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Peña-Trujillo V, Gallo-Bernal S, Kirsch J, Victoria T, Gee MS. 3 Tesla Fetal MR Imaging Quality and Safety Considerations. Magn Reson Imaging Clin N Am 2024; 32:385-394. [PMID: 38944429 DOI: 10.1016/j.mric.2024.02.007] [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: 07/01/2024]
Abstract
Medical imaging, particularly fetal MR imaging, has undergone a transformative shift with the introduction of 3 Tesla (3T) clinical MR imaging systems. The utilization of higher static magnetic fields in these systems has resulted in remarkable advancements, including superior soft tissue contrast, improved spatial and temporal resolution, and reduced image acquisition time. Despite these notable benefits, safety concerns have emerged, stemming from the elevated static magnetic field strength, amplified acoustic noise, and increased radiofrequency power deposition. This article provides an overview of fetal MR imaging at 3T, its benefits and drawbacks, and the potential safety issues.
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Affiliation(s)
- Valeria Peña-Trujillo
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Strret, Boston, MA 02114, USA; Department of Radiology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Pediatric Imaging Research Center (PIRC), Massachusetts General Hospital, 55 Fruit Strret, Boston, MA 02114, USA
| | - Sebastian Gallo-Bernal
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Strret, Boston, MA 02114, USA; Department of Radiology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Pediatric Imaging Research Center (PIRC), Massachusetts General Hospital, 55 Fruit Strret, Boston, MA 02114, USA; Department of Medicine, NYC Health + Hospitals/Queens, Icahn School of Medicine at Mount Sinai, 79-01 Broadway, Queens, NY 11373, USA
| | - John Kirsch
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Strret, Boston, MA 02114, USA; Department of Radiology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th, Chartlestown, MA 02129, USA
| | - Teresa Victoria
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Strret, Boston, MA 02114, USA; Department of Radiology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Pediatric Imaging Research Center (PIRC), Massachusetts General Hospital, 55 Fruit Strret, Boston, MA 02114, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Strret, Boston, MA 02114, USA; Department of Radiology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Pediatric Imaging Research Center (PIRC), Massachusetts General Hospital, 55 Fruit Strret, Boston, MA 02114, USA.
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George E, Jaimes C, Xu D, Kasprian G, Glenn OA. How to Perform Fetal MR Imaging. Magn Reson Imaging Clin N Am 2024; 32:443-457. [PMID: 38944433 DOI: 10.1016/j.mric.2024.02.008] [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: 07/01/2024]
Abstract
This article provides the readers with practical guidance on how to perform fetal MR imaging, including technical considerations such as scanner field strength and use of appropriate radiofrequency receive coils, and summarizes the role, strengths, and limitations of the various MR imaging sequences. The authors review the various factors to consider in scan preparation, including study indication, timing, maternal preparation, and the creation of an institutional fetal imaging protocol. Additional factors that go into scan optimization during acquisition including prioritizing maternal comfort and ways to troubleshoot various artifacts that maybe encountered in fetal imaging are discussed.
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Affiliation(s)
- Elizabeth George
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Camilo Jaimes
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, University of California, 1700 4th Street BH303B, San Francisco, CA 94143, USA
| | - Gregor Kasprian
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, Medical University of Vienna, Währinger Gürtel 18-21, Vienna 1090, Austria
| | - Orit A Glenn
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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Ellison J, Kim K, Li Y, Mu X, Glenn O, Ozhinsky E, Peyvandi S, Xu D. Estimate of fetal brain temperature using proton resonance frequency thermometry during 3 Tesla fetal magnetic resonance imaging. Quant Imaging Med Surg 2023; 13:7987-7995. [PMID: 38106288 PMCID: PMC10722078 DOI: 10.21037/qims-23-708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/28/2023] [Indexed: 12/19/2023]
Abstract
Background T2-weighted Single Shot Fast Spin Echo (SSFSE) scans at 3 Tesla (3T) are increasingly used to image fetal pathology due to their excellent tissue contrast resolution and signal-to-noise ratio (SNR). Temperature changes that may occur in response to radio frequency (RF) pulses used for these sequences at 3T have not been studied in human fetal brains. To evaluate the safety of T2-weighted SSFSE for fetal brains at 3T, magnetic resonance (MR) thermometry was used to measure relative temperature changes in a typical clinical fetal brain MR exam. Methods Relative temperature was estimated using sets of gradient recalled echo (GRE) images acquired before and after T2-weighted SSFSE images which lasted 27.47±8.19 minutes. Thirty-one fetuses with cardiac abnormalities, and 20 healthy controls were included in this study. Fetal brain temperature was estimated by proton resonance frequency (PRF) thermometry and compared to the estimated temperature in the gluteal muscle of the mother. Seven scans with excessive motion were excluded. Local outlier factor (LOF) was performed to remove 12 additional scans with spurious phase measurements due to motion degradation and potential field drift. Linear regression was performed to determine if temperature changes are dependent on the rate of energy deposition during the scan. Results For the 32 participants used in the analysis, 17 with cardiac abnormalities and 15 healthy controls, the average relative fetal temperate change was 0.19±0.73 ℃ higher than the mother, with no correlation between relative temperature change and the rate of images acquired during the scans (regression coefficient =-0.05, R-squared =0.05, P=0.22, F-statistic =1.60). The difference in the relative temperature changes between the fetal brain and mother's gluteal tissue in the healthy controls was on average 0.08 ℃ lower and found not to be statistically different (P=0.76) to the group with cardiac abnormalities. Conclusions Our results indicate that the estimated relative temperature changes of the fetal brain compared to the mother's gluteal tissue from RF pulses during the course of the T2-weighted SSFSE fetal MR exam are minimal. The differences in acquired phase between these regions through the exam were found not to be statistically different. These findings support that fetal brain imaging at 3T is within FDA limits and safe.
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Affiliation(s)
- Jacob Ellison
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
- UCSF/UC Berkeley Joint Graduate Group in Bioengineering, University of California San Francisco, San Francisco, CA, USA
| | - Kisoo Kim
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Yi Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Xin Mu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Orit Glenn
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Eugene Ozhinsky
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Shabnam Peyvandi
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
- UCSF/UC Berkeley Joint Graduate Group in Bioengineering, University of California San Francisco, San Francisco, CA, USA
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Maralani PJ, Pai V, Ertl-Wagner BB. Safety of Magnetic Resonance Imaging in Pregnancy. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:34-40. [PMID: 37747489 DOI: 10.1007/s00117-023-01207-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
Magnetic resonance imaging is being increasingly used to diagnose and follow up a variety of medical conditions in pregnancy, both for maternal and fetal indications. However, limited data regarding its safe use in pregnancy may be a source of anxiety and avoidance for both patients and their healthcare providers. In this review, we critically discuss the main safety concerns of Magnetic Resonance Imaging (MRI) in pregnancy including energy deposition, acoustic noise, and use of contrast agents, supported by data from animal and human studies. Use of maternal sedatives and concerns related to occupational exposure in pregnant personnel are also addressed. Exposure to gadolinium-based contrast agents and sedation for MRI during pregnancy should be avoided whenever feasible.
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Affiliation(s)
- Pejman Jabehdar Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Bayview Avenue, Room AG270C, 2075, Toronto, Ontario, Canada.
| | - Vivek Pai
- Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - Birgit B Ertl-Wagner
- Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
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Didier RA, Estroff JA. Fetal MRI: Counterpoint-3 T Is Truly Terrific If You Try! AJR Am J Roentgenol 2023; 221:584-585. [PMID: 37255037 DOI: 10.2214/ajr.23.29564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Ryne A Didier
- Maternal Fetal Care Center, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Judy A Estroff
- Maternal Fetal Care Center, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
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Manganaro L, Capuani S, Gennarini M, Miceli V, Ninkova R, Balba I, Galea N, Cupertino A, Maiuro A, Ercolani G, Catalano C. Fetal MRI: what's new? A short review. Eur Radiol Exp 2023; 7:41. [PMID: 37558926 PMCID: PMC10412514 DOI: 10.1186/s41747-023-00358-5] [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: 01/22/2023] [Accepted: 05/22/2023] [Indexed: 08/11/2023] Open
Abstract
Fetal magnetic resonance imaging (fetal MRI) is usually performed as a second-level examination following routine ultrasound examination, generally exploiting morphological and diffusion MRI sequences. The objective of this review is to describe the novelties and new applications of fetal MRI, focusing on three main aspects: the new sequences with their applications, the transition from 1.5-T to 3-T magnetic field, and the new applications of artificial intelligence software. This review was carried out by consulting the MEDLINE references (PubMed) and including only peer-reviewed articles written in English. Among the most important novelties in fetal MRI, we find the intravoxel incoherent motion model which allow to discriminate the diffusion from the perfusion component in fetal and placenta tissues. The transition from 1.5-T to 3-T magnetic field allowed for higher quality images, thanks to the higher signal-to-noise ratio with a trade-off of more frequent artifacts. The application of motion-correction software makes it possible to overcome movement artifacts by obtaining higher quality images and to generate three-dimensional images useful in preoperative planning.Relevance statementThis review shows the latest developments offered by fetal MRI focusing on new sequences, transition from 1.5-T to 3-T magnetic field and the emerging role of AI software that are paving the way for new diagnostic strategies.Key points• Fetal magnetic resonance imaging (MRI) is a second-line imaging after ultrasound.• Diffusion-weighted imaging and intravoxel incoherent motion sequences provide quantitative biomarkers on fetal microstructure and perfusion.• 3-T MRI improves the detection of cerebral malformations.• 3-T MRI is useful for both body and nervous system indications.• Automatic MRI motion tracking overcomes fetal movement artifacts and improve fetal imaging.
