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Ayyala RS, Dillman JR, Tkach JA, Young R, Kotagal M, Depinet H, Trout AT. Implementation of a Program for Appendicitis MRI in a Pediatric Hospital. AJR Am J Roentgenol 2024; 222:e2330695. [PMID: 38230903 DOI: 10.2214/ajr.23.30695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
MRI is increasingly used as an alternate to CT for the evaluation of suspected appendicitis in pediatric patients presenting to the emergency department (ED) with abdominal pain, when further imaging is needed after an initial ultrasound examination. The available literature shows a similar diagnostic performance of MRI and CT in this setting. At the authors' institution, to evaluate for appendicitis in children in the ED, MRI is performed using a rapid three-sequence free-breathing protocol without IV contrast media. Implementation of an MRI program for appendicitis in children involves multiple steps, including determination of imaging resource availability, collaboration with other services to develop imaging pathways, widespread educational efforts, and regular quality review. Such programs can face numerous practice-specific challenges, such as those involving scanner capacity, costs, and buy-in of impacted groups. Nonetheless, through careful consideration of these factors, MRI can be used to positively impact the care of children presenting to the ED with suspected appendicitis. This Clinical Perspective aims to provide guidance on the development of a program for appendicitis MRI in children, drawing on one institution's experience while highlighting the advantages of MRI and practical strategies for overcoming potential barriers.
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Affiliation(s)
- Rama S Ayyala
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rachel Young
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Meera Kotagal
- Department of Pediatric Surgery and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Holly Depinet
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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Ata NA, Trout AT, Dillman JR, Tkach JA, Ayyala RS. Technical and Diagnostic Performance of Rapid MRI for Evaluation of Appendicitis in a Pediatric Emergency Department. Acad Radiol 2024; 31:1102-1110. [PMID: 37863782 DOI: 10.1016/j.acra.2023.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/22/2023]
Abstract
RATIONALE AND OBJECTIVES Rationale MRI is increasingly used for diagnosis of pediatric appendicitis in the emergency care setting. Scan and room time are important to optimize workflow, especially in situations with limited MRI availability and accessibility. To describe our process to optimize and implement a rapid, non-contrast, free-breathing MRI protocol for appendicitis and to characterize the accuracy for diagnosis. MATERIALS AND METHODS Initial MRI protocol implemented for suspected appendicitis included five respiratory-triggered axial and coronal single shot fast spin echo (SSFSE) and radial T2W sequences with and without fat suppression (FS). This protocol was reassessed based on image quality. Subsequently, the coronal and axial T2W SSFSE FS sequence were removed. A three-sequence exam comprised the rapid MRI appendicitis protocol used for the remainder of the study. All examinations were performed on a 1.5 T scanner. For all examinations, the following information was obtained: scan time, diagnosis of appendicitis (by radiology report), surgery and pathology reports, and alternative diagnoses documented in radiology reports. MRI examination scan durations were compared between the five-sequence and three-sequence protocols, with Mann-Whitney U test, and proportions of false diagnoses were compared to Fisher's exact test. RESULTS 216 examinations were performed; 21 and 195 performed with five- and three-sequence protocol, respectively. The median duration of the five-sequence protocol was 20 (16.9-23.5) minutes vs.11 (9.5-13) minutes for the three sequence protocol (p < 0.0001). The majority (n = 157, 80.5% of 195) of examinations were performed in a goal time of< 15 min. 23 examinations took longer than 20 min (n = 12, n = 11 for the three- and five-sequence protocols, respectively) were due to repeat sequences or addition of non-standard sequences (requested by interpreting radiologist). 27 (90%) of the 30 reported positive cases were confirmed by pathology. There were three false-positive diagnoses (all three-sequence protocol exams) and one false-negative diagnosis (five-sequence protocol exam). Alternative diagnoses, including pancreatitis, omental infarct, masses, and ovarian pathology, were made in 42 (19%) cases. CONCLUSION A three-sequence, non-contrast, free- breathing MRI examination can be performed in less than 15 min in the emergency department and has high diagnostic accuracy for acute appendicitis in children and young adults.
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Affiliation(s)
- Nadeen Abu Ata
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.)
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (A.T.T.)
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.)
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.)
| | - Rama S Ayyala
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.).
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Serai SD, Franchi-Abella S, Syed AB, Tkach JA, Toso S, Ferraioli G. MR and Ultrasound Elastography for Fibrosis Assessment in Children: Practical Implementation and Supporting Evidence- AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024. [PMID: 38170833 DOI: 10.2214/ajr.23.30506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Quantitative MRI and ultrasound biomarkers of liver fibrosis have become important tools in the diagnosis and clinical management of children with chronic liver disease (CLD). In particular, MR elastography (MRE) is now routinely performed in clinical practice to evaluate the liver for fibrosis. Ultrasound shear-wave elastography has also become widely performed for this purpose, especially in young children. These noninvasive methods are increasingly used to replace liver biopsy for the diagnosis, quantitative staging, and treatment monitoring of patients with CLD. Although ultrasound has advantages of portability and lower equipment cost, available evidence indicates that MRI may have greater reliability and accuracy in liver fibrosis evaluation. In this AJR Expert Panel Narrative Review, we describe how, why, and when to use MRI- and ultrasound-based elastography methods for liver fibrosis assessment in children. Practical approaches are discussed for adapting and optimizing these methods in children, with consideration of clinical indications, patient preparation, equipment requirements, acquisition technique, as well as pitfalls and confounding factors. Guidance is provided for interpretation and reporting, and representative case examples are presented.
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Affiliation(s)
- Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia PA
| | - Stéphanie Franchi-Abella
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- AP-HP, Centre de Référence des maladies rares du foie de l'enfant, Service de radiologie pédiatrique diagnostique et interventionnelle, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- BIOMAPS UMR 9011 CNRS, Inserm, CEA, Orsay, France
| | - Ali B Syed
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Seema Toso
- Department of Pediatric Radiology, University Children's Hospital Geneva, 6 rue Willy Donzé, CH 1211, Genéve 14, Suisse
| | - Giovanna Ferraioli
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Medical School University of Pavia, Pavia 27100, Italy
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Liu RX, Li H, Towbin AJ, Ata NA, Smith EA, Tkach JA, Denson LA, He L, Dillman JR. Machine Learning Diagnosis of Small-Bowel Crohn Disease Using T2-Weighted MRI Radiomic and Clinical Data. AJR Am J Roentgenol 2024; 222:e2329812. [PMID: 37530398 DOI: 10.2214/ajr.23.29812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND. Radiologists have variable diagnostic performance and considerable interreader variability when interpreting MR enterography (MRE) examinations for suspected Crohn disease (CD). OBJECTIVE. The purposes of this study were to develop a machine learning method for predicting ileal CD by use of radiomic features of ileal wall and mesenteric fat from noncontrast T2-weighted MRI and to compare the performance of the method with that of expert radiologists. METHODS. This single-institution study included retrospectively identified patients who underwent MRE for suspected ileal CD from January 1, 2020, to January 31, 2021, and prospectively enrolled participants (patients with newly diagnosed ileal CD or healthy control participants) from December 2018 to October 2021. Using axial T2-weighted SSFSE images, a radiologist selected two slices showing greatest terminal ileal wall thickening. Four ROIs were segmented, and radiomic features were extracted from each ROI. After feature selection, support-vector machine models were trained to classify the presence of ileal CD. Three fellowship-trained pediatric abdominal radiologists independently classified the presence of ileal CD on SSFSE images. The reference standard was clinical diagnosis of ileal CD based on endoscopy and biopsy results. Radiomic-only, clinical-only, and radiomic-clinical ensemble models were trained and evaluated by nested cross-validation. RESULTS. The study included 135 participants (67 female, 68 male; mean age, 15.2 ± 3.2 years); 70 were diagnosed with ileal CD. The three radiologists had accuracies of 83.7% (113/135), 88.1% (119/135), and 86.7% (117/135) for diagnosing CD; consensus accuracy was 88.1%. Interradiologist agreement was substantial (κ = 0.78). The best-performing ROI was bowel core (AUC, 0.95; accuracy, 89.6%); other ROIs had worse performance (whole-bowel AUC, 0.86; fat-core AUC, 0.70; whole-fat AUC, 0.73). For the clinical-only model, AUC was 0.85 and accuracy was 80.0%. The ensemble model combining bowel-core radiomic and clinical models had AUC of 0.98 and accuracy of 93.5%. The bowel-core radiomic-only model had significantly greater accuracy than radiologist 1 (p = .009) and radiologist 2 (p = .02) but not radiologist 3 (p > .99) or the radiologists in consensus (p = .05). The ensemble model had greater accuracy than the radiologists in consensus (p = .02). CONCLUSION. A radiomic machine learning model predicted CD diagnosis with better performance than two of three expert radiologists. Model performance improved when radiomic data were ensembled with clinical data. CLINICAL IMPACT. Deployment of a radiomic-based model including T2-weighted MRI data could decrease interradiologist variability and increase diagnostic accuracy for pediatric CD.
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Affiliation(s)
- Richard X Liu
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Hailong Li
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Nadeen Abu Ata
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Ethan A Smith
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Lee A Denson
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lili He
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Pednekar A, Kocaoglu M, Wang H, Tanimoto A, Tkach JA, Lang S, Taylor MD. Accelerated Cine Cardiac MRI Using Deep Learning-Based Reconstruction: A Systematic Evaluation. J Magn Reson Imaging 2023. [PMID: 37855257 DOI: 10.1002/jmri.29081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Breath-holding (BH) for cine balanced steady state free precession (bSSFP) imaging is challenging for patients with impaired BH capacity. Deep learning-based reconstruction (DLR) of undersampled k-space promises to shorten BHs while preserving image quality and accuracy of ventricular assessment. PURPOSE To perform a systematic evaluation of DLR of cine bSSFP images from undersampled k-space over a range of acceleration factors. STUDY TYPE Retrospective. SUBJECTS Fifteen pectus excavatum patients (mean age 16.8 ± 5.4 years, 20% female) with normal cardiac anatomy and function and 12-second BH capability. FIELD STRENGTH/SEQUENCE 1.5-T, cine bSSFP. ASSESSMENT Retrospective DLR was conducted by applying compressed sensitivity encoding (C-SENSE) acceleration to systematically undersample fully sampled k-space cine bSSFP acquisition data over an acceleration/undersampling factor (R) considering a range of 2 to 8. Quality imperceptibility (QI) measures, including structural similarity index measure, were calculated using images reconstructed from fully sampled k-space as a reference. Image quality, including contrast and edge definition, was evaluated for diagnostic adequacy by three readers with varying levels of experience in cardiac MRI (>4 years, >18 years, and 1 year). Automated DL-based biventricular segmentation was performed commercially available software by cardiac radiologists with more than 4 years of experience. STATISTICAL TESTS Tukey box plots, linear mixed effects model, analysis of variance (ANOVA), weighted kappa, Kruskal-Wallis test, and Wilcoxon signed-rank test were employed as appropriate. A P-value <0.05 was considered statistically significant. RESULTS There was a significant decrease in the QI values and edge definition scores as R increased. Diagnostically adequate image quality was observed up to R = 5. The effect of R on all biventricular volumetric indices was non-significant (P = 0.447). DATA CONCLUSION The biventricular volumetric indices obtained from the reconstruction of fully sampled cine bSSFP acquisitions and DLR of the same k-space data undersampled by C-SENSE up to R = 5 may be comparable. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Amol Pednekar
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Murat Kocaoglu
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Hui Wang
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- MR Clinical Science, Philips Healthcare, Cincinnati, Ohio, USA
| | - Aki Tanimoto
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sean Lang
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Michael D Taylor
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Betz LH, Dillman JR, Towbin AJ, Anton CG, Chavhan GB, Crotty EJ, Morin CE, Pace E, Sreedher G, Zhang B, Tkach JA. Respiratory-Triggered Flow-Independent Noncontrast Non-ECG-Gated MRV (REACT) Versus CE-MRV for Central Venous Evaluation in Children and Young Adults: A Six-Reader Study. AJR Am J Roentgenol 2023; 221:240-248. [PMID: 36946900 DOI: 10.2214/ajr.22.28893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND. Contrast-enhanced MRI is commonly used to evaluate thoracic central venous patency in children and young adults. A flow-independent noncontrast non-ECG-gated 3D MRA-MR venography (MRV) technique described in 2019 as "relaxation-enhanced angiography without contrast and triggering (REACT)" may facilitate such evaluation. OBJECTIVE. The purpose of our study was to compare image quality, diagnostic confidence, and interreader agreement between respiratory-triggered REACT and 3D Dixon-based contrast-enhanced MRV (CE-MRV) for evaluating thoracic central venous patency in children and young adults. METHODS. This retrospective study included 42 consecutive children and young adults who underwent MRI of the neck and chest to evaluate central venous patency between August 2019 and January 2021 (median age, 5.2 years; IQR, 1.4-15.1 years; 22 female patients and 20 male patients). Examinations included respiratory-triggered REACT and navigator-gated CE-MRV sequences based on the institution's standard-of-care protocol. Six pediatric radiologists from four different institutions independently reviewed REACT and CE-MRV sequences; they assessed overall image quality (scale, 1-5; 5 = excellent), diagnostic confidence (scale, 1-5; 5 = extremely confident), and presence of clinically relevant artifact(s). Readers classified seven major central vessels as normal or abnormal (e.g., narrowing, thrombosis, or occlusion). Analysis used Wilcoxon signed rank and McNemar tests and Fleiss kappa coefficients. RESULTS. The distribution of overall image quality scores was higher (p = .02) for REACT than for CE-MRV for one reader (both sequences: median score, 5). Image quality scores were not significantly different between the sequences for the remaining five readers (all p > .05). Diagnostic confidence scores and frequency of clinically relevant artifact(s) were not significantly different between sequences for any reader (all p > .05). Interreader agreement for vessel classification as normal or abnormal was similar between sequences for all seven vessels (REACT: κ = 0.37-0.81; CE-MRV: κ = 0.34-0.81). Pooling readers and vessels, 65.4% of vessels were normal by both sequences; 18.7%, abnormal by both sequences; 9.8%, abnormal by REACT only; and 6.1%, abnormal by CE-MRV only. CONCLUSION. Respiratory-triggered REACT, in comparison with CE-MRV, showed no significant difference in image quality (aside from for one of six readers), diagnostic confidence, or frequency of artifact(s), with similar interreader agreement for vessel classification as normal or abnormal. CLINICAL IMPACT. High-resolution 3D MRV performed without IV contrast material can be used to assess central venous patency in children and young adults.
