOI: 10.1007/s00247-022-05539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/31/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022]
Abstract
Cystic fibrosis (CF) is one of the most common inherited and life-shortening pulmonary diseases in the Caucasian population. With the widespread introduction of newborn screening and the development of modulator therapy, tremendous advances have been made in recent years both in diagnosis and therapy. Since paediatric CF patients tend to be younger and have lower morbidity, the type of imaging modality that should be used to monitor the disease is often debated. Computed tomography (CT) is sensitive to many pulmonary pathologies, but radiation exposure limits its use, especially in children and adolescents. Conventional pulmonary magnetic resonance imaging (MRI) is a valid alternative to CT and, in most cases, provides sufficient information to guide treatment. Given the expected widespread availability of sequences with ultra-short echo times, there will be even fewer reasons to perform CT for follow-up of patients with CF. This review aims to provide an overview of the process and results of monitoring CF with MRI, particularly for centres not specialising in the disease.
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Affiliation(s)
- Daniel Gräfe
- Department of Pediatric Radiology, Leipzig University Hospital, Liebigstraße 20a, 04103, Leipzig, Germany.
| | - Freerk Prenzel
- Department of Pediatrics, Leipzig University Hospital, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Franz Wolfgang Hirsch
- Department of Pediatric Radiology, Leipzig University Hospital, Liebigstraße 20a, 04103, Leipzig, Germany
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17
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Pavlova OS, Gulyaev MV, Gervits LL, Hurshkainen AA, Nikulin AV, Puchnin VM, Teploukhova ED, Kuropatkina TA, Anisimov NV, Medvedeva NA, Pirogov YA. Т 1 mapping of rat lungs in 19 F MRI using octafluorocyclobutane. Magn Reson Med 2023; 89:2318-2331. [PMID: 36744719 DOI: 10.1002/mrm.29606] [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: 05/24/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE To demonstrate the feasibility of using octafluorocyclobutane (OFCB, c-C4 F8 ) for T1 mapping of lungs in 19 F MRI. METHODS The study was performed at 7 T in three healthy rats and three rats with pulmonary hypertension. To increase the sensitivity of 19 F MRI, a bent-shaped RF coil with periodic metal strips structure was used. The double flip angle method was used to calculate normalized transmitting RF field (B1n + ) maps and for correcting T1 maps built with the variable flip angle (VFA) method. The ultrashort TE pulse sequence was applied for acquiring MR images throughout the study. RESULTS The dependencies of OFCB relaxation times on its partial pressure in mixtures with oxygen, air, helium, and argon were obtained. T1 of OFCB linearly depended on its partial pressure with the slope of about 0.35 ms/kPa in the case of free diffusion. RF field inhomogeneity leads to distortion of T1 maps built with the VFA method, and therefore to high standard deviation of T1 in these maps. To improve the accuracy of the T1 maps, the B1n + maps were applied for VFA correction. This contributed to a 2-3-fold decrease in the SD of T1 values in the corresponding maps compared with T1 maps calculated without the correction. Three-dimensional T1 maps were obtained, and the mean T1 in healthy rat lungs was 35 ± 10 ms, and in rat lungs with pulmonary hypertension - 41 ± 9 ms. CONCLUSION OFCB has a spin-rotational relaxation mechanism and can be used for 19 F T1 mapping of lungs. The calculated OFCB maps captured ventilation defects induced by edema.