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Affiliation(s)
- Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy.
| | - Silvia Capuani
- National Research Council (CNR),, Institute for Complex Systems (ISC) c/o Physics Department Sapienza University of Rome, Rome, Italy
| | - Marco Gennarini
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Valentina Miceli
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Roberta Ninkova
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Angelica Cupertino
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessandra Maiuro
- National Research Council (CNR),, Institute for Complex Systems (ISC) c/o Physics Department Sapienza University of Rome, Rome, Italy
| | - Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
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Chandrasekhar P, Rangasami R, Andrew C, Paarthipan N. Establishing and Comparing the Normal apparent Diffusion Coefficient Values of Fetal Organs and Placenta Using 1.5 Tesla and 3.0 T MRI at Various Gestational Age. Ethiop J Health Sci 2023; 33:621-630. [PMID: 38784210 PMCID: PMC11111180 DOI: 10.4314/ejhs.v33i4.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 05/25/2024] Open
Abstract
Background Diffusion-weighted imaging (DWI) is the random Brownian motion of water molecules within a tissue voxel. The apparent diffusion coefficient (ADC) is a quantitative parameter calculated from the DWI that directly reflects the mobility of water molecules in biological tissues. The objective of this study was to establish and compare the normal reference ADC values of fetal organs and the placenta using 1.5 T and 3.0 T MRI at various gestational ages. Methods This was a retrospective and prospective observational study. This study included one hundred and three (103) singleton pregnancies for each magnetic field strength. Diffusion-weighted imaging was performed using single-shot spin-echo-planar imaging (EPI) in the axial plane of the fetal head-trunk with a slice thickness of 4mm and diffusion gradient values of b = 0 and b = 700-800 s/mm2. Results The mean ADC values of cerebral WM areas were significantly higher than the deep grey areas in the brain. The white-matter regions, lung, and placenta showed a positive and significant correlation with increasing gestational age in both field strengths. A statistically weak negative correlation was observed between increasing gestational age and ADC measurements obtained in the thalamus, cerebellum, pons, and kidney. Conclusion This study gives the reference values for both 1.5T and 3T MRI of vital organs. The current study shows that diffusion-weighted MRI can offer a promising technique to evaluate the structural development of fetal organs and can potentially act as a biomarker for predicting the functionality of the fetal organs in abnormalities.
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Affiliation(s)
- Priyanka Chandrasekhar
- Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai-600116, India
| | - Rajeswaran Rangasami
- Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai-600116, India
| | - Chitra Andrew
- Department of Fetal Medicine,Sri Ramachandra Institute of Higher Education and Research, Chennai-600116, India
| | - N Paarthipan
- Department of Radiology, Saveetha Medical College and Hospital,Chennai-602105, India
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Sepulveda W, Sepulveda F, Ranzini AC. Role of Fetal Magnetic Resonance Imaging in Differentiating Isolated Septal Agenesis from Septo-Optic Dysplasia: Case Study and Review. Fetal Diagn Ther 2023; 50:165-174. [PMID: 37015213 DOI: 10.1159/000530468] [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: 02/21/2023] [Accepted: 03/27/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION The detection of absent septi pellucidi (ASP) during obstetric ultrasound is a rare event. However, the clinical implications of this finding are significant. ASP can be associated with severe central nervous system anomalies such as holoprosencephaly, agenesis/dysgenesis of the corpus callosum, schizencephaly, severe ventriculomegaly, and open neural tube defects. In such cases, the prognosis is poor. When no such anomalies are identified, isolated ASP usually carries a good prognosis. However, some fetuses thought to have isolated ASP actually have septo-optic dysplasia (SOD), which is associated with optic nerve hypoplasia, hypothalamic-pituitary dysfunction, and developmental delay. CASE PRESENTATION A case in which fetal 3.0 Tesla magnetic resonance imaging (MRI) was considered crucial to definitively diagnose isolated ASP is presented. A review of the literature was conducted and analyzed to determine the role of MRI in the evaluation of fetuses with ASP, with special consideration on the differential diagnosis between isolated ASP and SOD. CONCLUSION Differentiating isolated ASP from SOD is imperative for adequate prenatal counseling. Unfortunately, making a prenatal diagnosis of SOD requires visualization and evaluation of the fetal optic nerves, chiasm, and pituitary gland, which is very demanding and not always possible using ultrasound. Fetal MRI has the potential of obtaining high-quality images of the fetal brain, and therefore this technique can be used for establishing the differential diagnosis in utero.
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Affiliation(s)
- Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Francisco Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
- Department of Neuroradiology, Institute of Neurosurgery "Dr. Alfonso Asenjo", National Health Service, Santiago, Chile
- Department of Radiology, Clinica Alemana, Santiago, Chile
| | - Angela C Ranzini
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, Ohio, USA
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Xie L, Xu H, He X, Fu H, Zhang L, Bai W, Li X, Bao L, Xu H, Li X, Guo Y. The potential of 1.5 T magnetic resonance imaging for the evaluation of fetal anomalies of the great vessels. Front Pediatr 2023; 11:1136892. [PMID: 37056942 PMCID: PMC10086421 DOI: 10.3389/fped.2023.1136892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/13/2023] [Indexed: 04/15/2023] Open
Abstract
Purpose To determine the efficacy of 1.5 T magnetic resonance imaging (MRI) for the diagnosis of anomalies of the fetal great arteries with comparison to fetal ultrasound, and to compare image quality between 1.5 T and 3.0 T MRI in fetal imaging of the great arteries. Methods We compared the results of postnatal exam or surgery and evaluated the application value of prenatal 1.5 T MRI in the assessment of fetal great-vessel anomalies. To further determine the diagnostic potential of 1.5 T MRI, 23 pregnant women with suspected fetal cardiovascular abnormalities who had undergone ultrasound and 3.0 T MRI were enrolled and compared, respectively. Results Prenatal MRI was superior to ultrasound in demonstrating aortic arch and branch abnormalities (sensitivity, 92.86% vs. 83.33%; specificity, 66.67% vs. 20%). The mean quality ratings for fetal MRI at 1.5 T was higher than 3.0 T (P < 0.001). Other than the fast scan speed afforded by 3.0 T MRI, the signal noise ratio (SNR) of 1.5 T MRI were higher than those of 3.0 T MRI; however, the difference in contrast to noise ratio (CNR) between the two imaging modalities was not statistically significant. Conclusions 1.5 T MRI can achieve an overall assessment of fetal great-vessel anomalies, especially aortic arch and branch abnormalities. Therefore, 1.5 T MRI can be considered a supplementary imaging modality for the prenatal assessment of extracardiac great vessels malformations.
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Affiliation(s)
- Linjun Xie
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hong Xu
- Department of Ultrasound, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xuelian He
- Laboratory of Nervous System Injuries and Diseases, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children at Sichuan University, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hang Fu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lu Zhang
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wei Bai
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xuesheng Li
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Li Bao
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Huayan Xu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaohong Li
- National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University; Sichuan Birth Defects Clinical Research Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Correspondence: Yingkun Guo Xiaohong Li
| | - Yingkun Guo
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- Correspondence: Yingkun Guo Xiaohong Li
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Xu J, Moyer D, Grant PE, Golland P, Iglesias JE, Adalsteinsson E. SVoRT: Iterative Transformer for Slice-to-Volume Registration in Fetal Brain MRI. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2022; 13436:3-13. [PMID: 37103480 PMCID: PMC10129054 DOI: 10.1007/978-3-031-16446-0_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Volumetric reconstruction of fetal brains from multiple stacks of MR slices, acquired in the presence of almost unpredictable and often severe subject motion, is a challenging task that is highly sensitive to the initialization of slice-to-volume transformations. We propose a novel slice-to-volume registration method using Transformers trained on synthetically transformed data, which model multiple stacks of MR slices as a sequence. With the attention mechanism, our model automatically detects the relevance between slices and predicts the transformation of one slice using information from other slices. We also estimate the underlying 3D volume to assist slice-to-volume registration and update the volume and transformations alternately to improve accuracy. Results on synthetic data show that our method achieves lower registration error and better reconstruction quality compared with existing state-of-the-art methods. Experiments with real-world MRI data are also performed to demonstrate the ability of the proposed model to improve the quality of 3D reconstruction under severe fetal motion.
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Affiliation(s)
- Junshen Xu
- Department of Electrical Engineering and Computer Science, MIT, Cambridge, MA, USA
| | - Daniel Moyer
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, USA
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Polina Golland
- Department of Electrical Engineering and Computer Science, MIT, Cambridge, MA, USA
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, USA
| | - Juan Eugenio Iglesias
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, UK
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Elfar Adalsteinsson
- Department of Electrical Engineering and Computer Science, MIT, Cambridge, MA, USA
- Institute for Medical Engineering and Science, MIT, Cambridge, MA, USA
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Powers AM, White C, Neuberger I, Maloney JA, Stence NV, Mirsky D. Fetal MRI Neuroradiology: Indications. Clin Perinatol 2022; 49:573-586. [PMID: 36113923 DOI: 10.1016/j.clp.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fetal MRI is a safe, noninvasive examination of the fetus and placenta, a complement to ultrasonography. MRI provides detailed CNS evaluation, including depicting parenchymal architecture and posterior fossa morphology, and is key in prenatal assessment of spinal dysraphism, neck masses, and ventriculomegaly. Fetal MRI is typically performed after 22 weeks gestation, and ultrafast T1 and T2-weighted MRI sequences are the core of the exam, with advanced sequences such as diffusion weighted imaging used for specific questions. The fetal brain grows and develops rapidly, and familiarity with gestational age specific norms is essential to MRI interpretation.