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Affiliation(s)
- Lisa H Betz
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Christopher G Anton
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Eric J Crotty
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Erika Pace
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, England
| | | | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
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Betz LH, Dillman JR, Jones BV, Tkach JA. MRI safety screening of children with implants: updates and challenges. Pediatr Radiol 2023; 53:1454-1468. [PMID: 37079039 DOI: 10.1007/s00247-023-05651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 04/21/2023]
Abstract
MRI is the imaging modality of choice for assessing many pediatric medical conditions. Although there are several inherent potential safety risks associated with the electromagnetic fields exploited for MRI, they are effectively mitigated through strict adherence to established MRI safety practices, enabling the safe and effective use of MRI in clinical practice. The potential hazards of the MRI environment may be exacerbated by/in the presence of implanted medical devices. Awareness of the unique MRI safety and screening challenges associated with these implanted devices is critical to ensuring MRI safety for the affected patients. In this review article, we will discuss the basics of MRI physics as they relate to MRI safety in the presence of implanted medical devices, strategies for assessing children with known or suspected implanted medical devices, and the particular management of several well-established common, as well as recently developed, implanted devices encountered at our institution.
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Affiliation(s)
- Lisa H Betz
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH, 45229, USA.
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Blaise V Jones
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Dillman JR, Ata NA, Towbin AJ, Anton CG, Smith EA, Zhang B, Imbus R, Tkach JA, Denson LA. The Simplified MR Index of Activity Score in Pediatric Small-Bowel Crohn Disease: An Interreader Agreement and Responsiveness Study. AJR Am J Roentgenol 2023; 220:126-133. [PMID: 35946860 PMCID: PMC10894589 DOI: 10.2214/ajr.22.28123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND. The simplified MR index of activity (MaRIA) score is used to assess the severity of small-bowel inflammation without use of IV contrast material. OBJECTIVE. The purposes of this study were to assess interreader agreement on the use of simplified MaRIA scores for evaluation of the inflammatory activity of terminal ileal Crohn disease in children and young adults and to assess whether simplified MaRIA scores change after biologic medical therapy. METHODS. This analysis was ancillary to a previously reported primary prospective research investigation. The study included 20 children and young adults with newly diagnosed ileal Crohn disease and 15 healthy control participants who underwent research small-bowel MRI examinations between December 2018 and October 2021. The participants with Crohn disease underwent baseline MRI and MRI 6 weeks and 6 months after beginning anti-tumor necrosis factor α-treatment as well as weighted pediatric Crohn disease activity index (wPCDAI) and C-reactive protein (CRP) assessment on the day of each examination. Control participants underwent one MRI examination. Four pediatric radiologists independently assigned simplified MaRIA scores using axial and coronal T2-weighted SSFSE images. Median simplified MaRIA score among readers was computed. Interreader agreement was assessed with Fleiss kappa coefficients and intra-class correlation coefficient (ICC). Analysis included the Mann-Whitney U test, Friedman test, and Spearman rank correlation. RESULTS. Simplified MaRIA scores (across time points and study groups) had substantial interreader agreement (κ = 0.65 [95% CI, 0.56-0.74]; ICC, 0.71 [95% CI, 0.63-0.78]). Median scores were higher in participants with Crohn disease at baseline than in healthy control participants (3.5 [IQR, 2.5-4.9] vs 0.5 [IQR, 0-2.0]; p < .001). Scores decreased after medical treatment in participants with Crohn disease (p = .005). The median score was 3.5 (IQR, 2.5-4.9) at baseline, 2.3 (IQR, 1.6-3.9) at 6 weeks, and 2.0 (IQR, 0.5-2.5) at 6 months. In participants with Crohn disease, median scores had significant correlations with wPCDAI (ρ = 0.46 [95% CI, 0.18-0.64]; p < .001) and CRP level (ρ = 0.48 [95% CI, 0.27-0.65]; p < .001). CONCLUSION. Radiologists had substantial agreement in use of simplified MaRIA scores to assess intestinal inflammation in ileal Crohn disease. Scores changed over time after medical therapy. CLINICAL IMPACT. The results support the simplified MaRIA score as an objective MRI-based clinical measure of intestinal inflammation in children and young adults with Crohn disease.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45244
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Nadeen Abu Ata
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45244
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45244
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Christopher G Anton
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45244
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Ethan A Smith
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45244
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rebecca Imbus
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45244
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45244
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Lee A Denson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital, Cincinnati, OH
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9
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Nasomyont N, Meisman AR, Ecklund K, Vajapeyam S, Cecil KM, Tkach JA, Altaye M, Corathers SD, Conard LA, Kalkwarf HJ, Dolan LM, Gordon CM. Changes in Bone Marrow Adipose Tissue in Transgender and Gender Non-Conforming Youth Undergoing Pubertal Suppression: A Pilot Study. J Clin Densitom 2022; 25:485-489. [PMID: 36064698 PMCID: PMC9669162 DOI: 10.1016/j.jocd.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022]
Abstract
Pubertal suppression with gonadotropin-releasing hormone (GnRH) agonists in transgender and gender non-conforming (TGNC) youth may affect acquisition of peak bone mass. Bone marrow adipose tissue (BMAT) has an inverse relationship with bone mineral density (BMD). To evaluate the effect of pubertal suppression on BMAT, in this pilot study we prospectively studied TGNC youth undergoing pubertal suppression and cisgender control participants with similar pubertal status over a 12-month period. BMD was measured by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. Magnetic Resonance T1 relaxometry (T1-R) and spectroscopy (MRS) were performed to quantify BMAT at the distal femur. We compared the change in BMD, T1-R values, and MRS lipid indices between the two groups. Six TGNC (two assigned female and four assigned male at birth) and three female control participants (mean age 10.9 and 11.7 years, respectively) were enrolled. The mean lumbar spine BMD Z-score declined by 0.29 in the TGNC group, but increased by 0.48 in controls (between-group difference 0.77, 95% CI: 0.05, 1.45). Similar findings were observed with the change in trabecular volumetric BMD at the 3% tibia site (-4.1% in TGNC, +3.2% in controls, between-group difference 7.3%, 95% CI: 0.5%-14%). Distal femur T1 values declined (indicative of increased BMAT) by 7.9% in the TGNC group, but increased by 2.1% in controls (between-group difference 10%, 95% CI: -12.7%, 32.6%). Marrow lipid fraction by MRS increased by 8.4% in the TGNC group, but declined by 0.1% in controls (between-group difference 8.5%, 95% CI: -50.2%, 33.0%). In conclusion, we observed lower bone mass acquisition and greater increases in BMAT indices by MRI and MRS in TGNC youth after 12 months of GnRH agonists compared with control participants. Early changes in BMAT may underlie an alteration in bone mass acquisition with pubertal suppression, including alterations in mesenchymal stem cells within marrow.
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Affiliation(s)
- Nat Nasomyont
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
| | - Andrea R Meisman
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Kirsten Ecklund
- Department of Radiology, Boston Children's Hospital, Boston, MA, United States
| | - Sridhar Vajapeyam
- Department of Radiology, Boston Children's Hospital, Boston, MA, United States
| | - Kim M Cecil
- Department of Radiology, Cincinnati Children's Hospital Medical Center and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Sarah D Corathers
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Lee Ann Conard
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Heidi J Kalkwarf
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Lawrence M Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Catherine M Gordon
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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10
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Dillman JR, Tkach JA, Imbus R, Towbin AJ, Denson LA. MRI-Based Characterization of Intestinal Motility in Children and Young Adults With Newly Diagnosed Ileal Crohn Disease Treated by Biologic Therapy: A Controlled Prospective Study. AJR Am J Roentgenol 2022; 219:655-664. [PMID: 35544371 PMCID: PMC10938237 DOI: 10.2214/ajr.22.27792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. Changes in intestinal motility in patients with newly diagnosed Crohn disease have historically been evaluated primarily in a subjective manner. OBJECTIVE. The purpose of this study was to assess longitudinal changes in objective intestinal motility scores in children and young adults with newly diagnosed ileal Crohn disease treated with biologic (anti-tumor necrosis factor-α) medical therapy compared with those in control participants. METHODS. This prospective study included 20 children and young adults (eight female and 12 male patients; mean age, 14.6 ± 2.1 [SD] years) with newly diagnosed ileal Crohn disease who were recruited between December 2018 and October 2021 as well as 15 control participants without any known gastrointestinal conditions (eight female and seven male patients; mean age, 18.1 ± 4.4 years). All participants underwent research MRI examinations of the small bowel, including dynamic cine 2D SSFP sequences. Patients with Crohn disease underwent additional research MRI examinations performed at both 6 weeks and 6 months after initiation of biologic therapy. Two operators independently derived terminal ileal intestinal motility scores from the dynamic cine sequences by use of FDA-approved software (with higher scores indicating greater intestinal motility). Intestinal motility scores were compared between patient and control groups by use of t tests, whereas changes in intestinal motility scores after treatment were assessed using linear mixed models. Interoperator absolute agreement was assessed using the intra-class correlation coefficient (ICC). RESULTS. Mean terminal ileal intestinal motility scores were not significantly different between patients with newly diagnosed ileal Crohn disease and control participants (for operator 1, 180.9 ± 63.3 vs 229.7 ± 115.2, respectively [p = .12]; for operator 2, 175.0 ± 62.2 vs 236.4 ± 117.4, respectively [p = .05]). Mean intestinal motility scores changed over time compared with baseline in response to biologic therapy, for operator 1 (180.9 ± 63.3 at baseline, 248.1 ± 104.9 at 6 weeks after treatment initiation, and 249.1 ± 73.2 at 6 months after treatment initiation [p = .04]) and operator 2 (175.0 ± 62.2 at baseline, 247.8 ± 112.7 at 6 weeks after treatment initiation, and 239.6 ± 72.7 at 6 months after treatment initiation [p = .03]). Absolute agreement in intestinal motility scores was excellent between operators (ICC = 0.89). CONCLUSION. MRI measurements of intestinal motility are dynamic in children and adults with newly diagnosed small-bowel Crohn disease, showing early increases in response to biologic therapy. CLINICAL IMPACT. MRI-based intestinal motility scores may aid individualized assessment of disease activity and treatment response in patients with small-bowel Crohn disease.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rebecca Imbus
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Lee A Denson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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11
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Dillman JR, Tkach JA, Pedneker A, Trout AT. Quantitative abdominal magnetic resonance imaging in children-special considerations. Abdom Radiol (NY) 2022; 47:3069-3077. [PMID: 34196762 DOI: 10.1007/s00261-021-03191-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 01/18/2023]
Abstract
The use of quantitative MRI methods for assessment of the abdomen in children has become commonplace over the past decade. Increasingly employed methods include MR elastography, chemical shift encoded (CSE) MR imaging for determination of proton density fat fraction, diffusion-weighted imaging, and a variety of relaxometry techniques, such as T1 and T2* mapping. These techniques can be used in a variety of settings to distinguish normal from abnormal tissue as well as determine the severity of disease. The performance of quantitative MRI methods in the pediatric population presents unique challenges as compared to adult populations. These challenges relate to multiple factors, including patient size, pediatric physiology, inability to breath hold, and greater physical motion during the examination. The purpose of this review article is to review quantitative MRI methods that may be used in clinical practice to assess the pediatric abdomen and to discuss special considerations when performing these techniques in children.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amol Pedneker
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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12
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Alves VPV, Dillman JR, Tkach JA, Bennett PS, Xanthakos SA, Trout AT. Comparison of Quantitative Liver US and MRI in Patients with Liver Disease. Radiology 2022; 304:660-669. [PMID: 35608446 DOI: 10.1148/radiol.212995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Quantitative US techniques can be used to identify changes of liver disease, but data regarding their diagnostic performance and relationship to MRI measures are sparse. Purpose To define associations between quantitative US and MRI measures of the liver in children, adolescents, and young adults with liver disease and to define the predictive ability of quantitative US measures to detect abnormal liver stiffening and steatosis defined with MRI. Materials and Methods In this prospective study, consecutive patients aged 8-21 years and known to have or suspected of having liver disease and body mass index less than 35 kg/m2 underwent 1.5-T MRI and quantitative liver US during the same visit at a pediatric academic medical center between April 2018 and December 2020. Acquired US parameters included shear-wave speed (SWS) and attenuation coefficient, among others. US parameters were compared with liver MR elastography and liver MRI proton density fat fraction (PDFF). Pearson correlation, multiple logistic regression, and receiver operating characteristic curve analyses were performed to assess associations and determine the performance of US relative to that of MRI. Results A total of 44 study participants (mean age, 16 years ± 4 [SD]; age range, 8-21 years; 23 male participants) were evaluated. There was a positive correlation between US SWS and MR elastography stiffness (r = 0.73, P < .001). US attenuation was positively correlated with MRI PDFF (r = 0.45, P = .001). For the prediction of abnormal (>2.8 kPa) liver shear stiffness, SWS (1.56 m/sec [7.3 kPa] cutoff) had an area under the receiver operating characteristic curve (AUC) of 0.95 with 91% sensitivity (95% CI: 71, 99) (20 of 22 participants) and 95% specificity (95% CI: 76, 99) (20 of 21 participants). For the prediction of abnormal (>5%) liver PDFF, US attenuation (0.55 dB/cm/MHz cutoff) had an AUC of 0.75 with a sensitivity of 73% (95% CI: 39, 94) (eight of 11 participants) and a specificity of 73% (95% CI: 55, 86) (24 of 33 participants). Conclusion In children, adolescents, and young adults with known or suspected liver disease, there was moderate to high correlation between US shear-wave speed (SWS) and MR elastography-derived stiffness. US SWS predicted an abnormal liver shear stiffness with high performance. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Khanna and Alazraki in this issue.
