Segmented K-space blipped-controlled aliasing in parallel imaging for high spatiotemporal resolution EPI

PURPOSE

A segmented k-space blipped-controlled aliasing in parallel imaging (skipped-CAIPI) sampling strategy for EPI is proposed, which allows for a flexible choice of EPI factor and phase encode bandwidth independent of the controlled aliasing in parallel imaging (CAIPI) sampling pattern.

THEORY AND METHODS

With previously proposed approaches, exactly two EPI trajectories were possible given a specific CAIPI pattern, either with slice gradient blips (blipped-CAIPI) or following a shot-selective CAIPI approach (higher resolution). Recently, interleaved multi-shot segmentation along shot-selective CAIPI trajectories has been applied for high-resolution anatomical imaging. For more flexibility and a broader range of applications, we propose segmentation along any blipped-CAIPI trajectory. Thus, all EPI factors and phase encode bandwidths available with traditional segmented EPI can be combined with controlled aliasing.

RESULTS

Temporal SNR maps of moderate-to-high-resolution time series acquisitions at varying undersampling factors demonstrate beneficial sampling alternatives to blipped-CAIPI or shot-selective CAIPI. Rapid high-resolution scans furthermore demonstrate SNR-efficient and motion-robust structural imaging with almost arbitrary EPI factor and minimal noise penalty.

CONCLUSION

Skipped-CAIPI sampling increases protocol flexibility for high spatiotemporal resolution EPI. In terms of SNR and efficiency, high-resolution functional or structural scans benefit vastly from a free choice of the CAIPI pattern. Even at moderate resolutions, the independence of sampling pattern, TE, and image matrix size is valuable for optimized functional protocol design. Although demonstrated with 3D-EPI, skipped-CAIPI is also applicable with simultaneous multislice EPI.

1-benzyl-1,4-diazepane reduces the efflux of resistance-nodulation-cell division pumps in Escherichia coli

Aim: To investigate the action mechanism of 1-benzyl-1,4-diazepane (1-BD) as efflux pump inhibitor (EPI) in Escherichia coli mutants: ΔacrAB or overexpressing AcrAB and AcrEF efflux pumps. Materials & methods: Effect of 1-BD on: antibiotic potentiation, by microdilution method; membrane functionality, by fluorimetric assays; ethidium bromide accumulation, by fluorometric real-time efflux assay; AcrB expression, by quantitative photoactivated localization microscopy. Results: 1-BD decreases the minimal inhibitory concentration of levofloxacin and other antibiotics and increase ethidium bromide accumulation in E. coli overexpressing efflux pumps but not in the ΔacrAB strain. 1-BD increases membranes permeability, without sensibly affecting inner membrane polarity and decreases acrAB transcription. Conclusion: 1-BD acts as an EPI in E. coli with a mixed mechanism, different from that of major reference EPIs.

The effects of coronavirus disease 2019 pandemic on the South African health system: A call to maintain essential health services

South Africa had its first coronavirus disease 2019 (COVID-19) case on 06 March 2020 in an individual who travelled overseas. Since then, cases have constantly increased and the pandemic has taken a toll on the health system. This requires extra mobilisation of resources to curb the disease and overcome financial loses whilst providing social protection to the poor. Assessing the effects of COVID-19 on South African health system is critical to identify challenges and act timely to strike a balance between managing the emergency and maintaining essential health services. We applied the World Health Organization (WHO) health systems framework to assess the effects of COVID-19 on South African health system, and proposed solutions to address the gaps, with a focus on human immunodeficiency virus (HIV) and expanded programme on immunisation (EPI) programmes. The emergence of COVID-19 pandemic has direct impact on the health system, negatively affecting its functionality, as depletion of resources to curb the emergency is eminent. Diversion of health workforce, suspension of services, reduced health-seeking behaviour, unavailability of supplies, deterioration in data monitoring and funding crunches are some of the noted challenges. In such emergencies, the ability to deliver essential services is dependent on baseline capacity of health system. Our approach advocates for close collaboration between essential services and COVID-19 teams to identify priorities, restructure essential services to accommodate physical distancing, promote task shifting at primary level, optimise the use of mobile/web-based technologies for service delivery/training/monitoring and involve private sector and non-health departments to increase management capacity. Strategic responses thus planned can assist in mitigating the adverse effects of the pandemic whilst preventing morbidity and mortality from preventable diseases in the population.

