1
|
Mazurek MH, Abruzzo AR, King AH, Koranteng E, Rigney G, Lie W, Razak S, Gupta R, Mehan WA, Lev MH, Hirsch JA, Buch K, Succi MD. Implementation of a Survey Spine MR Imaging Protocol for Cord Compression in the Emergency Department: Experience at a Level 1 Trauma Center. AJNR Am J Neuroradiol 2024:ajnr.A8326. [PMID: 38702066 DOI: 10.3174/ajnr.a8326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND PURPOSE Imaging stewardship in the emergency department (ED) is vital in ensuring patients receive optimized care. While suspected cord compression (CC) is a frequent indication for total spine MR imaging in the ED, the incidence of CC is low. Recently, our level 1 trauma center introduced a survey spine MR imaging protocol to evaluate for suspected CC while reducing examination time to avoid imaging overutilization. This study aims to evaluate the time savings, frequency of ordering patterns of the survey, and the symptoms and outcomes of patients undergoing the survey. MATERIALS AND METHODS This retrospective study examined patients who received a survey spine MR imaging in the ED at our institution between 2018 and 2022. All examinations were performed on a 1.5T GE Healthcare scanner by using our institutional CC survey protocol, which includes sagittal T2WI and STIR sequences through the cervical, thoracic, and lumbar spine. Examinations were read by a blinded, board-certified neuroradiologist. RESULTS A total of 2002 patients received a survey spine MR imaging protocol during the study period. Of these patients, 845 (42.2%, mean age 57 ± 19 years, 45% women) received survey spine MR imaging examinations for the suspicion of CC, and 120 patients (14.2% positivity rate) had radiographic CC. The survey spine MR imaging averaged 5 minutes and 50 seconds (79% faster than routine MR imaging). On multivariate analysis, trauma, back pain, lower extremity weakness, urinary or bowel incontinence, numbness, ataxia, and hyperreflexia were each independently associated with CC. Of the 120 patients with CC, 71 underwent emergent surgery, 20 underwent nonemergent surgery, and 29 were managed medically. CONCLUSIONS The survey spine protocol was positive for CC in 14% of patients in our cohort and acquired at a 79% faster rate compared with routine total spine. Understanding the positivity rate of CC, the clinical symptoms that are most associated with CC, and the subsequent care management for patients presenting with suspected cord compression who received the survey spine MR imaging may better inform the broad adoption and subsequent utilization of survey imaging protocols in emergency settings to increase throughput, improve allocation of resources, and provide efficient care for patients with suspected CC.
Collapse
Affiliation(s)
- Mercy H Mazurek
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Annie R Abruzzo
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Alexander H King
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Erica Koranteng
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Grant Rigney
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Winston Lie
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Shahaan Razak
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Rajiv Gupta
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - William A Mehan
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Michael H Lev
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Joshua A Hirsch
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Karen Buch
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Marc D Succi
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
2
|
Lang M, Clifford B, Lo WC, Applewhite BP, Tabari A, Filho ALMG, Hosseini Z, Longo MGF, Cauley SF, Setsompop K, Bilgic B, Feiweier T, Lev MH, Schaefer PW, Rapalino O, Huang SY, Conklin J. Clinical Evaluation of a 2-Minute Ultrafast Brain MR Protocol for Evaluation of Acute Pathology in the Emergency and Inpatient Settings. AJNR Am J Neuroradiol 2024; 45:379-385. [PMID: 38453413 PMCID: PMC11288578 DOI: 10.3174/ajnr.a8143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/07/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND PURPOSE The use of MR imaging in emergency settings has been limited by availability, long scan times, and sensitivity to motion. This study assessed the diagnostic performance of an ultrafast brain MR imaging protocol for evaluation of acute intracranial pathology in the emergency department and inpatient settings. MATERIALS AND METHODS Sixty-six adult patients who underwent brain MR imaging in the emergency department and inpatient settings were included in the study. All patients underwent both the reference and the ultrafast brain MR protocols. Both brain MR imaging protocols consisted of T1-weighted, T2/T2*-weighted, FLAIR, and DWI sequences. The ultrafast MR images were reconstructed by using a machine-learning assisted framework. All images were reviewed by 2 blinded neuroradiologists. RESULTS The average acquisition time was 2.1 minutes for the ultrafast brain MR protocol and 10 minutes for the reference brain MR protocol. There was 98.5% agreement on the main clinical diagnosis between the 2 protocols. In head-to-head comparison, the reference protocol was preferred in terms of image noise and geometric distortion (P < .05 for both). The ultrafast ms-EPI protocol was preferred over the reference protocol in terms of reduced motion artifacts (P < .01). Overall diagnostic quality was not significantly different between the 2 protocols (P > .05). CONCLUSIONS The ultrafast brain MR imaging protocol provides high accuracy for evaluating acute pathology while only requiring a fraction of the scan time. Although there was greater image noise and geometric distortion on the ultrafast brain MR protocol images, there was significant reduction in motion artifacts with similar overall diagnostic quality between the 2 protocols.
