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Subtle pitfalls in the search for faster medical imaging

Block, Kai Tobias
PMID: 35452309
ISSN: 1091-6490
CID: 5216922

Diagnostic abdominal MR imaging on a prototype low-field 0.55 T scanner operating at two different gradient strengths

Chandarana, Hersh; Bagga, Barun; Huang, Chenchan; Dane, Bari; Petrocelli, Robert; Bruno, Mary; Keerthivasan, Mahesh; Grodzki, David; Block, Kai Tobias; Stoffel, David; Sodickson, Daniel K
PURPOSE:To develop a protocol for abdominal imaging on a prototype 0.55 T scanner and to benchmark the image quality against conventional 1.5 T exam. METHODS:In this prospective IRB-approved HIPAA-compliant study, 10 healthy volunteers were recruited and imaged. A commercial MRI system was modified to operate at 0.55 T (LF) with two different gradient performance levels. Each subject underwent non-contrast abdominal examinations on the 0.55 T scanner utilizing higher gradients (LF-High), lower adjusted gradients (LF-Adjusted), and a conventional 1.5 T scanner. The following pulse sequences were optimized: fat-saturated T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and Dixon T1-weighted imaging (T1WI). Three readers independently evaluated image quality in a blinded fashion on a 5-point Likert scale, with a score of 1 being non-diagnostic and 5 being excellent. An exact paired sample Wilcoxon signed-rank test was used to compare the image quality. RESULTS:Diagnostic image quality (overall image quality score ≥ 3) was achieved at LF in all subjects for T2WI, DWI, and T1WI with no more than one unit lower score than 1.5 T. The mean difference in overall image quality score was not significantly different between LF-High and LF-Adjusted for T2WI (95% CI - 0.44 to 0.44; p = 0.98), DWI (95% CI - 0.43 to 0.36; p = 0.92), and for T1 in- and out-of-phase imaging (95%C I - 0.36 to 0.27; p = 0.91) or T1 fat-sat (water only) images (95% CI - 0.24 to 0.18; p = 1.0). CONCLUSION:Diagnostic abdominal MRI can be performed on a prototype 0.55 T scanner, either with conventional or with reduced gradient performance, within an acquisition time of 10 min or less.
PMID: 34415411
ISSN: 2366-0058
CID: 5048652

Assessing the qualitative and quantitative impacts of simple two-class vs multiple tissue-class MR-based attenuation correction for cardiac PET/MR

Robson, Philip M; Vergani, Vittoria; Benkert, Thomas; Trivieri, Maria Giovanna; Karakatsanis, Nicolas A; Abgral, Ronan; Dweck, Marc R; Moreno, Pedro R; Kovacic, Jason C; Block, Kai Tobias; Fayad, Zahi A
BACKGROUND:Hybrid PET/MR imaging has significant potential in cardiology due to its combination of molecular PET imaging and cardiac MR. Multi-tissue-class MR-based attenuation correction (MRAC) is necessary for accurate PET quantification. Moreover, for thoracic PET imaging, respiration is known to lead to misalignments of MRAC and PET data that result in PET artifacts. These factors can be addressed by using multi-echo MR for tissue segmentation and motion-robust or motion-gated acquisitions. However, the combination of these strategies is not routinely available and can be prone to errors. In this study, we examine the qualitative and quantitative impacts of multi-class MRAC compared to a more widely available simple two-class MRAC for cardiac PET/MR. METHODS AND RESULTS/RESULTS:In a cohort of patients with cardiac sarcoidosis, we acquired MRAC data using multi-echo radial gradient-echo MR imaging. Water-fat separation was used to produce attenuation maps with up to 4 tissue classes including water-based soft tissue, fat, lung, and background air. Simultaneously acquired 18F-fluorodeoxyglucose PET data were subsequently reconstructed using each attenuation map separately. PET uptake values were measured in the myocardium and compared between different PET images. The inclusion of lung and subcutaneous fat in the MRAC maps significantly affected the quantification of 18F-fluorodeoxyglucose activity in the myocardium but only moderately altered the appearance of the PET image without introduction of image artifacts. CONCLUSION/CONCLUSIONS:Optimal MRAC for cardiac PET/MR applications should include segmentation of all tissues in combination with compensation for the respiratory-related motion of the heart. Simple two-class MRAC is adequate for qualitative clinical assessment.
PMID: 31898004
ISSN: 1532-6551
CID: 4251762

Feasibility of quantitative assesment of renal function using motion-insensitive MR urography in pediatric patients [Meeting Abstract]

