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Wang M, Ma Y, Li L, Pan X, Wen Y, Qiu Y, Guo D, Zhu Y, Lian J, Tong D. Compressed Sensitivity Encoding Artificial Intelligence Accelerates Brain Metastasis Imaging by Optimizing Image Quality and Reducing Scan Time. AJNR Am J Neuroradiol 2024; 45:444-452. [PMID: 38485196 PMCID: PMC11288577 DOI: 10.3174/ajnr.a8161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/25/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND PURPOSE Accelerating the image acquisition speed of MR imaging without compromising the image quality is challenging. This study aimed to evaluate the feasibility of contrast-enhanced (CE) 3D T1WI and CE 3D-FLAIR sequences reconstructed with compressed sensitivity encoding artificial intelligence (CS-AI) for detecting brain metastases (BM) and explore the optimal acceleration factor (AF) for clinical BM imaging. MATERIALS AND METHODS Fifty-one patients with cancer with suspected BM were included. Fifty participants underwent different customized CE 3D-T1WI or CE 3D-FLAIR sequence scans. Compressed SENSE encoding acceleration 6 (CS6), a commercially available standard sequence, was used as the reference standard. Quantitative and qualitative methods were used to evaluate image quality. The SNR and contrast-to-noise ratio (CNR) were calculated, and qualitative evaluations were independently conducted by 2 neuroradiologists. After exploring the optimal AF, sample images were obtained from 1 patient by using both optimized sequences. RESULTS Quantitatively, the CNR of the CS-AI protocol for CE 3D-T1WI and CE 3D-FLAIR sequences was superior to that of the CS protocol under the same AF (P < .05). Compared with reference CS6, the CS-AI groups had higher CNR values (all P < .05), with the CS-AI10 scan having the highest value. The SNR of the CS-AI group was better than that of the reference for both CE 3D-T1WI and CE 3D-FLAIR sequences (all P < .05). Qualitatively, the CS-AI protocol produced higher image quality scores than did the CS protocol with the same AF (all P < .05). In contrast to the reference CS6, the CS-AI group showed good image quality scores until an AF of up to 10 (all P < .05). The CS-AI10 scan provided the optimal images, improving the delineation of normal gray-white matter boundaries and lesion areas (P < .05). Compared with the reference, CS-AI10 showed reductions in scan time of 39.25% and 39.93% for CE 3D-T1WI and CE 3D-FLAIR sequences, respectively. CONCLUSIONS CE 3D-T1WI and CE 3D-FLAIR sequences reconstructed with CS-AI for the detection of BM may provide a more effective alternative reconstruction approach than CS. CS-AI10 is suitable for clinical applications, providing optimal image quality and a shortened scan time.
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Affiliation(s)
- Mengmeng Wang
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
| | - Yue Ma
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
| | - Linna Li
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
| | - Xingchen Pan
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
| | - Yafei Wen
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
| | - Ying Qiu
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
| | - Dandan Guo
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
| | - Yi Zhu
- Philips Healthcare (Y.Z., J.L., D.T.), Beijing, China
| | - Jianxiu Lian
- Philips Healthcare (Y.Z., J.L., D.T.), Beijing, China
| | - Dan Tong
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
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Beyeler M, Rea E, Weber L, Belachew NF, Barvulsky Aleman E, Kielkopf M, Kurmann CC, Grunder L, Piechowiak EII, Meinel TR, Heldner MR, Seiffge D, Pilgram-Pastor S, Dobrocky T, Pabst T, Berger MD, Jung S, Arnold M, Gralla J, Fischer U, Kaesmacher J, Mujanovic A. Susceptibility vessel sign, a predictor of long-term outcome in patients with stroke treated with mechanical thrombectomy. J Neurointerv Surg 2023:jnis-2023-020793. [PMID: 37918910 DOI: 10.1136/jnis-2023-020793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The absence of the susceptibility vessel sign (SVS) in patients treated with mechanical thrombectomy (MT) is associated with poor radiological and clinical outcomes after 3 months. Underlying conditions, such as cancer, are assumed to influence SVS status and could potentially impact the long-term outcome. We aimed to assess SVS status as an independent predictor of long-term outcomes in MT-treated patients. METHODS SVS status was retrospectively determined in consecutive MT-treated patients at a comprehensive stroke center between 2010 and 2018. Predictors of long-term mortality and poor functional outcome (modified Rankin Scale (mRS) ≥3) up to 8 years were identified using multivariable Cox and logistic regression, respectively. RESULTS Of the 558 patients included, SVS was absent in 13% (n=71) and present in 87% (n=487) on baseline imaging. Patients without SVS were more likely to have active cancer (P=0.003) and diabetes mellitus (P<0.001) at the time of stroke. The median long-term follow-up time was 1058 days (IQR 533-1671 days). After adjustment for active cancer and diabetes mellitus, among others, the absence of SVS was associated with long-term mortality (adjusted HR (aHR) 2.11, 95% CI 1.35 to 3.29) and poor functional outcome in the long term (adjusted OR (aOR) 2.90, 95% CI 1.29 to 6.55). CONCLUSION MT-treated patients without SVS have higher long-term mortality rates and poorer long-term functional outcome. It appears that this association cannot be explained by comorbidities alone, and further studies are warranted.
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Affiliation(s)
- Morin Beyeler
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Erich Rea
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Loris Weber
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Nebiyat Filate Belachew
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Department of Neuroradiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Enrique Barvulsky Aleman
- Department of Neuroradiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Moritz Kielkopf
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Christoph C Kurmann
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Lorenz Grunder
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Eike Immo I Piechowiak
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Thomas R Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Sara Pilgram-Pastor
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Tomas Dobrocky
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Martin D Berger
- Department of Medical Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Jan Gralla
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Neurology Department, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Johannes Kaesmacher
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Adnan Mujanovic
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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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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Tabari A, Lang M, Awan K, Liu W, Clifford B, Lo WC, Splitthoff DN, Cauley S, Rapalino O, Schaefer P, Huang SY, Conklin J. Optimized flow compensation for contrast-enhanced T1-weighted Wave-CAIPI 3D MPRAGE imaging of the brain. Eur Radiol Exp 2023; 7:34. [PMID: 37394534 DOI: 10.1186/s41747-023-00351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/25/2023] [Indexed: 07/04/2023] Open
Abstract
Flow-related artifacts have been observed in highly accelerated T1-weighted contrast-enhanced wave-controlled aliasing in parallel imaging (CAIPI) magnetization-prepared rapid gradient-echo (MPRAGE) imaging and can lead to diagnostic uncertainty. We developed an optimized flow-mitigated Wave-CAIPI MPRAGE acquisition protocol to reduce these artifacts through testing in a custom-built flow phantom. In the phantom experiment, maximal flow artifact reduction was achieved with the combination of flow compensation gradients and radial reordered k-space acquisition and was included in the optimized sequence. Clinical evaluation of the optimized MPRAGE sequence was performed in 64 adult patients, who all underwent contrast-enhanced Wave-CAIPI MPRAGE imaging without flow-compensation and with optimized flow-compensation parameters. All images were evaluated for the presence of flow-related artifacts, signal-to-noise ratio (SNR), gray-white matter contrast, enhancing lesion contrast, and image sharpness on a 3-point Likert scale. In the 64 cases, the optimized flow mitigation protocol reduced flow-related artifacts in 89% and 94% of the cases for raters 1 and 2, respectively. SNR, gray-white matter contrast, enhancing lesion contrast, and image sharpness were rated as equivalent for standard and flow-mitigated Wave-CAIPI MPRAGE in all subjects. The optimized flow mitigation protocol successfully reduced the presence of flow-related artifacts in the majority of cases.Relevance statementAs accelerated MRI using novel encoding schemes become increasingly adopted in clinical practice, our work highlights the need to recognize and develop strategies to minimize the presence of unexpected artifacts and reduction in image quality as potential compromises to achieving short scan times.Key points• Flow-mitigation technique led to an 89-94% decrease in flow-related artifacts.• Image quality, signal-to-noise ratio, enhancing lesion conspicuity, and image sharpness were preserved with the flow mitigation technique.• Flow mitigation reduced diagnostic uncertainty in cases where flow-related artifacts mimicked enhancing lesions.