Collapse
Affiliation(s)
- Min Lang
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Bryan Clifford
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Wei-Ching Lo
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Brooks P Applewhite
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Azadeh Tabari
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | | | - Zahra Hosseini
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Maria Gabriela Figueiro Longo
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Stephen F Cauley
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Kawin Setsompop
- Departments of Radiology and Electrical Engineering (K.S.), Stanford University, Stanford, California
| | - Berkin Bilgic
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | - Michael H Lev
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Pamela W Schaefer
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Otto Rapalino
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Susie Y Huang
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - John Conklin
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| |
Collapse
|
3
|
Altmann S, Grauhan NF, Mercado MAA, Steinmetz S, Kronfeld A, Paul R, Benkert T, Uphaus T, Groppa S, Winter Y, Brockmann MA, Othman AE. Deep Learning Accelerated Brain Diffusion-Weighted MRI with Super Resolution Processing. Acad Radiol 2024:S1076-6332(24)00139-9. [PMID: 38521612 DOI: 10.1016/j.acra.2024.02.049] [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: 12/31/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES To investigate the clinical feasibility and image quality of accelerated brain diffusion-weighted imaging (DWI) with deep learning image reconstruction and super resolution. METHODS 85 consecutive patients with clinically indicated MRI at a 3 T scanner were prospectively included. Conventional diffusion-weighted data (c-DWI) with four averages were obtained. Reconstructions of one and two averages, as well as deep learning diffusion-weighted imaging (DL-DWI), were accomplished. Three experienced readers evaluated the acquired data using a 5-point Likert scale regarding overall image quality, overall contrast, diagnostic confidence, occurrence of artefacts and evaluation of the central region, basal ganglia, brainstem, and cerebellum. To assess interrater agreement, Fleiss' kappa (ϰ) was determined. Signal intensity (SI) levels for basal ganglia and the central region were estimated via automated segmentation, and SI values of detected pathologies were measured. RESULTS Intracranial pathologies were identified in 35 patients. DL-DWI was significantly superior for all defined parameters, independently from applied averages (p-value <0.001). Optimum image quality was achieved with DL-DWI by utilizing a single average (p-value <0.001), demonstrating very good (80.9%) to excellent image quality (14.5%) in nearly all cases, compared to 12.5% with very good and 0% with excellent image quality for c-MRI (p-value <0.001). Comparable results could be shown for diagnostic confidence. Inter-rater Fleiss' Kappa demonstrated moderate to substantial agreement for virtually all defined parameters, with good accordance, particularly for the assessment of pathologies (p = 0.74). Regarding SI values, no significant difference was found. CONCLUSION Ultra-fast diffusion-weighted imaging with super resolution is feasible, resulting in highly accelerated brain imaging while increasing diagnostic image quality.
Collapse
Affiliation(s)
- Sebastian Altmann
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany.
| | - Nils F Grauhan
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Mario Alberto Abello Mercado
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Sebastian Steinmetz
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Andrea Kronfeld
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Roman Paul
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Johannes Gutenberg University, Rhabanusstr. 3/Tower A, 55118 Mainz, Germany
| | | | - Timo Uphaus
- Department of Neurology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Yaroslav Winter
- Department of Neurology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany; Department of Neurology, Philipps-University Marburg, Baldingerstr, 35043 Marburg, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| |
Collapse
|
4
|
De Luca F, Kits A, Martin Muñoz D, Aspelin Å, Kvist O, Österman Y, Diaz Ruiz S, Skare S, Falk Delgado A. Elective one-minute full brain multi-contrast MRI versus brain CT in pediatric patients: a prospective feasibility study. BMC Med Imaging 2024; 24:23. [PMID: 38267889 PMCID: PMC10809606 DOI: 10.1186/s12880-024-01196-6] [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: 06/15/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Brain CT can be used to evaluate pediatric patients with suspicion of cerebral pathology when anesthetic and MRI resources are scarce. This study aimed to assess if pediatric patients referred for an elective brain CT could endure a diagnostic fast brain MRI without general anesthesia using a one-minute multi-contrast EPI-based sequence (EPIMix) with comparable diagnostic performance. METHODS Pediatric patients referred for an elective brain CT between March 2019 and March 2020 were prospectively included and underwent EPIMix without general anesthesia in addition to CT. Three readers (R1-3) independently evaluated EPIMix and CT images on two separate occasions. The two main study outcomes were the tolerance to undergo an EPIMix scan without general anesthesia and its performance to classify a scan as normal or abnormal. Secondary outcomes were assessment of disease category, incidental findings, diagnostic image quality, diagnostic confidence, and image artifacts. Further, a side-by-side evaluation of EPIMix and CT was performed. The signal-to-noise ratio (SNR) was calculated for EPIMix on T1-weighted, T2-weighted, and ADC images. Descriptive statistics, Fisher's exact test, and Chi-squared test were used to compare the two imaging modalities. RESULTS EPIMix was well tolerated by all included patients (n = 15) aged 5-16 (mean 11, SD 3) years old. Thirteen cases on EPIMix and twelve cases on CT were classified as normal by all readers (R1-3), while two cases on EPIMix and three cases on CT were classified as abnormal by one reader (R1), (R1-3, p = 1.00). There was no evidence of a difference in diagnostic confidence, image quality, or the presence of motion artifacts between EPIMix and CT (R1-3, p ≥ 0.10). Side-by-side evaluation (R2 + R4 + R5) reviewed all scans as lacking significant pathological findings on EPIMix and CT images. CONCLUSIONS Full brain MRI-based EPIMix sequence was well tolerated without general anesthesia with a diagnostic performance comparable to CT in elective pediatric patients. TRIAL REGISTRATION This study was approved by the Swedish Ethical Review Authority (ethical approval number/ID Ethical approval 2017/2424-31/1). This study was a clinical trial study, with study protocol published at ClinicalTrials.gov with Trial registration number NCT03847051, date of registration 18/02/2019.
