Pediatric magnetic resonance imaging: faster is better

Magnetic resonance imaging (MRI) has emerged as the preferred imaging modality for evaluating a wide range of pediatric medical conditions. Nevertheless, the long acquisition times associated with this technique can limit its widespread use in young children, resulting in motion-degraded or non-diagnostic studies. As a result, sedation or general anesthesia is often necessary to obtain diagnostic images, which has implications for the safety profile of MRI, the cost of the exam and the radiology department's clinical workflow. Over the last decade, several techniques have been developed to increase the speed of MRI, including parallel imaging, single-shot acquisition, controlled aliasing techniques, compressed sensing and artificial-intelligence-based reconstructions. These are advantageous because shorter examinations decrease the need for sedation and the severity of motion artifacts, increase scanner throughput, and improve system efficiency. In this review we discuss a framework for image acceleration in children that includes the synergistic use of state-of-the-art MRI hardware and optimized pulse sequences. The discussion is framed within the context of pediatric radiology and incorporates the authors' experience in deploying these techniques in routine clinical practice.

State-of-the-art magnetic resonance imaging sequences for pediatric body imaging

Longer examination time, need for anesthesia in smaller children and the inability of most children to hold their breath are major limitations of MRI in pediatric body imaging. Fortunately, with technical advances, many new and upcoming MRI sequences are overcoming these limitations. Advances in data acquisition and k-space sampling methods have enabled sequences with improved temporal and spatial resolution, and minimal artifacts. Sequences to minimize movement artifacts mainly utilize radial k-space filling, and examples include the stack-of-stars method for T1-weighted imaging and the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER)/BLADE method for T2-weighted imaging. Similarly, the sequences with improved temporal resolution and the ability to obtain multiple phases in a single breath-hold in dynamic imaging mainly use some form of partial k-space filling method. New sequences use a variable combination of data sampling methods like compressed sensing, golden-angle radial k-space filling, parallel imaging and partial k-space filling to achieve free-breathing, faster sequences that could be useful for pediatric abdominal and thoracic imaging. Simultaneous multi-slice method has improved diffusion-weighted imaging (DWI) with reduction in scan time and artifacts. In this review, we provide an overview of data sampling methods like parallel imaging, compressed sensing, radial k-space sampling, partial k-space sampling and simultaneous multi-slice. This is followed by newer available and upcoming sequences for T1-, T2- and DWI based on these other advances. We also discuss the Dixon method and newer approaches to reducing metal artifacts.

Pulsed spin-locking of spin-3/2 nuclei: 39K-NQR of potassium chlorate

A model was developed for predicting a locked signal under a series of refocusing pulses for Nuclear Quadrupole Resonance (NQR) of spin I=32 and tested with a powder of KClO₃. This work represents the first direct NQR detection of the ³⁹K line of potassium chlorate. The characteristic time constants, T₁,T_2e and T₂^∗, were measured to determine the detectability of potassium chlorate via ³⁹K-NQR. The echo train T_2e was found to be strongly dependent on the refocusing pulse-spacing and weakly dependent on the refocusing pulse strength. The optimal angles of the excitation and echo pulse for a pulse train were also determined, as well as, the resonance-frequency dependence on sample temperature.

Measuring transverse relaxation in highly paramagnetic systems

The enhancement of nuclear relaxation rates due to the interaction with a paramagnetic center (known as Paramagnetic Relaxation Enhancement) is a powerful source of structural and dynamics information, widely used in structural biology. However, many signals affected by the hyperfine interaction relax faster than the evolution periods of common NMR experiments and therefore they are broadened beyond detection. This gives rise to a so-called blind sphere around the paramagnetic center, which is a major limitation in the use of PREs. Reducing the blind sphere is extremely important in paramagnetic metalloproteins. The identification, characterization, and proper structural restraining of the first coordination sphere of the metal ion(s) and its immediate neighboring regions is key to understand their biological function. The novel HSQC scheme we propose here, that we termed R2-weighted, HSQC-AP, achieves this aim by detecting signals that escaped detection in a conventional HSQC experiment and provides fully reliable R2 values in the range of 1H R2 rates ca. 50-400 s-1. Independently on the type of paramagnetic center and on the size of the molecule, this experiment decreases the radius of the blind sphere and increases the number of detectable PREs. Here, we report the validation of this approach for the case of PioC, a small protein containing a high potential 4Fe-4S cluster in the reduced [Fe4S4]2+ form. The blind sphere was contracted to a minimal extent, enabling the measurement of R2 rates for the cluster coordinating residues.