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Affiliation(s)
- Vinicius P V Alves
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan R Dillman
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jean A Tkach
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Paula S Bennett
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stavra A Xanthakos
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew T Trout
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
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13
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Dillman JR, Benoit SW, Gandhi DB, Trout AT, Tkach JA, VandenHeuvel K, Devarajan P. Multiparametric quantitative renal MRI in children and young adults: comparison between healthy individuals and patients with chronic kidney disease. Abdom Radiol (NY) 2022; 47:1840-1852. [PMID: 35237897 DOI: 10.1007/s00261-022-03456-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Multiparametric quantitative renal MRI may provide noninvasive radiologic biomarkers of chronic kidney disease (CKD) based on investigations in animal models and adults. We aimed to (1) obtain normative multiparametric quantitative MRI data from the kidneys of healthy children and young adults, (2) compare MRI measurements between healthy control participants and patients with CKD, and (3) determine if MRI measurements correlate with clinical and laboratory data as well as histology. METHODS This was a prospective, case-control study of 20 healthy controls and 12 CKD patients who underwent percutaneous renal biopsy ranging from 12 to 23 years of age between October 2018 and March 2020. Kidney function was documented and pathology assessed for fibrosis/inflammation. Utilizing a field strength of 1.5T, we examined renal T1, T2, and T2* relaxation mapping, MR elastography (MRE), and diffusion-weighted imaging (DWI). A single analyst made all manual measurements for quantitative MRI pulse sequences. Independent measurements from cortex, medulla, and whole kidney were obtained by drawing regions of interest on single slices from the upper, mid, and lower kidney. A weighted average was calculated for each kidney; if two kidneys, the right and left were averaged. Continuous variables were compared with Mann-Whitney U test; bivariate relationships were assessed using Spearman rank-order correlation. RESULTS Median estimated glomerular filtration rate (eGFR) was 112.3 ml/min/1.73 m2 in controls (n = 20, 10 females) and 55.0 ml/min/m2 in CKD patients (n = 12, 2 females) (p < 0.0001). Whole kidney (1333 vs. 1291 ms; p = 0.018) and cortical (1212 vs 1137 ms; p < 0.0001) T1 values were higher in CKD patients. Cortical T1 values correlated with eGFR (rho = - 0.62; p = 0.0003) and cystatin C (rho = 0.58; p = 0.0007). Whole kidney (1.87 vs. 2.02 10-3 mm2/s; p = 0.007), cortical (1.89 vs. 2.04 10-3 mm2/s; p = 0.008), and medullary (1.87 vs. 1.98 10-3 mm2/s; p = 0.0095) DWI apparent diffusion coefficients (ADC) were lower in CKD patients. Whole kidney ADC correlated with eGFR (rho = 0.45; p = 0.012) and cystatin C (rho = - 0.46; p = 0.009). Cortical histologic inflammation correlated with DWI ADC (rho = - 0.71; p = 0.011). CONCLUSION Renal T1 relaxation and DWI ADC measurements differ between pediatric healthy controls and CKD patients, correlate with laboratory markers of CKD, and may have histologic correlates.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Stefanie W Benoit
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Deep B Gandhi
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katherine VandenHeuvel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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14
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Pednekar A, Gandhi D, Wang H, Tkach JA, Trout AT, Dillman JR. Performance of C-SENSE Accelerated Rapid Liver Shear Stiffness Measurement Using Displacement Wave Polarity-Inversion Motion Encoding: An Evaluation Study. J Magn Reson Imaging 2022; 56:754-765. [PMID: 35089614 DOI: 10.1002/jmri.28078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Liver shear stiffness measurement using magnetic resonance elastography (MRE) aids in the noninvasive diagnosis and staging of liver fibrosis. Inadequate breath-holds can lead to inaccurate stiffness estimation and/or failed MRE exams. PURPOSE To prospectively evaluate the performance of compressed sensitivity encoding (C-SENSE) accelerated rapid MRE measurement of liver shear stiffness using displacement wave polarity-inversion motion encoding. STUDY TYPE Retrospective. SUBJECTS Eleven with liver disease and 10 asymptomatic subjects. FIELD STRENGTH/SEQUENCE 1.5 T; gradient-recalled-echo (GRE) MRE. ASSESSMENT All participants underwent: 1) two-dimensional (2D) GRE MRE with inflow saturation using SENSE acceleration factor (R) of 2 (standard of care [SC]); 2) 2D rapid MRE with (RwS); and 3) without (RnS) inflow saturation using C-SENSE R = 3; and 4) spatial three-dimensional (3D) rapid MRE with inflow saturation (R3D) using C-SENSE R = 4; with nominally identical spatial resolution and coverage. Image analyst (D.G., 2 years of experience) drew identical and maximal regions of interest (ROIs) in right hepatic lobe. STATISTICAL TESTS Linear regression, intra-class correlation coefficients (ICC), Bland-Altman analyses, and the Wilcoxon signed-rank test were used to assess consistency and agreement of liver stiffness measurements for manually drawn identical and maximal ROIs. RESULTS In 21 participants (37 ± 14 years) with liver stiffness (2.3 ± 0.7 kPa), body mass index (BMI 27 ± 7 kg/m2 ), proton density fat fraction (PDFF 9 ± 9%), and T2 * (27 ± 4 msec); rapid MRE sequences showed excellent agreement (ICC > 0.95) with SC MRE and no correlation (r2 < 0.1) of the differences (mean difference <0.2 kPa, <6%; limits of agreement <0.4 kPa, <16%) with BMI, PDFF, and T2 *. Breath-hold times were: 14 seconds (SC), 5 seconds (RnS), 7 seconds (RwS) per slice, and 16 seconds for the R3D acquisition. DATA CONCLUSIONS C-SENSE accelerated GRE MRE sequences, using displacement wave polarity-inversion motion encoding, produce equivalent measurements of liver stiffness and have potential clinical benefit in patients with limited breath-holding capacity. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Amol Pednekar
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Deep Gandhi
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Hui Wang
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,MR Clinical Science, Philips, Cincinnati, Ohio, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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15
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Mukthapuram S, Beebe J, Tkach JA, Arya S, Haberman B, Peiro J, Lim FY, Woods JC, Kingma PS. Magnetic Resonance Imaging Assessment of Pulmonary Vascularity in Infants with Congenital Diaphragmatic Hernia: A Novel Tool for Direct Assessment of Severity of Pulmonary Hypertension and Hypoplasia. J Pediatr 2021; 239:89-94. [PMID: 34339729 DOI: 10.1016/j.jpeds.2021.07.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the feasibility of magnetic resonance imaging (MRI) for postnatal assessment of pulmonary vascularity in infants with congenital diaphragmatic hernia (CDH). STUDY DESIGN Infants with prenatally diagnosed CDH (n = 24) received postnatal pulmonary MRI. Infants with nonpulmonary birth defects served as controls (n = 5). Semiautomatic segmentation was performed to obtain total vascular volume using time of flight images to assess vascularity. RESULTS Average vascular density (vascular volume/lung volume) in control infants was 0.23 ± 0.06 mm3/mm3 compared with 0.18 ± 0.06 mm3/mm3 in infants with CDH is (P = .09). When stratified further based on CDH severity, the difference between control infants and moderate CDH group was statistically significant. (0.23 mm3/mm3 vs 0.15 mm3/mm3, P = .01). Ipsilateral vascular density on MRI in infants with CDH significantly correlated with the prenatal pulmonary hypertensive index (P = .0004, Spearman R = +0.87) and with number of days on mechanical ventilation (P = .04, Spearman R = -0.44), total days on inhaled nitric oxide (P = .02, Spearman R = -0.47), use of epoprostenol for acute pulmonary hypertension (PH) (0.14 mm3/mm3 vs 0.20 mm3/mm3, P = .005), and use of sildenafil for chronic PH (0.15 mm3/mm3 vs 0.19 mm3/mm3, P = .03). CONCLUSIONS Our results suggest that postnatal pulmonary vascularity assessed by MRI strongly correlates with prenatal and postnatal markers of PH severity and that pulmonary vascularity may serve as a direct measure of pulmonary vascular hypoplasia in infants with CDH.
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Affiliation(s)
- Shanmukha Mukthapuram
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jessica Beebe
- Department of Physiology and Biophysics, Case Western Reserve School of Medicine, Cleveland, OH
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Shreyas Arya
- Department of Newborn Medicine, Dayton Children's Hospital, Dayton, OH
| | - Beth Haberman
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jose Peiro
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Foong-Yen Lim
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jason C Woods
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Paul S Kingma
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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16
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Trout AT, Tkach JA. Editorial for "Quality Control of MR Elastography Using Percent Measurable Liver Volume Estimation". J Magn Reson Imaging 2021; 55:1900-1901. [PMID: 34713945 DOI: 10.1002/jmri.27974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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17
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Kocaoglu M, Pednekar A, Tkach JA, Taylor MD. Quantitative assessment of velocity and flow using compressed SENSE in children and young adults with adequate acquired temporal resolution. J Cardiovasc Magn Reson 2021; 23:113. [PMID: 34663351 PMCID: PMC8522244 DOI: 10.1186/s12968-021-00811-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Phase contrast (PC) cardiovascular magnetic resonance (CMR) imaging with parallel imaging acceleration is established and validated for measuring velocity and flow. However, additional acceleration to further shorten acquisition times would be beneficial in patients with complex vasculature who need multiple PC-CMR measurements, especially pediatric patients with higher heart rates. METHODS PC-CMR images acquired with compressed sensitivity encoding (C-SENSE) factors of 3 to 6 and standard of care PC-CMR with sensitivity encoding (SENSE) factor of 2 (S2) acquired as part of clinical CMR examinations performed between November 2020 and January 2021 were analyzed retrospectively. The velocity and flow through the ascending aorta (AAo), descending aorta (DAo), and superior vena cava (SVC) in a transverse plane at the level of pulmonary artery bifurcation were compared. Additionally, frequency power distribution and dynamic time warp distance were calculated for these acquisitions. To further validate the adequate temporal resolution requirement, patients with S2 PC-CMR in the same acquisition plane were added in frequency power distribution analysis. RESULTS Twenty-eight patients (25 males; 15.9 ± 1.9 years; body surface area (BSA) 1.7 ± 0.2 m2; heart rate 81 ± 16 bpm) underwent all five PC-CMR acquisitions during the study period. An additional 22 patients (16 males; 17.5 ± 7.7 years; BSA 1.6 ± 0.5 m2; heart rate 91 ± 16 bpm) were included for frequency power spectrum analysis. As expected, scan time decreased with increasing C-SENSE acceleration factor = 3 (37.5 ± 6.5 s, 26.4 ± 7.6%), 4 (28.1 ± 4.9 s, 44.7 ± 5.6%), 5 (21.6 ± 3.6 s, 57.6 ± 4.4%), and 6 (19.1 ± 3.2 s, 62.3 ± 4.2%) relative to SENSE = 2 (51.3 ± 10.1 s) PC-CMR acquisition. Mean peak velocity, net flow, and cardiac output were comparable (p > 0.87) between the five PC-CMR acquisitions with mean differences less than < 4%, < 2%, and < 3% respectively. All individual blood vessels showed a non-significant dependence of difference in fmax99 (< 4 Hz, p > 0.2), and dynamic time warp distance (p > 0.3) on the C-SENSE acceleration factor used. There was a strongly correlated (r = 0.74) increase in fmax99 (10.5 ± 2.2, range: 7.1-16.4 Hz) with increasing heart rate. The computed minimum required cardiac phase number was 15 ± 2.0 (range: 11-20) over the heart rate of 86 ± 15 bpm (range: 58-113 bpm). CONCLUSIONS Stroke volume, cardiac output, and mean peak velocity measurements using PC-CMR with C-SENSE of up to 6 agree with measurements by standard of care PC-CMR with SENSE = 2 and resulted in up to a 65% reduction in acquisition time. Adequate temporal sampling can be ensured by acquiring 20 cardiac phases throughout the entire cardiac cycle over a wide range of pediatric and young adult heart rates.
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Affiliation(s)
- Murat Kocaoglu
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, S1.533, 3333 Burnet Ave, Cincinnati, OH 45229 USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Amol Pednekar
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, S1.533, 3333 Burnet Ave, Cincinnati, OH 45229 USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Jean A. Tkach
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, S1.533, 3333 Burnet Ave, Cincinnati, OH 45229 USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Michael D. Taylor
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
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18
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Lindquist DM, Dillman JR, Tkach JA. Editorial for "Hepatic Iron Quantification Using a Free-Breathing 3D Radial Gradient Echo Technique and Validation with a 2D Biopsy-Calibrated R2* Relaxometry Method". J Magn Reson Imaging 2021; 55:1417-1418. [PMID: 34523184 DOI: 10.1002/jmri.27904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/18/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Diana M Lindquist
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jonathan R Dillman
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jean A Tkach
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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19
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Merhar SL, Kline JE, Braimah A, Kline-Fath BM, Tkach JA, Altaye M, He L, Parikh NA. Prenatal opioid exposure is associated with smaller brain volumes in multiple regions. Pediatr Res 2021; 90:397-402. [PMID: 33177677 PMCID: PMC8110593 DOI: 10.1038/s41390-020-01265-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND The impact of prenatal opioid exposure on brain development remains poorly understood. METHODS We conducted a prospective study of term-born infants with and without prenatal opioid exposure. Structural brain MRI was performed between 40 and 48 weeks postmenstrual age. T2-weighted images were processed using the Developing Human Connectome Project structural pipeline. We compared 63 relative regional brain volumes between groups. RESULTS Twenty-nine infants with prenatal opioid exposure and 42 unexposed controls were included. The groups had similar demographics, except exposed infants had lower birth weights, more maternal smoking and maternal Hepatitis C, fewer mothers with a college degree, and were more likely non-Hispanic White. After controlling for sex, postmenstrual age at scan, birth weight, and maternal education, exposed infants had significantly smaller relative volumes of the deep gray matter, bilateral thalamic ventrolateral nuclei, bilateral insular white matter, bilateral subthalamic nuclei, brainstem, and cerebrospinal fluid. Exposed infants had larger relative volumes of the right cingulate gyrus white matter and left occipital lobe white matter. CONCLUSIONS Infants with prenatal opioid exposure had smaller brain volumes in multiple regions compared to controls, with two regions larger in the opioid-exposed group. Further research should focus on the relative contributions of maternal opioids and other exposures. IMPACT Prenatal opioid exposure is associated with developmental and behavioral consequences, but the direct effects of opioids on the developing human brain are poorly understood. Prior small studies using MRI have shown smaller regional brain volumes in opioid-exposed infants and children. After controlling for covariates, infants with prenatal opioid exposure scanned at 40-48 weeks postmenstrual age had smaller brain volumes in multiple regions compared to controls, with two regions larger in the opioid-exposed group. This adds to the literature showing potential impact of prenatal opioid exposure on the developing brain.