Collapse
Affiliation(s)
- Francesca De Luca
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.
| | - Annika Kits
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Martin Muñoz
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Aspelin
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Kvist
- Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Yords Österman
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Diaz Ruiz
- Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- Department of Radiology, Lund University, Lund, Sweden
| | - Stefan Skare
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Falk Delgado
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
5
|
Poojar P, Qian E, Jin Z, Fung M, Maddocks AB, Geethanath S. Tailored magnetic resonance fingerprinting of post-operative pediatric brain tumor patients. Clin Imaging 2023; 102:53-59. [PMID: 37549563 DOI: 10.1016/j.clinimag.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Brain and spinal cord tumors are the second most common cancer in children and account for one out of four cancers diagnosed. However, the long acquisition times associated with acquiring both data types prohibit using quantitative MR (qMR) in pediatric imaging protocols. This study aims to demonstrate the tailored magnetic resonance fingerprinting's (TMRF) ability to simultaneously provide quantitative maps (T1, T2) and multi-contrast qualitative images (T1 weighted, T1 FLAIR, T2 weighted) rapidly in pediatric brain tumor patients. METHODS In this work, we imaged five pediatric patients with brain tumors (resected/residual) using TMRF at 3 T. We compared the TMRF-derived T2 weighted images with those from the vendor-supplied sequence (as the gold standard, GS) for healthy and pathological tissue signal intensities. The relaxometric maps from TMRF were subjected to a region of interest (ROI) analysis to differentiate between healthy and pathological tissues. We performed the Wilcoxon rank sum test to check for significant differences between the two tissue types. RESULTS We found significant differences (p < 0.05) in both T1 and T2 ROI values between the two tissue types. A strong correlation was found between the TMRF-based T2 weighted and GS signal intensities for the healthy (correlation coefficient, r = 0.99) and pathological tissues (r = 0.88). CONCLUSION The TMRF implementation provides the two relaxometric maps and can potentially save ~2 min if it replaces the T2-weighted imaging in the current protocol.
Collapse
Affiliation(s)
- Pavan Poojar
- Accessible Magnetic Resonance Laboratory, Biomedical Imaging and Engineering Institute, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Enlin Qian
- Columbia Magnetic Resonance Research Center, Columbia University, New York, NY, United States
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, NY, United States
| | - Maggie Fung
- GE Healthcare Applied Sciences Laboratory East, New York, NY, United States
| | - Alexis B Maddocks
- Columbia University Irving Medical Center, New York, NY, United States
| | - Sairam Geethanath
- Accessible Magnetic Resonance Laboratory, Biomedical Imaging and Engineering Institute, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| |
Collapse
|
6
|
Ko TS, Catennacio E, Shin SS, Stern J, Massey SL, Kilbaugh TJ, Hwang M. Advanced Neuromonitoring Modalities on the Horizon: Detection and Management of Acute Brain Injury in Children. Neurocrit Care 2023; 38:791-811. [PMID: 36949362 PMCID: PMC10241718 DOI: 10.1007/s12028-023-01690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/31/2023] [Indexed: 03/24/2023]
Abstract
Timely detection and monitoring of acute brain injury in children is essential to mitigate causes of injury and prevent secondary insults. Increasing survival in critically ill children has emphasized the importance of neuroprotective management strategies for long-term quality of life. In emergent and critical care settings, traditional neuroimaging modalities, such as computed tomography and magnetic resonance imaging (MRI), remain frontline diagnostic techniques to detect acute brain injury. Although detection of structural and anatomical abnormalities remains crucial, advanced MRI sequences assessing functional alterations in cerebral physiology provide unique diagnostic utility. Head ultrasound has emerged as a portable neuroimaging modality for point-of-care diagnosis via assessments of anatomical and perfusion abnormalities. Application of electroencephalography and near-infrared spectroscopy provides the opportunity for real-time detection and goal-directed management of neurological abnormalities at the bedside. In this review, we describe recent technological advancements in these neurodiagnostic modalities and elaborate on their current and potential utility in the detection and management of acute brain injury.