Decoupled LIGHT-SABRE variants allow hyperpolarization of asymmetric SABRE systems at an arbitrary field

Signal Amplification By Reversible Exchange, or SABRE, uses the singlet-order of parahydrogen to generate hyperpolarized signals on target nuclei, bypassing the limitations of traditional magnetic resonance. Experiments performed directly in the magnet provide a route to generate large magnetizations continuously without having to field-cycle the sample. For heteronuclear SABRE, these high-field methods have been restricted to the few SABRE complexes that exhibit efficient exchange with symmetric ligand environments as co-ligands induce chemical shift differences between the parahydrogen-derived hydrides, destroying the hyperpolarized spin order. Through careful consideration of the underlying spin physics, we introduce ¹H decoupled LIGHT-SABRE pulse sequence variants which bypasses this limitation, drastically expanding the scope of heteronuclear SABRE at high field.

The evolution of solution state NMR pulse sequences through the 'eyes' of triple-resonance spectroscopy

Careful pulse sequence design and optimization is critical to the success of a given NMR experiment. Over the past several decades the level of sophistication of NMR pulse sequences has increased tremendously, leading to large spectral sensitivity and resolution improvements, to data sets with far fewer artifacts, and to much more rapid acquisition times, opening up a wide range of applications. Here I briefly highlight how pulse sequence 'engineering' has evolved, focusing on liquid state NMR, and, in particular, on the HNCA-class of triple-resonance experiment. In many respects, the evolution of triple-resonance NMR mirrors the evolution of solution state NMR experiments in general, with 'tricks' that first appeared in triple-resonance pulse sequences or that were motivated by them now incorporated into a broad range of experiments.

Combination of OPSY and PhD-PHIP results in enhanced sensitivity in PHIP

Despite the large degree of polarization in PHIP experiments compared to the Boltzmann factor, the presence of a large amount of non-reacted molecules with thermal polarization is an important obstacle when dealing with very diluted samples. The feasibility of enhancing both sensitivity and resolution in a single experiment by combining two well established pulse sequences, OPSY and PHD-PHIP is presented. OPSY is used as a block for filtering the signals originated from thermally polarized protons. PhD-PHIP, on the other hand, is used as an acquisition block, increasing the resolution and further improving the sensitivity by preventing signal canceling in the presence of magnetic field inhomogeneities. Experiments in a complex sample with very low hyperpolarization levels are presented showing the excellent performance of the method.

Introduction to MRI Physics

Magnetic resonance imaging (MRI) is an imaging technique derived from radiofrequency (RF) signals of proton that are magnetized by a strong magnetic field. These protons typically originate from water, fat, or metabolites. The application of RF pulses is used to excite the magnetization, whereas pulsed magnetic field gradients are used to provide spatial localization. This chapter describes the fundamental principles giving rise to MR images. Furthermore, the connection between relaxation and image contrast is discussed.

Optimized phases for the acquisition of J-spectra in coupled spin systems for thermally and PHIP polarized molecules

We demonstrate that the relative phases in the refocusing pulses of multipulse sequences can compensate for pulse errors and off-resonant effects, which are commonly encountered in J-spectroscopy when CPMG is used for acquisition. The use of supercycles has been considered many times in the past, but always from the view point of time-domain NMR, that is, in an effort to lengthen the decay of the magnetization. Here we use simple spin-coupled systems, in which the quantum evolution of the system can be simulated and contrasted to experimental results. In order to explore fine details, we resort to partial J-spectroscopy, that is, to the acquisition of J-spectra of a defined multiplet, which is acquired with a suitable digital filter. We unambiguously show that when finite radiofrequency pulses are considered, the off-resonance effects on nearby multiplets affects the dynamics of the spins within the spectral window under acquisition. Moreover, the most robust phase cycling scheme for our setup consists of a 4-pulse cycle, with phases yyyy‾ or xxxx‾ for an excitation pulse with phase x. We show simulated and experimental results in both thermally polarized and PHIP hyperpolarized systems.

