An open source, 3D printed preclinical MRI phantom for repeated measures of contrast agents and reference standards

In medical imaging, clinicians, researchers and technicians have begun to use 3D printing to create specialized phantoms to replace commercial ones due to their customizable and iterative nature. Presented here is the design of a 3D printed open source, reusable magnetic resonance imaging (MRI) phantom, capable of flood-filling, with removable samples for measurements of contrast agent solutions and reference standards, and for use in evaluating acquisition techniques and image reconstruction performance. The phantom was designed using SolidWorks, a computer-aided design software package. The phantom consists of custom and off-the-shelf parts and incorporates an air hole and Luer Lock system to aid in flood filling, a marker for orientation of samples in the filled mode and bolt and tube holes for assembly. The cost of construction for all materials is under $90. All design files are open-source and available for download. To demonstrate utility, B₀ field mapping was performed using a series of gadolinium concentrations in both the unfilled and flood-filled mode. An excellent linear agreement (R²>0.998) was observed between measured relaxation rates (R₁/R₂) and gadolinium concentration. The phantom provides a reliable setup to test data acquisition and reconstruction methods and verify physical alignment in alternative nuclei MRI techniques (e.g. carbon-13 and fluorine-19 MRI). A cost-effective, open-source MRI phantom design for repeated quantitative measurement of contrast agents and reference standards in preclinical research is presented. Specifically, the work is an example of how the emerging technology of 3D printing improves flexibility and access for custom phantom design.

CT reconstruction techniques for improved accuracy of lung CT airway measurement

PURPOSE

To determine the impact of constrained reconstruction techniques on quantitative CT (qCT) of the lung parenchyma and airways for low x-ray radiation dose.

METHODS

Measurement of small airways with qCT remains a challenge, especially for low x-ray dose protocols. Images of the COPDGene quality assurance phantom (CTP698, The Phantom Laboratory, Salem, NY) were obtained using a GE discovery CT750 HD scanner for helical scans at x-ray radiation dose-equivalents ranging from 1 to 4.12 mSv (12-100 mA s current-time product). Other parameters were 40 mm collimation, 0.984 pitch, 0.5 s rotation, and 0.625 mm thickness. The phantom was sandwiched between 7.5 cm thick water attenuating phantoms for a total length of 20 cm to better simulate the scatter conditions of patient scans. Image data sets were reconstructed using STANDARD (STD), DETAIL, BONE, and EDGE algorithms for filtered back projection (FBP), 100% adaptive statistical iterative reconstruction (ASIR), and Veo reconstructions. Reduced (half) display field of view (DFOV) was used to increase sampling across airway phantom structures. Inner diameter (ID), wall area percent (WA%), and wall thickness (WT) measurements of eight airway mimicking tubes in the phantom, including a 2.5 mm ID (42.6 WA%, 0.4 mm WT), 3 mm ID (49.0 WA%, 0.6 mm WT), and 6 mm ID (49.0 WA%, 1.2 mm WT) were performed with Airway Inspector (Surgical Planning Laboratory, Brigham and Women's Hospital, Boston, MA) using the phase congruency edge detection method. The average of individual measures at five central slices of the phantom was taken to reduce measurement error.

RESULTS

WA% measures were greatly overestimated while IDs were underestimated for the smaller airways, especially for reconstructions at full DFOV (36 cm) using the STD kernel, due to poor sampling and spatial resolution (0.7 mm pixel size). Despite low radiation dose, the ID of the 6 mm ID airway was consistently measured accurately for all methods other than STD FBP. Veo reconstructions showed slight improvement over STD FBP reconstructions (4%-9% increase in accuracy). The most improved ID and WA% measures were for the smaller airways, especially for low dose scans reconstructed at half DFOV (18 cm) with the EDGE algorithm in combination with 100% ASIR to mitigate noise. Using the BONE + ASIR at half BONE technique, measures improved by a factor of 2 over STD FBP even at a quarter of the x-ray dose.