Collapse
Affiliation(s)
- Tiffany S Ko
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, USA.
| | - Eva Catennacio
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Samuel S Shin
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Joseph Stern
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA
| | - Shavonne L Massey
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Todd J Kilbaugh
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
7
|
Eisenmenger LB, Peret A, Roberts GS, Spahic A, Tang C, Kuner AD, Grayev AM, Field AS, Rowley HA, Kennedy TA. Focused Abbreviated Survey MRI Protocols for Brain and Spine Imaging. Radiographics 2023; 43:e220147. [PMID: 37167089 PMCID: PMC10262597 DOI: 10.1148/rg.220147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 05/13/2023]
Abstract
There has been extensive growth in both the technical development and the clinical applications of MRI, establishing this modality as one of the most powerful diagnostic imaging tools. However, long examination and image interpretation times still limit the application of MRI, especially in emergent clinical settings. Rapid and abbreviated MRI protocols have been developed as alternatives to standard MRI, with reduced imaging times, and in some cases limited numbers of sequences, to more efficiently answer specific clinical questions. A group of rapid MRI protocols used at the authors' institution, referred to as FAST (focused abbreviated survey techniques), are designed to include or exclude emergent or urgent conditions or screen for specific entities. These FAST protocols provide adequate diagnostic image quality with use of accelerated approaches to produce imaging studies faster than traditional methods. FAST protocols have become critical diagnostic screening tools at the authors' institution, allowing confident and efficient confirmation or exclusion of actionable findings. The techniques commonly used to reduce imaging times, the imaging protocols used at the authors' institution, and future directions in FAST imaging are reviewed to provide a practical and comprehensive overview of FAST MRI for practicing neuroradiologists. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
Collapse
Affiliation(s)
| | | | - Grant S. Roberts
- From the Departments of Radiology (L.B.E., A.P., A.D.K., A.M.G.,
A.S.F., H.A.R., T.A.K.) and Medical Physics (G.S.R., A.S., C.T.), University of
Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252
| | - Alma Spahic
- From the Departments of Radiology (L.B.E., A.P., A.D.K., A.M.G.,
A.S.F., H.A.R., T.A.K.) and Medical Physics (G.S.R., A.S., C.T.), University of
Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252
| | - Chenwei Tang
- From the Departments of Radiology (L.B.E., A.P., A.D.K., A.M.G.,
A.S.F., H.A.R., T.A.K.) and Medical Physics (G.S.R., A.S., C.T.), University of
Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252
| | - Anthony D. Kuner
- From the Departments of Radiology (L.B.E., A.P., A.D.K., A.M.G.,
A.S.F., H.A.R., T.A.K.) and Medical Physics (G.S.R., A.S., C.T.), University of
Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252
| | - Allison M. Grayev
- From the Departments of Radiology (L.B.E., A.P., A.D.K., A.M.G.,
A.S.F., H.A.R., T.A.K.) and Medical Physics (G.S.R., A.S., C.T.), University of
Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252
| | - Aaron S. Field
- From the Departments of Radiology (L.B.E., A.P., A.D.K., A.M.G.,
A.S.F., H.A.R., T.A.K.) and Medical Physics (G.S.R., A.S., C.T.), University of
Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252
| | - Howard A. Rowley
- From the Departments of Radiology (L.B.E., A.P., A.D.K., A.M.G.,
A.S.F., H.A.R., T.A.K.) and Medical Physics (G.S.R., A.S., C.T.), University of
Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252
| | - Tabassum A. Kennedy
- From the Departments of Radiology (L.B.E., A.P., A.D.K., A.M.G.,
A.S.F., H.A.R., T.A.K.) and Medical Physics (G.S.R., A.S., C.T.), University of
Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252
| |
Collapse
|
8
|
Pinter NK. The Right Imaging Protocol for the Right Patient. Continuum (Minneap Minn) 2023; 29:16-26. [PMID: 36795871 DOI: 10.1212/con.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE This article provides a high-level overview of the challenge of choosing the right imaging approach for an individual patient. It also presents a generalizable approach that can be applied to practice regardless of specific imaging technologies. ESSENTIAL POINTS This article constitutes an introduction to the in-depth, topic-focused analyses in the rest of this issue. It examines the broad principles that guide placing a patient on the right diagnostic trajectory, illustrated with real-life examples of current protocol recommendations and cases of advanced imaging techniques, as well as some thought experiments. Thinking about diagnostic imaging strictly in terms of imaging protocols is often inefficient because these protocols can be vague and have numerous variations. Broadly defined protocols may be sufficient, but their successful use often depends largely on the particular circumstances, with special emphasis on the relationship between neurologists and radiologists.
Collapse
|
9
|
Lang M, Cartmell S, Tabari A, Briggs D, Pianykh O, Kirsch J, Cauley S, Lo WC, Risacher S, Filho AG, Succi MD, Rapalino O, Schaefer P, Conklin J, Huang SY. Evaluation of the Aggregated Time Savings in Adopting Fast Brain MRI Techniques for Outpatient Brain MRI. Acad Radiol 2023; 30:341-348. [PMID: 34635436 PMCID: PMC8989721 DOI: 10.1016/j.acra.2021.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Clinical validation studies have demonstrated the ability of accelerated MRI sequences to decrease acquisition time and motion artifact while preserving image quality. The operational benefits, however, have been less explored. Here, we report our initial clinical experience in implementing fast MRI techniques for outpatient brain imaging during the COVID-19 pandemic. METHODS Aggregate acquisition times were extracted from the medical record on consecutive imaging examinations performed during matched pre-implementation (7/1/2019-12/31/2019) and post-implementation periods (7/1/2020-12/31/2020). Expected acquisition time reduction for each MRI protocol was calculated through manual collection of acquisition times for the conventional and accelerated sequences performed during the pre- and post-implementation periods. Aggregate and expected acquisition times were compared for the five most frequently performed brain MRI protocols: brain without contrast (BR-), brain with and without contrast (BR+), multiple sclerosis (MS), memory loss (MML), and epilepsy (EPL). RESULTS The expected time reductions for BR-, BR+, MS, MML, and EPL protocols were 6.6 min, 11.9 min, 14 min, 10.8 min, and 14.1 min, respectively. The overall median aggregate acquisition time was 31 [25, 36] min for the pre-implementation period and 18 [15, 22] min for the post-implementation period, with a difference of 13 min (42%). The median acquisition time was reduced by 4 min (25%) for BR-, 14.0 min (44%) for BR+, 14 min (38%) for MS, 11 min (52%) for MML, and 16 min (35%) for EPL. CONCLUSION The implementation of fast brain MRI sequences significantly reduced the acquisition times for the most commonly performed outpatient brain MRI protocols.