Khrichenko, D; Block, T; Kurugol, S; Chow, J; Krishnamurthy, R
Background: Quantitative assessment of kidney function in children using functional MR urography (fMRU) is challenging due to 1) long scan times, 2) respiratory/bulk motion artifact, and 3) non-availability of validated open-use software for analysis. In this study, we demonstrate the feasibility of quantitative assessment of renal function from motion-insensitive MR imaging using freely available validated software.
Method(s): In 6 patients (mean age: 5 years, range: 4 months-19 years) referred to fMRU from April 2019 until November 2020,MR imaging of the renal system was performed on a 3T scanner (Siemens Prisma or Skyra). After obtaining anatomy and T2W scans, contrast-enhanced imaging (single dose gadavist, 0.1 or 0.2 cc/s) of the kidneys was performed 15 minutes after injection of furosemide. A golden-angle radial sparse parallel (GRASP) technique was used to acquire 3D coronal images. Acquisition parameters: TR =3.3 ms; TE = 1.5 ms; flip angle = 13; 288x288 acquisition matrix; slice thickness = 2-3 mm; 6000-9000 radial spokes; acquisition time = 8-10 minutes. Dynamic images were reconstructed at 6.8 s temporal resolution using the freely available Yarra framework (https:
ISSN: 1432-1998
CID: 5024982

Magnetization-prepared GRASP MRI for rapid 3D T1 mapping and fat/water-separated T1 mapping

Feng, Li; Liu, Fang; Soultanidis, Georgios; Liu, Chenyu; Benkert, Thomas; Block, Kai Tobias; Fayad, Zahi A; Yang, Yang
PURPOSE/OBJECTIVE:This study aimed to (i) develop Magnetization-Prepared Golden-angle RAdial Sparse Parallel (MP-GRASP) MRI using a stack-of-stars trajectory for rapid free-breathing T1 mapping and (ii) extend MP-GRASP to multi-echo acquisition (MP-Dixon-GRASP) for fat/water-separated (water-specific) T1 mapping. METHODS:An adiabatic non-selective 180° inversion-recovery pulse was added to a gradient-echo-based golden-angle stack-of-stars sequence for magnetization-prepared 3D single-echo or 3D multi-echo acquisition. In combination with subspace-based GRASP-Pro reconstruction, the sequence allows for standard T1 mapping (MP-GRASP) or fat/water-separated T1 mapping (MP-Dixon-GRASP), respectively. The accuracy of T1 mapping using MP-GRASP was evaluated in a phantom and volunteers (brain and liver) against clinically accepted reference methods. The repeatability of T1 estimation was also assessed in the phantom and volunteers. The performance of MP-Dixon-GRASP for water-specific T1 mapping was evaluated in a fat/water phantom and volunteers (brain and liver). RESULTS:= 0.82). Water-specific T1 is different from in-phase and out-of-phase composite T1 (composite T1 when fat and water signal are mixed in phase or out of phase) both in the phantom and volunteers. CONCLUSION/CONCLUSIONS:This work demonstrated the initial performance of MP-GRASP and MP-Dixon-GRASP MRI for rapid 3D T1 mapping and 3D fat/water-separated T1 mapping in the brain (without motion) and in the liver (during free breathing). With fat/water-separated T1 estimation, MP-Dixon-GRASP could be potentially useful for imaging patients with fatty-liver diseases.
PMID: 33580909
ISSN: 1522-2594
CID: 4835572

Evaluation of liver fibrosis and cirrhosis on the basis of quantitative T1 mapping: Are acute inflammation, age and liver volume confounding factors?

Breit, Hanns C; Block, Kai T; Winkel, David J; Gehweiler, Julian E; Henkel, Maurice J; Weikert, Thomas; Stieltjes, Bram; Boll, Daniel T; Heye, Tobias J
PURPOSE/OBJECTIVE:To evaluate potential confounding factors in the quantitative assessment of liver fibrosis and cirrhosis using T1 relaxation times. METHODS:The study population is based on a radiology-information-system database search for abdominal MRI performed from July 2018 to April 2019 at our institution. After applying exclusion criteria 200 (59 ± 16 yrs) remaining patients were retrospectively included. 93 patients were defined as liver-healthy, 40 patients without known fibrosis or cirrhosis, and 67 subjects had a clinically or biopsy-proven liver fibrosis or cirrhosis. T1 mapping was performed using a slice based look-locker approach. A ROI based analysis of the left and the right liver was performed. Fat fraction, R2*, liver volume, laboratory parameters, sex, and age were evaluated as potential confounding factors. RESULTS:T1 values were significantly lower in healthy subjects without known fibrotic changes (1.5 T MRI: 575 ± 56 ms; 3 T MRI: 857 ± 128 ms) compared to patients with acute liver disease (1.5 T MRI: 657 ± 73 ms, p < 0.0001; 3 T MRI: 952 ± 37 ms, p = 0.028) or known fibrosis or cirrhosis (1.5 T MRI: 644 ± 83 ms, p < 0.0001; 3 T MRI: 995 ± 150 ms, p = 0.018). T1 values correlated moderately with the Child-Pugh stage at 1.5 T (p = 0.01, ρ = 0.35). CONCLUSION/CONCLUSIONS:T1 mapping is a capable predictor for detection of liver fibrosis and cirrhosis. Especially age is not a confounding factor and, hence, age-independent thresholds can be defined. Acute liver diseases are confounding factors and should be ruled out before employing T1-relaxometry based thresholds to screen for patients with liver fibrosis or cirrhosis.
PMID: 34051684
ISSN: 1872-7727
CID: 4904972

Free-breathing radial imaging using a pilot-tone radiofrequency transmitter for detection of respiratory motion