CONCLUSIONS

The flexibility of ASIR in combination with higher frequency algorithms, such as BONE, provided the greatest accuracy for conventional and low x-ray dose relative to FBP. Veo provided more modest improvement in qCT measures, likely due to its compatibility only with the smoother STD kernel.

Excite and receive solenoid radiofrequency coil for MRI-guided breast interventions

A radiofrequency coil based on a solenoid design was developed and integrated with a novel device for MR-guided breast interventions using a circumferential approach. The transmit/receive tapered solenoid design conforms to the shape of the pendent breast, and provides open circumferential needle access to breast tissue under rotational symmetry. Phantom and in vivo studies using a healthy volunteer demonstrated a superior uniformity using the tapered solenoid coil compared with a commercial 8-channel diagnostic imaging coil. The solenoid coil design has important advantages due to localized transmit/receive such as B(1) -homogeneity and reduced specific absorption ratio (SAR) especially at high-field strengths. Because it provides open access and a rotationally symmetric local field, the tapered solenoid design can easily be adapted for bilateral imaging and 3D MR-guided breast interventions.

On the use of hyperpolarized helium MRI for conformal avoidance lung radiotherapy

We wanted to illustrate the feasibility of using hyperpolarized helium magnetic resonance imaging (HPH-MRI) to obtain functional information that may assist in improving conformal avoidance of ventilating lung tissue during thoracic radiotherapy. HPH-MRI images were obtained from a volunteer patient and were first fused with a proton density-weighted (PD(w)) MRI to provide corresponding anatomic detail; they were then fused with the treatment planning computed tomography scan of a patient from our treatment planning database who possessed equivalent thoracic dimensions. An optimized treatment plan was then generated using the TomoTherapy treatment planning system, designating the HPH-enhancing regions as ventilation volume (VV). A dose-volume histogram compares the dosimetry of the lungs as a paired organ, the VV, and the lungs minus the VV. The clinical consequences of these changes was estimated using a bio-effect model, the parallel architecture model, or the local damage (f(dam)) model. Model parameters were chosen from published studies linking the incidence of grade 3+ pneumonitis, with the dose and volume irradiated. For two hypothetical treatment plans of 60 Gy in 30 fractions delivered to a right upper-lobe lung mass, one using and one ignoring the VV as an avoidance structure, the mean normalized total dose (NTD(mean)) values for the lung subvolumes were: lungs = 12.5 Gy₃ vs. 13.52 Gy₃, VV = 9.94 Gy₃ vs. 13.95 Gy₃, and lungs minus VV = 16.69 Gy₃ vs. 19.16 Gy₃. Using the f(dam) values generated from these plans, one would predict a reduction of the incidence of grade 3+ radiation pneumonitis from 12%-4% when compared with a conventionally optimized plan. The use of HPH-MRI to identify ventilated lung subvolumes is feasible and has the potential to be incorporated into conformal avoidance treatment planning paradigms. A prospective clinical study evaluating this imaging technique is being developed.

Optimizing dynamic T2* MR imaging for measurement of cerebral blood flow using infusions for cerebral blood volume

We describe an approach to measuring cerebral blood flow (CBF) based on independent measurements of cerebral blood volume (CBV) and mean transit time (MTT) with calculation of CBF by using the central volume theorem: CBF = CBV / MTT. This permits optimization of the individual acquisitions and analyses. In particular, measurement of CBV during contrast infusion, rather than simultaneously with MTT from a single bolus, yields values more consistent with those of other methods.