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Affiliation(s)
- Stephanie L Merhar
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
| | - Julia E Kline
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Adebayo Braimah
- Imaging Research Center, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Beth M Kline-Fath
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Lili He
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Nehal A Parikh
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
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20
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Merhar SL, Kline JE, Braimah A, Kline-Fath BM, Tkach JA, Altaye M, He L, Parikh NA. Correction: Prenatal opioid exposure is associated with smaller brain volumes in multiple regions. Pediatr Res 2021; 90:493. [PMID: 33293683 DOI: 10.1038/s41390-020-01297-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Stephanie L Merhar
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH, USA. .,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
| | - Julia E Kline
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Adebayo Braimah
- Imaging Research Center, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Beth M Kline-Fath
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Lili He
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Nehal A Parikh
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
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21
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Gandhi DB, Pednekar A, Braimah AB, Dudley J, Tkach JA, Trout AT, Miethke AG, Franck MD, Heilman JA, Dzyubak B, Lake DS, Dillman JR. Assessment of agreement between manual and automated processing of liver MR elastography for shear stiffness estimation in children and young adults with autoimmune liver disease. Abdom Radiol (NY) 2021; 46:3927-3934. [PMID: 33811261 DOI: 10.1007/s00261-021-03073-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare automated versus standard of care manual processing of 2D gradient recalled echo (GRE) liver MR Elastography (MRE) in children and young adults. MATERIALS AND METHODS 2D GRE liver MRE data from research liver MRI examinations performed as part of an autoimmune liver disease registry between March 2017 and March 2020 were analyzed retrospectively. All liver MRE data were acquired at 1.5 T with 60 Hz mechanical vibration frequency. For manual processing, two independent readers (R1, R2) traced regions of interest on scanner generated shear stiffness maps. Automated processing was performed using MREplus+ (Resoundant Inc.) using 90% (A90) and 95% (A95) confidence masks. Agreement was evaluated using intra-class correlation coefficients (ICC) and Bland-Altman analyses. Classification performance was evaluated using receiver operating characteristic curve (ROC) analyses. RESULTS In 65 patients with mean age of 15.5 ± 3.8 years (range 8-23 years; 35 males) median liver shear stiffness was 2.99 kPa (mean 3.55 ± 1.69 kPa). Inter-reader agreement for manual processing was very strong (ICC = 0.99, mean bias = 0.01 kPa [95% limits of agreement (LoA): - 0.41 to 0.44 kPa]). Correlation between manual and A95 automated processing was very strong (R1: ICC = 0.988, mean bias = 0.13 kPa [95% LoA: - 0.40 to 0.68 kPa]; R2: ICC = 0.987, mean bias = 0.13 kPa [95% LoA: - 0.44 to 0.69 kPa]). Automated measurements were perfectly replicable (ICC = 1.0; mean bias = 0 kPa). CONCLUSION Liver shear stiffness values obtained using automated processing showed excellent agreement with manual processing. Automated processing of liver MRE was perfectly replicable.
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Affiliation(s)
- Deep B Gandhi
- Department of Radiology, Imaging Research Center (IRC), Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Amol Pednekar
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Imaging Research Center, 3333 Burnet Avenue, Suite S1.533, Cincinnati, OH, 45229, USA.
| | - Adebayo B Braimah
- Department of Radiology, Imaging Research Center (IRC), Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Jonathan Dudley
- Department of Radiology, Imaging Research Center (IRC), Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alexander G Miethke
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Hepatology, Gastroenterology and Nutrition, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Marnix D Franck
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Radboud University, Nijmegen, The Netherlands
| | | | - Bogdan Dzyubak
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - David S Lake
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Jonathan R Dillman
- Department of Radiology, Imaging Research Center (IRC), Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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22
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Merhar SL, Jiang W, Parikh NA, Yin W, Zhou Z, Tkach JA, Wang L, Kline-Fath BM, He L, Braimah A, Vannest J, Lin W. Effects of prenatal opioid exposure on functional networks in infancy. Dev Cogn Neurosci 2021; 51:100996. [PMID: 34388637 PMCID: PMC8363826 DOI: 10.1016/j.dcn.2021.100996] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 11/20/2022] Open
Abstract
Prenatal opioid exposure has been linked to altered neurodevelopment and visual problems such as strabismus and nystagmus. The neural substrate underlying these alterations is unclear. Resting-state functional connectivity MRI (rsfMRI) is an advanced and well-established technique to evaluate brain networks. Few studies have examined the effects of prenatal opioid exposure on resting-state network connectivity in infancy. In this pilot study, we characterized network connectivity in opioid-exposed infants (n = 19) and controls (n = 20) between 4–8 weeks of age using both a whole-brain connectomic approach and a seed-based approach. Prenatal opioid exposure was associated with differences in distribution of betweenness centrality and connection length, with positive connections unique to each group significantly longer than common connections. The unique connections in the opioid-exposed group were more often inter-network connections while unique connections in controls and connections common to both groups were more often intra-network. The opioid-exposed group had smaller network volumes particularly in the primary visual network, but similar network strength as controls. Network topologies as determined by dice similarity index were different between groups, particularly in visual and executive control networks. These results may provide insight into the neural basis for the developmental and visual problems associated with prenatal opioid exposure.
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Affiliation(s)
- Stephanie L Merhar
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital and University of Cincinnati, Department of Pediatrics, Cincinnati, OH, USA.
| | - Weixiong Jiang
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nehal A Parikh
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital and University of Cincinnati, Department of Pediatrics, Cincinnati, OH, USA
| | - Weiyan Yin
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zhen Zhou
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jean A Tkach
- Imaging Research Center, Cincinnati Children's Hospital, Cincinnati, OH, USA; Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Li Wang
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beth M Kline-Fath
- Imaging Research Center, Cincinnati Children's Hospital, Cincinnati, OH, USA; Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Lili He
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital and University of Cincinnati, Department of Pediatrics, Cincinnati, OH, USA
| | - Adebayo Braimah
- Imaging Research Center, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Weili Lin
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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23
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Navaratna R, Zhao R, Colgan TJ, Hu HH, Bydder M, Yokoo T, Bashir MR, Middleton MS, Serai SD, Malyarenko D, Chenevert T, Smith M, Henderson W, Hamilton G, Shu Y, Sirlin CB, Tkach JA, Trout AT, Brittain JH, Hernando D, Reeder SB. Temperature-corrected proton density fat fraction estimation using chemical shift-encoded MRI in phantoms. Magn Reson Med 2021; 86:69-81. [PMID: 33565112 DOI: 10.1002/mrm.28669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Chemical shift-encoded MRI (CSE-MRI) is well-established to quantify proton density fat fraction (PDFF) as a quantitative biomarker of hepatic steatosis. However, temperature is known to bias PDFF estimation in phantom studies. In this study, strategies were developed and evaluated to correct for the effects of temperature on PDFF estimation through simulations, temperature-controlled experiments, and a multi-center, multi-vendor phantom study. THEORY AND METHODS A technical solution that assumes and automatically estimates a uniform, global temperature throughout the phantom is proposed. Computer simulations modeled the effect of temperature on PDFF estimation using magnitude-, complex-, and hybrid-based CSE-MRI methods. Phantom experiments were performed to assess the temperature correction on PDFF estimation at controlled phantom temperatures. To assess the temperature correction method on a larger scale, the proposed method was applied to data acquired as part of a nine-site multi-vendor phantom study and compared to temperature-corrected PDFF estimation using an a priori guess for ambient room temperature. RESULTS Simulations and temperature-controlled experiments show that as temperature deviates further from the assumed temperature, PDFF bias increases. Using the proposed correction method and a reasonable a priori guess for ambient temperature, PDFF bias and variability were reduced using magnitude-based CSE-MRI, across MRI systems, field strengths, protocols, and varying phantom temperature. Complex and hybrid methods showed little PDFF bias and variability both before and after correction. CONCLUSION Correction for temperature reduces temperature-related PDFF bias and variability in phantoms across MRI vendors, sites, field strengths, and protocols for magnitude-based CSE-MRI, even without a priori information about the temperature.
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Affiliation(s)
- Ruvini Navaratna
- Department of Medical Physics, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Ruiyang Zhao
- Department of Medical Physics, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Timothy J Colgan
- Department of Radiology, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Houchun Harry Hu
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Mark Bydder
- Department of Radiological Sciences, University of California - Los Angeles, Los Angeles, California, USA
| | - Takeshi Yokoo
- Department of Radiology, University of Texas - Southwestern Medical Center, Dallas, Texas, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.,Division of Hepatology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.,Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael S Middleton
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | - Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dariya Malyarenko
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark Smith
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Walter Henderson
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | - Gavin Hamilton
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | - Yunhong Shu
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Diego Hernando
- Department of Medical Physics, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Scott B Reeder
- Department of Medical Physics, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Department of Biomedical Engineering, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Department of Medicine, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Department of Emergency Medicine, University of Wisconsin - Madison, Madison, Wisconsin, USA
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24
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Hu HH, Yokoo T, Bashir MR, Sirlin CB, Hernando D, Malyarenko D, Chenevert TL, Smith MA, Serai SD, Middleton MS, Henderson WC, Hamilton G, Shaffer J, Shu Y, Tkach JA, Trout AT, Obuchowski N, Brittain JH, Jackson EF, Reeder SB. Linearity and Bias of Proton Density Fat Fraction as a Quantitative Imaging Biomarker: A Multicenter, Multiplatform, Multivendor Phantom Study. Radiology 2021; 298:640-651. [PMID: 33464181 DOI: 10.1148/radiol.2021202912] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Proton density fat fraction (PDFF) estimated by using chemical shift-encoded (CSE) MRI is an accepted imaging biomarker of hepatic steatosis. This work aims to promote standardized use of CSE MRI to estimate PDFF. Purpose To assess the accuracy of CSE MRI methods for estimating PDFF by determining the linearity and range of bias observed in a phantom. Materials and Methods In this prospective study, a commercial phantom with 12 vials of known PDFF values were shipped across nine U.S. centers. The phantom underwent 160 independent MRI examinations on 27 1.5-T and 3.0-T systems from three vendors. Two three-dimensional CSE MRI protocols with minimal T1 bias were included: vendor and standardized. Each vendor's confounder-corrected complex or hybrid magnitude-complex based reconstruction algorithm was used to generate PDFF maps in both protocols. The Siemens reconstruction required a configuration change to correct for water-fat swaps in the phantom. The MRI PDFF values were compared with the known PDFF values by using linear regression with mixed-effects modeling. The 95% CIs were calculated for the regression slope (ie, proportional bias) and intercept (ie, constant bias) and compared with the null hypothesis (slope = 1, intercept = 0). Results Pooled regression slope for estimated PDFF values versus phantom-derived reference PDFF values was 0.97 (95% CI: 0.96, 0.98) in the biologically relevant 0%-47.5% PDFF range. The corresponding pooled intercept was -0.27% (95% CI: -0.50%, -0.05%). Across vendors, slope ranges were 0.86-1.02 (vendor protocols) and 0.97-1.0 (standardized protocol) at 1.5 T and 0.91-1.01 (vendor protocols) and 0.87-1.01 (standardized protocol) at 3.0 T. The intercept ranges (absolute PDFF percentage) were -0.65% to 0.18% (vendor protocols) and -0.69% to -0.17% (standardized protocol) at 1.5 T and -0.48% to 0.10% (vendor protocols) and -0.78% to -0.21% (standardized protocol) at 3.0 T. Conclusion Proton density fat fraction estimation derived from three-dimensional chemical shift-encoded MRI in a commercial phantom was accurate across vendors, imaging centers, and field strengths, with use of the vendors' product acquisition and reconstruction software. © RSNA, 2021 See also the editorial by Dyke in this issue.
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Affiliation(s)
- Houchun H Hu
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Takeshi Yokoo
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Mustafa R Bashir
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Claude B Sirlin
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Diego Hernando
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Dariya Malyarenko
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Thomas L Chenevert
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Mark A Smith
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Suraj D Serai
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Michael S Middleton
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Walter C Henderson
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Gavin Hamilton
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Jean Shaffer
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Yunhong Shu
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Jean A Tkach
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Andrew T Trout
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Nancy Obuchowski
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Jean H Brittain
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Edward F Jackson
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
| | - Scott B Reeder
- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
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- From the Department of Radiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43235 (H.H.H., M.A.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Radiology (M.R.B., J.S.), Department of Medicine, Division of Gastroenterology (M.R.B.), and Center for Advanced Magnetic Resonance Development (M.R.B., J.S.), Duke University Medical Center, Durham, NC; Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S., M.S.M., W.C.H., G.H.); Departments of Radiology (D.H., J.H.B., S.B.R.), Medical Physics (D.H., E.F.J., S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Michigan, Ann Arbor, Mich (D.M., T.L.C.); Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (S.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (Y.S.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.A.T., A.T.T.); Department of Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio (N.O.); and Calimetrix, LLC, Madison, Wis (J.H.B.)
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25
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Wang H, Pednekar A, Tkach JA, Bridgewater KR, Trout AT, Dillman JR, Dumoulin CL. Fusing acceleration and saturation techniques with wave amplitude labeling of time-shifted zeniths MR elastography. Magn Reson Med 2020; 85:1552-1560. [PMID: 32936497 DOI: 10.1002/mrm.28488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/21/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To design a new 2D gradient recalled echo MR elastography (MRE) pulse sequence with inflow saturation for measuring liver stiffness in half the breath-hold time compared to standard of care (SC) 2D GRE MRE sequences. METHODS FASTWALTZ (fusing acceleration and saturation techniques with wave amplitude labeling of time-shifted zeniths) MRE employs an interleaved dual TR strategy with wave amplitude labeling and compressed SENSE undersampling to reduce breath-hold time while incorporating inflow saturation to suppress flow artifacts. The sequence was implemented and compared with SC MRE both in phantoms and in vivo in 5 asymptomatic volunteers. Stiffness values, region of interest size, and breath-hold times were compared between sequences. RESULTS Stiffness values were comparable between FASTWALTZ and SC MRE for both phantoms and in-vivo data. In volunteers, the group mean stiffness values at 60 Hz and region of interest size were 1.96 ± 0.30 kilopascals and 2279 ± 516 mm2 for SC MRE, and 1.95 ± 0.29 kilopascals and 2061 ± 464 mm2 for FASTWALTZ. Breath-hold duration for FASTWALTZ was 6.3 s compared to 13.3 s for SC MRE. CONCLUSION FASTWALTZ provides comparable stiffness values in half the breath-hold time compared to SC MRE and may have clinical benefits in patients with limited breath-holding capacity.