Echo planar time-resolved imaging with subspace reconstruction and optimized spatiotemporal encoding

PURPOSE

To develop new encoding and reconstruction techniques for fast multi-contrast/quantitative imaging.

METHODS

The recently proposed Echo Planar Time-resolved Imaging (EPTI) technique can achieve fast distortion- and blurring-free multi-contrast/quantitative imaging. In this work, a subspace reconstruction framework is developed to improve the reconstruction accuracy of EPTI at high encoding accelerations. The number of unknowns in the reconstruction is significantly reduced by modeling the temporal signal evolutions using low-rank subspace. As part of the proposed reconstruction approach, a B₀ -update algorithm and a shot-to-shot B₀ variation correction method are developed to enable the reconstruction of high-resolution tissue phase images and to mitigate artifacts from shot-to-shot phase variations. Moreover, the EPTI concept is extended to 3D k-space for 3D GE-EPTI, where a new "temporal-variant" of CAIPI encoding is proposed to further improve performance.

RESULTS

The effectiveness of the proposed subspace reconstruction was demonstrated first in 2D GESE EPTI, where the reconstruction achieved higher accuracy when compared to conventional B₀ -informed GRAPPA. For 3D GE-EPTI, a retrospective undersampling experiment demonstrates that the new temporal-variant CAIPI encoding can achieve up to 72× acceleration with close to 2× reduction in reconstruction error when compared to conventional spatiotemporal-CAIPI encoding. In a prospective undersampling experiment, high-quality whole-brain T 2 ∗ and tissue phase maps at 1 mm isotropic resolution were acquired in 52 seconds at 3T using 3D GE-EPTI with temporal-variant CAIPI encoding.

CONCLUSION

The proposed subspace reconstruction and optimized temporal-variant CAIPI encoding can further improve the performance of EPTI for fast quantitative mapping.

Small Session Size and Big Vial Size: Operational Research Assessing Open Vial Vaccine Wastage at the Service Delivery Points in the Mandalay Region of Myanmar During 2018

The World Health Organization (WHO) recommends immunization programmes to monitor vaccine wastage at storage and service delivery points. As there were no vaccine wastage assessments in Myanmar, we aimed to assess the vaccine wastage rates in the Mandalay region. We conducted a cross-sectional descriptive study with the inclusion of all immunization sessions conducted through the twenty randomly selected subcentres in the year 2018. The wastage rates were calculated by aggregating vaccine utilization data from selected subcentres. The vaccine wastage rates for Bacillus Calmette–Guérin (BCG) (54.9%), inactivated polio vaccine (28.3%), and measles-rubella (27.4%) were higher than the WHO indicative rates. The high vaccine wastage rates were seen in lyophilized vaccines (36.9%), vaccines requiring only a single dose per child for complete immunization (39.1%), and those with a large vial size of 20 doses (38.8%). The median session size for BCG (6), measles-rubella (4) and inactivated polio vaccine (2) were lower than their vaccine vial size of 20, 10, and 5 doses, respectively. The wastage was high due to smaller session size and larger vial size, necessitating the disposal of unused doses. Better micro-planning to increase the session size and procuring vaccines with smaller vial sizes needs to be tested as a strategy to reduce vaccine wastage.

Efficient spiral in-out and EPI balanced steady-state free precession cine imaging using a high-performance 0.55T MRI

PURPOSE

Low-field MRI offers favorable physical properties for SNR-efficient long readout acquisitions such as spiral and EPI. We used a 0.55 tesla (T) MRI system equipped with high-performance hardware to increase the sampling duty cycle and extend the TR of balanced steady-state free precession (bSSFP) cardiac cine acquisitions, which typically are limited by banding artifacts.

METHODS

We developed a high-efficiency spiral in-out bSSFP acquisition, with zeroth- and first-gradient moment nulling, and an EPI bSSFP acquisition for cardiac cine imaging using a contemporary MRI system modified to operate at 0.55T. Spiral in-out and EPI bSSFP cine protocols, with TR = 8 ms, were designed to maintain both spatiotemporal resolution and breath-hold length. Simulations, phantom imaging, and healthy volunteer imaging studies (n = 12) were performed to assess SNR and image quality using these high sampling duty-cycle bSSFP sequences.