Collapse
Affiliation(s)
- Min Lang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
| | - Samuel Cartmell
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Daniel Briggs
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Oleg Pianykh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - John Kirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Stephen Cauley
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Wei-Ching Lo
- Siemens Medical Solutions, Boston, Massachusetts
| | - Seretha Risacher
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Augusto Goncalves Filho
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Marc D Succi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Pamela Schaefer
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Susie Y Huang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts.
| |
Collapse
|
10
|
Ahamed SH, Tang PH. Letter to the Editor. Cost-effectiveness of ultrafast brain MRI in pediatric patients. J Neurosurg 2022; 138:1168-1169. [PMID: 36461820 DOI: 10.3171/2022.10.jns222433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Phua Hwee Tang
- KK Women’s and Children’s Hospital, Singapore, Singapore
| |
Collapse
|
11
|
Yun SY, Heo YJ. Accelerated Nonenhanced 3D T1-MPRAGE Using Wave-Controlled Aliasing in Parallel Imaging for Infant Brain Imaging. AJNR Am J Neuroradiol 2022; 43:1797-1801. [PMID: 36265893 DOI: 10.3174/ajnr.a7680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/19/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE MPRAGE is the most commonly used sequence for high-resolution 3D T1-weighted imaging in pediatric patients. However, its longer scan time is a major drawback because pediatric patients are prone to motion and frequently require sedation. This study compared nonenhanced accelerated MPRAGE using wave-controlled aliasing in parallel imaging (wave-T1-MPRAGE) with standard MPRAGE in infants. MATERIALS AND METHODS We retrospectively evaluated 68 infants (mean age, 1.78 [SD. 1.70] months) who underwent nonenhanced standard and wave-T1-MPRAGE. Two neuroradiologists independently assessed each image for image quality, artifacts, myelination degree, and anatomic delineation using the 4-point Likert scale. For diagnostic performance, both observers determined whether nonenhancing lesions were present in the brain parenchyma in 2 types of nonenhanced MPRAGE sequences. RESULTS Wave-T1-MPRAGE showed a significantly lower mean score and lower interobserver agreement for overall image quality and anatomic delineation than standard MPRAGE (P< .001 for each). However, there were no significant differences between the 2 types of MPRAGE sequences for motion artifacts (P = .90 for observer 1, P = .14 for observer 2) and degree of myelination (P = .16 for observer 1, P = .32 for observer 2). Among the nonenhancing pathologic lesions observed on standard MPRAGE by both observers, only 2 were missed on wave-T1-MPRAGE, and they were very tiny, faint, nonhemorrhagic WM injuries. CONCLUSIONS Although wave-T1-MPRAGE showed lower overall image quality than standard MPRAGE, the diagnostic performance for nonenhancing parenchymal lesions was comparable. Wave-T1-MPRAGE could be an alternative for diagnosing intracranial lesions in infants, with marked scan time reduction.
Collapse
Affiliation(s)
- S Y Yun
- From the Department of Radiology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Y J Heo
- From the Department of Radiology, Inje University Busan Paik Hospital, Busan, South Korea
| |
Collapse
|
12
|
Gallo-Bernal S, Bedoya MA, Gee MS, Jaimes C. Pediatric magnetic resonance imaging: faster is better. Pediatr Radiol 2022:10.1007/s00247-022-05529-x. [PMID: 36261512 DOI: 10.1007/s00247-022-05529-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/29/2022] [Accepted: 10/03/2022] [Indexed: 10/24/2022]
Abstract
Magnetic resonance imaging (MRI) has emerged as the preferred imaging modality for evaluating a wide range of pediatric medical conditions. Nevertheless, the long acquisition times associated with this technique can limit its widespread use in young children, resulting in motion-degraded or non-diagnostic studies. As a result, sedation or general anesthesia is often necessary to obtain diagnostic images, which has implications for the safety profile of MRI, the cost of the exam and the radiology department's clinical workflow. Over the last decade, several techniques have been developed to increase the speed of MRI, including parallel imaging, single-shot acquisition, controlled aliasing techniques, compressed sensing and artificial-intelligence-based reconstructions. These are advantageous because shorter examinations decrease the need for sedation and the severity of motion artifacts, increase scanner throughput, and improve system efficiency. In this review we discuss a framework for image acceleration in children that includes the synergistic use of state-of-the-art MRI hardware and optimized pulse sequences. The discussion is framed within the context of pediatric radiology and incorporates the authors' experience in deploying these techniques in routine clinical practice.