Solomon, Eddy; Rigie, David S; Vahle, Thomas; Paška, Jan; Bollenbeck, Jan; Sodickson, Daniel K; Boada, Fernando E; Block, Kai Tobias; Chandarana, Hersh
PURPOSE/OBJECTIVE:To describe an approach for detection of respiratory signals using a transmitted radiofrequency (RF) reference signal called Pilot-Tone (PT) and to use the PT signal for creation of motion-resolved images based on 3D stack-of-stars imaging under free-breathing conditions. METHODS:This work explores the use of a reference RF signal generated by a small RF transmitter, placed outside the MR bore. The reference signal is received in parallel to the MR signal during each readout. Because the received PT amplitude is modulated by the subject's breathing pattern, a respiratory signal can be obtained by detecting the strength of the received PT signal over time. The breathing-induced PT signal modulation can then be used for reconstructing motion-resolved images from free-breathing scans. The PT approach was tested in volunteers using a radial stack-of-stars 3D gradient echo (GRE) sequence with golden-angle acquisition. RESULTS:Respiratory signals derived from the proposed PT method were compared to signals from a respiratory cushion sensor and k-space-center-based self-navigation under different breathing conditions. Moreover, the accuracy was assessed using a modified acquisition scheme replacing the golden-angle scheme by a zero-angle acquisition. Incorporating the PT signal into eXtra-Dimensional (XD) motion-resolved reconstruction led to improved image quality and clearer anatomical depiction of the lung and liver compared to k-space-center signal and motion-averaged reconstruction, when binned into 6, 8, and 10 motion states. CONCLUSION/CONCLUSIONS:PT is a novel concept for tracking respiratory motion. Its small dimension (8 cm), high sampling rate, and minimal interaction with the imaging scan offers great potential for resolving respiratory motion.
PMID: 33306216
ISSN: 1522-2594
CID: 4709402

Comparison of contrast-enhanced videofluoroscopy to unenhanced dynamic MRI in minor patients following surgical correction of velopharyngeal dysfunction

Arendt, C T; Eichler, K; Mack, M G; Leithner, D; Zhang, S; Block, K T; Berdan, Y; Sader, R; Wichmann, J L; Gruber-Rouh, T; Vogl, T J; Hoelter, M C
OBJECTIVES/OBJECTIVE:To compare dynamic magnetic resonance imaging (MRI) with videofluoroscopy (VFS) regarding image quality and assessment of gap size between soft palate (SP) and posterior pharyngeal wall (PPW) in children and adolescents following surgical correction of velopharyngeal dysfunction (VPD). METHODS:Twenty-one patients undergoing unenhanced 3-T MRI and contrast-enhanced VFS were included in this IRB-approved prospective study. The MRI scan protocol comprised refocused gradient-echo sequences in transverse and sagittal planes during speech, with TE 1.97 ms, TR 3.95 ms, flip angle 8°, matrix size 128 × 128, and 5-mm slice thickness. Radial k-space sampling and sliding window reconstruction were used to achieve an image acquisition rate of 28 frames per second (fps). VFS with 30 fps was similarly performed in both planes. Closure of the velopharyngeal port during phonation was evaluated by two experienced radiologists. RESULTS:Eleven (52.4%) patients displayed a complete closure, whereas ten (47.6%) patients showed a post-operative gap during speech. VFS and MRI equally identified the cases with persistent or recurrent VPD. Differences in SP-PPW distance between VFS (3.9 ± 1.6 mm) and MRI (4.1 ± 1.5 mm) were not statistically significant (p = 0.5). The subjective overall image quality of MRI was rated inferior (p < 0.001) compared with VFS, with almost perfect inter-rater agreement (κ = 0.90). The presence of susceptibility artifacts did not limit anatomical measurements. CONCLUSION/CONCLUSIONS:Dynamic MRI is equally reliable as VFS to assess persistent or recurrent inadequate velum closure in patients following surgical treatment of VPD. KEY POINTS/CONCLUSIONS:• Unenhanced 3-T dynamic MRI and contrast-enhanced videofluoroscopy are equally useful for the identification of patients with incomplete velopharyngeal closure during speech. • MRI using refocused gradient-echo acquisition with radial k-space sampling and sliding window reconstruction generates diagnostic images with 28 frames per second. • MRI can offer a radiation-free alternative to currently established videofluoroscopy for young patients.
PMID: 32740819
ISSN: 1432-1084
CID: 4560642

Free-breathing fat and R 2 * quantification in the liver using a stack-of-stars multi-echo acquisition with respiratory-resolved model-based reconstruction

Schneider, Manuel; Benkert, Thomas; Solomon, Eddy; Nickel, Dominik; Fenchel, Matthias; Kiefer, Berthold; Maier, Andreas; Chandarana, Hersh; Block, Kai Tobias
PMID: 32301168
ISSN: 1522-2594
CID: 4383802

How to Implement AI in the Clinical Enterprise: Opportunities and Lessons Learned

Lui, Yvonne W; Geras, Krzysztof; Block, K Tobias; Parente, Marc; Hood, Joseph; Recht, Michael P
PMID: 33153543
ISSN: 1558-349x
CID: 4671212