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Affiliation(s)
- Hui Wang
- MR Clinical Science, Philips, Cincinnati, Ohio, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amol Pednekar
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kaley R Bridgewater
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Charles L Dumoulin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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26
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Dillman JR, Serai SD, Miethke AG, Singh R, Tkach JA, Trout AT. Comparison of liver T1 relaxation times without and with iron correction in pediatric autoimmune liver disease. Pediatr Radiol 2020; 50:935-942. [PMID: 32409910 DOI: 10.1007/s00247-020-04663-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/21/2020] [Accepted: 03/12/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) T1 relaxometry (mapping) has been reported as a quantitative biomarker of liver injury due to inflammation and fibrosis. OBJECTIVE To assess the relationship between liver MRI T1 relaxometry measurements obtained using a modified Look-Locker inversion recovery (MOLLI) pulse sequence without and with iron (T2*) correction (cT1) in pediatric autoimmune liver disease. MATERIALS AND METHODS This cross-sectional study was institutional review board-approved, with informed consent obtained. MRI was acquired at 1.5 T in patients participating in an autoimmune liver disease registry. T1 relaxometry was performed using a MOLLI sequence with a 5(3)3-s acquisition strategy. A multi-echo gradient echo sequence was used to measure liver T2*. Non-iron-corrected native T1 (ms), calculated as the mean of four slices through the mid-liver, was measured using T1 parametric maps generated off-line. A proprietary T2* correction (Perspectum Diagnostics, Oxford, UK), blinded to native T1 values, calculated cT1 values. The relationship between native T1 and cT1 measurements was assessed using Spearman rank correlation and Bland-Altman analyses. RESULTS Forty-eight patients with a mean (standard deviation [SD]) age of 15.2 (4.1) years were included. Mean (SD) liver native T1 was 651.2 (123.9) ms and mean (SD) cT1 was 919.5 (86.8) ms, with excellent positive correlation between values (r=0.91 [95% confidence interval (CI): 0.85-0.95]; P<0.0001). Mean bias between native T1 and cT1 measurements was 268.3 ms (95% limits of agreement: 131.9-404.7 ms). CONCLUSION There is excellent positive correlation between liver native T1 and cT1 measurements in pediatric patients with autoimmune liver disease. This relationship brings into question the need to perform T1 iron correction in this patient population. T1 and cT1 measurements are not interchangeable, however, due to considerable systematic bias with cT1 values being considerably higher.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. .,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexander G Miethke
- Division of Hepatology, Gastroenterology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ruchi Singh
- Division of Hepatology, Gastroenterology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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27
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Ooi MB, Li Z, Robison RK, Wang D, Anderson AG, Zwart NR, Bakhru A, Nagaraj S, Mathews T, Hey S, Koonen JJ, Dimitrov IE, Friel HT, Lu Q, Obara M, Saha I, Wang H, Wang Y, Zhao Y, Temkit M, Hu HH, Chenevert TL, Togao O, Tkach JA, Nagaraj UD, Pinho MC, Gupta RK, Small JE, Kunst MM, Karis JP, Andre JB, Miller JH, Pinter NK, Pipe JG. Spiral T1 Spin-Echo for Routine Postcontrast Brain MRI Exams: A Multicenter Multireader Clinical Evaluation. AJNR Am J Neuroradiol 2020; 41:238-245. [PMID: 32029467 DOI: 10.3174/ajnr.a6409] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/10/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Spiral MR imaging has several advantages compared with Cartesian MR imaging that can be leveraged for added clinical value. A multicenter multireader study was designed to compare spiral with standard-of-care Cartesian postcontrast structural brain MR imaging on the basis of relative performance in 10 metrics of image quality, artifact prevalence, and diagnostic benefit. MATERIALS AND METHODS Seven clinical sites acquired 88 total subjects. For each subject, sites acquired 2 postcontrast MR imaging scans: a spiral 2D T1 spin-echo, and 1 of 4 routine Cartesian 2D T1 spin-echo/TSE scans (fully sampled spin-echo at 3T, 1.5T, partial Fourier, TSE). The spiral acquisition matched the Cartesian scan for scan time, geometry, and contrast. Nine neuroradiologists independently reviewed each subject, with the matching pair of spiral and Cartesian scans compared side-by-side, and scored on 10 image-quality metrics (5-point Likert scale) focused on intracranial assessment. The Wilcoxon signed rank test evaluated relative performance of spiral versus Cartesian, while the Kruskal-Wallis test assessed interprotocol differences. RESULTS Spiral was superior to Cartesian in 7 of 10 metrics (flow artifact mitigation, SNR, GM/WM contrast, image sharpness, lesion conspicuity, preference for diagnosing abnormal enhancement, and overall intracranial image quality), comparable in 1 of 10 metrics (motion artifacts), and inferior in 2 of 10 metrics (susceptibility artifacts, overall extracranial image quality) related to magnetic susceptibility (P < .05). Interprotocol comparison confirmed relatively higher SNR and GM/WM contrast for partial Fourier and TSE protocol groups, respectively (P < .05). CONCLUSIONS Spiral 2D T1 spin-echo for routine structural brain MR imaging is feasible in the clinic with conventional scanners and was preferred by neuroradiologists for overall postcontrast intracranial evaluation.
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Affiliation(s)
- M B Ooi
- From Philips Healthcare (M.B.O., I.E.D., H.T.F., Q.L., H.W., Y.W., Y.Z.)
| | - Z Li
- Gainesville, Florida; Barrow Neurological Institute (Z.L., A.G.A., N.R.Z., J.P.K.)
| | - R K Robison
- Rochester, Minnesota; Phoenix Children's Hospital (R.K.R., M.T., H.H.H., J.H.M.)
| | - D Wang
- Phoenix, Arizona; Mayo Clinic (D.W., J.G.P.)
| | - A G Anderson
- Gainesville, Florida; Barrow Neurological Institute (Z.L., A.G.A., N.R.Z., J.P.K.)
| | - N R Zwart
- Gainesville, Florida; Barrow Neurological Institute (Z.L., A.G.A., N.R.Z., J.P.K.)
| | - A Bakhru
- Buffalo, New York; Philips Healthcare (A.B., S.N., T.M.)
| | - S Nagaraj
- Buffalo, New York; Philips Healthcare (A.B., S.N., T.M.)
| | - T Mathews
- Buffalo, New York; Philips Healthcare (A.B., S.N., T.M.)
| | - S Hey
- Bangalore, India; Philips Healthcare, (S.H., J.J.K.), Best, the Netherlands
| | - J J Koonen
- Bangalore, India; Philips Healthcare, (S.H., J.J.K.), Best, the Netherlands
| | - I E Dimitrov
- From Philips Healthcare (M.B.O., I.E.D., H.T.F., Q.L., H.W., Y.W., Y.Z.)
| | - H T Friel
- From Philips Healthcare (M.B.O., I.E.D., H.T.F., Q.L., H.W., Y.W., Y.Z.)
| | - Q Lu
- From Philips Healthcare (M.B.O., I.E.D., H.T.F., Q.L., H.W., Y.W., Y.Z.)
| | - M Obara
- Philips Healthcare (M.O.), Tokyo, Japan
| | - I Saha
- Philips Healthcare (I.S.), Gurgaon, India
| | - H Wang
- From Philips Healthcare (M.B.O., I.E.D., H.T.F., Q.L., H.W., Y.W., Y.Z.)
| | - Y Wang
- From Philips Healthcare (M.B.O., I.E.D., H.T.F., Q.L., H.W., Y.W., Y.Z.)
| | - Y Zhao
- From Philips Healthcare (M.B.O., I.E.D., H.T.F., Q.L., H.W., Y.W., Y.Z.)
| | - M Temkit
- Rochester, Minnesota; Phoenix Children's Hospital (R.K.R., M.T., H.H.H., J.H.M.)
| | - H H Hu
- Rochester, Minnesota; Phoenix Children's Hospital (R.K.R., M.T., H.H.H., J.H.M.)
| | - T L Chenevert
- University of Michigan (T.L.C.), Ann Arbor, Michigan
| | - O Togao
- Kyushu University Hospital (O.T.), Kyushu, Japan
| | - J A Tkach
- Cincinnati Children's Hospital (J.A.T., U.D.N.), Cincinnati, Ohio
| | - U D Nagaraj
- Cincinnati Children's Hospital (J.A.T., U.D.N.), Cincinnati, Ohio
| | - M C Pinho
- University of Texas Southwestern Medical Center (M.C.P.), Dallas, Texas
| | - R K Gupta
- Fortis Memorial Research Institute (R.K.G.), Gurgaon, India
| | - J E Small
- Lahey Hospital and Medical Center (J.E.S., M.M.K.), Burlington, Massachusetts
| | - M M Kunst
- Lahey Hospital and Medical Center (J.E.S., M.M.K.), Burlington, Massachusetts
| | - J P Karis
- Gainesville, Florida; Barrow Neurological Institute (Z.L., A.G.A., N.R.Z., J.P.K.)
| | - J B Andre
- University of Washington (J.B.A.), Seattle, Washington
| | - J H Miller
- Rochester, Minnesota; Phoenix Children's Hospital (R.K.R., M.T., H.H.H., J.H.M.)
| | - N K Pinter
- Phoenix, Arizona; DENT Neurologic Institute (N.K.P.)
| | - J G Pipe
- Phoenix, Arizona; Mayo Clinic (D.W., J.G.P.)
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28
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Merhar SL, Gozdas E, Tkach JA, Parikh NA, Kline-Fath BM, He L, Yuan W, Altaye M, Leach JL, Holland SK. Neonatal Functional and Structural Connectivity Are Associated with Cerebral Palsy at Two Years of Age. Am J Perinatol 2020; 37:137-145. [PMID: 30919395 PMCID: PMC8103821 DOI: 10.1055/s-0039-1683874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The accuracy of structural magnetic resonance imaging (MRI) to predict later cerebral palsy (CP) in newborns with perinatal brain injury is variable. Diffusion tensor imaging (DTI) and task-based functional MRI (fMRI) show promise as predictive tools. We hypothesized that infants who later developed CP would have reduced structural and functional connectivity as compared with those without CP. STUDY DESIGN We performed DTI and fMRI using a passive motor task at 40 to 48 weeks' postmenstrual age in 12 infants with perinatal brain injury. CP was diagnosed at age 2 using a standardized examination. RESULTS Five infants had CP at 2 years of age, and seven did not have CP. Tract-based spatial statistics showed a widespread reduction of fractional anisotropy (FA) in almost all white matter tracts in the CP group. Using the median FA value in the corticospinal tracts as a cutoff, FA was 100% sensitive and 86% specific to predict CP compared with a sensitivity of 60 to 80% and a specificity of 71% for structural MRI. During fMRI, the CP group had reduced functional connectivity from the right supplemental motor area as compared with the non-CP group. CONCLUSION DTI and fMRI obtained soon after birth are potential biomarkers to predict CP in newborns with perinatal brain injury.
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Affiliation(s)
- Stephanie L. Merhar
- Perinatal Institute, Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH,University of Cincinnati Department of Pediatrics, Cincinnati OH
| | - Elveda Gozdas
- Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Jean A. Tkach
- Imaging Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati OH,Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Nehal A. Parikh
- Perinatal Institute, Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH,University of Cincinnati Department of Pediatrics, Cincinnati OH
| | - Beth M. Kline-Fath
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Lili He
- Perinatal Institute, Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati OH,Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - James L. Leach
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
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29
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Williams SL, Tkach JA, Rattan MS, South AP, Wessel J, Kingma PS. Feeding Tolerance, Intestinal Motility, and Superior Mesenteric Artery Blood Flow in Infants with Gastroschisis. Neonatology 2020; 117:95-101. [PMID: 31851996 DOI: 10.1159/000504226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/17/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine the relationship of superior mesenteric artery (SMA) blood flow and intestinal motility with feeding tolerance in infants with gastroschisis. STUDY DESIGN This was a prospective observational cohort study of 23 infants with gastroschisis. Magnetic resonance images were obtained at abdominal wall closure, initiation of feeds, and full feeds. Motility and SMA flow data were correlated with feeding tolerance. RESULT All infants had abnormal motility, and most continued with abnormal motility despite achieving full feeds. Increased SMA flow at the time of abdominal wall closure was found to be significantly related to the earlier achievement of full feeds (ρ = -0.45, p = 0.05) and trended towards earlier initiation of feeds (ρ = -0.36, p = 0.13), shorter parenteral nutrition days (ρ = -0.42, p = 0.07), and earlier discharge (ρ = -0.41, p = 0.08). CONCLUSION Increased SMA blood flow at the time of abdominal wall closure is positively correlated with feeding tolerance, suggesting the importance of initial intestinal perfusion in the pathophysiology for feeding intolerance and intestinal dysmotility in gastroschisis.