Artifact reduction in undersampled projection reconstruction MRI of the peripheral vessels using selective excitation

The projection reconstruction (PR)-HyperTRICKS (time resolved imaging of contrast kinetics) acquisition integrates the benefits of through-plane Cartesian slice encoding and in-plane undersampled PR. It provides high spatial resolution both in-plane (about 1 mm(2)) and through-plane (1-2 mm), as well as relatively high temporal resolution (about 0.25 frames per second). However, undersampling artifacts that originate from anatomy superior or inferior to a coronal imaging FOV may severely degrade the image quality. In coronal MRA acquisitions, the slice coverage is limited in order to achieve high temporal resolution. In this report we describe an artifact reduction method that uses selective excitation in PR-HyperTRICKS. This technique significantly reduces undersampling streak artifacts while it increases the slice coverage.

SNR improvement for multiinjection time-resolved high-resolution CE-MRA of the peripheral vasculature

Peripheral MR angiography (MRA) should ideally provide images over a large field of view with high spatial resolution and adequate temporal resolution to accommodate differences in regional filling times. Image subtraction is usually used to remove background signals. In examination protocols involving multiple injections at multiple sites, previously injected contrast present in the mask image provides a substantial decrease in the subtraction image signal. Bolus chase methods avoid this problem but provide limited time for acquisition of high-resolution images at each station. We present here a technique applied to peripheral angiography that provides high spatial and temporal resolution while maintaining high SNR in multiple injection examinations. Undersampled projection imaging was used to increase spatial resolution relative to a previously reported technique using a Cartesian acquisition technique. Late acquisition of high spatial frequencies and temporal matched-filtering were used to increase spatial resolution and SNR, respectively. Temporal correlation analysis was applied to permit multistation examinations without mask subtraction, thus providing an additional gain in SNR relative to multistation subtraction methods. Quantitative analysis is provided to evaluate the signal and noise behavior in the matched-filtering process due to multiinjection and mask subtraction.

Time-resolved, undersampled projection reconstruction imaging for high-resolution CE-MRA of the distal runoff vessels

Imaging of the blood vessels below the knee using contrast-enhanced (CE) MRI is challenging due to the need to coordinate image acquisition and arrival of the contrast in the targeted vessels. Time-resolved acquisitions have been successful in consistently capturing images of the arterial phase of the bolus of contrast agent in the distal extremities. Although time-resolved exams are robust in this respect, higher spatial resolution for the depiction of tight stenoses and the small vessels in the lower leg is desirable. A modification to a high-spatial-resolution T(1)-weighted pulse sequence (projection reconstruction-time resolved imaging of contrast kinetics (PR-TRICKS)) that improves the through-plane spatial resolution by a factor of 2 and maintains a high frame rate is presented. The undersampled PR-TRICKS pulse sequence has been modified to double the spatial resolution in the slice direction by acquiring high-spatial-frequency slice data only after first pass of the bolus of contrast agent. The acquisition reported in the present work (PR-hyperTRICKS) has been used to image healthy volunteers and patients with known vascular disease. The temporal resolution was found to be beneficial in capturing arterial phase images in the presence of asymmetric filling of vessels.

Embedded MR fluoroscopy: high temporal resolution real-time imaging during high spatial resolution 3D MRA acquisition

A method termed "embedded fluoroscopy" for simultaneously acquiring a real-time sequence of 2D images during acquisition of a 3D image is presented. The 2D images are formed by periodically sampling the central phase encodes of the slab-select direction during the 3D acquisition. The tradeoffs in spatial and temporal resolution are quantified by two parameters: the "redundancy" (R), the fraction of the 3D acquisition sampled more than once; and the "effective temporal resolution" (T), the time between temporal updates of the central views. The method is applied to contrast-enhanced MR angiography (CE-MRA). The contrast bolus dynamics are portrayed in real time in the 2D image sequence while a high-resolution 3D image is being acquired. The capability of the 2D acquisition to measure contrast enhancement with only a 5% degradation of the spatial resolution of the 3D CE-MR angiogram is shown theoretically. The method is tested clinically in 15 CE-MRA patient studies of the carotid and renal arteries.