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Affiliation(s)
- Azadeh Tabari
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Min Lang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Komal Awan
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Wei Liu
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | | | | | | | - Stephen Cauley
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Otto Rapalino
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Pamela Schaefer
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Susie Y Huang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
- Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - John Conklin
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
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5
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Goncalves Filho ALM, Awan KM, Conklin J, Ngamsombat C, Cauley SF, Setsompop K, Liu W, Splitthoff DN, Lo WC, Kirsch JE, Schaefer PW, Rapalino O, Huang SY. Validation of a highly accelerated post-contrast wave-controlled aliasing in parallel imaging (CAIPI) 3D-T1 MPRAGE compared to standard 3D-T1 MPRAGE for detection of intracranial enhancing lesions on 3-T MRI. Eur Radiol 2023; 33:2905-2915. [PMID: 36460923 PMCID: PMC9718459 DOI: 10.1007/s00330-022-09265-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES High-resolution post-contrast T1-weighted imaging is a workhorse sequence in the evaluation of neurological disorders. The T1-MPRAGE sequence has been widely adopted for the visualization of enhancing pathology in the brain. However, this three-dimensional (3D) acquisition is lengthy and prone to motion artifact, which often compromises diagnostic quality. The goal of this study was to compare a highly accelerated wave-controlled aliasing in parallel imaging (CAIPI) post-contrast 3D T1-MPRAGE sequence (Wave-T1-MPRAGE) with the standard 3D T1-MPRAGE sequence for visualizing enhancing lesions in brain imaging at 3 T. METHODS This study included 80 patients undergoing contrast-enhanced brain MRI. The participants were scanned with a standard post-contrast T1-MPRAGE sequence (acceleration factor [R] = 2 using GRAPPA parallel imaging technique, acquisition time [TA] = 5 min 18 s) and a prototype post-contrast Wave-T1-MPRAGE sequence (R = 4, TA = 2 min 32 s). Two neuroradiologists performed a head-to-head evaluation of both sequences and rated the visualization of enhancement, sharpness, noise, motion artifacts, and overall diagnostic quality. A 15% noninferiority margin was used to test whether post-contrast Wave-T1-MPRAGE was noninferior to standard T1-MPRAGE. Inter-rater and intra-rater agreement were calculated. Quantitative assessment of CNR/SNR was performed. RESULTS Wave-T1-MPRAGE was noninferior to standard T1-MPRAGE for delineating enhancing lesions with unanimous agreement in all cases between raters. Wave-T1-MPRAGE was noninferior in the perception of noise (p < 0.001), motion artifact (p < 0.001), and overall diagnostic quality (p < 0.001). CONCLUSION High-accelerated post-contrast Wave-T1-MPRAGE enabled a two-fold reduction in acquisition time compared to the standard sequence with comparable performance for visualization of enhancing pathology and equivalent perception of noise, motion artifacts and overall diagnostic quality without loss of clinically important information. KEY POINTS • Post-contrast wave-controlled aliasing in parallel imaging (CAIPI) T1-MPRAGE accelerated the acquisition of three-dimensional (3D) high-resolution post-contrast images by more than two-fold. • Post-contrast Wave-T1-MPRAGE was noninferior to standard T1-MPRAGE with unanimous agreement between reviewers (100% in 80 cases) for the visualization of intracranial enhancing lesions. • Wave-T1-MPRAGE was equivalent to the standard sequence in the perception of noise in 94% (75 of 80) of cases and was preferred in 16% (13 of 80) of cases for decreased motion artifact.
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Affiliation(s)
- Augusto Lio M Goncalves Filho
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Komal Manzoor Awan
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Chanon Ngamsombat
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Nakhon Pathom, Thailand
| | - Stephen F Cauley
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Kawin Setsompop
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Wei Liu
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | | | | | - John E Kirsch
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Pamela W Schaefer
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Susie Y Huang
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA.
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, GRB-273A, Boston, MA, 02114, USA.
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Lee EJ, Kim MG, Chung MS, Kim SO, Byun JS, Yim Y. Diagnosis of intracranial lesions using accelerated 3D T1 MPRAGE with wave-CAIPI technique: comparison with conventional 3D T1 MPRAGE. Sci Rep 2022; 12:21930. [PMID: 36536040 PMCID: PMC9763340 DOI: 10.1038/s41598-022-25725-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
We aimed to evaluate the agreement in the diagnosis of intracranial lesions between conventional pre-contrast 3D T1 magnetization-prepared rapid gradient echo (MPRAGE) and wave-CAIPI (wave-controlled aliasing in parallel imaging) MPRAGE. Institutional review board approval was obtained and informed consent was waived for this retrospective study. We included 149 consecutive patients who had undergone brain MR with both conventional MPRAGE (scan time: 5 min 42 s) and wave-CAIPI MPRAGE (scan time: 2 min 44 s) from February to June 2018. All images were independently reviewed by two radiologists for the diagnosis of intracranial lesion and scored image quality using visual analysis. One technician measured signal-to-noise ratio. The agreement for diagnosis of intracranial lesion was calculated, and the intra- and interobserver agreements were analyzed by using kappa value. For the diagnosis of intracranial lesion, the conventional and wave-CAIPI MPRAGE demonstrated 99.7% of agreement (297 of 298) in the pooled analysis with very good agreement (k = 0.994). Intra- and inter-observer agreement showed very good (k > 0.9 in all) and good (k > 0.75) agreement, respectively. In the quantitative analysis, the signal-to-noise ratio had no difference (P > 0.05 for all). The overall image quality was poorer in images of wave-CAIPI MPRAGE (P < 0.001), but motion artifact had no difference between two sequences (P = 0.06). Compared to conventional MPRAGE, pre-contrast 3D T1 wave-CAIPI MPRAGE achieved higher agreement for the diagnosis of intracranial lesions and reduced the scan time by approximately 50%.