Basic Pulse Sequences in Magnetic Resonance Imaging

Magnetic resonance images are obtained by a combination of different radiofrequency pulses and gradient waveforms applied to the subject inside a magnetic field. There are multiple pulse sequences used in clinical and preclinical studies adjusted to whatever physician or researches want to analyze, from basic anatomic images to accurate diagnostic techniques as diffusion, perfusion, or functional imaging. In this chapter, we present the most used radiofrequency pulse combinations of the two groups of sequences available in magnetic resonance imaging: spin-echo and gradient-echo sequences.

Review of key concepts in magnetic resonance physics

MR physics can be a challenging subject for practicing pediatric radiologists. Although many excellent texts provide very comprehensive reviews of the field of MR physics at various levels of understanding, the authors of this paper explain several key concepts in MR physics that are germane to clinical practice in a non-rigorous but practical fashion. With the basic understanding of these key concepts, practicing pediatric radiologists can build on their knowledge of current clinical MR techniques and future advances in MR applications. Given the challenges of both the increased need for rapid imaging in non-sedated children and the rapid physiological cardiovascular and respiratory motion in pediatric patients, many advances in complex MR techniques are being applied to imaging these children. The key concepts are as follows: (1) structure of a pulse sequence, (2) k-space, (3) "trade-off triangle" and (4) fat suppression. This review is the first of five manuscripts in a minisymposium on pediatric MR. The authors' goal for this review is to aid in understanding the MR techniques described in the subsequent manuscripts on brain imaging and body imaging in this minisymposium.

Pulse sequence considerations for simulation and postimplant dosimetry of prostate brachytherapy

PURPOSE

The purpose of this work is to present a brief review of MRI physics principles pertinent to prostate brachytherapy, and a summary of our experience in optimizing protocols for prostate brachytherapy applications.

METHODS AND MATERIALS

We summarized essential MR imaging characteristics and their interplays that need to be considered for prostate brachytherapy applications. These include spatial resolution, signal-to-noise ratio, image contrast, artifacts, geometric distortion, specific absorption rate, and total scan time. We further described the optimization of the protocols for three pulse sequences: three-dimensional (3D) fast-spoiled gradient echo sequence for T1-weighted imaging, 3D fast-spin echo sequence for T2-weighted imaging, and 3D fast imaging in steady-state precession sequence for combined T1 and T2-weighed imaging. The utilization of an endorectal coil was also described.

RESULTS

Using the optimized protocols, we acquired high-quality images of the entire prostate within 3-5 minutes for each sequence. These images display the desired image contrasts and a spatial resolution that is equal to or better than 0.59 mm × 0.73 mm × 1.2 mm. While 3D fast-spoiled gradient echo sequence and 3D fast-spin echo sequence depict radioactive seed markers and anatomic structures separately, 3D fast imaging in steady-state precession sequence demonstrates great promise for imaging both seed markers and prostate anatomy simultaneously in a single acquisition.

CONCLUSIONS

We have optimized current MRI protocols and demonstrated that the anatomic structures and positive contrast radioactive seed markers for prostate post-implant dosimetry can be adequately imaged either separately or simultaneously using different pulse sequences within a total scan time of 3-5 minutes each.

Interpreting body MRI cases: what you need to know to get started

Interpreting body MRI cases can seem overwhelming to an uninitiated radiologist. The standard study includes a variety of pulse sequences, the names of which vary depending on the MR vendor. Pulse sequences may be displayed haphazardly on the picture archiving and communication system (PACS), frequently not synchronized with the imaging protocol. Adding to the complexity is the use of different gadolinium-based contrast agents, which may affect the timing and diagnostic yield of each sequence. The following introductory primer for interpreting body MRI cases is meant to create a basic framework for efficiently reviewing body MRI cases to provide high quality interpretations, fully utilizing the diagnostic information of the modality. There are 4 components that need to be mastered when interpreting body MRI cases including: (1) recognizing the key sequences in a basic body MRI protocol, (2) learning how to best display the key pulse sequences on PACS, (3) understanding the technique and clinical utility of each sequence and learning how to utilize sequences to be an "MR Pathologist", and (4) understanding the key features of the different gadolinium based contrast agents.