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Affiliation(s)
- Andria M Powers
- Children's Hospital and Medical Center, University of Nebraska Medical Center, 8200 Dodge Street, Omaha, NE 68114, USA.
| | - Christina White
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
| | - Ilana Neuberger
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
| | - John A Maloney
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
| | - Nicholas V Stence
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
| | - David Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Box 125, Aurora, CO, 80045, USA
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Guimaraes CVA, Dahmoush HM. Fetal Brain Anatomy. Neuroimaging Clin N Am 2022; 32:663-681. [PMID: 35843668 DOI: 10.1016/j.nic.2022.04.009] [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: 11/19/2022]
Abstract
"Fetal brain development has been well studied, allowing for an ample knowledge of the normal changes that occur during gestation. Imaging modalities used to evaluate the fetal central nervous system (CNS) include ultrasound and MRI. MRI is the most accurate imaging modality for parenchymal evaluation and depiction of developmental CNS anomalies. The depiction of CNS abnormalities in a fetus can only be accurately made when there is an understanding of its normal development. This article reviews the expected normal fetal brain anatomy and development during gestation. Additional anatomic structures seen on brain imaging sequences are also reviewed."
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Affiliation(s)
- Carolina V A Guimaraes
- Division Chief of Pediatric Radiology, Department of Radiology, University of North Carolina, School of Medicine, 2006 Old Clinic Building, CB# 7510, Chapel Hill, NC 27599-7510, USA.
| | - Hisham M Dahmoush
- Department of Radiology, Stanford School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94304, USA
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Bourgioti C, Zafeiropoulou K, Tzavara C, Daskalakis G, Fotopoulos S, Theodora M, Nikolaidou ME, Konidari M, Gourtsoyianni S, Panourgias E, Koutoulidis V, Martzoukos EA, Konstantinidou AE, Moulopoulos LA. Comparison between 1.5-T and 3.0-T MRI for the diagnosis of placenta accreta spectrum disorders. Diagn Interv Imaging 2022; 103:408-417. [PMID: 35568666 DOI: 10.1016/j.diii.2022.04.005] [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: 01/19/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Accurate antenatal diagnosis of placenta accreta spectrum (PAS) is important for optimal management. The purpose of this study was to compare the respective capabilities of 1.5-T and 3.0-T MRI in the diagnosis of PAS. MATERIALS AND METHODS Between March 2016-March 2021, 190 pregnant women at high risk for PAS underwent dedicated prenatal MRI with either 1.5-T or 3.0-T units at a tertiary imaging center. Cesarian section and MRI were performed less than 6 weeks from each other. Prospectively collected data were evaluated by two experienced genitourinary radiologists for presence and extent of PAS. A comparative study was designed to investigate differences in predictive ability between 1.5-T and 3.0-T MRI groups. Sensitivity, specificity, accuracy, negative and positive prognostic values relative to intraoperative/histological findings, were computed for both groups and were compared with chi-square (χ 2) test. Interobserver agreement was estimated using Kappa test. RESULTS One hundred-eighty-two gravid women were included in the study; of these, 91/182 (50%) women were evaluated with 1.5-T (mean age, 35 ± 5.1 [SD] years; mean gestational age: 32.5 weeks) and 91/182 (50%) with 3.0-T MRI (mean age, 34.9 ± 4.9 [SD] years; mean gestational age, 32.1 weeks). 1.5-T MRI yielded 95.7% sensitivity (95% CI: 87.8-99.1) and 81.8% specificity (95% CI: 59.8) and 3.0-T MRI 93.8% sensitivity (95% CI: 86.0-97.9) and 83.3% specificity (95% CI: 48.2-97.7) for PAS identification, with no differences between the two groups (P = 0.725 and P >0.999, respectively). MRI showed excellent predictive ability for detecting extrauterine placental spread with 100% sensitivity (95% CI: 89.4-100.0), 96.7% specificity (95% CI: 88.1-99.6) for 1.5-T and 97% sensitivity (95% CI: 84.2-99.9), 96.7% specificity (95% CI: 88.1-99.6) for 3.0-T without differences between the two groups (P > 0.999). Interobserver agreement was excellent for both groups. The most frequently detected MRI signs of PAS for both 1.5-T and 3.0-T groups were placental heterogeneity (n = 85, 93.5% vs. n = 90, 98.9%; P = 0.413), and intraplacental fetal vessels (n = 64, 70.3% vs. n = 65, 71.4%; P = 0.870). CONCLUSION This study suggests that 3.0-T MRI and 1.5-T MRI are equivalent for the diagnosis of PAS.
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Affiliation(s)
- Charis Bourgioti
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece.
| | - Konstantina Zafeiropoulou
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
| | - Chara Tzavara
- Department of Health, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - George Daskalakis
- Department of Fetal and Maternal Medicine, First Department of Gynaecology and Obstetrics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Stavros Fotopoulos
- Department of Gynaecology and Obstetrics, IASO Maternity Hospital, Athens 15123, Greece
| | - Marianna Theodora
- Department of Fetal and Maternal Medicine, First Department of Gynaecology and Obstetrics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | | | - Marianna Konidari
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
| | - Sofia Gourtsoyianni
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
| | - Evangelia Panourgias
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
| | - Vassilis Koutoulidis
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
| | | | | | - Lia Angela Moulopoulos
- First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
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14
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Stout JN, Bedoya MA, Grant PE, Estroff JA. Fetal Neuroimaging Updates. Magn Reson Imaging Clin N Am 2021; 29:557-581. [PMID: 34717845 PMCID: PMC8562558 DOI: 10.1016/j.mric.2021.06.007] [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: 11/29/2022]
Abstract
MR imaging is used in conjunction with ultrasound screening for fetal brain abnormalities because it offers better contrast, higher resolution, and has multiplanar capabilities that increase the accuracy and confidence of diagnosis. Fetal motion still severely limits the MR imaging sequences that can be acquired. We outline the current acquisition strategies for fetal brain MR imaging and discuss the near term advances that will improve its reliability. Prospective and retrospective motion correction aim to make the complement of MR neuroimaging modalities available for fetal diagnosis, improve the performance of existing modalities, and open new horizons to understanding in utero brain development.
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Affiliation(s)
- Jeffrey N Stout
- Fetal and Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - M Alejandra Bedoya
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - P Ellen Grant
- Fetal and Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Judy A Estroff
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Maternal Fetal Care Center, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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15
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Papaioannou G, Klein W, Cassart M, Garel C. Indications for magnetic resonance imaging of the fetal central nervous system: recommendations from the European Society of Paediatric Radiology Fetal Task Force. Pediatr Radiol 2021; 51:2105-2114. [PMID: 34137935 DOI: 10.1007/s00247-021-05104-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/25/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022]
Abstract
Fetal central nervous system MRI is a well-established method to complement a high-quality fetal ultrasound and to clarify sonographically detected abnormalities in complex pregnancies. However, there is still worldwide heterogeneity and confusion regarding the indications of fetal central nervous system MRI, which has roots in differences among countries regarding the performance of ultrasound examinations and legislation on pregnancy termination. The purpose of this article is to clarify the indications for fetal central nervous system MRI by focusing on the ultrasound findings that guide further investigation with MRI and highlight the strengths and the weaknesses of each modality on imaging the fetal central nervous system.
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Affiliation(s)
- Georgia Papaioannou
- Department of Pediatric Radiology, Mitera Maternity and Children's Hospital, 6 Erythrou Stavrou str, Maroussi, 15123, Athens, Greece.
| | - Willemijn Klein
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud Medical Center, Nijmegen, Netherlands
| | - Marie Cassart
- Department of Radiology and Fetal Medicine, Iris South Hospitals, Brussels, Belgium
| | - Catherine Garel
- Department of Radiology, Armand-Trousseau Hospital, Paris, France
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16
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Andescavage N, Limperopoulos C. Emerging placental biomarkers of health and disease through advanced magnetic resonance imaging (MRI). Exp Neurol 2021; 347:113868. [PMID: 34562472 DOI: 10.1016/j.expneurol.2021.113868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 12/12/2022]
Abstract
Placental dysfunction is a major cause of fetal demise, fetal growth restriction, and preterm birth, as well as significant maternal morbidity and mortality. Infant survivors of placental dysfunction are at elevatedrisk for lifelong neuropsychiatric morbidity. However, despite the significant consequences of placental disease, there are no clinical tools to directly and non-invasively assess and measure placental function in pregnancy. In this work, we will review advanced MRI techniques applied to the study of the in vivo human placenta in order to better detail placental structure, architecture, and function. We will discuss the potential of these measures to serve as optimal biomarkers of placental dysfunction and review the evidence of these tools in the discrimination of health and disease in pregnancy. Efforts to advance our understanding of in vivo placental development are necessary if we are to optimize healthy pregnancy outcomes and prevent brain injury in successive generations. Current management of many high-risk pregnancies cannot address placental maldevelopment or injury, given the standard tools available to clinicians. Once accurate biomarkers of placental development and function are constructed, the subsequent steps will be to introduce maternal and fetal therapeutics targeting at optimizing placental function. Applying these biomarkers in future studies will allow for real-time assessments of safety and efficacy of novel interventions aimed at improving maternal-fetal well-being.