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Affiliation(s)
- Eun Jung Lee
- Department of Radiology, Human Medical Imaging & Intervention Center, Seoul, Korea ,grid.254224.70000 0001 0789 9563Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-Ro, Dongjak-Gu, Seoul, Republic of Korea
| | - Min Gu Kim
- grid.254224.70000 0001 0789 9563Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-Ro, Dongjak-Gu, Seoul, Republic of Korea
| | - Mi Sun Chung
- Department of Radiology, Human Medical Imaging & Intervention Center, Seoul, Korea ,grid.254224.70000 0001 0789 9563Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-Ro, Dongjak-Gu, Seoul, Republic of Korea
| | - Seon-Ok Kim
- grid.267370.70000 0004 0533 4667Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, Republic of Korea
| | - Jun Soo Byun
- Department of Radiology, Human Medical Imaging & Intervention Center, Seoul, Korea ,grid.254224.70000 0001 0789 9563Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-Ro, Dongjak-Gu, Seoul, Republic of Korea
| | - Younghee Yim
- grid.254224.70000 0001 0789 9563Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-Ro, Dongjak-Gu, Seoul, Republic of Korea
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Clinical validation of Wave-CAIPI susceptibility-weighted imaging for routine brain MRI at 1.5 T. Eur Radiol 2022; 32:7128-7135. [PMID: 35925387 DOI: 10.1007/s00330-022-08871-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 04/07/2022] [Accepted: 05/10/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Wave-CAIPI (Controlled Aliasing in Parallel Imaging) enables dramatic reduction in acquisition time of 3D MRI sequences such as 3D susceptibility-weighted imaging (SWI) but has not been clinically evaluated at 1.5 T. We sought to compare highly accelerated Wave-CAIPI SWI (Wave-SWI) with two alternative standard sequences, conventional three-dimensional SWI and two-dimensional T2*-weighted Gradient-Echo (T2*w-GRE), in patients undergoing routine brain MRI at 1.5 T. METHODS In this study, 172 patients undergoing 1.5 T brain MRI were scanned with a more commonly used susceptibility sequence (standard SWI or T2*w-GRE) and a highly accelerated Wave-SWI sequence. Two radiologists blinded to the acquisition technique scored each sequence for visualization of pathology, motion and signal dropout artifacts, image noise, visualization of normal anatomy (vessels and basal ganglia mineralization), and overall diagnostic quality. Superiority testing was performed to compare Wave-SWI to T2*w-GRE, and non-inferiority testing with 15% margin was performed to compare Wave-SWI to standard SWI. RESULTS Wave-SWI performed superior in terms of visualization of pathology, signal dropout artifacts, visualization of normal anatomy, and overall image quality when compared to T2*w-GRE (all p < 0.001). Wave-SWI was non-inferior to standard SWI for visualization of normal anatomy and pathology, signal dropout artifacts, and overall image quality (all p < 0.001). Wave-SWI was superior to standard SWI for motion artifact (p < 0.001), while both conventional susceptibility sequences were superior to Wave-SWI for image noise (p < 0.001). CONCLUSIONS Wave-SWI can be performed in a 1.5 T clinical setting with robust performance and preservation of diagnostic quality. KEY POINTS • Wave-SWI accelerated the acquisition of 3D high-resolution susceptibility images in 70% of the acquisition time of the conventional T2*GRE. • Wave-SWI performed superior to T2*w-GRE for visualization of pathology, signal dropout artifacts, and overall diagnostic image quality. • Wave-SWI was noninferior to standard SWI for visualization of normal anatomy and pathology, signal dropout artifacts, and overall diagnostic image quality.
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8
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Baek HJ, Heo YJ, Kim D, Yun SY, Baek JW, Jeong HW, Choo HJ, Lee JY, Oh SI. Usefulness of Wave-CAIPI for Postcontrast 3D T1-SPACE in the Evaluation of Brain Metastases. AJNR Am J Neuroradiol 2022; 43:857-863. [PMID: 35618423 DOI: 10.3174/ajnr.a7520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/24/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE High-resolution postcontrast 3D T1WI is a widely used sequence for evaluating brain metastasis, despite the long scan time. This study aimed to compare highly accelerated postcontrast 3D T1-weighted sampling perfection with application-optimized contrasts by using different flip angle evolution by using wave-controlled aliasing in parallel imaging (wave-T1-SPACE) with the commonly used standard high-resolution postcontrast 3D T1-SPACE for the evaluation of brain metastases. MATERIALS AND METHODS Among the 387 patients who underwent postcontrast wave-T1-SPACE and standard SPACE, 56 patients with suspected brain metastases were retrospectively included. Two neuroradiologists assessed the number of enhancing lesions according to lesion size, contrast-to-noise ratiolesion/parenchyma, contrast-to-noise ratiowhite matter/gray matter, contrast ratiolesion/parenchyma, and overall image quality for the 2 different sequences. RESULTS Although there was no significant difference in the evaluation of larger enhancing lesions (>5 mm) between the 2 different sequences (P = .66 for observer 1, P = .26 for observer 2), wave-T1-SPACE showed a significantly lower number of smaller enhancing lesions (<5 mm) than standard SPACE (1.61 [SD, 0.29] versus 2.84 [SD, 0.47] for observer 1; 1.41 [SD, 0.19] versus 2.68 [SD, 0.43] for observer 2). Furthermore, mean contrast-to-noise ratiolesion/parenchyma and overall image quality of wave-T1-SPACE were significantly lower than those in standard SPACE. CONCLUSIONS Postcontrast wave-T1-SPACE showed comparable diagnostic performance for larger enhancing lesions (>5 mm) and marked scan time reduction compared with standard SPACE. However, postcontrast wave-T1-SPACE showed underestimation of smaller enhancing lesions (<5 mm) and lower image quality than standard SPACE. Therefore, postcontrast wave-T1-SPACE should be interpreted carefully in the evaluation of brain metastasis.
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Affiliation(s)
- H J Baek
- From the Department of Radiology (H.J.B.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Y J Heo
- Department of Radiology (Y.J.H., D.K., S.Y.Y., J.W.B., H.W.J., H.J.C.), Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - D Kim
- Department of Radiology (Y.J.H., D.K., S.Y.Y., J.W.B., H.W.J., H.J.C.), Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - S Y Yun
- Department of Radiology (Y.J.H., D.K., S.Y.Y., J.W.B., H.W.J., H.J.C.), Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - J W Baek
- Department of Radiology (Y.J.H., D.K., S.Y.Y., J.W.B., H.W.J., H.J.C.), Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - H W Jeong
- Department of Radiology (Y.J.H., D.K., S.Y.Y., J.W.B., H.W.J., H.J.C.), Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - H J Choo
- Department of Radiology (Y.J.H., D.K., S.Y.Y., J.W.B., H.W.J., H.J.C.), Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - J Y Lee
- Department of Internal Medicine (J.Y.L), Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - S-I Oh
- Department of Neurology (S.-I.O.), Inje University Busan Paik Hospital, Busan, Republic of Korea
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9
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Sundermann B, Billebaut B, Bauer J, Iacoban CG, Alykova O, Schülke C, Gerdes M, Kugel H, Neduvakkattu S, Bösenberg H, Mathys C. Practical Aspects of novel MRI Techniques in Neuroradiology: Part 1-3D Acquisitions, Dixon Techniques and Artefact Reduction. ROFO-FORTSCHR RONTG 2022; 194:1100-1108. [PMID: 35545104 DOI: 10.1055/a-1800-8692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recently introduced MRI techniques offer improved image quality and facilitate examinations of patients even when artefacts are expected. They pave the way for novel diagnostic imaging strategies in neuroradiology. These methods include improved 3D imaging, movement and metal artefact reduction techniques as well as Dixon techniques. METHODS Narrative review with an educational focus based on current literature research and practical experiences of different professions involved (physicians, MRI technologists/radiographers, physics/biomedical engineering). Different hardware manufacturers are considered. RESULTS AND CONCLUSIONS 3D FLAIR is an example of a versatile 3D Turbo Spin Echo sequence with broad applicability in routine brain protocols. It facilitates detection of smaller lesions and more precise measurements for follow-up imaging. It also offers high sensitivity for extracerebral lesions. 3D techniques are increasingly adopted for imaging arterial vessel walls, cerebrospinal fluid spaces and peripheral nerves. Improved hybrid-radial acquisitions are available for movement artefact reduction in a broad application spectrum. Novel susceptibility artefact reduction techniques for targeted application supplement previously established metal artefact reduction sequences. Most of these techniques can be further adapted to achieve the desired diagnostic performances. Dixon techniques allow for homogeneous fat suppression in transition areas and calculation of different image contrasts based on a single acquisition. KEY POINTS · 3D FLAIR can replace 2 D FLAIR for most brain imaging applications and can be a cornerstone of more precise and more widely applicable protocols.. · Further 3D TSE sequences are increasingly replacing 2D TSE sequences for specific applications.. · Improvement of artefact reduction techniques increase the potential for effective diagnostic MRI exams despite movement or near metal implants.. · Dixon techniques facilitate homogeneous fat suppression and simultaneous acquisition of multiple contrasts.. CITATION FORMAT · Sundermann B, Billebaut B, Bauer J et al. Practical Aspects of novel MRI Techniques in Neuroradiology: Part 1-3D Acquisitions, Dixon Techniques and Artefact Reduction. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1800-8692.