Nuclear magnetic resonance at millitesla fields using a zero-field spectrometer

We describe new analytical capabilities for nuclear magnetic resonance (NMR) experiments in which signal detection is performed with chemical resolution (via spin-spin J couplings) in the zero to ultra-low magnetic field region, below 1μT. Using magnetic fields in the 100μT to 1mT range, we demonstrate the implementation of conventional NMR pulse sequences with spin-species selectivity.

Comparison of two single-breath-held 3-D acquisitions with multi-breath-held 2-D cine steady-state free precession MRI acquisition in children with single ventricles

BACKGROUND

Breath-held two-dimensional balanced steady--state free precession cine acquisition (2-D breath-held SSFP), accelerated with parallel imaging, is the method of choice for evaluating ventricular function due to its superior blood-to-myocardial contrast, edge definition and high intrinsic signal-to-noise ratio throughout the cardiac cycle.

OBJECTIVE

The purpose of this study is to qualitatively and quantitatively compare the two different single-breath-hold 3-D cine SSFP acquisitions using 1) multidirectional sensitivity encoding (SENSE) acceleration factors (3-D multiple SENSE SSFP), and 2) k-t broad-use linear acceleration speed-up technique (3-D k-t SSFP) with the conventional 2-D breath-held SSFP in non-sedated asymptomatic volunteers and children with single ventricle congenital heart disease.

MATERIALS AND METHODS

Our prospective study was performed on 30 non-sedated subjects (9 healthy volunteers and 21 functional single ventricle patients), ages 12.5 +/- 2.8 years. Two-dimensional breath-held SSFP with SENSE acceleration factor of 2, eight-fold accelerated 3-D k-t SSFP, and 3-D multiple SENSE SSFP with total parallel imaging factor of 4 were performed to evaluate ventricular volumes and mass in the short-axis orientation. Image quality scores (blood myocardial contrast, edge definition and interslice alignment) and volumetric analysis (end systolic volume, end diastolic volume and ejection fraction) were performed on the data sets by experienced users. Paired t-test was performed to compare each of the 3-D k-t SSFP and 3-D multiple SENSE SSFP clinical scores against 2-D breath-held SSFP. Bland-Altman analysis was performed on left ventricle (LV) and single ventricle volumetry. Interobserver and intraobserver variability in volumetric measurements were determined using intraclass coefficients.

RESULTS

The clinical scores were highest for the 2-D breath-held SSFP images. Between the two 3-D sequences, 3-D multiple SENSE SSFP performed better than 3-D k-t SSFP. Bland-Altman analysis for volumes indicated that variability was more between 3-D k-t SSFP and 2-D breath-held SSFP acquisitions than between 3-D multiple SENSE SSFP and 2-D breath-held SSFP acquisitions. In the non-sedated population, interslice alignment scores were better for 3-D k-t SSFP and 3-D multiple SENSE SSFP than 2-D breath-held SSFP. The blood-myocardial contrast and edge definition scores were better for 2-D breath-held SSFP than 3-D k-t SSFP and 3-D multiple SENSE SSFP. Scan duration was shorter for 3-D acquisition sequences compared to the 2-D breath-held stack.

CONCLUSION

Three-dimensional k-t SSFP and 3-D multiple SENSE for ventricular volumetry release the constraints of multiple breath-holds in children and overcome problems related to interslice misalignment caused by inconsistent amplitude of breathing. Three-dimensional multiple SENSE SSFP performed better in our pediatric population than 3-D k-t SSFP. However, these 3-D sequences produce lower-quality diagnostic images than the gold standard 2-D breath-held SSFP sequence.