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Affiliation(s)
- Sadie L Williams
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jean A Tkach
- Imaging Research Center and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mantosh S Rattan
- Imaging Research Center and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew P South
- Division of Neonatology, Children's Hospital Medical Center of Akron, Akron, Ohio, USA
| | - Jacqueline Wessel
- Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul S Kingma
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA, .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA, .,Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,
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30
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Critser PJ, Higano NS, Tkach JA, Olson ES, Spielberg DR, Kingma PS, Fleck RJ, Lang SM, Moore RA, Taylor MD, Woods JC. Cardiac Magnetic Resonance Imaging Evaluation of Neonatal Bronchopulmonary Dysplasia-associated Pulmonary Hypertension. Am J Respir Crit Care Med 2020; 201:73-82. [PMID: 31539272 PMCID: PMC6938152 DOI: 10.1164/rccm.201904-0826oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/19/2019] [Indexed: 12/25/2022] Open
Abstract
Rationale: Patients with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH) have increased morbidity and mortality. Noninvasive assessment relies on echocardiograms (echos), which are technically challenging in this population. Improved assessment could augment decisions regarding PH therapies.Objectives: We hypothesized that neonatal cardiac magnetic resonance imaging (MRI) will correlate with BPD severity and predict short-term clinical outcomes, including need for PH therapies for infants with BPD.Methods: A total of 52 infants (31 severe BPD, 9 moderate BPD, and 12 with either mild or no BPD) were imaged between 39 and 47 weeks postmenstrual age on a neonatal-sized, neonatal ICU-sited 1.5-T magnetic resonance (MR) scanner. MR left ventricular eccentricity index (EI), main pulmonary artery-to-aorta (PA/AO) diameter ratio, and pulmonary arterial blood flow were determined. Echos obtained for clinical indications were reviewed. MRI and echo indices were compared with BPD severity and clinical outcomes, including length of stay (LOS), duration of respiratory support, respiratory support at discharge, and PH therapy.Measurements and Main Results: PA/AO ratio increased with BPD severity. Increased PA/AO ratio, MR-EI, and echo-EIs were associated with increased LOS and duration of respiratory support. No correlation was seen between pulmonary arterial blood flow and BPD outcomes. Controlling for gestational age, birth weight, and BPD severity, MR-EI was associated with LOS and duration of respiratory support. Increased PA/AO ratio and MR-EI were associated with PH therapy during hospitalization and at discharge.Conclusions: MRI can provide important image-based measures of cardiac morphology that relate to disease severity and clinical outcomes in neonates with BPD.
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Affiliation(s)
| | - Nara S. Higano
- Center for Pulmonary Imaging Research
- Division of Pulmonary Medicine
| | | | - Emilia S. Olson
- Center for Pulmonary Imaging Research
- Department of Radiology, and
| | - David R. Spielberg
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Pulmonary Medicine Service, Texas Children’s Hospital, Houston, Texas; and
| | - Paul S. Kingma
- Division of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert J. Fleck
- Department of Radiology, and
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sean M. Lang
- Division of Cardiology
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ryan A. Moore
- Division of Cardiology
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael D. Taylor
- Division of Cardiology
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jason C. Woods
- Center for Pulmonary Imaging Research
- Division of Pulmonary Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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31
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Gilligan LA, Trout AT, Lam S, Singh R, Tkach JA, Serai SD, Miethke AG, Dillman JR. Differentiating pediatric autoimmune liver diseases by quantitative magnetic resonance cholangiopancreatography. Abdom Radiol (NY) 2020; 45:168-176. [PMID: 31422438 DOI: 10.1007/s00261-019-02184-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Autoimmune liver diseases (AILD), including primary sclerosing cholangitis (PSC), autoimmune sclerosing cholangitis (ASC), and autoimmune hepatitis (AIH), have overlapping clinical features but distinct management strategies and outcomes. The purpose of this study was to assess the diagnostic performance of quantitative magnetic resonance cholangiopancreatography (MRCP) parameters for distinguishing PSC/ASC from AIH in children and young adults. MATERIALS AND METHODS This IRB-approved, cross-sectional study included participants from an institutional AILD registry that underwent baseline serum liver biochemistry testing and 3D fast spin-echo MRCP. The biliary tree was extracted and modeled from MRCP images using novel proprietary software (MRCP+ ™; Perspectum Diagnostics; Oxford, United Kingdom), and quantitative parameters were generated (e.g., biliary tree volume; number and length of bile ducts, strictures, and dilations; bile duct median/maximum diameters). Mann-Whitney U tests were performed to compare laboratory values and MRCP metrics between patient cohorts (clinical diagnosis of PSC/ASC versus AIH). Receiver operating characteristic (ROC) curves and multivariable logistic regression were used to assess diagnostic performance of serum biochemistry values and MRCP parameters for discriminating PSC/ASC from AIH. RESULTS Thirty percent (14/47) of MRCP exams failed post-processing due to motion artifact. The remaining 33 patients included 20 males and 13 females, with a mean age of 15.1 ± 3.9 years. Eighteen patients were assigned the clinical diagnosis of PSC or ASC and 15 of AIH. All but one quantitative MRCP parameter were significantly different between cohorts (p < 0.05) and predictive of diagnosis (ROC p < 0.05), including numbers of bile duct strictures (area under curve [AUC] = 0.86, p < 0.0001) and dilations (AUC = 0.87, p < 0.0001) and total length of dilated ducts (AUC = 0.89, p < 0.0001). Laboratory values were not significantly different between cohorts (p > 0.05). The best multivariable model for distinguishing PSC/ASC from AIH included total length of dilated ducts (odds ratio [OR], 1.08; 95% CI 1.02-1.14) and maximum left hepatic duct diameter (OR, 1.21; 95% CI 0.57-2.56) [AUC = 0.92]. CONCLUSION Quantitative MRCP parameters provide good discrimination of PSC/ASC from AIH.
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Affiliation(s)
- Leah A Gilligan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Simon Lam
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ruchi Singh
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Suraj D Serai
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexander G Miethke
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Adaikalam SA, Higano NS, Tkach JA, Yen Lim F, Haberman B, Woods JC, Kingma PS. Neonatal lung growth in congenital diaphragmatic hernia: evaluation of lung density and mass by pulmonary MRI. Pediatr Res 2019; 86:635-640. [PMID: 31238333 DOI: 10.1038/s41390-019-0480-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/23/2019] [Accepted: 06/18/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Outcomes of infants with congenital diaphragmatic hernia (CDH) are primarily dependent on the severity of pulmonary hypoplasia. It is previously unknown whether postnatal lung growth in infants with CDH represents true parenchymal lung growth or merely an expansion in volume of the existing tissue. We hypothesized that lung volume growth in CDH infants will be accompanied by an increase in lung mass and that CDH infants will demonstrate accelerated catch-up growth of the more hypoplastic lung. METHODS We used fetal and post-CDH repair MRI of 12 infants to measure lung volume and density, which was used to calculate lung mass. RESULTS The average increase in right lung mass was 1.1 ± 1.1 g/week (p = 0.003) and the average increase in left lung mass was 1.8 ± 0.7 g/week (p < 0.001). When the ratio of left-to-right lung mass of the prenatal MRI was compared to post-repair MRI, the ratio significantly increased in all infants with average prenatal and post-repair ratios of 0.30 and 0.73, respectively (p = 0.002). CONCLUSION Lung growth in infants with CDH is indeed growth in lung mass (i.e. parenchyma), and the lungs demonstrate catch-up growth (i.e., increased rate of growth in the more hypoplastic ipsilateral lung).
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Affiliation(s)
- Stephanie A Adaikalam
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nara S Higano
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jean A Tkach
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Foong Yen Lim
- Divisions of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Beth Haberman
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul S Kingma
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Gilligan LA, Dillman JR, Tkach JA, Xanthakos SA, Gill JK, Trout AT. Magnetic resonance imaging T1 relaxation times for the liver, pancreas and spleen in healthy children at 1.5 and 3 tesla. Pediatr Radiol 2019; 49:1018-1024. [PMID: 31049609 DOI: 10.1007/s00247-019-04411-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/12/2019] [Accepted: 04/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND T1 relaxation time is a potential magnetic resonance imaging (MRI) biomarker for fibrosis and inflammation of the solid abdominal organs. However, normal T1 relaxation times of the solid abdominal organs have not been defined for children. OBJECTIVE The purpose of this study was to measure T1 relaxation times of the liver, pancreas and spleen in healthy children. MATERIALS AND METHODS This was an institutional review board-approved study of a convenience sample of prospectively recruited, healthy children ages 7 to 17 years undergoing research abdominal MRI (1.5 or 3 T) as part of a larger research study between February 2018 and October 2018. For the current study, T1 mapping was performed with a Modified Look-Locker sequence covering the upper abdomen. A single reviewer placed freehand regions of interest on the T1 parametric maps in the liver, pancreas and spleen, inclusive of as much parenchyma as possible. Student's t-tests and linear regression were used to compare T1 values by age and gender. RESULTS Thirty-two participants were included (16 female:16 male; mean age: 12.2±3.1 years; n=16 at 1.5 T). Median T1 relaxation times (ms) per organ were liver: 581±64 (1.5 T), 783±88 (3 T); pancreas: 576±55 (1.5 T), 730±30 (3 T), and spleen: 1,172±71 (1.5 T), 1,356±87 (3 T). T1 values were not statistically significantly different between males and females. At both 1.5 and 3 T field strengths, linear regression showed no significant association between age and T1 values for the liver, pancreas and spleen. CONCLUSION We report normal T1 relaxation times for the liver, pancreas and spleen at 1.5 and 3 T in a cohort of healthy children.
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Affiliation(s)
- Leah A Gilligan
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
| | - Jonathan R Dillman
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
| | - Stavra A Xanthakos
- Department of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jacqueline K Gill
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
| | - Andrew T Trout
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Dillman JR, Trout AT, Merrow AC, Moore RA, Rattan MS, Crotty EJ, Fleck RJ, Yoneyama M, Wang H, Tkach JA. Non-contrast three-dimensional gradient recalled echo Dixon-based magnetic resonance angiography/venography in children. Pediatr Radiol 2019; 49:407-414. [PMID: 30406414 DOI: 10.1007/s00247-018-4297-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/18/2018] [Accepted: 10/24/2018] [Indexed: 12/25/2022]
Abstract
Magnetic resonance imaging (MRI) has been considered a valuable diagnostic tool for noninvasive imaging of the vasculature in children and adults for more than two decades. While a variety of non-contrast MRI methods have been described for imaging of both arteries and veins (e.g., time-of-flight, phase contrast, and balanced steady-state free precession imaging), contrast-enhanced magnetic resonance angiography/venography are the most commonly employed vascular imaging techniques due to their high spatial and contrast resolutions and general reliability. In this technical innovation article, we describe a novel 3-D respiratory-triggered gradient recalled echo Dixon-based MR angiography/MR venography technique that provides high-resolution anatomical imaging of the vasculature of the neck, body and extremities without the need for intravenous contrast material or breath-holding.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. .,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Arnold C Merrow
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ryan A Moore
- Heart Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mantosh S Rattan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Eric J Crotty
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert J Fleck
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Hui Wang
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Philips Healthcare, Best, The Netherlands
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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35
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Wang H, Tkach JA, Trout AT, Dumoulin CL, Dillman JR. Respiratory-triggered spin-echo echo-planar imaging-based mr elastography for evaluating liver stiffness. J Magn Reson Imaging 2018; 50:391-396. [DOI: 10.1002/jmri.26610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/22/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- Hui Wang
- MR Clinical Science; Philips; Cincinnati Ohio USA
- Department of Radiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio USA
- Department of Radiology; University of Cincinnati College of Medicine; Cincinnati Ohio USA
| | - Jean A. Tkach
- Department of Radiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio USA
- Department of Radiology; University of Cincinnati College of Medicine; Cincinnati Ohio USA
| | - Andrew T. Trout
- Department of Radiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio USA
- Department of Radiology; University of Cincinnati College of Medicine; Cincinnati Ohio USA
| | - Charles L. Dumoulin
- Department of Radiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio USA
- Department of Radiology; University of Cincinnati College of Medicine; Cincinnati Ohio USA
| | - Jonathan R. Dillman
- Department of Radiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio USA
- Department of Radiology; University of Cincinnati College of Medicine; Cincinnati Ohio USA
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36
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Higano NS, Spielberg DR, Fleck RJ, Schapiro AH, Walkup LL, Hahn AD, Tkach JA, Kingma PS, Merhar SL, Fain SB, Woods JC. Neonatal Pulmonary Magnetic Resonance Imaging of Bronchopulmonary Dysplasia Predicts Short-Term Clinical Outcomes. Am J Respir Crit Care Med 2018; 198:1302-1311. [PMID: 29790784 PMCID: PMC6290936 DOI: 10.1164/rccm.201711-2287oc] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/23/2018] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Bronchopulmonary dysplasia (BPD) is a serious neonatal pulmonary condition associated with premature birth, but the underlying parenchymal disease and trajectory are poorly characterized. The current National Institute of Child Health and Human Development (NICHD)/NHLBI definition of BPD severity is based on degree of prematurity and extent of oxygen requirement. However, no clear link exists between initial diagnosis and clinical outcomes. OBJECTIVES We hypothesized that magnetic resonance imaging (MRI) of structural parenchymal abnormalities will correlate with NICHD-defined BPD disease severity and predict short-term respiratory outcomes. METHODS A total of 42 neonates (20 severe BPD, 6 moderate, 7 mild, 9 non-BPD control subjects; 40 ± 3-wk postmenstrual age) underwent quiet-breathing structural pulmonary MRI (ultrashort echo time and gradient echo) in a neonatal ICU-sited, neonatal-sized 1.5 T scanner, without sedation or respiratory support unless already clinically prescribed. Disease severity was scored independently by two radiologists. Mean scores were compared with clinical severity and short-term respiratory outcomes. Outcomes were predicted using univariate and multivariable models, including clinical data and scores. MEASUREMENTS AND MAIN RESULTS MRI scores significantly correlated with severities and predicted respiratory support at neonatal ICU discharge (P < 0.0001). In multivariable models, MRI scores were by far the strongest predictor of respiratory support duration over clinical data, including birth weight and gestational age. Notably, NICHD severity level was not predictive of discharge support. CONCLUSIONS Quiet-breathing neonatal pulmonary MRI can independently assess structural abnormalities of BPD, describe disease severity, and predict short-term outcomes more accurately than any individual standard clinical measure. Importantly, this nonionizing technique can be implemented to phenotype disease, and has potential to serially assess efficacy of individualized therapies.