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Affiliation(s)
- Benedikt Sundermann
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Germany.,Clinic for Radiology, University Hospital Münster, Germany
| | - Benoit Billebaut
- Clinic for Radiology, University Hospital Münster, Germany.,School for Radiologic Technologists, University Hospital Münster, Germany
| | - Jochen Bauer
- Clinic for Radiology, University Hospital Münster, Germany
| | - Catalin George Iacoban
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Olga Alykova
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | | | - Maike Gerdes
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Harald Kugel
- Clinic for Radiology, University Hospital Münster, Germany
| | | | - Holger Bösenberg
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Christian Mathys
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Germany.,Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Germany
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10
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Conklin J, Tabari A, Longo MGF, Cobos CJ, Setsompop K, Cauley SF, Kirsch JE, Huang SY, Rapalino O, Gee MS, Caruso PJ. Evaluation of highly accelerated wave controlled aliasing in parallel imaging (Wave-CAIPI) susceptibility-weighted imaging in the non-sedated pediatric setting: a pilot study. Pediatr Radiol 2022; 52:1115-1124. [PMID: 35119490 DOI: 10.1007/s00247-021-05273-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/28/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Susceptibility-weighted imaging (SWI) is highly sensitive for intracranial hemorrhagic and mineralized lesions but is associated with long scan times. Wave controlled aliasing in parallel imaging (Wave-CAIPI) enables greater acceleration factors and might facilitate broader application of SWI, especially in motion-prone populations. OBJECTIVE To compare highly accelerated Wave-CAIPI SWI to standard SWI in the non-sedated pediatric outpatient setting, with respect to the following variables: estimated scan time, image noise, artifacts, visualization of normal anatomy and visualization of pathology. MATERIALS AND METHODS Twenty-eight children (11 girls, 17 boys; mean age ± standard deviation [SD] = 128.3±62 months) underwent 3-tesla (T) brain MRI, including standard three-dimensional (3-D) SWI sequence followed by a highly accelerated Wave-CAIPI SWI sequence for each subject. We rated all studies using a predefined 5-point scale and used the Wilcoxon signed rank test to assess the difference for each variable between sequences. RESULTS Wave-CAIPI SWI provided a 78% and 67% reduction in estimated scan time using the 32- and 20-channel coils, respectively, corresponding to estimated scan time reductions of 3.5 min and 3 min, respectively. All 28 children were imaged without anesthesia. Inter-reader agreement ranged from fair to substantial (k=0.67 for evaluation of pathology, 0.55 for anatomical contrast, 0.3 for central noise, and 0.71 for artifacts). Image noise was rated higher in the central brain with wave SWI (P<0.01), but not in the peripheral brain. There was no significant difference in the visualization of normal anatomical structures and visualization of pathology between the standard and wave SWI sequences (P=0.77 and P=0.79, respectively). CONCLUSION Highly accelerated Wave-CAIPI SWI of the brain can provide similar image quality to standard SWI, with estimated scan time reduction of 3-3.5 min depending on the radiofrequency coil used, with fewer motion artifacts, at a cost of mild but perceptibly increased noise in the central brain.
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Affiliation(s)
- John Conklin
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Azadeh Tabari
- Harvard Medical School, Boston, MA, USA. .,Division of Pediatric Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
| | - Maria Gabriela Figueiro Longo
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Camilo Jaimes Cobos
- Harvard Medical School, Boston, MA, USA.,Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Kawin Setsompop
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Stephen F Cauley
- Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - John E Kirsch
- Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Susie Yi Huang
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Otto Rapalino
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael S Gee
- Harvard Medical School, Boston, MA, USA.,Division of Pediatric Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Paul J Caruso
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Pediatric Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
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11
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Ding J, Duan Y, Wang M, Yuan Y, Zhuo Z, Gan L, Song Q, Gao B, Yang L, Liu H, Hou Y, Zheng F, Chen R, Wang J, Lin L, Zhang B, Zhang G, Liu Y. Acceleration of Brain Susceptibility-Weighted Imaging with Compressed Sensitivity Encoding: A Prospective Multicenter Study. AJNR Am J Neuroradiol 2022; 43:402-409. [PMID: 35241421 PMCID: PMC8910792 DOI: 10.3174/ajnr.a7441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/17/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE While three-dimensional susceptibility-weighted imaging has been widely suggested for intracranial vessel imaging, hemorrhage detection, and other neuro-diseases, its relatively long scan time has necessitated the clinical verification of recent progresses of fast imaging techniques. Our aim was to evaluate the effectiveness of brain SWI accelerated by compressed sensitivity encoding to identify the optimal acceleration factors for clinical practice. MATERIALS AND METHODS Ninety-nine subjects, prospectively enrolled from 5 centers, underwent 8 brain SWI sequences: 5 different folds of compressed sensitivity encoding acceleration (CS2, CS4, CS6, CS8, and CS10), 2 different folds of sensitivity encoding acceleration (SF2 and SF4), and 1 without acceleration. Images were assessed quantitatively on both the SNR of the red nucleus and its contrast ratio to the CSF and, subjectively, with scoring on overall image quality; visibility of the substantia nigra-red nucleus, basilar artery, and internal cerebral vein; and diagnostic confidence of the cerebral microbleeds and other intracranial diseases. RESULTS Compressed sensitivity encoding showed a promising ability to reduce the acquisition time (from 202 to 41 seconds) of SWI while increasing the acceleration factor from 2 to 10, though at the cost of decreasing the SNR, contrast ratio, and the scores of visual assessments. The visibility of the substantia nigra-red nucleus and internal cerebral vein became unacceptable in CS6 to CS10. The basilar artery was well-distinguished, and diseases including cerebral microbleeds, cavernous angiomas, intracranial gliomas, venous malformations, and subacute hemorrhage were well-diagnosed in all compressed sensitivity encoding sequences. CONCLUSIONS Compressed sensitivity encoding factor 4 is recommended in routine practice. Compressed sensitivity encoding factor 10 is potentially a fast surrogate for distinguishing the basilar artery and detecting susceptibility-related abnormalities (eg, cerebral microbleeds, cavernous angiomas, gliomas, and venous malformation) at the sacrifice of visualization of the substantia nigra-red nucleus and internal cerebral vein.