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Affiliation(s)
- Olga S Pavlova
- Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia.,Faculty of Physics, Lomonosov Moscow State University, Moscow, Russia
| | - Mikhail V Gulyaev
- Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Lev L Gervits
- Nesmeyanov Institute of Organoelement Compounds of Russian Academy of Sciences, Moscow, Russia
| | - Anna A Hurshkainen
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | - Anton V Nikulin
- Center of Photonics and 2D Materials, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
| | - Viktor M Puchnin
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | | | | | | | | | - Yury A Pirogov
- Faculty of Physics, Lomonosov Moscow State University, Moscow, Russia
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18
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HERZ THORAX – Regionale Lungenfunktion bei Lymphangioleiomyomatose mit der MRT diagnostizieren. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/a-1855-6347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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19
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Seemann F, Javed A, Chae R, Ramasawmy R, O'Brien K, Baute S, Xue H, Lederman RJ, Campbell-Washburn AE. Imaging gravity-induced lung water redistribution with automated inline processing at 0.55 T cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2022; 24:35. [PMID: 35668497 PMCID: PMC9172183 DOI: 10.1186/s12968-022-00862-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/05/2022] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Quantitative assessment of dynamic lung water accumulation is of interest to unmask latent heart failure. We develop and validate a free-breathing 3D ultrashort echo time (UTE) sequence with automated inline image processing to image changes in lung water density (LWD) using high-performance 0.55 T cardiovascular magnetic resonance (CMR). METHODS Quantitative lung water CMR was performed on 15 healthy subjects using free-breathing 3D stack-of-spirals proton density weighted UTE at 0.55 T. Inline image reconstruction and automated image processing was performed using the Gadgetron framework. A gravity-induced redistribution of LWD was provoked by sequentially acquiring images in the supine, prone, and again supine position. Quantitative validation was performed in a phantom array of vials containing mixtures of water and deuterium oxide. RESULTS The phantom experiment validated the capability of the sequence in quantifying water density (bias ± SD 4.3 ± 4.8%, intraclass correlation coefficient, ICC = 0.97). The average global LWD was comparable between imaging positions (supine 24.7 ± 3.4%, prone 22.7 ± 3.1%, second supine 25.3 ± 3.6%), with small differences between imaging phases (first supine vs prone 2.0%, p < 0.001; first supine vs second supine - 0.6%, p = 0.001; prone vs second supine - 2.7%, p < 0.001). In vivo test-retest repeatability in LWD was excellent (- 0.17 ± 0.91%, ICC = 0.97). A regional LWD redistribution was observed in all subjects when repositioning, with a predominant posterior LWD accumulation when supine, and anterior accumulation when prone (difference in anterior-posterior LWD: supine - 11.6 ± 2.7%, prone 5.5 ± 2.7%, second supine - 11.4 ± 2.9%). Global LWD maps were calculated inline within 23.2 ± 0.3 s following the image reconstruction using the automated pipeline. CONCLUSIONS Redistribution of LWD due to gravitational forces can be depicted and quantified using a validated free-breathing 3D proton density weighted UTE sequence and inline automated image processing pipeline on a high-performance 0.55 T CMR system.
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Affiliation(s)
- Felicia Seemann
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Ahsan Javed
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Rachel Chae
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Kendall O'Brien
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Scott Baute
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Hui Xue
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
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20
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Ciet P, Bertolo S, Ros M, Casciaro R, Cipolli M, Colagrande S, Costa S, Galici V, Gramegna A, Lanza C, Lucca F, Macconi L, Majo F, Paciaroni A, Parisi GF, Rizzo F, Salamone I, Santangelo T, Scudeller L, Saba L, Tomà P, Morana G. State-of-the-art review of lung imaging in cystic fibrosis with recommendations for pulmonologists and radiologists from the "iMAging managEment of cySTic fibROsis" (MAESTRO) consortium. Eur Respir Rev 2022; 31:31/163/210173. [PMID: 35321929 DOI: 10.1183/16000617.0173-2021] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/20/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Imaging represents an important noninvasive means to assess cystic fibrosis (CF) lung disease, which remains the main cause of morbidity and mortality in CF patients. While the development of new imaging techniques has revolutionised clinical practice, advances have posed diagnostic and monitoring challenges. The authors aim to summarise these challenges and make evidence-based recommendations regarding imaging assessment for both clinicians and radiologists. STUDY DESIGN A committee of 21 experts in CF from the 10 largest specialist centres in Italy was convened, including a radiologist and a pulmonologist from each centre, with the overall aim of developing clear and actionable recommendations for lung imaging in CF. An a priori threshold of at least 80% of the votes was required for acceptance of each statement of recommendation. RESULTS After a systematic review of the relevant literature, the committee convened to evaluate 167 articles. Following five RAND conferences, consensus statements were developed by an executive subcommittee. The entire consensus committee voted and approved 28 main statements. CONCLUSIONS There is a need for international guidelines regarding the appropriate timing and selection of imaging modality for patients with CF lung disease; timing and selection depends upon the clinical scenario, the patient's age, lung function and type of treatment. Despite its ubiquity, the use of the chest radiograph remains controversial. Both computed tomography and magnetic resonance imaging should be routinely used to monitor CF lung disease. Future studies should focus on imaging protocol harmonisation both for computed tomography and for magnetic resonance imaging. The introduction of artificial intelligence imaging analysis may further revolutionise clinical practice by providing fast and reliable quantitative outcomes to assess disease status. To date, there is no evidence supporting the use of lung ultrasound to monitor CF lung disease.