Effect of windowing and zero-filled reconstruction of MRI data on spatial resolution and acquisition strategy

Standard, MR spin-warp sampling strategies acquire data on a rectangular k-space grid. That method samples data from the "corners" of k-space, i.e., data that lie in a region of k-space outside of an ellipse just inscribed in the rectangular boundary. Illustrative calculations demonstrate that the data in the corners of k-space contribute to the useful resolution only if an interpolation method such as a zero-filled reconstruction is used. The consequences of this finding on data acquisition and data windowing strategies are discussed. A further implication of this result is that the spatial resolution of images reconstructed with zero-filling (but without radial windowing) is expected to display angular dependence, even when the phase- and frequency-encoded resolutions are identical. This hypothesis is experimentally verified with a slit geometry phantom. It is also observed that images reconstructed without zero-filling do not display the angular dependence of spatial resolution predicted solely by the maximal k-space extent of the raw data. The implications of these results for 3D contrast-enhanced angiographic acquisitions with elliptical centric view ordering are explored with simulations.

Dependence of venous enhancement on the field of view in 3D contrast-enhanced MRA using the elliptical centric view order

The dependence of venous suppression on the acquisition field of view (FOV) in elliptical centric 3D contrast-enhanced magnetic resonance angiography (CE-MRA) is studied theoretically and experimentally. It is hypothesized that a reduced FOV in an arterial phase acquisition results in improved venous suppression. An expression is derived linking the k-space representation of a vein to venous return time and acquisition parameters. For a y x z FOV reduction from 24 cm x 7.2 cm to 18 cm x 3.6 cm, equivalent voxel size, and venous return times ranging from 0-7 s, the mean improvement in venous suppression ranged from 7.0% for the 19-mm-diameter vein to 32.1% in the 6-mm-diameter vein, assuming a step function-shaped venous enhancement profile. Decreased venous enhancement with reduced FOV is also observed for scans with equivalent acquisition times, although the degree of suppression is dependent on the shape of the venous enhancement curve.

High-spatial-resolution contrast-enhanced MR angiography of the renal arteries: a prospective comparison with digital subtraction angiography

PURPOSE

To evaluate a high-spatial-resolution three-dimensional (3D) contrast material-enhanced magnetic resonance (MR) angiographic technique for detecting proximal and distal renal arterial stenosis.

MATERIALS AND METHODS

Twenty-five patients underwent high-spatial-resolution small-field-of-view (FOV) 3D contrast-enhanced MR angiography of the renal arteries, which was followed several minutes later by more standard, large-FOV 3D contrast-enhanced MR angiography that included the distal aorta and iliac arteries. For both acquisitions, MR fluoroscopic triggering and an elliptic centric view order were used. Two readers evaluated the MR angiograms for grade and hemodynamic significance of renal arterial stenosis, diagnostic quality, and presence of artifacts. MR imaging results for each patient were compared with those of digital subtraction angiograms.

RESULTS

The high-spatial-resolution small-FOV technique provided high sensitivity (97%) and specificity (92%) for the detection of renal arterial stenosis, including all four distal stenoses encountered. The portrayal of the segmental renal arteries was adequate for diagnosis in 19 (76%) of 25 patients. In 12% of the patients, impaired depiction of the segmental arteries was linked to motion.

CONCLUSION

The combined high-spatial-resolution small-FOV and large-FOV MR angiographic examination provides improved spatial resolution in the region of the renal arteries while maintaining coverage of the abdominal aorta and iliac arteries.

Carotid artery: elliptic centric contrast-enhanced MR angiography compared with conventional angiography

PURPOSE

To determine the accuracy of elliptic centric contrast material-enhanced magnetic resonance (MR) angiography by using conventional angiography as the reference standard.

MATERIALS AND METHODS

Fifty patients were examined prospectively with contrast-enhanced MR angiography and conventional angiography. The two examinations were performed within 1 week of each other. Two patients underwent conventional angiography of only one carotid artery, which yielded 98 arteries for comparison.