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Affiliation(s)
- J. Ding
- From the Department of Radiology (J.D., Y.D., Z.Z., L.G., F.Z., R.C., Y.L.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Y. Duan
- From the Department of Radiology (J.D., Y.D., Z.Z., L.G., F.Z., R.C., Y.L.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - M. Wang
- Department of Radiology (M.W., B.Z.), The Affiliated Drum Tower Hospital of Nanjing UniversityMedical School, Jiangsu, China
| | - Y. Yuan
- Department of Radiology (Y.Y., G.Z.), Beijing Royal Integrative Medicine Hospital, Beijing, China
| | - Z. Zhuo
- From the Department of Radiology (J.D., Y.D., Z.Z., L.G., F.Z., R.C., Y.L.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - L. Gan
- From the Department of Radiology (J.D., Y.D., Z.Z., L.G., F.Z., R.C., Y.L.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Q. Song
- Department of Radiology (Q.S., B.G.), First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - B. Gao
- Department of Radiology (Q.S., B.G.), First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - L. Yang
- Department of Radiology (L.Y., H.L., Y.H.), Shengjing Hospital of ChinaMedical University, Shenyang, China
| | - H. Liu
- Department of Radiology (L.Y., H.L., Y.H.), Shengjing Hospital of ChinaMedical University, Shenyang, China
| | - Y. Hou
- Department of Radiology (L.Y., H.L., Y.H.), Shengjing Hospital of ChinaMedical University, Shenyang, China
| | - F. Zheng
- From the Department of Radiology (J.D., Y.D., Z.Z., L.G., F.Z., R.C., Y.L.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - R. Chen
- From the Department of Radiology (J.D., Y.D., Z.Z., L.G., F.Z., R.C., Y.L.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - J. Wang
- Philips Healthcare (J.W., L.L.), Beijing, China
| | - L. Lin
- Philips Healthcare (J.W., L.L.), Beijing, China
| | - B. Zhang
- Department of Radiology (M.W., B.Z.), The Affiliated Drum Tower Hospital of Nanjing UniversityMedical School, Jiangsu, China
| | - G. Zhang
- Department of Radiology (Y.Y., G.Z.), Beijing Royal Integrative Medicine Hospital, Beijing, China
| | - Y. Liu
- From the Department of Radiology (J.D., Y.D., Z.Z., L.G., F.Z., R.C., Y.L.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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12
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Duan C, Xiong Y, Cheng K, Xiao S, Lyu J, Wang C, Bian X, Zhang J, Zhang D, Chen L, Zhou X, Lou X. Accelerating susceptibility-weighted imaging with deep learning by complex-valued convolutional neural network (ComplexNet): validation in clinical brain imaging. Eur Radiol 2022; 32:5679-5687. [PMID: 35182203 DOI: 10.1007/s00330-022-08638-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/15/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Susceptibility-weighted imaging (SWI) is crucial for the characterization of intracranial hemorrhage and mineralization, but has the drawback of long acquisition times. We aimed to propose a deep learning model to accelerate SWI, and evaluate the clinical feasibility of this approach. METHODS A complex-valued convolutional neural network (ComplexNet) was developed to reconstruct high-quality SWI from highly accelerated k-space data. ComplexNet can leverage the inherently complex-valued nature of SWI data and learn richer representations by using complex-valued network. SWI data were acquired from 117 participants who underwent clinical brain MRI examination between 2019 and 2021, including patients with tumor, stroke, hemorrhage, traumatic brain injury, etc. Reconstruction quality was evaluated using quantitative image metrics and image quality scores, including overall image quality, signal-to-noise ratio, sharpness, and artifacts. RESULTS The average reconstruction time of ComplexNet was 19 ms per section (1.33 s per participant). ComplexNet achieved significantly improved quantitative image metrics compared to a conventional compressed sensing method and a real-valued network with acceleration rates of 5 and 8 (p < 0.001). Meanwhile, there was no significant difference between fully sampled and ComplexNet approaches in terms of overall image quality and artifacts (p > 0.05) at both acceleration rates. Furthermore, ComplexNet showed comparable diagnostic performance to the fully sampled SWI for visualizing a wide range of pathology, including hemorrhage, cerebral microbleeds, and brain tumor. CONCLUSIONS ComplexNet can effectively accelerate SWI while providing superior performance in terms of overall image quality and visualization of pathology for routine clinical brain imaging. KEY POINTS • The complex-valued convolutional neural network (ComplexNet) allowed fast and high-quality reconstruction of highly accelerated SWI data, with an average reconstruction time of 19 ms per section. • ComplexNet achieved significantly improved quantitative image metrics compared to a conventional compressed sensing method and a real-valued network with acceleration rates of 5 and 8 (p < 0.001). • ComplexNet showed comparable diagnostic performance to the fully sampled SWI for visualizing a wide range of pathology, including hemorrhage, cerebral microbleeds, and brain tumor.
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Affiliation(s)
- Caohui Duan
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Yongqin Xiong
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Kun Cheng
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Sa Xiao
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Jinhao Lyu
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Cheng Wang
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Xiangbing Bian
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Jing Zhang
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Dekang Zhang
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Ling Chen
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Xin Zhou
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, 430071, People's Republic of China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.
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Arefeen Y, Beker O, Cho J, Yu H, Adalsteinsson E, Bilgic B. Scan-specific artifact reduction in k-space (SPARK) neural networks synergize with physics-based reconstruction to accelerate MRI. Magn Reson Med 2022; 87:764-780. [PMID: 34601751 PMCID: PMC8627503 DOI: 10.1002/mrm.29036] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE To develop a scan-specific model that estimates and corrects k-space errors made when reconstructing accelerated MRI data. METHODS Scan-specific artifact reduction in k-space (SPARK) trains a convolutional-neural-network to estimate and correct k-space errors made by an input reconstruction technique by back-propagating from the mean-squared-error loss between an auto-calibration signal (ACS) and the input technique's reconstructed ACS. First, SPARK is applied to generalized autocalibrating partially parallel acquisitions (GRAPPA) and demonstrates improved robustness over other scan-specific models, such as robust artificial-neural-networks for k-space interpolation (RAKI) and residual-RAKI. Subsequent experiments demonstrate that SPARK synergizes with residual-RAKI to improve reconstruction performance. SPARK also improves reconstruction quality when applied to advanced acquisition and reconstruction techniques like 2D virtual coil (VC-) GRAPPA, 2D LORAKS, 3D GRAPPA without an integrated ACS region, and 2D/3D wave-encoded imaging. RESULTS SPARK yields SSIM improvement and 1.5 - 2× root mean squared error (RMSE) reduction when applied to GRAPPA and improves robustness to ACS size for various acceleration rates in comparison to other scan-specific techniques. When applied to advanced reconstruction techniques such as residual-RAKI, 2D VC-GRAPPA and LORAKS, SPARK achieves up to 20% RMSE improvement. SPARK with 3D GRAPPA also improves RMSE performance by ~2×, SSIM performance, and perceived image quality without a fully sampled ACS region. Finally, SPARK synergizes with non-Cartesian, 2D and 3D wave-encoding imaging by reducing RMSE between 20% and 25% and providing qualitative improvements. CONCLUSION SPARK synergizes with physics-based acquisition and reconstruction techniques to improve accelerated MRI by training scan-specific models to estimate and correct reconstruction errors in k-space.
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Affiliation(s)
- Yamin Arefeen
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Onur Beker
- Computer and Communication Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Jaejin Cho
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Heng Yu
- Department of Automation, Tsinghua University, Beijing, China
| | - Elfar Adalsteinsson
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Berkin Bilgic
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
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14
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Karimi D, Jaimes C, Machado-Rivas F, Vasung L, Khan S, Warfield SK, Gholipour A. Deep learning-based parameter estimation in fetal diffusion-weighted MRI. Neuroimage 2021; 243:118482. [PMID: 34455242 PMCID: PMC8573718 DOI: 10.1016/j.neuroimage.2021.118482] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 11/24/2022] Open
Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) of fetal brain is challenged by frequent fetal motion and signal to noise ratio that is much lower than non-fetal imaging. As a result, accurate and robust parameter estimation in fetal DW-MRI remains an open problem. Recently, deep learning techniques have been successfully used for DW-MRI parameter estimation in non-fetal subjects. However, none of those prior works has addressed the fetal brain because obtaining reliable fetal training data is challenging. To address this problem, in this work we propose a novel methodology that utilizes fetal scans as well as scans from prematurely-born infants. High-quality newborn scans are used to estimate accurate maps of the parameter of interest. These parameter maps are then used to generate DW-MRI data that match the measurement scheme and noise distribution that are characteristic of fetal data. In order to demonstrate the effectiveness and reliability of the proposed data generation pipeline, we used the generated data to train a convolutional neural network (CNN) to estimate color fractional anisotropy (CFA). We evaluated the trained CNN on independent sets of fetal data in terms of reconstruction accuracy, precision, and expert assessment of reconstruction quality. Results showed significantly lower reconstruction error (n=100,p<0.001) and higher reconstruction precision (n=20,p<0.001) for the proposed machine learning pipeline compared with standard estimation methods. Expert assessments on 20 fetal test scans showed significantly better overall reconstruction quality (p<0.001) and more accurate reconstruction of 11 regions of interest (p<0.001) with the proposed method.