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Affiliation(s)
- Nara S. Higano
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology
| | - David R. Spielberg
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology
| | | | | | - Laura L. Walkup
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology
| | | | | | - Paul S. Kingma
- Division of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital, Cincinnati, Ohio; and
| | - Stephanie L. Merhar
- Division of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital, Cincinnati, Ohio; and
| | - Sean B. Fain
- Department of Medical Physics and
- Department of Radiology, University of Wisconsin–Madison, Madison, Wisconsin
| | - Jason C. Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology
- Department of Radiology, and
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37
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Gozdas E, Parikh NA, Merhar SL, Tkach JA, He L, Holland SK. Altered functional network connectivity in preterm infants: antecedents of cognitive and motor impairments? Brain Struct Funct 2018; 223:3665-3680. [PMID: 29992470 DOI: 10.1007/s00429-018-1707-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/24/2018] [Indexed: 12/12/2022]
Abstract
Very preterm infants (≤ 31 weeks gestational age) are at high risk for brain injury and delayed development. Applying functional connectivity and graph theory methods to resting state MRI data (fcMRI), we tested the hypothesis that preterm infants would demonstrate alterations in connectivity measures both globally and in specific networks related to motor, language and cognitive function, even when there is no anatomical imaging evidence of injury. Fifty-one healthy full-term controls and 24 very preterm infants without significant neonatal brain injury, were evaluated at term-equivalent age with fcMRI. Preterm subjects showed lower functional connectivity from regions associated with motor, cognitive, language and executive function, than term controls. Examining brain networks using graph theory measures of functional connectivity, very preterm infants also exhibited lower rich-club coefficient and assortativity but higher small-worldness and no significant difference in modularity when compared to term infants. The findings provide evidence that functional connectivity exhibits deficits soon after birth in very preterm infants in key brain networks responsible for motor, language and executive functions, even in the absence of anatomical lesions. These functional network measures could serve as prognostic biomarkers for later developmental disabilities and guide decisions about early interventions.
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Affiliation(s)
- Elveda Gozdas
- Department of Physics, University of Cincinnati, Cincinnati, OH, USA.,Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nehal A Parikh
- Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Stephanie L Merhar
- Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jean A Tkach
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lili He
- Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Medpace Inc., Cincinnati, OH, USA
| | - Scott K Holland
- Department of Physics, University of Cincinnati, Cincinnati, OH, USA. .,Medpace Inc., Cincinnati, OH, USA.
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38
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Higano NS, Bates AJ, Tkach JA, Fleck RJ, Lim FY, Woods JC, Kingma PS. Pre- and post-operative visualization of neonatal esophageal atresia/tracheoesophageal fistula via magnetic resonance imaging. J Pediatr Surg Case Rep 2017; 29:5-8. [PMID: 29399473 DOI: 10.1016/j.epsc.2017.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Esophageal atresia (EA) is a relatively uncommon congenital anomaly, often observed in conjunction with tracheoesophageal fistula (TEF). Surgical repair in neonates typically takes place with little information about the pre-existing EA/TEF structure because there are currently no acceptable tools for evaluating EA/TEF anatomy prior to repair; chest x-ray radiograph does not identify malformation sub-type or gap length, while x-ray computed tomography (CT) demonstrate an unacceptably high exposure to ionizing radiation. There is a need for safe imaging methods to evaluate pre-operative EA/TEF anatomy, which would add value in surgical planning; this need may be met with high-resolution structural MRI. We report three cases of Type-C EA/TEF in neonates. Patients were imaged prior to surgical repair using high-resolution ultrashort echo time (UTE) magnetic resonance imaging (MRI) to visualize tracheoesophageal anatomy and allow for informed surgical planning and risk management. One of the three patients was imaged post-repair to evaluate surgical efficacy and evolution of the tracheoesophageal anatomy.
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Affiliation(s)
- Nara S Higano
- Center for Pulmonary Imaging Research, Imaging Research Center and Department of Pulmonary Medicine, Cincinnati Children's Hospital, OH 45229 USA.,Department of Physics, Washington University in St. Louis, MO 63130, USA
| | - Alister J Bates
- Center for Pulmonary Imaging Research, Imaging Research Center and Department of Pulmonary Medicine, Cincinnati Children's Hospital, OH 45229 USA.,Upper Airway Center, Cincinnati Children's Hospital, OH 45229 USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital, OH 45229 USA
| | - Robert J Fleck
- Upper Airway Center, Cincinnati Children's Hospital, OH 45229 USA.,Department of Radiology, Cincinnati Children's Hospital, OH 45229 USA
| | - Foong Y Lim
- Divisions of Pediatric General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital, OH 45229 USA.,Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital, OH 45229 USA
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Imaging Research Center and Department of Pulmonary Medicine, Cincinnati Children's Hospital, OH 45229 USA.,Department of Physics, Washington University in St. Louis, MO 63130, USA.,Department of Radiology, Cincinnati Children's Hospital, OH 45229 USA
| | - Paul S Kingma
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital, OH 45229 USA.,Cincinnati Fetal Center
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Schopper MA, Walkup LL, Tkach JA, Higano NS, Lim FY, Haberman B, Woods JC, Kingma PS. Evaluation of Neonatal Lung Volume Growth by Pulmonary Magnetic Resonance Imaging in Patients with Congenital Diaphragmatic Hernia. J Pediatr 2017; 188:96-102.e1. [PMID: 28669608 DOI: 10.1016/j.jpeds.2017.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/25/2017] [Accepted: 06/01/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate postnatal lung volume in infants with congenital diaphragmatic hernia (CDH) and determine if a compensatory increase in lung volume occurs during the postnatal period. STUDY DESIGN Using a novel pulmonary magnetic resonance imaging method for imaging neonatal lungs, the postnatal lung volumes in infants with CDH were determined and compared with prenatal lung volumes obtained via late gestation magnetic resonance imaging. RESULTS Infants with left-sided CDH (2 mild, 9 moderate, and 1 severe) were evaluated. The total lung volume increased in all infants, with the contralateral lung increasing faster than the ipsilateral lung (mean ± SD: 4.9 ± 3.0 mL/week vs 3.4 ± 2.1 mL/week, P = .005). In contrast to prenatal studies, the volume of lungs of infants with more severe CDH grew faster than the lungs of infants with more mild CDH (Spearman's ρ=-0.086, P = .01). Although the contralateral lung volume grew faster in both mild and moderate groups, the majority of total lung volume growth in moderate CDH came from increased volume of the ipsilateral lung (42% of total lung volume increase in the moderate group vs 32% of total lung volume increase in the mild group, P = .09). Analysis of multiple clinical variables suggests that increased weight gain was associated with increased compensatory ipsilateral lung volume growth (ρ = 0.57, P = .05). CONCLUSIONS These results suggest a potential for postnatal catch-up growth in infants with pulmonary hypoplasia and suggest that weight gain may increase the volume growth of the more severely affected lung.
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Affiliation(s)
- Melissa A Schopper
- Section of Neonatology, Perinatal and Pulmonary Biology, The Perinatal Institute, Cincinnati, OH
| | - Laura L Walkup
- Division of Pulmonary Medicine, Department of Radiology, Center for Pulmonary Imaging Research, Cincinnati, OH
| | - Jean A Tkach
- Department of Radiology, Imaging Research Center, Austin, TX
| | - Nara S Higano
- Division of Pulmonary Medicine, Department of Radiology, Center for Pulmonary Imaging Research, Cincinnati, OH; Deparment of Physics, Washington University in St. Louis, St. Louis, MO
| | - Foong Yen Lim
- Cincinnati Fetal Center, Cincinnati, OH; Divisions of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Beth Haberman
- Section of Neonatology, Perinatal and Pulmonary Biology, The Perinatal Institute, Cincinnati, OH
| | - Jason C Woods
- Division of Pulmonary Medicine, Department of Radiology, Center for Pulmonary Imaging Research, Cincinnati, OH; Deparment of Physics, Washington University in St. Louis, St. Louis, MO
| | - Paul S Kingma
- Section of Neonatology, Perinatal and Pulmonary Biology, The Perinatal Institute, Cincinnati, OH; Cincinnati Fetal Center, Cincinnati, OH.
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Merhar SL, Tkach JA, Woods JC, South AP, Wiland EL, Rattan MS, Dumoulin CL, Kline-Fath BM. Neonatal imaging using an on-site small footprint MR scanner. Pediatr Radiol 2017; 47:1001-1011. [PMID: 28470389 DOI: 10.1007/s00247-017-3855-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/09/2017] [Accepted: 03/30/2017] [Indexed: 01/06/2023]
Abstract
With its soft-tissue definition, multiplanar capabilities and advanced imaging techniques, magnetic resonance imaging (MRI) for neonatal care can provide better understanding of pathology, allowing for improved care and counseling to families. However, MR imaging in neonates is often difficult due to patient instability and the complex support necessary for survival. In our institution, we have installed a small footprint magnet in the neonatal intensive care unit (NICU) to minimize patient risks and provide the ability to perform MR imaging safely in this population. With this system, we have been able to provide more information with regard to central nervous system disorders, abdominal pathology, and pulmonary and airway abnormalities, and have performed postmortem imaging as an alternative or supplement to pathological autopsy. In our experience, an MR scanner situated within the NICU has allowed for safer and more expedited imaging of this vulnerable population.
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Affiliation(s)
- Stephanie L Merhar
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Perinatal Institute, Cincinnati, OH, USA
| | - Jean A Tkach
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - Jason C Woods
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew P South
- Division of Neonatology, Children's Hospital Medical Center of Akron, Akron, OH, USA
| | - Emily L Wiland
- Division of Neonatology, Children's Hospital Medical Center of Akron, Akron, OH, USA
| | - Mantosh S Rattan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - Charles L Dumoulin
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
| | - Beth M Kline-Fath
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.
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41
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Higano NS, Fleck RJ, Spielberg DR, Walkup LL, Hahn AD, Thomen RP, Merhar SL, Kingma PS, Tkach JA, Fain SB, Woods JC. Quantification of neonatal lung parenchymal density via ultrashort echo time MRI with comparison to CT. J Magn Reson Imaging 2017; 46:992-1000. [PMID: 28160357 DOI: 10.1002/jmri.25643] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/06/2017] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To demonstrate that ultrashort echo time (UTE) magnetic resonance imaging (MRI) can achieve computed tomography (CT)-like quantification of lung parenchyma in free-breathing, non-sedated neonates. Because infant CTs are used sparingly, parenchymal disease evaluation via UTE MRI has potential for translational impact. MATERIALS AND METHODS Two neonatal control cohorts without suspected pulmonary morbidities underwent either a research UTE MRI (n = 5; 1.5T) or a clinically-ordered CT (n = 9). Whole-lung means and anterior-posterior gradients of UTE-measured image intensity (arbitrary units, au, normalized to muscle) and CT-measured density (g/cm3 ) were compared (Mann-Whitney U-test). Separately, a diseased neonatal cohort (n = 5) with various pulmonary morbidities underwent both UTE MRI and CT. UTE intensity and CT density were compared with Spearman correlations within ∼33 anatomically matched regions of interest (ROIs) in each diseased subject, spanning low- to high-density tissues. Radiological classifications were evaluated in all ROIs, with mean UTE intensities and CT densities compared in each classification. RESULTS In control subjects, whole-lung UTE intensities (0.51 ± 0.04 au) were similar to CT densities (0.44 ± 0.09 g/cm3 ) (P = 0.062), as were UTE (0.021 ± 0.020 au/cm) and CT (0.034 ± 0.024 [g/cm3 ]/cm) anterior-posterior gradients (P = 0.351). In diseased subjects' ROIs, significant correlations were observed between UTE and CT (P ≤0.007 in each case). Relative differences between UTE and CT were small in all classifications (4-25%). CONCLUSION These results demonstrate a strong association between UTE image intensity and CT density, both between whole-lung tissue in control patients and regional radiological pathologies in diseased patients. This indicates the potential for UTE MRI to longitudinally evaluate neonatal pulmonary disease and to provide visualization of pathologies similar to CT, without sedation/anesthesia or ionizing radiation. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:992-1000.
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Affiliation(s)
- Nara S Higano
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Physics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Robert J Fleck
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - David R Spielberg
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Laura L Walkup
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew D Hahn
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Robert P Thomen
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Stephanie L Merhar
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul S Kingma
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sean B Fain
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Physics, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Hahn AD, Higano NS, Walkup LL, Thomen RP, Cao X, Merhar SL, Tkach JA, Woods JC, Fain SB. Pulmonary MRI of neonates in the intensive care unit using 3D ultrashort echo time and a small footprint MRI system. J Magn Reson Imaging 2016; 45:463-471. [PMID: 27458992 DOI: 10.1002/jmri.25394] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/01/2016] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To determine the feasibility of pulmonary magnetic resonance imaging (MRI) of neonatal lung structures enabled by combining two novel technologies: first, a 3D radial ultrashort echo time (UTE) pulse sequence capable of high spatial resolution full-chest imaging in nonsedated quiet-breathing neonates; and second, a unique, small-footprint 1.5T MRI scanner design adapted for neonatal imaging and installed within the neonatal intensive care unit (NICU). MATERIALS AND METHODS Ten patients underwent MRI within the NICU, in accordance with an approved Institutional Review Board protocol. Five had clinical diagnoses of bronchopulmonary dysplasia (BPD), and five had putatively normal lung function. Pulmonary imaging was performed at 1.5T using 3D radial UTE and standard 3D fast gradient recalled echo (FGRE). Diagnostic quality, presence of motion artifacts, and apparent severity of lung pathology were evaluated by two radiologists. Quantitative metrics were additionally used to evaluate lung parenchymal signal. RESULTS UTE images showed significantly higher signal in lung parenchyma (P < 0.0001) and fewer apparent motion artifacts compared to FGRE (P = 0.046). Pulmonary pathology was more severe in patients diagnosed with BPD relative to controls (P = 0.001). Infants diagnosed with BPD also had significantly higher signal in lung parenchyma, measured using UTE, relative to controls (P = 0.002). CONCLUSION These results demonstrate the technical feasibility of pulmonary MRI in free-breathing, nonsedated infants in the NICU at high, isotropic resolutions approaching that achievable with computed tomography (CT). There is potential for pulmonary MRI to play a role in improving how clinicians understand and manage care of neonatal and pediatric pulmonary diseases. J. Magn. Reson. Imaging 2016. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:463-471.