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Affiliation(s)
- Nickie Andescavage
- Developing Brain Institute, Department of Radiology, Children's National, Washington DC, USA; Department of Neonatology, Children's National, Washington DC, USA
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17
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Yetisir F, Abaci Turk E, Guerin B, Gagoski BA, Grant PE, Adalsteinsson E, Wald LL. Safety and imaging performance of two-channel RF shimming for fetal MRI at 3T. Magn Reson Med 2021; 86:2810-2821. [PMID: 34240759 DOI: 10.1002/mrm.28895] [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: 04/23/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE This study investigates whether two-channel radiofrequency (RF) shimming can improve imaging without increasing specific absorption rate (SAR) for fetal MRI at 3T. METHODS Transmit field ( B 1 + ) average and variation in the fetus was simulated in seven numerical pregnant body models. Safety was quantified by maternal and fetal peak local SAR and fetal average SAR. The shim parameter space was divided into improved B 1 + (magnitude and homogeneity) and improved SAR regions, and an overlap where RF shimming improved both classes of metrics compared with birdcage mode was assessed. Additionally, the effect of fetal position, tissue detail, and dielectric properties on transmit field and SAR was studied. RESULTS A region of subject-specific RF shim parameter space improving both B 1 + and SAR metrics was found for five of the seven models. Optimizing only B 1 + metrics improved B 1 + efficiency across models by 15% on average and 28% for the best-case model. B 1 + variation improved by 26% on average and 49% for the best case. However, for these shim settings, fetal SAR increased by up to 106%. The overlap region, where both B 1 + and SAR metrics improve, showed an average B 1 + efficiency improvement of 6% on average across models and 19% for the best-case model. B 1 + variation improved by 13% on average and 40% for the best case. RFS could also decrease maternal/fetal SAR by up to 49%/58%. CONCLUSION RF shimming can improve imaging compared with birdcage mode without increasing fetal and maternal SAR when a patient-specific SAR model is incorporated into the shimming procedure.
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Affiliation(s)
- Filiz Yetisir
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Esra Abaci Turk
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Bastien Guerin
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Borjan A Gagoski
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Elfar Adalsteinsson
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Lawrence L Wald
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, USA
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18
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Zhao JJ, Lu Y, Cui JY, Ma LQ, Zhang RP, Xu Z. Characteristics of symptomatic plaque on high-resolution magnetic resonance imaging and its relationship with the occurrence and recurrence of ischemic stroke. Neurol Sci 2021; 42:3605-3613. [PMID: 34236554 DOI: 10.1007/s10072-021-05457-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Atherosclerosis is the most common cause of ischemia stroke. Computed tomographic angiography (CTA) and digital subtraction angiography (DSA) are used to evaluate the degree of lumen stenosis. However, these examinations are invasive and can only reveal mild to moderate stenosis. High-resolution magnetic resonance imaging (HRMRI) seems a more intuitive way to show the pathological changes of vascular wall. Hence, we conducted a systematic retrospective study to determine the characteristics of symptomatic plaques in patients with intracranial atherosclerosis on HRMRI and their association with the occurrence and recurrence of ischemic stroke events. METHODS The PubMed database was searched for relevant studies reported from January 31, 2010, to October 31, 2020. RESULTS We selected 14 clinical outcome studies. We found that plaque enhancement and positive remodeling on HRMRI indicate symptomatic plaques. Besides, intraplaque hemorrhage and positive remodeling index are closely related to the occurrence of stroke. However, it is still controversial whether the initial enhancement of plaque and the occurrence and recurrence of stroke are related. There is also no significant correlation between vascular stenosis and symptomatic plaque or the occurrence and recurrence of ischemic stroke. CONCLUSION High-resolution magnetic resonance imaging can be used as an assessment tool to predict the risk of stroke onset and recurrence in patients with atherosclerosis, but further research is also needed.
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Affiliation(s)
- Jie-Ji Zhao
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu Province, China
| | - Yue Lu
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu Province, China
| | - Jun-Yi Cui
- Department of Neurology, The People's Hospital of Suzhou New District, No. 95, Huashan Road, Suzhou, Jiangsu Province, China
| | - Lin-Qing Ma
- Department of Neurology, The People's Hospital of Suzhou New District, No. 95, Huashan Road, Suzhou, Jiangsu Province, China.
| | - Run-Ping Zhang
- Department of Neurology, The People's Hospital of Suzhou New District, No. 95, Huashan Road, Suzhou, Jiangsu Province, China.
| | - Zhuan Xu
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu Province, China.
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19
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Ginosar Y, Bromberg Z, Nachmanson N, Ariel I, Skarzinski G, Hagai L, Elchalal U, Shapiro J, Abramovitch R. Chronic hypoxia in pregnant mice impairs the placental and fetal vascular response to acute hypercapnia in BOLD-MRI hemodynamic response imaging. Placenta 2021; 110:29-38. [PMID: 34116499 DOI: 10.1016/j.placenta.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 04/29/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Brief hypercapnic challenge causes acute placental hypoperfusion with fetal brain sparing on BOLD-MRI. We hypothesize that this non-invasive imaging strategy can distinguish between normal pregnancy and chronic placental hypoperfusion (using the maternal hypoxia model). METHODS Eighteen pregnant female ICR mice were randomized to three groups: normoxia, late-onset hypoxia (12%O2;E13.5-17.5) and early-onset hypoxia (12%O2;E10.5-17.5). On E17.5, animals were imaged in a 4.7-T Bruker-Biospec MRI scanner. Fast coronal True-FISP was performed to identify organs of interest (placenta and fetal heart, liver and brain). BOLD-MRI was performed at baseline and during a 4-min hypercapnic challenge (5%CO2). %-change in placental and fetal signal was analyzed from T2*-weighted gradient echo MR images. Following MRI, fetuses and placentas were harvested, weighed and immuno-stained. RESULTS In normoxic mice, hypercapnia caused reduction in BOLD-MRI signal in placenta (-44% ± 7%; p < 0.0001), fetal liver (-32% ± 7%; p < 0.0001) and fetal heart (-54% ± 12%; p < 0.002), with relative fetal brain sparing (-12% ± 5%; p < 0.0001). These changes were markedly attenuated in both hypoxia groups. Baseline fetal brain/placenta SI ratio was highest in normoxic mice (1.14 ± 0.017) and reduced with increasing duration of hypoxia (late-onset hypoxia: 1.00 ± 0.026; early-onset hypoxia: 0.91 ± 0.016; p = 0.02). Both hypoxic groups exhibited fetal growth restriction with prominent placental glycogen-containing cells, particularly in early-onset hypoxia. There was increased fetal neuro- and intestinal-apoptosis in early-onset hypoxia only. CONCLUSIONS BOLD-MRI with brief hypercapnic challenge distinguished between normoxia and both hypoxia groups, while fetal neuroapoptosis was only observed after early-onset hypoxia. This suggests that BOLD-MRI with hypercapnic challenge can identify chronic fetal asphyxia before the onset of irreversible brain injury.
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Affiliation(s)
- Yehuda Ginosar
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel; Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA; The Wohl Institute for Translational Medicine, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel.
| | - Zohar Bromberg
- The Goldyne Savad Institute of Gene Therapy and MRI Laboratory, Human Biology Research Center, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel; The Wohl Institute for Translational Medicine, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Nathalie Nachmanson
- The Goldyne Savad Institute of Gene Therapy and MRI Laboratory, Human Biology Research Center, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel; The Wohl Institute for Translational Medicine, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Ilana Ariel
- Perinatal Pathology Unit, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Galina Skarzinski
- Perinatal Pathology Unit, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Lital Hagai
- Medical Student, Hebrew University-Hadassah Medical School, Ein Karem, Jerusalem, Israel
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Joel Shapiro
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Rinat Abramovitch
- The Goldyne Savad Institute of Gene Therapy and MRI Laboratory, Human Biology Research Center, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel; The Wohl Institute for Translational Medicine, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel
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20
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Jabehdar Maralani P, Kapadia A, Liu G, Moretti F, Ghandehari H, Clarke SE, Wiebe S, Garel J, Ertl-Wagner B, Hurrell C, Schieda N. Canadian Association of Radiologists Recommendations for the Safe Use of MRI During Pregnancy. Can Assoc Radiol J 2021; 73:56-67. [PMID: 34000852 DOI: 10.1177/08465371211015657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The use of magnetic resonance imaging (MRI) during pregnancy is associated with concerns among patients and health professionals with regards to fetal safety. In this work, the Canadian Association of Radiologists (CAR) Working Group on MRI in Pregnancy presents recommendations for the use of MRI in pregnancy, derived from literature review as well as expert panel opinions and discussions. The working group, which consists of academic subspecialty radiologists and obstetrician-gynaecologists, aimed to provide updated, evidence-based recommendations addressing safety domains related to energy deposition, acoustic noise, and gadolinium-based contrast agent use based on magnetic field strength (1.5T and 3T) and trimester scanned, in addition to the effects of sedative use and occupational exposure.