RESULTS

With conventional angiography as the reference standard and by using a 70% threshold for internal carotid arterial diameter stenosis, maximum intensity projection (MIP) images had a sensitivity of 93.3%, specificity of 85.1%, and accuracy of 87.6%, whereas reformatted transverse source images had a sensitivity of 83.3%, specificity of 97.0%, and accuracy of 92.8%. Interobserver variability for conventional angiograms was 0.97, for MIP images was 0.91, and for source images was 0.90. The contrast-enhanced MR angiographic technique had a sensitivity of 88.9% and specificity of 58.1% for the presence of irregularity and/or ulceration. All 50 examinations were triggered appropriately so that minimal or no venous signal intensity was depicted.

CONCLUSION

Contrast-enhanced elliptic centric three-dimensional MR angiography offers high-spatial-resolution, venous-suppressed images of the carotid arteries that appear to be adequate to replace conventional angiography in most patients examined prior to carotid endarterectomy.

Three-dimensional contrast-enhanced MR angiography with real-time fluoroscopic triggering: design specifications and technical reliability in 330 patient studies

Technical reliability was determined for triggering three-dimensional (3D) contrast material-enhanced magnetic resonance (MR) angiography with MR fluoroscopy. Technical requirements for high reliability were also identified. Reliability was evaluated in 330 consecutive patient studies of the neck, thorax, abdomen, and pelvis. Contrast material arrival was detected fluoroscopically in 325 of the 330 studies (98.5%), and the 3D sequence was successfully triggered in 321 of 330 studies (97.3%). Fluoroscopic triggering of centrically encoded 3D MR angiographic acquisitions is a highly reliable means of obtaining 3D MR angiograms with high spatial resolution.

Theoretical limits of spatial resolution in elliptical-centric contrast-enhanced 3D-MRA

The point spread function (PSF) for contrast-enhanced three-dimensional (3D) MR angiography using the elliptical centric view order is derived. This view order has been shown previously to provide high venous suppression thereby enabling long acquisition times capable of high spatial resolution. The dependence of the PSF on TR, field of view (FOV), scan time, and trigger time are shown explicitly. Theoretical predictions are corroborated with experimental results in phantoms and in vivo. The PSF width decreases as the square root of the product of TR and the two phase encoding FOV's for fixed nominal voxel size. The PSF peak amplitude increases as the reciprocal of this product. Theory and experiment demonstrate that acquisition times over 40 sec provide superior resolution compared to shorter acquisitions, despite falling levels of contrast agent concentration. The analysis predicts that an isotropic spatial resolution of 1 mm before zero filling is possible in a FOV large enough to encompass the carotid and vertebral arteries bilaterally. Magn Reson Med 42:1106-1116, 1999.

Real-time imaging and triggering of 3D contrast-enhanced MR angiograms using MR fluoroscopy

Although a variety of timing techniques and data acquisition strategies have been used for three-dimensional contrast-enhanced MR angiography, many are still limited by inadequate overall reliability, limited spatial resolution, or complexity. A technique is presented in this work in which contrast arrival is detected in the targeted vasculature in real time using MR fluoroscopy. Upon detection the operator triggers a 3D MR angiographic acquisition which uses an elliptical centric view order. It is shown that the view order intrinsically provides a high degree of venous suppression which in turn allows acquisition times of 30 s or longer, permitting high spatial resolution. The reliability of fluoroscopic triggering in bolus detection is shown to be over 90%. The technique provides high quality contrast-enhanced MR angiograms for many vascular regions.