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Affiliation(s)
- Pierluigi Ciet
- Radiology and Nuclear Medicine Dept, Erasmus MC, Rotterdam, The Netherlands .,Pediatric Pulmonology and Allergology Dept, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.,Depts of Radiology and Medical Science, University of Cagliari, Cagliari, Italy
| | - Silvia Bertolo
- Radiology Dept, Ca'Foncello S. Maria Hospital, Treviso, Italy
| | - Mirco Ros
- Dept of Pediatrics, Ca'Foncello S. Maria Hospital, Treviso, Italy
| | - Rosaria Casciaro
- Dept of Pediatrics, IRCCS Institute "Giannina Gaslini", Cystic Fibrosis Centre, Genoa, Italy
| | - Marco Cipolli
- Regional Reference Cystic Fibrosis center, University hospital of Verona, Verona, Italy
| | - Stefano Colagrande
- Dept of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence- Careggi Hospital, Florence, Italy
| | - Stefano Costa
- Dept of Pediatrics, Gaetano Martino Hospital, Messina, Italy
| | - Valeria Galici
- Cystic Fibrosis Centre, Dept of Paediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Andrea Gramegna
- Respiratory Disease and Adult Cystic Fibrosis Centre, Internal Medicine Dept, IRCCS Ca' Granda, Milan, Italy.,Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Cecilia Lanza
- Radiology Dept, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Francesca Lucca
- Regional Reference Cystic Fibrosis center, University hospital of Verona, Verona, Italy
| | - Letizia Macconi
- Radiology Dept, Tuscany Reference Cystic Fibrosis Centre, Meyer Children's Hospital, Florence, Italy
| | - Fabio Majo
- Dept of Pediatrics, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Giuseppe Fabio Parisi
- Pediatric Pulmonology Unit, Dept of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Francesca Rizzo
- Radiology Dept, IRCCS Institute "Giannina Gaslini", Cystic Fibrosis Center, Genoa, Italy
| | | | - Teresa Santangelo
- Dept of Radiology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Luigia Scudeller
- Clinical Epidemiology, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Luca Saba
- Depts of Radiology and Medical Science, University of Cagliari, Cagliari, Italy
| | - Paolo Tomà
- Dept of Radiology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Morana
- Radiology Dept, Ca'Foncello S. Maria Hospital, Treviso, Italy
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21
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Bhattacharya I, Ramasawmy R, Javed A, Lowery M, Henry J, Mancini C, Machado T, Jones A, Julien-Williams P, Lederman RJ, Balaban RS, Chen MY, Moss J, Campbell-Washburn AE. Assessment of Lung Structure and Regional Function Using 0.55 T MRI in Patients With Lymphangioleiomyomatosis. Invest Radiol 2022; 57:178-186. [PMID: 34652290 PMCID: PMC9926400 DOI: 10.1097/rli.0000000000000832] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Contemporary lower-field magnetic resonance imaging (MRI) may offer advantages for lung imaging by virtue of the improved field homogeneity. The aim of this study was to evaluate the utility of lower-field MRI for combined morphologic imaging and regional lung function assessment. We evaluate low-field MRI in patients with lymphangioleiomyomatosis (LAM), a rare lung disease associated with parenchymal cysts and respiratory failure. MATERIALS AND METHODS We performed lung imaging on a prototype low-field (0.55 T) MRI system in 65 patients with LAM. T2-weighted imaging was used for assessment of lung morphology and to derive cyst scores, the percent of lung parenchyma occupied by cysts. Regional lung function was assessed using oxygen-enhanced MRI with breath-held ultrashort echo time imaging and inhaled 100% oxygen as a T1-shortening MR contrast agent. Measurements of percent signal enhancement from oxygen inhalation and percentage of lung with low oxygen enhancement, indicating functional deficits, were correlated with global pulmonary function test measurements taken within 2 days. RESULTS We were able to image cystic abnormalities using T2-weighted MRI in this patient population and calculate cyst score with strong correlation to computed tomography measurements (R = 0.86, P < 0.0001). Oxygen-enhancement maps demonstrated regional deficits in lung function of patients with LAM. Heterogeneity of oxygen enhancement between cysts was observed within individual patients. The percent low-enhancement regions showed modest, but significant, correlation with FEV1 (R = -0.37, P = 0.007), FEV1/FVC (R = -0.33, P = 0.02), and cyst score (R = 0.40, P = 0.02). The measured arterial blood ΔT1 between normoxia and hyperoxia, used as a surrogate for dissolved oxygen in blood, correlated with DLCO (R = -0.28, P = 0.03). CONCLUSIONS Using high-performance 0.55 T MRI, we were able to perform simultaneous imaging of pulmonary structure and regional function in patients with LAM.