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Affiliation(s)
| | - Anish Kapadia
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Grace Liu
- Department of Obstetrics and Gynecology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Felipe Moretti
- Department of Obstetrics and Gynecology, 12365University of Ottawa, Ottawa, Ontario, Canada
| | - Hournaz Ghandehari
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Clarke
- Department of Diagnostic Radiology, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheldon Wiebe
- Department of Medical Imaging, 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juliette Garel
- Département de radiologie, radio-oncologie et médecine nucléaire, Université de Montréal, Montréal, Québec, Canada
| | - Birgit Ertl-Wagner
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Casey Hurrell
- Research and Policy Development - Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Radiology, 12365University of Ottawa, Ottawa, Ontario, Canada
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21
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Story L, Knight CL, Ho A, Arulkumaran S, Matthews J, Lovell H, McCabe L, Byrne M, Egloff A, Jacques AET, Carmichael J, Hajnal J, Shennan A, Rutherford M. Maternal and fetal incidental findings on antenatal magnetic resonance imaging. Pediatr Radiol 2021; 51:1839-1847. [PMID: 34046707 PMCID: PMC8426300 DOI: 10.1007/s00247-021-05074-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/09/2020] [Accepted: 03/28/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) examinations are increasingly used in antenatal clinical practice. Incidental findings are a recognized association with imaging and although in some circumstances their identification can alter management, they are often associated with increased anxiety, for both patient and clinician, as well as increased health care costs. OBJECTIVE This study aimed to evaluate the incidence of unexpected findings in both the mother and fetus during antenatal MRI examinations. MATERIALS AND METHODS A retrospective study was undertaken over a five-year period at St.. Thomas' Hospital in London. Maternal incidental findings were recorded from all clinical reports of all fetal MRIs performed (for clinical reasons and in healthy volunteers) during this period. Fetal incidental findings were recorded only in cases where women with uncomplicated pregnancies were participating as healthy volunteers. RESULTS A total of 2,569 MRIs were included; 17% of women had maternal incidental findings. Of these, 1,099 were women with uncomplicated pregnancies who undertook research MRIs as healthy volunteers; fetal incidental findings were identified in 12.3%. CONCLUSION Incidental findings are a common occurrence in antenatal MRI. Consideration should be given to counseling women appropriately before imaging and ensuring that robust local protocols are in place for follow-up and further management of such cases.
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Affiliation(s)
- Lisa Story
- Department of Women and Children's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, SE1 7EH, UK. .,Fetal Medicine Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
| | - Caroline L. Knight
- Department of Women and Children’s Health, King’s College London, 10th Floor North Wing, St. Thomas’ Hospital, London, SE1 7EH UK ,Fetal Medicine Unit, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Alison Ho
- Department of Women and Children’s Health, King’s College London, 10th Floor North Wing, St. Thomas’ Hospital, London, SE1 7EH UK
| | | | | | - Holly Lovell
- Department of Women and Children’s Health, King’s College London, 10th Floor North Wing, St. Thomas’ Hospital, London, SE1 7EH UK
| | - Laura McCabe
- Centre for the Developing Brain, King’s College, London, London, UK
| | - Megan Byrne
- Fetal Medicine Unit, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Alexia Egloff
- Centre for the Developing Brain, King’s College, London, London, UK
| | | | - Jim Carmichael
- Department of Radiology, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Jo Hajnal
- Centre for the Developing Brain, King’s College, London, London, UK
| | - Andrew Shennan
- Department of Women and Children’s Health, King’s College London, 10th Floor North Wing, St. Thomas’ Hospital, London, SE1 7EH UK
| | - Mary Rutherford
- Centre for the Developing Brain, King’s College, London, London, UK
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22
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Barrera CA, Francavilla ML, Serai SD, Edgar JC, Jaimes C, Gee MS, Roberts TPL, Otero HJ, Adzick NS, Victoria T. Specific Absorption Rate and Specific Energy Dose: Comparison of 1.5-T versus 3.0-T Fetal MRI. Radiology 2020; 295:664-674. [PMID: 32255418 DOI: 10.1148/radiol.2020191550] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background MRI performed at 3.0 T offers greater signal-to-noise ratio and better spatial resolution than does MRI performed at 1.5 T; however, for fetal MRI, there are concerns about the potential for greater radiofrequency energy administered to the fetus at 3.0-T MRI. Purpose To compare the specific absorption rate (SAR) and specific energy dose (SED) of fetal MRI at 1.5 and 3.0 T. Materials and Methods In this retrospective study, all fetal MRI examinations performed with 1.5- and 3.0-T scanners at one institution between July 2012 and October 2016 were evaluated. Two-dimensional (2D) and three-dimensional (3D) steady-state free precession (SSFP), single-shot fast spin-echo, 2D and 3D T1-weighted spoiled gradient-echo (SPGR), and echo-planar imaging sequences were performed. SAR, SED, accumulated SED, and acquisition time were retrieved from the Digital Imaging and Communications in Medicine header. Data are presented as mean ± standard deviation. Two one-sided tests with equivalence bounds of 0.5 (Cohen d effect size) were performed, with statistical equivalence considered at P < .05. Results A total of 2952 pregnant women were evaluated. Mean maternal age was 30 years ± 6 (age range, 12-49 years), mean gestational age was 24 weeks ± 6 (range, 17-40 weeks). A total of 3247 fetal MRI scans were included, with 2784 (86%) obtained at 1.5 T and 463 (14%) obtained at 3.0 T. In total, 93 764 sequences were performed, with 81 535 (87%) performed at 1.5 T and 12 229 (13%) performed at 3.0 T. When comparing 1.5- with 3.0-T MRI sequences, mean SAR (1.09 W/kg ± 0.69 vs 1.14 W/kg ± 0.61), mean SED (33 J/kg ± 27 vs 38 J/kg ± 26), and mean accumulated SED (965 J/kg ± 408 vs 996 J/kg ± 366, P < .001) were equivalent. Conclusion Fetal 1.5- and 3.0-T MRI examinations were found to have equivalent energy metrics in most cases. The 3.0-T sequences, such as two-dimensional T1-weighted spoiled gradient-echo and three-dimensional steady-state free precession, may require modification to keep the energy delivered to the patient as low as possible. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Christian A Barrera
- From the Departments of Radiology (C.A.B., M.L.F., S.D.S., J.C.E., T.P.L.R., H.J.O., T.V.) and Surgery (N.S.A.), The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (J.C.E., T.P.L.R.); Department of Radiology, Boston Children's Hospital, Boston, Mass (C.J.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G.)
| | - Michael L Francavilla
- From the Departments of Radiology (C.A.B., M.L.F., S.D.S., J.C.E., T.P.L.R., H.J.O., T.V.) and Surgery (N.S.A.), The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (J.C.E., T.P.L.R.); Department of Radiology, Boston Children's Hospital, Boston, Mass (C.J.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G.)
| | - Suraj D Serai
- From the Departments of Radiology (C.A.B., M.L.F., S.D.S., J.C.E., T.P.L.R., H.J.O., T.V.) and Surgery (N.S.A.), The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (J.C.E., T.P.L.R.); Department of Radiology, Boston Children's Hospital, Boston, Mass (C.J.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G.)
| | - J Christopher Edgar
- From the Departments of Radiology (C.A.B., M.L.F., S.D.S., J.C.E., T.P.L.R., H.J.O., T.V.) and Surgery (N.S.A.), The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (J.C.E., T.P.L.R.); Department of Radiology, Boston Children's Hospital, Boston, Mass (C.J.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G.)
| | - Camilo Jaimes
- From the Departments of Radiology (C.A.B., M.L.F., S.D.S., J.C.E., T.P.L.R., H.J.O., T.V.) and Surgery (N.S.A.), The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (J.C.E., T.P.L.R.); Department of Radiology, Boston Children's Hospital, Boston, Mass (C.J.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G.)
| | - Michael S Gee
- From the Departments of Radiology (C.A.B., M.L.F., S.D.S., J.C.E., T.P.L.R., H.J.O., T.V.) and Surgery (N.S.A.), The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (J.C.E., T.P.L.R.); Department of Radiology, Boston Children's Hospital, Boston, Mass (C.J.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G.)
| | - Timothy P L Roberts
- From the Departments of Radiology (C.A.B., M.L.F., S.D.S., J.C.E., T.P.L.R., H.J.O., T.V.) and Surgery (N.S.A.), The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (J.C.E., T.P.L.R.); Department of Radiology, Boston Children's Hospital, Boston, Mass (C.J.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G.)
| | - Hansel J Otero
- From the Departments of Radiology (C.A.B., M.L.F., S.D.S., J.C.E., T.P.L.R., H.J.O., T.V.) and Surgery (N.S.A.), The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (J.C.E., T.P.L.R.); Department of Radiology, Boston Children's Hospital, Boston, Mass (C.J.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G.)
| | - N Scott Adzick
- From the Departments of Radiology (C.A.B., M.L.F., S.D.S., J.C.E., T.P.L.R., H.J.O., T.V.) and Surgery (N.S.A.), The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (J.C.E., T.P.L.R.); Department of Radiology, Boston Children's Hospital, Boston, Mass (C.J.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G.)
| | - Teresa Victoria
- From the Departments of Radiology (C.A.B., M.L.F., S.D.S., J.C.E., T.P.L.R., H.J.O., T.V.) and Surgery (N.S.A.), The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (J.C.E., T.P.L.R.); Department of Radiology, Boston Children's Hospital, Boston, Mass (C.J.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G.)
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23
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Abstract
OBJECTIVES To review the current imaging techniques available for the evaluation of the fetal brain. FINDINGS Ultrasound remains the initial screening modality with routine scanning typically performed at 18-20 weeks gestation. When a central nervous system (CNS) abnormality is noted by ultrasound, MRI is increasingly being used to further clarify findings. Fetal MRI has the unique ability to provide high detailed anatomical information of the entire human fetus with high contrast resolution. This technique has grown due to the development of rapid single shot image acquisition sequences, improvement of motion correction strategies and optimizing shimming techniques. CONCLUSIONS The assessment of fetal CNS anomalies continues to improve. Advanced MRI techniques have allowed for further delineation of CNS anomalies and have become a cornerstone in the assessment of fetal brain well-being. Those interpreting fetal studies need to be familiar with the strengths and limitations of each exam and be sensitive to the impact discussing findings can have regarding perinatal care and delivery planning. Collaboration with neurologists, neurosurgeons, geneticists, counselors, and maternal fetal specialists are key in providing the best care to the families we treat.
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Affiliation(s)
- Agustin M Cardenas
- Department of Radiology, Children's of Alabama University of Alabama at Birmingham
| | - Matthew T Whitehead
- Department of Radiology, Children's of Alabama University of Alabama at Birmingham
| | - Dorothy I Bulas
- Department of Radiology, Children's of Alabama University of Alabama at Birmingham; George Washington School of Medicine, Washington, DC.