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Affiliation(s)
- Andrew D Hahn
- Department of Medical Physics, University of Wisconsin, Madison, WI
| | - Nara S Higano
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Physics, Washington University in St. Louis, St. Louis, MO
| | - Laura L Walkup
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Robert P Thomen
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Physics, Washington University in St. Louis, St. Louis, MO
| | - Xuefeng Cao
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Physics, University of Cincinnati, Cincinnati, OH
| | - Stephanie L Merhar
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jean A Tkach
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Physics, Washington University in St. Louis, St. Louis, MO
| | - Sean B Fain
- Department of Medical Physics, University of Wisconsin, Madison, WI
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Merhar SL, Gozdas E, Tkach JA, Harpster KL, Schwartz TL, Yuan W, Kline-Fath BM, Leach JL, Altaye M, Holland SK. Functional and structural connectivity of the visual system in infants with perinatal brain injury. Pediatr Res 2016; 80:43-8. [PMID: 26991261 DOI: 10.1038/pr.2016.49] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/23/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Infants with perinatal brain injury are at risk of later visual problems. Advanced neuroimaging techniques show promise to detect functional and structural alterations of the visual system. We hypothesized that infants with perinatal brain injury would have less brain activation during a visual functional magnetic resonance imaging (fMRI) task and reduced task-based functional connectivity and structural connectivity as compared with healthy controls. METHODS Ten infants with perinatal brain injury and 20 control infants underwent visual fMRI and diffusion tensor imaging (DTI) during natural sleep with no sedation. Activation maps, functional connectivity maps, and structural connectivity were analyzed and compared between the two groups. RESULTS Most infants in both groups had negative activation in the visual cortex during the fMRI task. Infants with brain injury showed reduced activation in the occipital cortex, weaker connectivity between visual areas and other areas of the brain during the visual task, and reduced fractional anisotropy in white matter tracts projecting to visual regions, as compared with control infants. CONCLUSION Infants with brain injury sustained in the perinatal period showed evidence of decreased brain activity and functional connectivity during a visual task and altered structural connectivity as compared with healthy term neonates.
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Affiliation(s)
- Stephanie L Merhar
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Elveda Gozdas
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jean A Tkach
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Karen L Harpster
- Division of Occupational and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Terry L Schwartz
- Division of Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Beth M Kline-Fath
- Department of Radiology and Medical imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James L Leach
- Department of Radiology and Medical imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Scott K Holland
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Higano NS, Hahn AD, Tkach JA, Cao X, Walkup LL, Thomen RP, Merhar SL, Kingma PS, Fain SB, Woods JC. Retrospective respiratory self-gating and removal of bulk motion in pulmonary UTE MRI of neonates and adults. Magn Reson Med 2016; 77:1284-1295. [PMID: 26972576 DOI: 10.1002/mrm.26212] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/09/2016] [Accepted: 02/20/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE To implement pulmonary three-dimensional (3D) radial ultrashort echo-time (UTE) MRI in non-sedated, free-breathing neonates and adults with retrospective motion tracking of respiratory and intermittent bulk motion, to obtain diagnostic-quality, respiratory-gated images. METHODS Pulmonary 3D radial UTE MRI was performed at 1.5 tesla (T) during free breathing in neonates and adult volunteers for validation. Motion-tracking waveforms were obtained from the time course of each free induction decay's initial point (i.e., k-space center), allowing for respiratory-gated image reconstructions that excluded data acquired during bulk motion. Tidal volumes were calculated from end-expiration and end-inspiration images. Respiratory rates were calculated from the Fourier transform of the motion-tracking waveform during quiet breathing, with comparison to physiologic prediction in neonates and validation with spirometry in adults. RESULTS High-quality respiratory-gated anatomic images were obtained at inspiration and expiration, with less respiratory blurring at the expense of signal-to-noise for narrower gating windows. Inspiration-expiration volume differences agreed with physiologic predictions (neonates; Bland-Altman bias = 6.2 mL) and spirometric values (adults; bias = 0.11 L). MRI-measured respiratory rates compared well with the observed rates (biases = -0.5 and 0.2 breaths/min for neonates and adults, respectively). CONCLUSIONS Three-dimensional radial pulmonary UTE MRI allows for retrospective respiratory self-gating and removal of intermittent bulk motion in free-breathing, non-sedated neonates and adults. Magn Reson Med 77:1284-1295, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Nara S Higano
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Physics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Andrew D Hahn
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Xuefeng Cao
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Physics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laura L Walkup
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robert P Thomen
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Physics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Stephanie L Merhar
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul S Kingma
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sean B Fain
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Physics, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Walkup LL, Tkach JA, Higano NS, Thomen RP, Fain SB, Merhar SL, Fleck RJ, Amin RS, Woods JC. Quantitative Magnetic Resonance Imaging of Bronchopulmonary Dysplasia in the Neonatal Intensive Care Unit Environment. Am J Respir Crit Care Med 2015; 192:1215-22. [PMID: 26186608 PMCID: PMC4731620 DOI: 10.1164/rccm.201503-0552oc] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/16/2015] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Bronchopulmonary dysplasia (BPD) is a prevalent yet poorly characterized pulmonary complication of premature birth; the current definition is based solely on oxygen dependence at 36 weeks postmenstrual age without objective measurements of structural abnormalities across disease severity. OBJECTIVES We hypothesize that magnetic resonance imaging (MRI) can spatially resolve and quantify the structural abnormalities of the neonatal lung parenchyma associated with premature birth. METHODS Using a unique, small-footprint, 1.5-T MRI scanner within our neonatal intensive care unit (NICU), diagnostic-quality MRIs using commercially available sequences (gradient echo and spin echo) were acquired during quiet breathing in six patients with BPD, six premature patients without diagnosed BPD, and six full-term NICU patients (gestational ages, 23-39 wk) at near term-equivalent age, without administration of sedation or intravenous contrast. Images were scored by a radiologist using a modified Ochiai score, and volumes of high- and low-signal intensity lung parenchyma were quantified by segmentation and threshold analysis. MEASUREMENTS AND MAIN RESULTS Signal increases, putatively combinations of fibrosis, edema, and atelectasis, were present in all premature infants. Infants with diagnosed BPD had significantly greater volume of high-signal lung (mean ± SD, 26.1 ± 13.8%) compared with full-term infants (7.3 ± 8.2%; P = 0.020) and premature infants without BPD (8.2 ± 6.4%; P = 0.026). Signal decreases, presumably alveolar simplification, only appeared in the most severe BPD cases, although cystic appearance did increase with severity. CONCLUSIONS Pulmonary MRI reveals quantifiable, significant differences between patients with BPD, premature patients without BPD, and full-term control subjects. These methods could be implemented to individually phenotype disease, which may impact clinical care and predict future outcomes.
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Affiliation(s)
- Laura L. Walkup
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Department of Radiology
| | | | - Nara S. Higano
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Department of Radiology
- Department of Physics, Washington University in St. Louis, St. Louis, Missouri; and
| | - Robert P. Thomen
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Department of Radiology
- Department of Physics, Washington University in St. Louis, St. Louis, Missouri; and
| | - Sean B. Fain
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | | | | | - Raouf S. Amin
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jason C. Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Department of Radiology
- Department of Physics, Washington University in St. Louis, St. Louis, Missouri; and
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Ireland CM, Giaquinto RO, Loew W, Tkach JA, Pratt RG, Kline-Fath BM, Merhar SL, Dumoulin CL. A novel acoustically quiet coil for neonatal MRI system. Concepts Magn Reson Part B Magn Reson Eng 2015; 45:107-114. [PMID: 26457072 PMCID: PMC4594852 DOI: 10.1002/cmr.b.21287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
MRI acoustic exposure has the potential to elicit physiological distress and impact development in preterm and term infants. To mitigate this risk, a novel acoustically quiet coil was developed to reduce the sound pressure level experienced by neonates during MR procedures. The new coil has a conventional high-pass birdcage RF design, but is built on a framework of sound abating material. We evaluated the acoustic and MR imaging performance of the quiet coil and a conventional body coil on two small footprint NICU MRI systems. Sound pressure level and frequency response measurements were made for six standard clinical MR imaging protocols. The average sound pressure level, reported for all six imaging pulse sequences, was 82.2 dBA for the acoustically quiet coil, and 91.1 dBA for the conventional body coil. The sound pressure level values measured for the acoustically quiet coil were consistently lower, 9 dBA (range 6-10 dBA) quieter on average. The acoustic frequency response of the two coils showed a similar harmonic profile for all imaging sequences. However, the amplitude was lower for the quiet coil, by as much as 20 dBA.
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Affiliation(s)
- Christopher M Ireland
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA ; Department of Biomedical, Chemical, and Environmental Engineering, 601 Engineering Research Center, University of Cincinnati, 2901 Woodside Drive, Cincinnati, OH 45220, USA
| | - Randy O Giaquinto
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA
| | - Wolfgang Loew
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA
| | - Jean A Tkach
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA
| | - Ronald G Pratt
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA
| | - Beth M Kline-Fath
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA
| | - Stephanie L Merhar
- Division of Neonatology and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA
| | - Charles L Dumoulin
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA
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Tkach JA, Li Y, Pratt RG, Baroch KA, Loew W, Daniels BR, Giaquinto RO, Merhar SL, Kline-Fath BM, Dumoulin CL. Characterization of acoustic noise in a neonatal intensive care unit MRI system. Pediatr Radiol 2014; 44:1011-9. [PMID: 24595878 PMCID: PMC4241776 DOI: 10.1007/s00247-014-2909-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/13/2013] [Accepted: 01/29/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND To eliminate the medical risks and logistical challenges of transporting infants from the neonatal intensive care unit (NICU) to the radiology department for magnetic resonance imaging, a small-footprint 1.5-T MRI scanner has been developed for neonatal imaging within the NICU. MRI is known to be noisy, and exposure to excessive acoustic noise has the potential to elicit physiological distress and impact development in the term and preterm infant. OBJECTIVE To measure and compare the acoustic noise properties of the NICU MRI system against those of a conventional 1.5-T MRI system. MATERIALS AND METHODS We performed sound pressure level measurements in the NICU MRI scanner and in a conventional adult-size whole-body 1.5-T MRI system. Sound pressure level measurements were made for six standard clinical MR imaging protocols. RESULTS The average sound pressure level value, reported in unweighted (dB) and A-weighted (dBA) decibels for all six imaging pulse sequences, was 73.8 dB and 88 dBA for the NICU scanner, and 87 dB and 98.4 dBA for the conventional MRI scanner. The sound pressure level values measured on the NICU scanner for each of the six MR imaging pulse sequences were consistently and significantly (P = 0.03) lower, with an average difference of 14.2 dB (range 10-21 dB) and 11 dBA (range 5-18 dBA). The sound pressure level frequency response of the two MR systems showed a similar harmonic structure above 200 Hz for all imaging sequences. The amplitude, however, was appreciably lower for the NICU scanner, by as much as 30 dB, for frequencies below 200 Hz. CONCLUSION The NICU MRI system is quieter than conventional MRI scanners, improving safety for the neonate and facilitating siting of the unit within the NICU.
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Affiliation(s)
- Jean A Tkach
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, 240 Albert Sabin Way, MLC 5033, Cincinnati, OH, 45229, USA,
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Tkach JA, Hillman NH, Jobe AH, Loew W, Pratt RG, Daniels BR, Kallapur SG, Kline-Fath BM, Merhar SL, Giaquinto RO, Winter PM, Li Y, Ikegami M, Whitsett JA, Dumoulin CL. An MRI system for imaging neonates in the NICU: initial feasibility study. Pediatr Radiol 2012; 42:1347-56. [PMID: 22735927 DOI: 10.1007/s00247-012-2444-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 05/09/2012] [Accepted: 05/17/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transporting premature infants from a neonatal intensive care unit (NICU) to a radiology department for MRI has medical risks and logistical challenges. OBJECTIVE To develop a small 1.5-T MRI system for neonatal imaging that can be easily installed in the NICU and to evaluate its performance using a sheep model of human prematurity. MATERIALS AND METHODS A 1.5-T MRI system designed for orthopedic use was adapted for neonatal imaging. The system was used for MRI examinations of the brain, chest and abdomen in 12 premature lambs during the first hours of life. Spin-echo, fast spin-echo and gradient-echo MR images were evaluated by two pediatric radiologists. RESULTS All animals remained physiologically stable throughout the imaging sessions. Animals were imaged at two or three time points. Seven brain MRI examinations were performed in seven different animals, 23 chest examinations in 12 animals and 19 abdominal examinations in 11 animals. At each anatomical location, high-quality images demonstrating good spatial resolution, signal-to-noise ratio and tissue contrast were routinely obtained within 30 min using standard clinical protocols. CONCLUSION Our preliminary experience demonstrates the feasibility and potential of the neonatal MRI system to provide state-of-the-art MRI capabilities within the NICU. Advantages include overall reduced cost and site demands, lower acoustic noise, improved ease of access and reduced medical risk to the neonate.
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Affiliation(s)
- Jean A Tkach
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5033, Cincinnati, OH 45229, USA.
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Lee GR, Tkach JA, Griswold MA. Time-efficient slab-selective water excitation for 3D MRI. Magn Reson Med 2012; 67:127-36. [DOI: 10.1002/mrm.22994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/22/2011] [Accepted: 04/15/2011] [Indexed: 11/11/2022]
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50
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Tkach JA, Chen X, Freebairn LA, Schmithorst VJ, Holland SK, Lewis BA. Neural correlates of phonological processing in speech sound disorder: a functional magnetic resonance imaging study. Brain Lang 2011; 119:42-9. [PMID: 21458852 PMCID: PMC3162995 DOI: 10.1016/j.bandl.2011.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 02/10/2011] [Accepted: 02/14/2011] [Indexed: 05/15/2023]
Abstract
Speech sound disorders (SSD) are the largest group of communication disorders observed in children. One explanation for these disorders is that children with SSD fail to form stable phonological representations when acquiring the speech sound system of their language due to poor phonological memory (PM). The goal of this study was to examine PM in individuals with histories of SSD employing functional MR imaging (fMRI). Participants were six right-handed adolescents with a history of early childhood SSD and seven right-handed matched controls with no history of speech and language disorders. We performed an fMRI study using an overt non-word repetition (NWR). Right lateralized hypoactivation in the inferior frontal gyrus and middle temporal gyrus was observed. The former suggests a deficit in the phonological processing loop supporting PM, while the later may indicate a deficit in speech perception. Both are cognitive processes involved in speech production. Bilateral hyperactivation observed in the pre and supplementary motor cortex, inferior parietal, supramarginal gyrus and cerebellum raised the possibility of compensatory increases in cognitive effort or reliance on the other components of the articulatory rehearsal network and phonologic store. These findings may be interpreted to support the hypothesis that individuals with SSD may have a deficit in PM and to suggest the involvement of compensatory mechanisms to counteract dysfunction of the normal network.
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Affiliation(s)
- Jean A Tkach
- Case Center of Imaging Research, Department of Radiology, Case Western Reserve University, Cleveland, OH, USA.
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