Collapse
Affiliation(s)
- Sebastian Gallo-Bernal
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - M Alejandra Bedoya
- Department of Radiology, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., 2nd floor, Main Building, Boston, MA, 02115, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Camilo Jaimes
- Department of Radiology, Harvard Medical School, Boston, MA, USA. .,Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., 2nd floor, Main Building, Boston, MA, 02115, USA.
| |
Collapse
|
13
|
Lang M, Rapalino O, Huang S, Lev MH, Conklin J, Wald LL. Emerging Techniques and Future Directions: Fast and Portable Magnetic Resonance Imaging. Magn Reson Imaging Clin N Am 2022; 30:565-582. [PMID: 35995480 DOI: 10.1016/j.mric.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fast MRI and portable MRI are emerging as promising technologies to improve the speed, efficiency, and availability of MR imaging. Fast MRI methods are increasingly being adopted to create screening protocols for the diagnosis and management of acute pathology in the emergency department. Faster imaging can facilitate timely diagnosis, reduce motion artifacts, and improve departmental MR operations. Point-of-care and portable MRI are emerging technologies that require radiologists to reenvision the role of MRI as a tool with greater accessibility, fewer siting constraints, and the ability to provide valuable diagnostic information at the bedside. Recently introduced commercially available pulse sequences and new MRI scanners are bringing these technologies closer to the patient's clinical setting, and we expect their use to only increase over the coming decade. This article provides an overview of these emerging technologies for emergency radiologists.
Collapse
Affiliation(s)
- Min Lang
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Susie Huang
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Athinoula A. Martinos Center for Biomedical Imaging, 149 13th Street, Charleston, MA 02129, USA
| | - Michael H Lev
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Lawrence L Wald
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Athinoula A. Martinos Center for Biomedical Imaging, 149 13th Street, Charleston, MA 02129, USA
| |
Collapse
|
14
|
Af Burén S, Kits A, Lönn L, De Luca F, Sprenger T, Skare S, Falk Delgado A. A 78 Seconds Complete Brain MRI Examination in Ischemic Stroke: A Prospective Cohort Study. J Magn Reson Imaging 2022; 56:884-892. [PMID: 35170134 PMCID: PMC9544312 DOI: 10.1002/jmri.28107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Fast 78-second multicontrast echo-planar MRI (EPIMix) has shown good diagnostic performance for detecting infarctions at a comprehensive stroke center, but its diagnostic performance has not been evaluated in a prospective study at a primary stroke center. PURPOSE To prospectively determine whether EPIMix was noninferior in detecting ischemic lesions compared to routine clinical MRI. STUDY TYPE Prospective cohort study. POPULATION A total of 118 patients with acute MRI and symptoms of ischemic stroke. FIELD STRENGTH AND SEQUENCE A 3 T. EPIMix (echo-planar based: T1-FLAIR, T2-weighted, T2-FLAIR, T2*, DWI) and routine clinical MRI sequences (T1-weighted fast spin echo, T2-weighted PROPELLER, T2-weighted-FLAIR fast spin echo, T2* gradient echo echo-planar, and DWI spin echo echo-planar). ASSESSMENT Three radiologists, blinded for clinical information, assessed signs of ischemic lesions (DWI↑, ADC↓, and T2/T2-FLAIR↑) on EPIMix and routine clinical MRI, with disagreements solved in consensus with a fourth reader to establish the reference standard. STATISTICAL TESTS Diagnostic performance including sensitivity and specificity against the reference standard was evaluated. EPIMix sensitivity was tested for noninferiority compared to the reference standard using Nam's restricted maximum likelihood estimation (RMLE) Score. A P-value < 0.05 was considered statistically significant. RESULTS Of 118 patients (mean age 62 ± 16 years, 58% males), 25% (n = 30) had MRI signs of acute infarcts. EPIMix was noninferior with 97% (95% CI 83-100) sensitivity for reader 1, 100% (95% CI 88-100) sensitivity for reader 2, and 90% (95% CI 88-98) sensitivity for reader 3 vs. 93% (95% CI 78-99) sensitivity for readers 1 and 2 and 90% (95% CI 74-98) for reader 3 on routine clinical MRI. Specificity was 99% (95% CI 94-100) for reader 1, 100% (95% CI 96-100) for reader 2, and 98% (95% CI 92-100) for reader 3 on EPIMix vs. 100% (95% CI 96-100) for all readers on routine clinical MRI. CONCLUSION EPIMix was noninferior to routine clinical MRI for the diagnosis of acute ischemic stroke. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Siri Af Burén
- Department of Radiology, Capio Saint Göran Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Annika Kits
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lucas Lönn
- Department of Radiology, Capio Saint Göran Hospital, Stockholm, Sweden
| | - Francesca De Luca
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tim Sprenger
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.,MR Applied Science Laboratory Europe, GE Healthcare, Stockholm, Sweden
| | - Stefan Skare
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Falk Delgado
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
15
|