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24
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van Gemert J, Brink W, Remis R, Webb A. A simulation study on the effect of optimized high permittivity materials on fetal imaging at 3T. Magn Reson Med 2019; 82:1822-1831. [PMID: 31199014 PMCID: PMC6771485 DOI: 10.1002/mrm.27849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/10/2019] [Accepted: 05/19/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE One of the main concerns in fetal MRI is the radiofrequency power that is absorbed both by the mother and the fetus. Passive shimming using high permittivity materials in the form of "dielectric pads" has previously been shown to increase the B 1 + efficiency and homogeneity in different applications, while reducing the specific absorption rate (SAR). In this work, we study the effect of optimized dielectric pads for 3 pregnant models. METHODS Pregnant models in the 3rd, 7th, and 9th months of gestation were used for simulations in a birdcage coil at 3T. Dielectric pads were optimized regions of interest (ROI) using previously developed methods for B 1 + efficiency and homogeneity and were designed for 2 ROIs: the entire fetus and the brain of the fetus. The SAR was evaluated in terms of the whole-body SAR, average SAR in the fetus and amniotic fluid, and maximum 10 g-averaged SAR in the mother, fetus, and amniotic fluid. RESULTS The optimized dielectric pads increased the transmit efficiency up to 55% and increased the B 1 + homogeneity in almost every tested configuration. The B 1 + -normalized whole-body SAR was reduced by more than 31% for all body models. The B 1 + -normalized local SAR was reduced in most scenarios by up to 62%. CONCLUSION Simulations have shown that optimized high permittivity pads can reduce SAR in pregnant subjects at the 3rd, 7th, and 9th month of gestation, while improving the transmit field homogeneity in the fetus. However, significantly more work is required to demonstrate that fetal imaging is safe under standard operating conditions.
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Affiliation(s)
- Jeroen van Gemert
- Circuits & Systems Group, Electrical Engineering, Mathematics and Computer Science Faculty, Delft University of Technology, The Netherlands
| | - Wyger Brink
- Department of Radiology, C.J. Gorter Center for High-Field MRI, Leiden University Medical Center, The Netherlands
| | - Rob Remis
- Circuits & Systems Group, Electrical Engineering, Mathematics and Computer Science Faculty, Delft University of Technology, The Netherlands
| | - Andrew Webb
- Department of Radiology, C.J. Gorter Center for High-Field MRI, Leiden University Medical Center, The Netherlands
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25
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Stammes MA, Bugby SL, Porta T, Pierzchalski K, Devling T, Otto C, Dijkstra J, Vahrmeijer AL, de Geus-Oei LF, Mieog JSD. Modalities for image- and molecular-guided cancer surgery. Br J Surg 2018; 105:e69-e83. [PMID: 29341161 DOI: 10.1002/bjs.10789] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/25/2017] [Accepted: 11/05/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Surgery is the cornerstone of treatment for many solid tumours. A wide variety of imaging modalities are available before surgery for staging, although surgeons still rely primarily on visual and haptic cues in the operating environment. Image and molecular guidance might improve the adequacy of resection through enhanced tumour definition and detection of aberrant deposits. Intraoperative modalities available for image- and molecular-guided cancer surgery are reviewed here. METHODS Intraoperative cancer detection techniques were identified through a systematic literature search, with selection of peer-reviewed publications from January 2012 to January 2017. Modalities were reviewed, described and compared according to 25 predefined characteristics. To summarize the data in a comparable way, a three-point rating scale was applied to quantitative characteristics. RESULTS The search identified ten image- and molecular-guided surgery techniques, which can be divided into four groups: conventional, optical, nuclear and endogenous reflectance modalities. Conventional techniques are the most well known imaging modalities, but unfortunately have the drawback of a defined resolution and long acquisition time. Optical imaging is a real-time modality; however, the penetration depth is limited. Nuclear modalities have excellent penetration depth, but their intraoperative use is limited by the use of radioactivity. Endogenous reflectance modalities provide high resolution, although with a narrow field of view. CONCLUSION Each modality has its strengths and weaknesses; no single technique will be suitable for all surgical procedures. Strict selection of modalities per cancer type and surgical requirements is required as well as combining techniques to find the optimal balance.
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Affiliation(s)
- M A Stammes
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands.,Percuros, Enschede, The Netherlands
| | - S L Bugby
- Space Research Centre, Department of Physics and Astronomy, University of Leicester, Leicester, UK
| | - T Porta
- Maastricht MultiModal Molecular Imaging Institute (M4I), Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, The Netherlands
| | - K Pierzchalski
- Maastricht MultiModal Molecular Imaging Institute (M4I), Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, The Netherlands
| | | | - C Otto
- Medical Cell Bio Physics, University of Twente, Enschede, The Netherlands
| | - J Dijkstra
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - A L Vahrmeijer
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - L-F de Geus-Oei
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands.,Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, The Netherlands
| | - J S D Mieog
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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26
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Chapman T, Alazraki AL, Eklund MJ. A survey of pediatric diagnostic radiologists in North America: current practices in fetal magnetic resonance imaging. Pediatr Radiol 2018; 48:1924-1935. [PMID: 30178081 DOI: 10.1007/s00247-018-4236-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/30/2018] [Accepted: 08/10/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Fetal magnetic resonance imaging (MRI) is an imaging examination in evolution. Rapid developments over recent decades have led to better image quality, an increased number of examinations and greater impact on patient care. OBJECTIVE To gather data regarding current practices among established programs in North America and provide information to radiologists interested in implementing or growing a fetal MRI service. MATERIALS AND METHODS An electronic survey containing 15 questions relevant to the use of fetal MRI was submitted to pediatric radiologists and neuroradiologists. Items regarded scheduling and reporting logistics, magnet strength, patient positioning and patient preparation. Answers and comments were collected, and descriptive statistics were summarized. RESULTS One hundred and six survey responses were evaluated. Of the survey responses, 62/106 (58.5%) allow fetal MR scheduling any time during the day and 72/105 (68.6%) exclusively use 1.5-T strength platforms for fetal MRI, while only 7/105 (6.7%) use exclusively 3 T. Patient positioning is variable: supine, 40/106 (37.8%); left lateral decubitus, 22/106 (20.8%), and, patient's choice, 43/106 (40.6%). Of the centers responding, 51/104 (49.0%) require no particular fasting instructions, while 20/104 (19.2%) request the patient avoid caffeine before the scanning. CONCLUSION Logistical trends in performing fetal MRI may supplement the American College of Radiology's published technical standards and offer guidance to radiologists new to the field.
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Affiliation(s)
- Teresa Chapman
- Department of Radiology, Seattle Children's Hospital, Mail Stop MA.07.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Adina L Alazraki
- Department of Radiology and Imaging Sciences,Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Meryle J Eklund
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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27
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da Silva NA, Vassallo J, Sarian LO, Cognard C, Sevely A. Magnetic resonance imaging of the fetal brain at 3 Tesla: Preliminary experience from a single series. Medicine (Baltimore) 2018; 97:e12602. [PMID: 30290631 PMCID: PMC6200506 DOI: 10.1097/md.0000000000012602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 09/02/2018] [Indexed: 11/30/2022] Open
Abstract
To report our preliminary experience with cerebral fetal magnetic resonance imaging (MRI) with a 3 Tesla (3T) scanner. We assessed feasibility, time of acquisition, and possibility to establish a diagnosis.Fifty-nine pregnant women had fetal MRI performed during the third trimester of pregnancy due to clinical or sonography concern of a central nervous system anomaly. No fetal or maternal sedation was used. The MRI protocol consisted of T2 turbo-spin-echo images in 3 planes of space. No T1-weighted images were performed. All images were analyzed by 2 pediatric neuroradiologists, who evaluated spatial resolution, artifacts, time of acquisition, and possibility to establish a diagnosis suspected by sonography.Examinations were performed safely for all patients. The images required longer time of acquisition (approximately 75 seconds for each plane in the space). The specific absorption rate was not exceeded in any fetus. Cerebral fetal MRI was normal in 22 cases. The spectrum of diagnostics included isolated ventriculomegaly, posterior fossa malformation, corpus callosum malformation, gyration anomalies, craniosynostosis, tuberous sclerosis, microcephaly, external hydrocephaly, midline arachnoid cyst, cerebral lesions, and persistent hyperplastic primitive vitreous.In our series, 3 T MRI of fetal brain was feasible and able to establish a diagnosis but required longer time of acquisition.