A flexible view ordering technique for high-quality real-time 2DFT MR fluoroscopy

A method to tailor the view order to the reconstruction cycle is introduced for real-time MRI. It is well known that view sharing and oversampling central k-space views can improve the temporal resolution of gradient-echo pulse sequences. By ordering phase-encodes to synchronize k-space acquisition with the reconstruction cycle, apparent temporal resolution can match the frame rate with as few as one-fourth of the phase-encodes sampled per reconstruction. Spatial resolution is maintained by periodically updating high spatial frequencies. In addition to apparent temporal resolution, three other criteria for real-time imaging are identified and evaluated: display latency, dispersion, and frame-to-frame consistency. Latency is minimized by ordering views in a reverse-centric manner within each reconstruction interval, sampling high-energy views immediately prior to beginning reconstruction. Dispersion is kept low and consistent by synchronizing acquisition and reconstruction, thus avoiding poorly timed reconstruction instances. Real-time implementation demonstrates pulsatile time-of-flight blood signal enhancement in humans.

3D contrast-enhanced MR angiography using fluoroscopic triggering and an elliptical centric view order

Although a variety of timing techniques and data acquisition strategies have been used for three-dimensional contrast-enhanced MR angiography, many are still limited by inadequate overall reliability, limited spatial resolution, or complexity. A technique is presented in this work in which contrast arrival is detected in the targetted vasculature in real time using MR fluoroscopy. Upon detection the operator triggers a 3D MR angiographic acquisition which uses an elliptical centric view order. It is shown that the view order intrinsically provides a high degree of venous suppression which in turn allows acquisition times of 30 seconds or longer, permitting high spatial resolution. The reliability of fluoroscopic triggering in bolus detection is shown to be over 90%. The technique provides high quality contrast-enhanced MR angiograms for many vascular regions.

Carotid arteries: maximizing arterial to venous contrast in fluoroscopically triggered contrast-enhanced MR angiography with elliptic centric view ordering

PURPOSE

To obtain high-spatial-resolution, venous-suppressed, contrast material-enhanced, three-dimensional (3D) magnetic resonance (MR) angiograms of the carotid arteries and aortic arch by using an elliptic centric view ordering with MR fluoroscopic triggering.

MATERIALS AND METHODS

Forty consecutive patients with cerebrovascular disease in the differential diagnosis were evaluated with fluoroscopically triggered 3D MR angiography (gadoteridol dose range, 0.1-0.3 mmol per kilogram of body weight; mean acquisition time, 40 second +/- 8 [SD]). The contrast-enhanced 3D MR angiograms were evaluated for overall quality, vascular signal intensity, venous suppression, and motion artifact. Twenty patients also underwent two-dimensional (2D) time-of-flight (TOF) MR angiography. The overall quality of the 2D TOF MR angiograms and comparative quality between the 2D TOF and contrast-enhanced 3D MR angiograms were determined.

RESULTS

The contrast-enhanced 3D MR angiograms were of excellent or more than adequate quality for diagnosis in 36 of the 40 studies (90%). In 35 of the 38 contrast-enhanced 3D studies in which the contrast material bolus was detected fluoroscopically, the internal jugular vein signal intensity was either not detectable or barely visible. In 18 of the 20 patients who also underwent 2D TOF MR angiography, the quality of the contrast-enhanced 3D MR angiograms was graded as markedly superior or superior.

CONCLUSION

Contrast-enhanced, elliptic centric 3D MR angiography with real-time MR fluoroscopic triggering offers high-spatial-resolution images of the carotid arteries and aortic arch with reliable venous suppression.

Interactive three-point localization of double-oblique sections using MR fluoroscopy

Magnetic resonance imaging allows significant freedom in selecting the orientation and position of a tomographic section. However, it can nonetheless be challenging to determine quickly and efficiently the correct parameters required to image a targeted anatomic structure that may lie at an oblique angle in the imaging volume. We describe a three-point tool in which a) the user interactively selects three points from an anatomic structure of interest during live MR fluoroscopy; b) adjustments to pulse sequence are calculated to image the tomographic section defined by the three points; and c) the section is then immediately imaged fluoroscopically. The tool allows quick localization of, for example, longitudinal images of specific arterial structures.