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Affiliation(s)
- Davood Karimi
- Computational Radiology Laboratory (CRL), Department of Radiology, Boston Children's Hospital, and Harvard Medical School, USA.
| | - Camilo Jaimes
- Computational Radiology Laboratory (CRL), Department of Radiology, Boston Children's Hospital, and Harvard Medical School, USA
| | - Fedel Machado-Rivas
- Computational Radiology Laboratory (CRL), Department of Radiology, Boston Children's Hospital, and Harvard Medical School, USA
| | - Lana Vasung
- Department of Pediatrics at Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Shadab Khan
- Computational Radiology Laboratory (CRL), Department of Radiology, Boston Children's Hospital, and Harvard Medical School, USA
| | - Simon K Warfield
- Computational Radiology Laboratory (CRL), Department of Radiology, Boston Children's Hospital, and Harvard Medical School, USA
| | - Ali Gholipour
- Computational Radiology Laboratory (CRL), Department of Radiology, Boston Children's Hospital, and Harvard Medical School, USA
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15
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Mossa-Basha M, Zhu C, Wu L. Vessel Wall MR Imaging in the Pediatric Head and Neck. Magn Reson Imaging Clin N Am 2021; 29:595-604. [PMID: 34717847 DOI: 10.1016/j.mric.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vessel wall MR imaging (VWI) is a technique that progressively has gained traction in clinical diagnostic applications for evaluation of intracranial and extracranial vasculopathies, with increasing use in pediatric populations. The technique has shown promise in detection, differentiation, and characterization of both inflammatory and noninflammatory vasculopathies. In this article, optimal techniques for intracranial and extracranial VWI as well as applications and value for pediatric vascular disease evaluation are discussed.
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Affiliation(s)
- Mahmud Mossa-Basha
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, 325 9th Avenue, Seattle, WA 98104, USA
| | - Lei Wu
- Department of Radiology, University of Washington, 1660 South Columbian Way, Seattle, WA 98108, USA
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16
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Sakurama A, Fushimi Y, Nakajima S, Sakata A, Hinoda T, Oshima S, Otani S, Wicaksono KP, Liu W, Maki T, Okada T, Takahashi R, Nakamoto Y. Clinical Application of MPRAGE Wave Controlled Aliasing in Parallel Imaging (Wave-CAIPI): A Comparative Study with MPRAGE GRAPPA. Magn Reson Med Sci 2021; 21:633-647. [PMID: 34602534 PMCID: PMC9618934 DOI: 10.2463/mrms.mp.2021-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Purpose: To compare reliability and elucidate clinical application of magnetization-prepared rapid gradient-echo (MPRAGE) with 9-fold acceleration by using wave-controlled aliasing in parallel imaging (Wave-CAIPI 3 × 3) in comparison to conventional MPRAGE accelerated by using generalized autocalibrating partially parallel acquisition (GRAPPA) 2 × 1. Methods: A total of 26 healthy volunteers and 33 patients were included in this study. Subjects were scanned with two MPRAGEs, GRAPPA 2 × 1 and Wave-CAIPI 3 × 3 acquired in 5 min 21 s and 1 min 42 s, respectively, on a 3T MR scanner. Healthy volunteers underwent additional two MPRAGEs (CAIPI 3 × 3 and GRAPPA 3 × 3). The image quality of the four MPRAGEs was visually evaluated with a 5-point scale in healthy volunteers, and the SNR of four MPRAGEs was also calculated by measuring the phantom 10 times with each MPRAGE. Based on the results of the visual evaluation, voxel-based morphometry (VBM) analyses, including subfield analysis, were performed only for GRAPPA 2 × 1 and Wave-CAIPI 3 × 3. Correlation of segmentation results between GRAPPA 2 × 1 and Wave-CAIPI 3 × 3 was assessed. Results: In visual evaluations, scores for MPRAGE GRAPPA 2 × 1 (mean rank: 4.00) were significantly better than those for Wave-CAIPI 3 × 3 (mean rank: 3.00), CAIPI 3 × 3 (mean rank: 1.83), and GRAPPA 3 × 3 (mean rank: 1.17), and scores for Wave-CAIPI 3×3 were significantly better than those for CAIPI 3 × 3 and GRAPPA 3 × 3. Image noise was evident at the center for additional MPRAGE CAIPI 3 × 3 and GRAPPA 3 × 3. The correlation of segmentation results between GRAPPA 2 × 1 and Wave-CAIPI 3 × 3 was higher than 0.85 in all VOIs except globus pallidus. Subfield analysis of hippocampus also showed a high correlation between GRAPPA 2 × 1 and Wave-CAIPI 3 × 3. Conclusion: MPRAGE Wave-CAIPI 3 × 3 shows relatively better contrast, despite of its short scan time of 1 min 42 s. The volumes derived from automated segmentation of MPRAGE Wave-CAIPI are considered to be reliable measures.
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Affiliation(s)
- Azusa Sakurama
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Satoshi Nakajima
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Akihiko Sakata
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Takuya Hinoda
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Sonoko Oshima
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Sayo Otani
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Krishna Pandu Wicaksono
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Wei Liu
- Siemens Shenzhen Magnetic Resonance Ltd
| | - Takakuni Maki
- Department of Neurology, Graduate School of Medicine, Kyoto University
| | - Tomohisa Okada
- Human Brain Research Center, Graduate School of Medicine, Kyoto University
| | - Ryosuke Takahashi
- Department of Neurology, Graduate School of Medicine, Kyoto University
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
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17
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Vachha B, Huang SY. MRI with ultrahigh field strength and high-performance gradients: challenges and opportunities for clinical neuroimaging at 7 T and beyond. Eur Radiol Exp 2021; 5:35. [PMID: 34435246 PMCID: PMC8387544 DOI: 10.1186/s41747-021-00216-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
Research in ultrahigh magnetic field strength combined with ultrahigh and ultrafast gradient technology has provided enormous gains in sensitivity, resolution, and contrast for neuroimaging. This article provides an overview of the technical advantages and challenges of performing clinical neuroimaging studies at ultrahigh magnetic field strength combined with ultrahigh and ultrafast gradient technology. Emerging clinical applications of 7-T MRI and state-of-the-art gradient systems equipped with up to 300 mT/m gradient strength are reviewed, and the impact and benefits of such advances to anatomical, structural and functional MRI are discussed in a variety of neurological conditions. Finally, an outlook and future directions for ultrahigh field MRI combined with ultrahigh and ultrafast gradient technology in neuroimaging are examined.
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Affiliation(s)
- Behroze Vachha
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Susie Y Huang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, 149 13th Street, Room 2301, Charlestown, MA, 02129, USA.
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18
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Ngamsombat C, Gonçalves Filho ALM, Longo MGF, Cauley SF, Setsompop K, Kirsch JE, Tian Q, Fan Q, Polak D, Liu W, Lo WC, Gilberto González R, Schaefer PW, Rapalino O, Conklin J, Huang SY. Evaluation of Ultrafast Wave-Controlled Aliasing in Parallel Imaging 3D-FLAIR in the Visualization and Volumetric Estimation of Cerebral White Matter Lesions. AJNR Am J Neuroradiol 2021; 42:1584-1590. [PMID: 34244127 DOI: 10.3174/ajnr.a7191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/29/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to evaluate an ultrafast 3D-FLAIR sequence using Wave-controlled aliasing in parallel imaging encoding (Wave-FLAIR) compared with standard 3D-FLAIR in the visualization and volumetric estimation of cerebral white matter lesions in a clinical setting. MATERIALS AND METHODS Forty-two consecutive patients underwent 3T brain MR imaging, including standard 3D-FLAIR (acceleration factor = 2, scan time = 7 minutes 50 seconds) and resolution-matched ultrafast Wave-FLAIR sequences (acceleration factor = 6, scan time = 2 minutes 45 seconds for the 20-channel coil; acceleration factor = 9, scan time = 1 minute 50 seconds for the 32-channel coil) as part of clinical evaluation for demyelinating disease. Automated segmentation of cerebral white matter lesions was performed using the Lesion Segmentation Tool in SPM. Student t tests, intraclass correlation coefficients, relative lesion volume difference, and Dice similarity coefficients were used to compare volumetric measurements among sequences. Two blinded neuroradiologists evaluated the visualization of white matter lesions, artifacts, and overall diagnostic quality using a predefined 5-point scale. RESULTS Standard and Wave-FLAIR sequences showed excellent agreement of lesion volumes with an intraclass correlation coefficient of 0.99 and mean Dice similarity coefficient of 0.97 (SD, 0.05) (range, 0.84-0.99). Wave-FLAIR was noninferior to standard FLAIR for visualization of lesions and motion. The diagnostic quality for Wave-FLAIR was slightly greater than for standard FLAIR for infratentorial lesions (P < .001), and there were fewer pulsation artifacts on Wave-FLAIR compared with standard FLAIR (P < .001). CONCLUSIONS Ultrafast Wave-FLAIR provides superior visualization of infratentorial lesions while preserving overall diagnostic quality and yields white matter lesion volumes comparable with those estimated using standard FLAIR. The availability of ultrafast Wave-FLAIR may facilitate the greater use of 3D-FLAIR sequences in the evaluation of patients with suspected demyelinating disease.