Demir S, Clifford B, Lo WC, Tabari A, Goncalves Filho ALM, Lang M, Cauley SF, Setsompop K, Bilgic B, Lev MH, Schaefer PW, Rapalino O, Huang SY, Hilbert T, Feiweier T, Conklin J. Optimization of magnetization transfer contrast for EPI FLAIR brain imaging. Magn Reson Med 2022; 87:2380-2387. [PMID: 34985151 PMCID: PMC8847235 DOI: 10.1002/mrm.29141] [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: 08/27/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate the impact of magnetization transfer (MT) on brain tissue contrast in turbo-spin-echo (TSE) and EPI fluid-attenuated inversion recovery (FLAIR) images, and to optimize an MT-prepared EPI FLAIR pulse sequence to match the tissue contrast of a clinical reference TSE FLAIR protocol. METHODS Five healthy volunteers underwent 3T brain MRI, including single slice TSE FLAIR, multi-slice TSE FLAIR, EPI FLAIR without MT-preparation, and MT-prepared EPI FLAIR with variations of the MT-preparation parameters, including number of preparation pulses, pulse amplitude, and resonance offset. Automated co-registration and gray matter (GM) versus white matter (WM) segmentation was performed using a T1-MPRAGE acquisition, and the GM versus WM signal intensity ratio (contrast ratio) was calculated for each FLAIR acquisition. RESULTS Without MT preparation, EPI FLAIR showed poor tissue contrast (contrast ratio = 0.98), as did single slice TSE FLAIR. Multi-slice TSE FLAIR provided high tissue contrast (contrast ratio = 1.14). MT-prepared EPI FLAIR closely approximated the contrast of the multi-slice TSE FLAIR images for two combinations of the MT-preparation parameters (contrast ratio = 1.14). Optimized MT-prepared EPI FLAIR provided a 50% reduction in scan time compared to the reference TSE FLAIR acquisition. CONCLUSION Optimized MT-prepared EPI FLAIR provides comparable brain tissue contrast to the multi-slice TSE FLAIR images used in clinical practice.
Collapse
Affiliation(s)
- Serdest Demir
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bryan Clifford
- Siemens Medical Solutions USA, Boston, Massachusetts, USA
| | - Wei-Ching Lo
- Siemens Medical Solutions USA, Boston, Massachusetts, USA
| | - Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Min Lang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephen F Cauley
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, USA
| | - Kawin Setsompop
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Berkin Bilgic
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael H Lev
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pamela W Schaefer
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Susie Y Huang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, USA
| | | | | | - John Conklin
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Sprenger T, Kits A, Norbeck O, van Niekerk A, Berglund J, Rydén H, Avventi E, Skare S. NeuroMix-A single-scan brain exam. Magn Reson Med 2021; 87:2178-2193. [PMID: 34904751 DOI: 10.1002/mrm.29120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE Implement a fast, motion-robust pulse sequence that acquires T1 -weighted, T2 -weighted, T2 * -weighted, T2 fluid-attenuated inversion recovery, and DWI data in one run with only one prescription and one prescan. METHODS A software framework was developed that configures and runs several sequences in one main sequence. Based on that framework, the NeuroMix sequence was implemented, containing motion robust single-shot sequences using EPI and fast spin echo (FSE) readouts (without EPI distortions). Optional multi-shot sequences that provide better contrast, higher resolution, or isotropic resolution could also be run within the NeuroMix sequence. An optimized acquisition order was implemented that minimizes times where no data is acquired. RESULTS NeuroMix is customizable and takes between 1:20 and 4 min for a full brain scan. A comparison with the predecessor EPIMix revealed significant improvements for T2 -weighted and T2 fluid-attenuated inversion recovery, while taking only 8 s longer for a similar configuration. The optional contrasts were less motion robust but offered a significant increase in quality, detail, and contrast. Initial clinical scans on 1 pediatric and 1 adult patient showed encouraging image quality. CONCLUSION The single-shot FSE readouts for T2 -weighted and T2 fluid-attenuated inversion recovery and the optional multishot FSE and 3D-EPI contrasts significantly increased diagnostic value compared with EPIMix, allowing NeuroMix to be considered as a standalone brain MRI application.
Collapse
Affiliation(s)
- Tim Sprenger
- MR Applied Science Laboratory Europe, GE Healthcare, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Annika Kits
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Norbeck
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Adam van Niekerk
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Berglund
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Henric Rydén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Enrico Avventi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Skare
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
17
|
Abstract
Several articles in the literature have demonstrated a promising role for breast MRI techniques that are more economic in total exam time than others when used as supplement to mammography for detection and diagnosis of breast cancer. There are many technical factors that must be considered in the shortened breast MRI protocols to cut down time of standard ones, including using optimal fat suppression, gadolinium-chelates intravascular contrast administrations for dynamic imaging with post processing subtractions and maximum intensity projections (MIP) high spatial and temporal resolution among others. Multiparametric breast MRI that includes both gadolinium-dependent, i.e., dynamic contrast-enhanced (DCE-MRI) and gadolinium-free techniques, i.e., diffusion-weighted/diffusion-tensor magnetic resonance imaging (DWI/DTI) are shown by several investigators that can provide extremely high sensitivity and specificity for detection of breast cancer. This article provides an overview of the proven indications for breast MRI including breast cancer screening for higher than average risk, determining chemotherapy induced tumor response, detecting residual tumor after incomplete surgical excision, detecting occult cancer in patients presenting with axillary node metastasis, detecting residual tumor after incomplete breast cancer surgical excision, detecting cancer when results of conventional imaging are equivocal, as well patients suspicious of having breast implant rupture. Despite having the highest sensitivity for breast cancer detection, there are pitfalls, however, secondary to false positive and false negative contrast enhancement and contrast-free MRI techniques. Awareness of the strengths and limitations of different approaches to obtain state of the art MR images of the breast will facilitate the work-up of patients with suspicious breast lesions.