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Affiliation(s)
- Ipshita Bhattacharya
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Ahsan Javed
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Margaret Lowery
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Jennifer Henry
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Christine Mancini
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Tania Machado
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Amanda Jones
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Patricia Julien-Williams
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Robert S Balaban
- Systems Biology Center, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Marcus Y Chen
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Joel Moss
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
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22
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Landini N, Ciet P, Janssens HM, Bertolo S, Ros M, Mattone M, Catalano C, Majo F, Costa S, Gramegna A, Lucca F, Parisi GF, Saba L, Tiddens HAWM, Morana G. Management of respiratory tract exacerbations in people with cystic fibrosis: Focus on imaging. Front Pediatr 2022; 10:1084313. [PMID: 36814432 PMCID: PMC9940849 DOI: 10.3389/fped.2022.1084313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/28/2022] [Indexed: 02/09/2023] Open
Abstract
Respiratory tract exacerbations play a crucial role in progressive lung damage of people with cystic fibrosis, representing a major determinant in the loss of functional lung tissue, quality of life and patient survival. Detection and monitoring of respiratory tract exacerbations are challenging for clinicians, since under- and over-treatment convey several risks for the patient. Although various diagnostic and monitoring tools are available, their implementation is hampered by the current definition of respiratory tract exacerbation, which lacks objective "cut-offs" for clinical and lung function parameters. In particular, the latter shows a large variability, making the current 10% change in spirometry outcomes an unreliable threshold to detect exacerbation. Moreover, spirometry cannot be reliably performed in preschool children and new emerging tools, such as the forced oscillation technique, are still complementary and need more validation. Therefore, lung imaging is a key in providing respiratory tract exacerbation-related structural and functional information. However, imaging encompasses several diagnostic options, each with different advantages and limitations; for instance, conventional chest radiography, the most used radiological technique, may lack sensitivity and specificity in respiratory tract exacerbations diagnosis. Other methods, including computed tomography, positron emission tomography and magnetic resonance imaging, are limited by either radiation safety issues or the need for anesthesia in uncooperative patients. Finally, lung ultrasound has been proposed as a safe bedside option but it is highly operator-dependent and there is no strong evidence of its possible use during respiratory tract exacerbation. This review summarizes the clinical challenges of respiratory tract exacerbations in patients with cystic fibrosis with a special focus on imaging. Firstly, the definition of respiratory tract exacerbation is examined, while diagnostic and monitoring tools are briefly described to set the scene. This is followed by advantages and disadvantages of each imaging technique, concluding with a diagnostic imaging algorithm for disease monitoring during respiratory tract exacerbation in the cystic fibrosis patient.
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Affiliation(s)
- Nicholas Landini
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I Hospital, "Sapienza" Rome University, Rome, Italy
| | - Pierluigi Ciet
- Department of Radiology and Nuclear Medicine, Erasmus MC - Sophia, Rotterdam, Netherlands.,Department of Radiology, University Cagliari, Cagliari, Italy.,Department of Pediatrics, division of Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Hettie M Janssens
- Department of Pediatrics, division of Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Silvia Bertolo
- Department of Radiology, S. Maria Ca'Foncello Regional Hospital, Treviso, Italy
| | - Mirco Ros
- Department of Pediatrics, Ca'Foncello S. Maria Hospital, Treviso, Italy
| | - Monica Mattone
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I Hospital, "Sapienza" Rome University, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I Hospital, "Sapienza" Rome University, Rome, Italy
| | - Fabio Majo
- Pediatric Pulmonology & Cystic Fibrosis Unit Bambino Gesú Children's Hospital, IRCCS Rome, Rome, Italy
| | - Stefano Costa
- Department of Pediatrics, Gaetano Martino Hospital, Messina, Italy
| | - Andrea Gramegna
- Department of Pathophisiology and Transplantation, University of Milan, Milan, Italy.,Respiratory Disease and Adult Cystic Fibrosis Centre, Internal Medicine Department, IRCCS Ca' Granda, Milan, Italy
| | - Francesca Lucca
- Regional Reference Cystic Fibrosis Center, University Hospital of Verona, Verona, Italy
| | - Giuseppe Fabio Parisi
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Luca Saba
- Department of Radiology, University Cagliari, Cagliari, Italy
| | - Harm A W M Tiddens
- Department of Radiology and Nuclear Medicine, Erasmus MC - Sophia, Rotterdam, Netherlands.,Department of Pediatrics, division of Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Giovanni Morana
- Department of Radiology, S. Maria Ca'Foncello Regional Hospital, Treviso, Italy
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23
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Weinreb JC. Low-Cost Low-Field MRI Has Arrived: What Does It Mean for Radiology? J Am Coll Radiol 2021; 19:71-72. [PMID: 34736909 DOI: 10.1016/j.jacr.2021.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Jeffrey C Weinreb
- Department of Diagnostic Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.
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