Appropriate selection of MRI sequences for common scenarios in clinical practice

Knowledge about sequence properties is essential to plan and acquire a diagnostic MRI examination. The broad four categories of sequences include spin echo (SE), gradient echo (GRE), inversion recovery (IR) and echoplanar imaging (EPI). Varieties of sequences from these four categories are available for clinical application. They have different contrast mechanisms, spatial and contrast resolution and speed of acquisition. Choice of sequence differs in various scenarios in clinical practice such as solid organ imaging, moving target imaging, bone and bone marrow imaging, cartilage imaging and vessel imaging, taking into consideration properties of sequences to answer the clinical question. Broad classification of sequences and differences in their contrast, spatial and contrast resolution, and speed of acquisition are discussed in this review. A few common clinical scenarios of MRI imaging are illustrated, along with reasons for the given sequence choices.

11-interval PFG pulse sequence for improved measurement of fast velocities of fluids with high diffusivity in systems with short T2(∗)

Magnetic resonance (MR) was used to measure SF6 gas velocities in beds filled with particles of 1.1 mm and 0.5 mm in diameter. Four pulse sequences were tested: a traditional spin echo pulse sequence, the 9-interval and 13-interval pulse sequence of Cotts et al. (1989) and a newly developed 11-interval pulse sequence. All pulse sequences measured gas velocity accurately in the region above the particles at the highest velocities that could be achieved (up to 0.1 ms(-1)). The spin echo pulse sequence was unable to measure gas velocity accurately in the bed of particles, due to effects of background gradients, diffusivity and acceleration in flow around particles. The 9- and 13-interval pulse sequence measured gas velocity accurately at low flow rates through the particles (expected velocity <0.06 ms(-1)), but could not measure velocity accurately at higher flow rates. The newly developed 11-interval pulse sequence was more accurate than the 9- and 13-interval pulse sequences at higher flow rates, but for velocities in excess of 0.1 ms(-1) the measured velocity was lower than the expected velocity. The increased accuracy arose from the smaller echo time that the new pulse sequence enabled, reducing selective attenuation of signal from faster moving nuclei.

Measuring spin relaxation with standard pulse sequences in the singlet-triplet basis

Pulsed electrically and optically-detected magnetic resonance are extremely sensitive to changes in the permutation symmetry of weakly-coupled spin pairs, and are well-suited for investigating devices with a small number of spins. However, the change in observable from conventional electron spin resonance modifies the results of standard inductively-detected pulse sequences which are routinely used to obtain phase coherence and lifetimes. Whilst these effects have been discussed for single-pulse experiments, their role in multi-pulse sequences is less clear. Here, we investigate this effect in Hahn echo and inversion-recovery sequences, and show a second set of narrower echoes are produced that distort measurement outcomes. We demonstrate that phase cycling is able to deconvolve the additional echo signals, allowing spin relaxation times to be reliably extracted.

Very-low-field MRI of laser polarized xenon-129

We describe a homebuilt MRI system for imaging laser-polarized xenon-129 at a very low holding field of 2.2mT. A unique feature of this system was the use of Maxwell coils oriented at so-called "magic angles" to generate the transverse magnetic field gradients, which provided a simple alternative to Golay coils. We used this system to image a laser-polarized xenon-129 phantom with both a conventional gradient-echo and a fully phase-encoded pulse sequence. In other contexts, a fully phase-encoded acquisition, also known as single-point or constant-time imaging, has been used to enable distortion-free imaging of short-T₂^∗ species. Here we used this technique to overcome imperfections associated with our homebuilt MRI system while also taking full advantage of the long T₂^∗ available at very low field. Our results demonstrate that xenon-129 image quality can be dramatically improved at low field by combining a fully phase-encoded k-space acquisition with auxiliary measurements of system imperfections including B₀ field drift and gradient infidelity.

Magnetic resonance enterography in Crohn’s disease: Standard and advanced techniques

Crohn’s disease (CD) is a chronic autoimmune disorder that affects mainly young people. The clinical management is based on the Crohn’s Disease Activity Index and especially on biologic parameters with or without additional endoscopic and imaging procedures, such as barium and computed tomography examinations. Recently, magnetic resonance (MR) imaging has been a promising diagnostic radiologic technique with lack of ionizing radiation, enabling superior tissue contrast resolution due to new pulse-sequence developments. Therefore, MR enterography has the potential to become the modality of choice for imaging the small bowel in CD patients.