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Affiliation(s)
- C Ngamsombat
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Department of Radiology (C.N.), Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand
| | - A L M Gonçalves Filho
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - M G F Longo
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - S F Cauley
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - K Setsompop
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology (K.S., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - J E Kirsch
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - Q Tian
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - Q Fan
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - D Polak
- Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Department of Physics and Astronomy (D.P.), Heidelberg University, Heidelberg, Germany.,Siemens Healthcare GmbH, (D.P., W.-C.L.), Erlangen, Germany
| | - W Liu
- Siemens Shenzhen Magnetic Resonance Ltd (W.L.), Shenzhen, China
| | - W-C Lo
- Siemens Healthcare GmbH, (D.P., W.-C.L.), Erlangen, Germany
| | - R Gilberto González
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - P W Schaefer
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - O Rapalino
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - J Conklin
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - S Y Huang
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.) .,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology (K.S., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
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19
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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.
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20
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Puy L, Pasi M, Rodrigues M, van Veluw SJ, Tsivgoulis G, Shoamanesh A, Cordonnier C. Cerebral microbleeds: from depiction to interpretation. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-323951. [PMID: 33563804 DOI: 10.1136/jnnp-2020-323951] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 11/04/2022]
Abstract
Cerebral microbleeds (CMBs) are defined as hypointense foci visible on T2*-weighted and susceptible-weighted MRI sequences. CMBs are increasingly recognised with the widespread use of MRI in healthy individuals as well as in the context of cerebrovascular disease or dementia. They can also be encountered in major critical medical conditions such as in patients requiring extracorporeal mechanical oxygenation. The advent of MRI-guided postmortem neuropathological examinations confirmed that, in the context of cerebrovascular disease, the vast majority of CMBs correspond to recent or old microhaemorrhages. Detection of CMBs is highly influenced by MRI parameters, in particular field strength, postprocessing methods used to enhance T2* contrast and three dimensional sequences. Despite recent progress, harmonising imaging parameters across research studies remains necessary to improve cross-study comparisons. CMBs are helpful markers to identify the nature and the severity of the underlying chronic small vessel disease. In daily clinical practice, presence and numbers of CMBs often trigger uncertainty for clinicians especially when antithrombotic treatments and acute reperfusion therapies are discussed. In the present review, we discuss those clinical dilemmas and address the value of CMBs as diagnostic and prognostic markers for future vascular events.
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Affiliation(s)
- Laurent Puy
- Department of Neurology, U1172 - LilNCog - Lille Neuroscience & Cognition, Univ. Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Marco Pasi
- Department of Neurology, U1172 - LilNCog - Lille Neuroscience & Cognition, Univ. Lille, Inserm, CHU Lille, F-59000 Lille, France
| | - Mark Rodrigues
- Centre for Clinical Brain Sciences, The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, Midlothian, UK
| | - Susanne J van Veluw
- Neurology Department, Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ashkan Shoamanesh
- Department of Medicine (Neurology), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada
| | - Charlotte Cordonnier
- Department of Neurology, U1172 - LilNCog - Lille Neuroscience & Cognition, Univ. Lille, Inserm, CHU Lille, F-59000 Lille, France
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21
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Goncalves Filho ALM, Conklin J, Longo MGF, Cauley SF, Polak D, Liu W, Splitthoff DN, Lo WC, Kirsch JE, Setsompop K, Schaefer PW, Huang SY, Rapalino O. Accelerated Post-contrast Wave-CAIPI T1 SPACE Achieves Equivalent Diagnostic Performance Compared With Standard T1 SPACE for the Detection of Brain Metastases in Clinical 3T MRI. Front Neurol 2020; 11:587327. [PMID: 33193054 PMCID: PMC7653188 DOI: 10.3389/fneur.2020.587327] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose: Brain magnetic resonance imaging (MRI) examinations using high-resolution 3D post-contrast sequences offer increased sensitivity for the detection of metastases in the central nervous system but are usually long exams. We evaluated whether the diagnostic performance of a highly accelerated Wave-controlled aliasing in parallel imaging (Wave-CAIPI) post-contrast 3D T1 SPACE sequence was non-inferior to the standard high-resolution 3D T1 SPACE sequence for the evaluation of brain metastases. Materials and Methods: Thirty-three patients undergoing evaluation for brain metastases were prospectively evaluated with a standard post-contrast 3D T1 SPACE sequence and an optimized Wave-CAIPI 3D T1 SPACE sequence, which was three times faster than the standard sequence. Two blinded neuroradiologists performed a head-to-head comparison to evaluate the visualization of pathology, perception of artifacts, and the overall diagnostic quality. Wave-CAIPI post-contrast T1 SPACE was tested for non-inferiority relative to standard T1 SPACE using a 15% non-inferiority margin. Results: Wave-CAIPI post-contrast T1 SPACE was non-inferior to the standard T1 SPACE for visualization of enhancing lesions (P < 0.01) and offered equivalent diagnostic quality performance and only marginally higher background noise compared to the standard sequence. Conclusions: Our findings suggest that Wave-CAIPI post-contrast T1 SPACE provides equivalent visualization of pathology and overall diagnostic quality with three times reduced scan time compared to the standard 3D T1 SPACE.
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Affiliation(s)
- Augusto Lio M Goncalves Filho
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Maria Gabriela F Longo
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Stephen F Cauley
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Daniel Polak
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Siemens Healthcare GmbH, Erlangen, Germany
| | - Wei Liu
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | | | - Wei-Ching Lo
- Siemens Medical Solutions, Boston, MA, United States
| | - John E Kirsch
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Kawin Setsompop
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States.,Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Pamela W Schaefer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Susie Y Huang
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States.,Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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22
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Hill CS, Devesa SC, Ince W, Borg A, Aquilina K. A systematic review of ongoing clinical trials in optic pathway gliomas. Childs Nerv Syst 2020; 36:1869-1886. [PMID: 32556546 PMCID: PMC7434789 DOI: 10.1007/s00381-020-04724-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/03/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Optic pathway gliomas (OPGs), also known as Visual Pathway Gliomas, are insidious, debilitating tumours. They are most commonly WHO grade 1 pilocytic astrocytomas and frequently occur in patients with neurofibromatosis type 1. The location of OPGs within the optic pathway typically precludes complete resection or optimal radiation dosing, hence outcomes remain poor compared to many other low-grade gliomas. The aim of this systematic review was to formulate a comprehensive list of all current ongoing clinical trials that are specifically looking at clinical care of OPGs in order to identify trends in current research and provide an overview to guide future research efforts. METHODS This systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The Cochrane Controlled Register of Trials (CENTRAL) and ClinicalTrials.gov were searched. Inclusion and exclusion criteria were applied and final results were reviewed. RESULTS 501 clinical trials were identified with the search strategy. All were screened and eligible studies extracted and reviewed. This yielded 36 ongoing clinical trials, 27 of which were pharmacological agents in phase I-III. The remaining trials were a mixture of biological agents, radiation optimisation, diagnostic imaging, surgical intervention, and a social function analysis. CONCLUSION OPG is a complex multifaceted disease, and advances in care require ongoing research efforts across a spectrum of different research fields. This review provides an update on the current state of research in OPG and summarises ongoing trials.