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Affiliation(s)
- Nivaldo Adolfo da Silva
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas, Campinas (UNICAMP), Campinas-SP, Brazil
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire (CHU) - Hôpital Pierre Paul Riquet, University of Toulouse, Toulouse, France
- Department of Neuroradiology, Diagnósticos da América (DASA Group), São Paulo
| | - José Vassallo
- Laboratory of Molecular and Investigative Pathology-LAPE, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas-SP, Brazil
| | - Luis Otávio Sarian
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas-SP, Brazil
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire (CHU) - Hôpital Pierre Paul Riquet, University of Toulouse, Toulouse, France
| | - Annick Sevely
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire (CHU) - Hôpital Pierre Paul Riquet, University of Toulouse, Toulouse, France
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28
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Yadav BK, Krishnamurthy U, Buch S, Jella P, Hernandez-Andrade E, Yeo L, Korzeniewski SJ, Trifan A, Hassan SS, Haacke EM, Romero R, Neelavalli J. Imaging putative foetal cerebral blood oxygenation using susceptibility weighted imaging (SWI). Eur Radiol 2018; 28:1884-1890. [PMID: 29247352 PMCID: PMC5884705 DOI: 10.1007/s00330-017-5160-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/03/2017] [Accepted: 10/27/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the magnetic susceptibility, ∆χ v , as a surrogate marker of venous blood oxygen saturation, S v O 2, in second- and third-trimester normal human foetuses. METHODS Thirty-six pregnant women, having a mean gestational age (GA) of 31 2/7 weeks, underwent magnetic resonance imaging (MRI). Susceptibility-weighted imaging (SWI) data from the foetal brain were acquired. ∆χ v of the superior sagittal sinus (SSS) was quantified using MR susceptometry from the intra-vascular phase measurements. Assuming the magnetic property of foetal blood, ∆χ do , is the same as that of adult blood, S v O 2 was derived from the measured Δχ v . The variation of ∆χ v and S v O 2, as a function of GA, was statistically evaluated. RESULTS The mean ∆χ v in the SSS in the second-trimester (n = 8) and third-trimester foetuses (n = 28) was found to be 0.34± 0.06 ppm and 0.49 ±0.05 ppm, respectively. Correspondingly, the derived S v O 2 values were 69.4% ±3.27% and 62.6% ±3.25%. Although not statistically significant, an increasing trend (p = 0.08) in Δχ v and a decreasing trend (p = 0.22) in S v O 2 with respect to advancing gestation was observed. CONCLUSION We report cerebral venous blood magnetic susceptibility and putative oxygen saturation in healthy human foetuses. Cerebral oxygen saturation in healthy human foetuses, despite a slight decreasing trend, does not change significantly with advancing gestation. KEY POINTS • Cerebral venous magnetic susceptibility and oxygenation in human foetuses can be quantified. • Cerebral venous oxygenation was not different between second- and third-trimester foetuses. • Foetal cerebral venous oxygenation does not change significantly with advancing gestation.
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Affiliation(s)
- Brijesh Kumar Yadav
- Department of Radiology, Wayne State University School of Medicine, 4201 St. Antoine, Detroit, MI, 48201, USA
- Department of Biomedical Engineering, Wayne State University College of Engineering, Detroit, MI, USA
| | - Uday Krishnamurthy
- Department of Radiology, Wayne State University School of Medicine, 4201 St. Antoine, Detroit, MI, 48201, USA
- Department of Biomedical Engineering, Wayne State University College of Engineering, Detroit, MI, USA
| | - Sagar Buch
- The MRI Institute for Biomedical Research, Waterloo, ON, Canada
| | - Pavan Jella
- Department of Radiology, Wayne State University School of Medicine, 4201 St. Antoine, Detroit, MI, 48201, USA
| | - Edgar Hernandez-Andrade
- Perinatology Research Branch, NICHD/NIH/DHHS, Hutzel Women's Hospital, 3990 John R, 4 Brush, Detroit, MI, 48201, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Hutzel Women's Hospital, 3990 John R, 4 Brush, Detroit, MI, 48201, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Steven J Korzeniewski
- Perinatology Research Branch, NICHD/NIH/DHHS, Hutzel Women's Hospital, 3990 John R, 4 Brush, Detroit, MI, 48201, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Anabela Trifan
- Department of Radiology, Wayne State University School of Medicine, 4201 St. Antoine, Detroit, MI, 48201, USA
| | - Sonia S Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Hutzel Women's Hospital, 3990 John R, 4 Brush, Detroit, MI, 48201, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - E Mark Haacke
- Department of Radiology, Wayne State University School of Medicine, 4201 St. Antoine, Detroit, MI, 48201, USA
- Department of Biomedical Engineering, Wayne State University College of Engineering, Detroit, MI, USA
- The MRI Institute for Biomedical Research, Waterloo, ON, Canada
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Hutzel Women's Hospital, 3990 John R, 4 Brush, Detroit, MI, 48201, USA.
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA.
| | - Jaladhar Neelavalli
- Department of Radiology, Wayne State University School of Medicine, 4201 St. Antoine, Detroit, MI, 48201, USA.
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29
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Robinson AJ, Ederies MA. Fetal neuroimaging: an update on technical advances and clinical findings. Pediatr Radiol 2018; 48:471-485. [PMID: 29550864 DOI: 10.1007/s00247-017-3965-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/14/2017] [Accepted: 08/09/2017] [Indexed: 10/17/2022]
Abstract
This paper is based on a literature review from 2011 to 2016. The paper is divided into two main sections. The first section relates to technical advances in fetal imaging techniques, including fetal motion compensation, imaging at 3.0 T, 3-D T2-weighted MRI, susceptibility-weighted imaging, computed tomography, morphometric analysis, diffusion tensor imaging, spectroscopy and fetal behavioral assessment. The second section relates to clinical updates, including cerebral lamination, migrational anomalies, midline anomalies, neural tube defects, posterior fossa anomalies, sulcation/gyration and hypoxic-ischemic insults.
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Affiliation(s)
- Ashley J Robinson
- Sidra Medical and Research Center, Qatar Foundation, Education City North, Al Luqta Street, Doha, 26999, Qatar. .,Clinical Radiology, Weill-Cornell Medical College, New York, NY, USA.
| | - M Ashraf Ederies
- Sidra Medical and Research Center, Qatar Foundation, Education City North, Al Luqta Street, Doha, 26999, Qatar.,Clinical Radiology, Weill-Cornell Medical College, New York, NY, USA
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30
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Priego G, Barrowman NJ, Hurteau-Miller J, Miller E. Does 3T Fetal MRI Improve Image Resolution of Normal Brain Structures between 20 and 24 Weeks' Gestational Age? AJNR Am J Neuroradiol 2017; 38:1636-1642. [PMID: 28619840 DOI: 10.3174/ajnr.a5251] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/29/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Stronger magnetic fields have the potential to improve fetal image resolution. Our objective was to detect whether there was better anatomic resolution of brain structures in fetuses imaged with a 3T magnet compared with a 1.5T magnet. MATERIALS AND METHODS Multiple cerebral and facial anatomic structures were retrospectively assessed in 28 fetal MR imaging scans with normal findings (12 at 3T and 16 at 1.5T) with a 0-3 grading score. Fetuses were assessed during the second trimesters (gestational age, 20-24 weeks). The association between the quality ratings and magnetic field strengths (1.5T versus 3T) was evaluated by a linear mixed-effects model. A quantitative assessment of the signal intensity was also performed in the different layers of the developing brain. Comparative log-ratios were calculated across the different layers of the fetal brain. RESULTS There was a statistically significant interaction between location and magnetic field strength (P < .001). The cerebral structures of the cerebellum, pons, venous system, semicircular canal, and cochlea showed statistically significant higher values on the 3T magnet. Similarly, statistical significance was also obtained on the quantitative assessment of the multilayer appearance of the brain; the 3T magnet had a median factor of 8.38 higher than the 1.5T magnet (95% CI, 4.73-14.82). Other anatomic structures assessed in the supratentorial compartment of the brain showed higher values on the 3T magnet with no statistical significance. CONCLUSIONS Both magnets depict cerebral and facial normal anatomic structures; however, our data indicates better anatomic detail on the 3T than on the 1.5T magnet.
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Affiliation(s)
- G Priego
- From the Department of Medical Imaging (G.P., J.H.-M., E.M.)
- Dr Priego is now with Department of Medical Imaging, Queen's Hospital, London, UK
| | - N J Barrowman
- Research Institute (N.J.B.), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | | | - E Miller
- From the Department of Medical Imaging (G.P., J.H.-M., E.M.)
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31
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Manganaro L, Bernardo S, Antonelli A, Vinci V, Saldari M, Catalano C. Fetal MRI of the central nervous system: State-of-the-art. Eur J Radiol 2017; 93:273-283. [PMID: 28668426 DOI: 10.1016/j.ejrad.2017.06.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 05/31/2017] [Accepted: 06/05/2017] [Indexed: 12/17/2022]
Abstract
Prenatal ultrasonographic (US) examination is considered as the first tool in the assessment of fetal abnormalities. However, several large-scale studies point out that some malformations, in particular central nervous system (CNS) anomalies, are not well characterized through US. Therefore, the actual malformation severity is not always related to prenatal ultrasound (US) findings. Over the past 20 years, ultrafast Magnetic Resonance Imaging (MRI) has progressively increased as a prenatal 3rd level diagnostic technique with a good sensitivity, particularly for the study of fetal CNS malformations. In fact, CNS anomalies are the most common clinical indications for fetal MRI, representing about 80% of the total examinations. This review covers the recent literature on fetal brain MRI, with emphasis on techniques, safety and indications.
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Affiliation(s)
- Lucia Manganaro
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Silvia Bernardo
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Amanda Antonelli
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Valeria Vinci
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Matteo Saldari
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Carlo Catalano
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
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Weisstanner C, Gruber GM, Brugger PC, Mitter C, Diogo MC, Kasprian G, Prayer D. Fetal MRI at 3T-ready for routine use? Br J Radiol 2017; 90:20160362. [PMID: 27768394 PMCID: PMC5605013 DOI: 10.1259/bjr.20160362] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Fetal MR now plays an important role in the clinical work-up of pregnant females. It is performed mainly at 1.5 T. However, the desire to obtain a more precise fetal depiction or the fact that some institutions have access only to a 3.0 T scanner has resulted in a growing interest in performing fetal MR at 3.0 T. The aim of this article was to provide a reference for the use of 3.0 T MRI as a prenatal diagnostic method.