Collapse
Affiliation(s)
- Anabel M Scaranelo
- Medical Imaging Department, 12366University of Toronto, Ontario, Canada.,Breast Imaging Division, Joint Department of Medical Imaging, University of Health Network, Sinai Health and Women's College Hospital, Toronto, Ontario, Canada
| |
Collapse
|
18
|
Wave-controlled aliasing in parallel imaging magnetization-prepared gradient echo (wave-CAIPI MPRAGE) accelerates speed for pediatric brain MRI with comparable diagnostic performance. Sci Rep 2021; 11:13296. [PMID: 34168260 PMCID: PMC8225910 DOI: 10.1038/s41598-021-92759-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/11/2021] [Indexed: 01/07/2023] Open
Abstract
We aimed to compare accelerated post-contrast magnetization-prepared rapid gradient-echo (MPRAGE) using wave-controlled aliasing in parallel imaging (wave-CAIPI) with conventional MPRAGE as a reliable method to diagnose intracranial lesions in pediatric patients. A total of 23 consecutive pediatric patients who underwent post-contrast wave-CAIPI and conventional MPRAGE (scan time: 2 min 39 s vs. 5 min 46 s) were retrospectively evaluated. Two radiologists independently assessed each image for the presence of intracranial lesions. Quantitative [contrast-to-noise ratio (CNR), contrast rate (CR), and signal-to-noise ratio (SNR)] and qualitative parameters (overall image quality, gray-white matter differentiation, demarcation of basal ganglia and sulci, and motion artifacts) were also surveyed. Wave-CAIPI MPRAGE and conventional MPRAGE detected enhancing and non-enhancing intracranial lesions with 100% agreement. Although wave-CAIPI MPRAGE had a lower SNR (all p < 0.05) and overall image quality (overall analysis, p = 0.02) compared to conventional MPRAGE, other quantitative (CNR and CR) and qualitative parameters (gray-white differentiation, demarcation of basal ganglia and sulci, and motion artifacts) were comparable in the pooled analysis and between both observers (all p > 0.05). Wave-CAIPI MPRAGE was a reliable method for diagnosing intracranial lesions in pediatric patients as conventional MPRAGE at half the scan time.
Collapse
|
19
|
Sebastian LJD, Ahuja C, Sekar S, Senthilvelan S, Kulanthaivelu K, Lanka V, Goel V, Mohapatra S, Jain C, Senthilkumaran S, Garg A, Balasundaram P, Kumar A, Kapil A, Kesavadas C, Gupta V. COVID-19: Indian Society of Neuroradiology (ISNR) Consensus Statement and Recommendations for Safe Practice of Neuroimaging and Neurointerventions. Neuroradiol J 2020; 33:353-367. [PMID: 32894991 PMCID: PMC7482040 DOI: 10.1177/1971400920946989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The ongoing COVID-19 pandemic has forced every radiology set-up to evolve and formulate guidelines for day-to-day functioning. The sub-speciality of neuroradiology, both diagnostic and neuro-intervention, forms a very important part of any radiology or 'neuro-care' set-up. The present document is a consensus statement of the Indian Society of Neuroradiology, prepared after reviewing the available data and working experience. It scientifically tries to answer many questions faced by neuroradiologists everyday in practice. It encompasses simple things such as which patients need to be imaged, what precautions are essential, the work-flows, cleaning of radiology equipment, how to carry out neuro-interventions in COVID-suspect patients, and what procedures/tests to avoid, or their alternatives, to minimise the spread of COVID infection both to the patients and health care personnel. As radiology set-ups can be large, every sub-speciality may have certain precautions which will not be covered in general guidelines, and this document tries to answer those for neuroradiologists. Carefully evolved Standards of Operating Procedure (SOPs) and guidelines are the need of the hour to guide in providing uninterrupted and adequate services to the needy without compromising the safety of the specialised work force and facilities involved.
Collapse
Affiliation(s)
| | - Chirag Ahuja
- Department of Radiology, PGIMER, Chandigarh, India
| | - Sabarish Sekar
- Department of Imaging sciences and Intervention radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
| | - Santhakumar Senthilvelan
- Department of Imaging sciences and Intervention radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
| | | | - Vivek Lanka
- Department of Neuroimaging and Interventional Radiology, NIMHANS, Bangalore, India
| | - Vinay Goel
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sarita Mohapatra
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Chirag Jain
- Department of Radiology, PGIMER, Chandigarh, India
| | - S. Senthilkumaran
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ajay Kumar
- Department of Radiology, PGIMER, Chandigarh, India
| | - Aarti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekharan Kesavadas
- Department of Imaging sciences and Intervention radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
| | | |
Collapse
|