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Affiliation(s)
- Ciaran Scott Hill
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK.
- UCL Cancer Institute, University College London, London, UK.
| | | | - William Ince
- Ipswich Hospital, East Suffolk and North Essex NHS Trust, Health Road, Ipswich, IP45PD, UK
| | - Anouk Borg
- Department of Neurosurgery, Oxford University Hospital, Oxford, UK
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
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23
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Longo MGF, Conklin J, Cauley SF, Setsompop K, Tian Q, Polak D, Polackal M, Splitthoff D, Liu W, González RG, Schaefer PW, Kirsch JE, Rapalino O, Huang SY. Evaluation of Ultrafast Wave-CAIPI MPRAGE for Visual Grading and Automated Measurement of Brain Tissue Volume. AJNR Am J Neuroradiol 2020; 41:1388-1396. [PMID: 32732274 DOI: 10.3174/ajnr.a6703] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/18/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE Volumetric brain MR imaging typically has long acquisition times. We sought to evaluate an ultrafast MPRAGE sequence based on Wave-CAIPI (Wave-MPRAGE) compared with standard MPRAGE for evaluation of regional brain tissue volumes. MATERIALS AND METHODS We performed scan-rescan experiments in 10 healthy volunteers to evaluate the intraindividual variability of the brain volumes measured using the standard and Wave-MPRAGE sequences. We then evaluated 43 consecutive patients undergoing brain MR imaging. Patients underwent 3T brain MR imaging, including a standard MPRAGE sequence (acceleration factor [R] = 2, acquisition time [TA] = 5.2 minutes) and an ultrafast Wave-MPRAGE sequence (R = 9, TA = 1.15 minutes for the 32-channel coil; R = 6, TA = 1.75 minutes for the 20-channel coil). Automated segmentation of regional brain volume was performed. Two radiologists evaluated regional brain atrophy using semiquantitative visual rating scales. RESULTS The mean absolute symmetrized percent change in the healthy volunteers participating in the scan-rescan experiments was not statistically different in any brain region for both the standard and Wave-MPRAGE sequences. In the patients undergoing evaluation for neurodegenerative disease, the Dice coefficient of similarity between volumetric measurements obtained from standard and Wave-MPRAGE ranged from 0.86 to 0.95. Similarly, for all regions, the absolute symmetrized percent change for brain volume and cortical thickness showed <6% difference between the 2 sequences. In the semiquantitative visual comparison, the differences between the 2 radiologists' scores were not clinically or statistically significant. CONCLUSIONS Brain volumes estimated using ultrafast Wave-MPRAGE show low intraindividual variability and are comparable with those estimated using standard MPRAGE in patients undergoing clinical evaluation for suspected neurodegenerative disease.
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Affiliation(s)
- M G F Longo
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.)
| | - J Conklin
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.).,Radiology, Athinoula A. Martinos Center for Biomedical Imaging, (J.C., S.F.C., K.S., Q.T., D.P., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (J.C., S.F.C., K.S., R.G.G., P.W.S., S.Y.H.), Boston, Massachusetts
| | - S F Cauley
- Radiology, Athinoula A. Martinos Center for Biomedical Imaging, (J.C., S.F.C., K.S., Q.T., D.P., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (J.C., S.F.C., K.S., R.G.G., P.W.S., S.Y.H.), Boston, Massachusetts
| | - K Setsompop
- Radiology, Athinoula A. Martinos Center for Biomedical Imaging, (J.C., S.F.C., K.S., Q.T., D.P., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (J.C., S.F.C., K.S., R.G.G., P.W.S., S.Y.H.), Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology (K.S., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Q Tian
- Radiology, Athinoula A. Martinos Center for Biomedical Imaging, (J.C., S.F.C., K.S., Q.T., D.P., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - D Polak
- Radiology, Athinoula A. Martinos Center for Biomedical Imaging, (J.C., S.F.C., K.S., Q.T., D.P., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Department of Physics and Astronomy (D.P.), Heidelberg University, Heidelberg, Germany.,Siemens (D.P., D.S., W.L.), Erlangen, Germany
| | - M Polackal
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.)
| | | | - W Liu
- Siemens (D.P., D.S., W.L.), Erlangen, Germany
| | - R G González
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.).,Harvard Medical School (J.C., S.F.C., K.S., R.G.G., P.W.S., S.Y.H.), Boston, Massachusetts
| | - P W Schaefer
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.).,Harvard Medical School (J.C., S.F.C., K.S., R.G.G., P.W.S., S.Y.H.), Boston, Massachusetts
| | - J E Kirsch
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.)
| | - O Rapalino
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.)
| | - S Y Huang
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.).,Radiology, Athinoula A. Martinos Center for Biomedical Imaging, (J.C., S.F.C., K.S., Q.T., D.P., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (J.C., S.F.C., K.S., R.G.G., P.W.S., S.Y.H.), Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology (K.S., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
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24
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Conklin J, Frosch MP, Mukerji S, Rapalino O, Maher M, Schaefer PW, Lev MH, Gonzalez RG, Das S, Champion SN, Magdamo C, Sen P, Harrold GK, Alabsi H, Normandin E, Shaw B, Lemieux J, Sabeti P, Branda JA, Brown EN, Westover MB, Huang SY, Edlow BL. Cerebral Microvascular Injury in Severe COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32743599 DOI: 10.1101/2020.07.21.20159376] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
IMPORTANCE Microvascular lesions are common in patients with severe COVID-19. Radiologic-pathologic correlation in one case suggests a combination of microvascular hemorrhagic and ischemic lesions that may reflect an underlying hypoxic mechanism of injury, which requires validation in larger studies. OBJECTIVE To determine the incidence, distribution, and clinical and histopathologic correlates of microvascular lesions in patients with severe COVID-19. DESIGN Observational, retrospective cohort study: March to May 2020. SETTING Single academic medical center. PARTICIPANTS Consecutive patients (16) admitted to the intensive care unit with severe COVID-19, undergoing brain MRI for evaluation of coma or focal neurologic deficits. EXPOSURES Not applicable. MAIN OUTCOME AND MEASURES Hypointense microvascular lesions identified by a prototype ultrafast high-resolution susceptibility-weighted imaging (SWI) MRI sequence, counted by two neuroradiologists and categorized by neuroanatomic location. Clinical and laboratory data (most recent measurements before brain MRI). Brain autopsy and cerebrospinal fluid PCR for SARS-CoV 2 in one patient who died from severe COVID-19. RESULTS Eleven of 16 patients (69%) had punctate and linear SWI lesions in the subcortical and deep white matter, and eight patients (50%) had >10 SWI lesions. In 4/16 patients (25%), lesions involved the corpus callosum. Brain autopsy in one patient revealed that SWI lesions corresponded to widespread microvascular injury, characterized by perivascular and parenchymal petechial hemorrhages and microscopic ischemic lesions. CONCLUSIONS AND RELEVANCE SWI lesions are common in patients with neurological manifestations of severe COVID-19 (coma and focal neurologic deficits). The distribution of lesions is similar to that seen in patients with hypoxic respiratory failure, sepsis, and disseminated intravascular coagulation. Collectively, these radiologic and histopathologic findings suggest that patients with severe COVID-19 are at risk for multifocal microvascular hemorrhagic and ischemic lesions in the subcortical and deep white matter.
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