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Affiliation(s)
- Christian Weisstanner
- 1 Division of Neuro- and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
- 2 Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Gerlinde M Gruber
- 3 Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Peter C Brugger
- 3 Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Christan Mitter
- 1 Division of Neuro- and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Mariana C Diogo
- 4 Neuroradiology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Gregor Kasprian
- 1 Division of Neuro- and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- 1 Division of Neuro- and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
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Bekiesinska-Figatowska M, Romaniuk-Doroszewska A, Duczkowska A, Duczkowski M, Iwanowska B, Szkudlińska-Pawlak S. Fetal MRI versus postnatal imaging in the MR-compatible incubator. Radiol Med 2016; 121:719-28. [PMID: 27255502 PMCID: PMC4989009 DOI: 10.1007/s11547-016-0649-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/09/2016] [Indexed: 12/28/2022]
Abstract
Introduction One of the aims of fetal magnetic resonance imaging (MRI) is to avoid postnatal scanning. However, clinicians sometimes wish to have postnatal confirmation of prenatal findings. This study’s purpose was to check whether there was indeed the added value of neonatal MRI performed in the MR-compatible incubator (INC) after fetal examination. Materials and methods Material consists of 25 neonates (14 girls) who underwent prenatal and postnatal MRI in a 1.5 T scanner, the latter in INC. Mean time of prenatal MRI was 30th gestational week, of postnatal MRI—16th day of life. Results In 14 cases (56 %) postnatal findings were the same as prenatal ones. In 11 (44 %) postnatal MRI showed some different/new/more precise results, in two the differences were attributed to other factors than the advantage of postnatal MRI over prenatal one. Altogether then postnatal results were partly discordant with prenatal ones in 9/25 cases (36 %). Conclusions In most cases there was no added value of postnatal MRI as compared to prenatal one. This value lied in small details that could not have been noticed on prenatal MRI or required contrast medium administration to be noticed. On the other hand, MR examination performed with use of the dedicated neonatal coils in the MR-compatible incubator is a safe and reliable method of visualization of these small details with better spatial resolution thus helping to establish final diagnosis, treatment plan and prognosis.
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Affiliation(s)
| | - Anna Romaniuk-Doroszewska
- Department of Diagnostic Imaging, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211, Warsaw, Poland
| | - Agnieszka Duczkowska
- Department of Diagnostic Imaging, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211, Warsaw, Poland
| | - Marek Duczkowski
- Department of Diagnostic Imaging, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211, Warsaw, Poland
| | - Beata Iwanowska
- Department of Diagnostic Imaging, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211, Warsaw, Poland
| | - Sylwia Szkudlińska-Pawlak
- Department of Diagnostic Imaging, Institute of Mother and Child, ul. Kasprzaka 17a, 01-211, Warsaw, Poland
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Cannie MM, De Keyzer F, Van Laere S, Leus A, de Mey J, Fourneau C, De Ridder F, Van Cauteren T, Willekens I, Jani JC. Potential Heating Effect in the Gravid Uterus by Using 3-T MR Imaging Protocols: Experimental Study in Miniature Pigs. Radiology 2016; 279:754-61. [DOI: 10.1148/radiol.2015151258] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mieke M Cannie
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Frederik De Keyzer
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Sigrid Van Laere
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Astrid Leus
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Johan de Mey
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Catherine Fourneau
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Filip De Ridder
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Toon Van Cauteren
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Inneke Willekens
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
| | - Jacques C Jani
- From the Departments of Radiology (M.M.C.), Fetopathology (C.F.), and Obstetrics and Gynecology (J.C.J.), University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium; Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium (F.D.K.); Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium (M.M.C., A.L., J.d.M., F.D.R., T.V.C., I.W.); and Animalarium, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.V.L.)
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35
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Magnetic resonance angiography of fetal vasculature at 3.0 T. Eur Radiol 2016; 26:4570-4576. [PMID: 27189488 DOI: 10.1007/s00330-016-4243-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/25/2015] [Accepted: 01/22/2016] [Indexed: 10/21/2022]
Abstract
Magnetic resonance angiography has not been used much previously for visualizing fetal vessels in utero for reasons that include a contraindication for the use of exogenous contrast agents, maternal respiratory motion and fetal motion. In this work, we report the feasibility of using an appropriately modified clinical time-of-flight magnetic resonance imaging sequence for non-contrast angiography of human fetal and placental vessels at 3.0 T. Using this 2D angiography technique, it is possible to visualize fetal vascular networks in late pregnancy. KEY POINTS • 3D-visualization of fetal vasculature is feasible using non-contrast MRA at 3.0 T. • Visualization of placental vasculature is also possible with this method. • Fetal MRA can serve as a vascular localizer for quantitative MRI studies. • This method can be extended to 1.5 T.
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36
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Simões RV, Sanz-Cortes M, Muñoz-Moreno E, Gratacós E, Vázquez É, Bargalló N, Fernandez-Zubillaga A. Feasibility and technical features of fetal brain magnetic resonance spectroscopy in 1.5 T scanners. Am J Obstet Gynecol 2015; 213:741-2. [PMID: 26116100 DOI: 10.1016/j.ajog.2015.06.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/07/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
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Bouyssi-Kobar M, du Plessis AJ, Robertson RL, Limperopoulos C. Fetal magnetic resonance imaging: exposure times and functional outcomes at preschool age. Pediatr Radiol 2015; 45:1823-30. [PMID: 26155983 DOI: 10.1007/s00247-015-3408-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 04/20/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Fetal magnetic resonance imaging (MRI) has been routinely used as a noninvasive diagnostic tool for more than a decade; however, there is a paucity of follow-up studies examining the effects of prenatal exposure to 1.5-T MRI on developmental outcome. OBJECTIVE The objective of this study was to assess the safety of 1.5-T fetal MRI by evaluating functional outcomes of preschool children who were exposed in utero. MATERIALS AND METHODS In the context of a prospective observational study, healthy pregnant women underwent a 1.5-T MRI study using single-shot fast spin echo (SSFSE) sequences during the second or third trimester of pregnancy. The study was approved by the institutional review board at our institution, and written informed consent was obtained from all study participants. MRI scanning times were recorded, and prenatal/postnatal clinical data were collected prospectively. Functional outcomes were assessed using the Vineland Adaptive Behavior Scale (VABS), a widely used, norm-referenced and psychometrically sound functional assessment. RESULTS We studied 72 healthy pregnant women, who underwent fetal MRI at a mean gestational age of 30.5 ± 3.1 weeks. The cohort of fetuses was composed of 43% females, and 18 fetuses were scanned during the second trimester. All fetuses were born at term with appropriate birth weights (3.54 ± 0.5 kg) for gestational age. Mean age at follow-up testing was 24.5 ± 6.7 months. All children had age-appropriate scores in the communication, daily living, socialization and motor skills subdomains of the VABS (z-scores, P > 0.05). Furthermore, all children passed their newborn otoacoustic emission test and had normal hearing at preschool age. MRI study duration and exposure time to radio frequency waves and SSFSE sequences were not associated with adverse functional outcomes or hearing impairment. CONCLUSION Prenatal exposure to 1.5-T MRI during the second or third trimester of pregnancy in a cohort of healthy fetuses is not associated with disturbances in functional outcomes or hearing impairment at preschool age.
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Affiliation(s)
- Marine Bouyssi-Kobar
- Institute for Biomedical Sciences, George Washington University, Washington, DC, USA.,Advanced Pediatric Brain Imaging Research Laboratory, Departments of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Adré J du Plessis
- Fetal and Transitional Medicine, Children's National Health System, Washington, DC, USA
| | - Richard L Robertson
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA
| | - Catherine Limperopoulos
- Advanced Pediatric Brain Imaging Research Laboratory, Departments of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA. .,Fetal and Transitional Medicine, Children's National Health System, Washington, DC, USA.
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38
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Story L, Rutherford M. Advances and applications in fetal magnetic resonance imaging. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/tog.12203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Lisa Story
- London Deanery; Darent Valley Hospital; Darenth Wood Road Dartford Kent DA2 8DA UK
| | - Mary Rutherford
- King's College London; Perinatal Imaging Unit; St Thomas's Hospital; Westminster Bridge Road London SE1 7EH UK
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Tocchio S, Kline-Fath B, Kanal E, Schmithorst VJ, Panigrahy A. MRI evaluation and safety in the developing brain. Semin Perinatol 2015; 39:73-104. [PMID: 25743582 PMCID: PMC4380813 DOI: 10.1053/j.semperi.2015.01.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Magnetic resonance imaging (MRI) evaluation of the developing brain has dramatically increased over the last decade. Faster acquisitions and the development of advanced MRI sequences, such as magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI), perfusion imaging, functional MR imaging (fMRI), and susceptibility-weighted imaging (SWI), as well as the use of higher magnetic field strengths has made MRI an invaluable tool for detailed evaluation of the developing brain. This article will provide an overview of the use and challenges associated with 1.5-T and 3-T static magnetic fields for evaluation of the developing brain. This review will also summarize the advantages, clinical challenges, and safety concerns specifically related to MRI in the fetus and newborn, including the implications of increased magnetic field strength, logistics related to transporting and monitoring of neonates during scanning, and sedation considerations, and a discussion of current technologies such as MRI conditional neonatal incubators and dedicated small-foot print neonatal intensive care unit (NICU) scanners.
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Affiliation(s)
- Shannon Tocchio
- Pediatric Imaging Research Center, Department of Radiology Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Beth Kline-Fath
- Department of Radiology Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Emanuel Kanal
- Director, Magnetic Resonance Services; Professor of Neuroradiology; Department of Radiology, University of Pittsburgh Medical Center (UPMC)
| | - Vincent J. Schmithorst
- Pediatric Imaging Research Center, Department of Radiology Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ashok Panigrahy
- Pediatric Imaging Research Center, Department of Radiology Children׳s Hospital of Pittsburgh of UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA.
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