RESULTS

Spiral in-out bSSFP performed favorably at 0.55T and generated good image quality, whereas EPI bSSFP suffered motion and flow artifacts. There was no difference in ejection fraction comparing spiral in-out with standard Cartesian imaging. Moreover, human images demonstrated a 79% ± 21% increase in myocardial SNR using spiral in-out bSSFP and 50% ± 14% increase in SNR using EPI bSSFP as compared with the reference Cartesian acquisition. Spiral in-out acquisitions at 0.55T recovered 69% ± 14% of the myocardial SNR at 1.5T.

CONCLUSION

Efficient bSSFP spiral in-out provided high-quality cardiac cine imaging and SNR recovery on a high-performance 0.55T MRI system.

Look-Locker FAIR TrueFISP for arterial spin labelling on mouse at 9.4 T

Pulsed arterial spin labelling remains a non-invasive and highly used method for the study of rodent cerebral blood flow (CBF). Flow-sensitive alternating inversion recovery (FAIR) is one of the most commonly used MR-sequences for this purpose and exists with many different strategies to record the images. This study investigates Look-Locker (LL) TrueFISP readout for FAIR as an alternative to the standard EPI readout, which is provided by the manufacturer. The aim was to show the improved image quality using TrueFISP and to verify the reproducibility of the determination of the cerebral blood flow values. The measurement of many inversion points also allowed to investigate the influence of the correct blood relaxation rate on the fit of the CBF data. For the LL-FAIR TrueFISP an in-house written method was created. The method was tested on a group of C57BL/6 mice at the field strength of 9.4 T. The results show CBF maps with less distortion than for EPI and the values found are in good agreement with the literature. A comparison of the CBF values found with EPI and LL-TrueFISP shows very small differences, most being not significant. In conclusion, the method presented gives equivalent CBF maps in comparison to standard FAIR-EPI. Both methods have the same measurement time. TrueFISP has the advantage to EPI of producing undistorted images over larger areas of the mouse brain. It is advisable to check the value of the blood relaxation rate by measurement or to estimate it as a fitting parameter.

Analysis of EPI phase correction with low flip-angle excitation to reduce the required minimum TE: Application to whole-brain, submillimeter-resolution fMRI at 3 T

PURPOSE

Echo planar imaging is used widely for its imaging speed. However, its applications often suffer from ghost artifacts. In the community, an approach using three navigator echoes is used commonly for the artifact correction. Although this scheme is effective, as the matrix size increases for high-resolution imaging, the navigator echoes can contribute significantly to increasing the "required minimum TE." To overcome this issue, this work proposes the use of an alternative navigator echo scheme called the "TR-external" scheme.

METHODS

The TR-external scheme reduces the required minimum TE by allocating an  additional excitation loop for the navigator echoes before every main excitation loop. In this work, a detailed analysis on the TR-external scheme was performed to assess its performance in comparison to the standard scheme. Visual fMRI was performed to check the feasibility of using the TR-external scheme for detecting functional signals.

RESULTS

The performance of the TR-external scheme was comparable with that of the standard scheme in terms of the SNR, elimination of ghost artifacts, and the BOLD detection. For a given matrix size (288 × 288), the TR-external scheme allowed a substantially shorter TE (5.94 ms) compared with the standard scheme, which resulted in a higher SNR. Furthermore, this feature enabled the submillimeter-resolution (0.73 × 0.73 mm² ) fMRI measurement with a favorable TE (35 ms) at 3 T. The fMRI results revealed that activated voxels are well localized along the cortical ribbon.

CONCLUSION

A TR-external scheme for EPI phase correction was implemented at 3 T. Its feasibility for submillimeter-resolution fMRI was successfully demonstrated.

Quality and reliability of vaccination documentation in the routine childhood immunization program in Burkina Faso: Results from a cross-sectional survey

INTRODUCTION

Accurate and timely vaccination data are important to the Expanded Program on Immunization (EPI) to assess individual vaccination status and to monitor performance and vaccine coverage (VC). Since 2013, Burkina Faso introduced several new vaccines into the routine childhood immunization schedule. However, sustained efforts for a timely update and alignment of immunization home-based (HBRs) and health facility-based records (FBRs) with the evolving schedule were not implemented.

METHODS

In 2016-17, we conducted a 6-week cross-sectional survey in 30 health facilities (HFs) across 10 health districts (HDs), targeting children aged < 24 months and their caregivers. Data collected included sociodemographics, availability of vaccination recording fields in HBRs, and vaccination dates. We evaluated the characteristics, completion patterns, and concordance of HBRs and FBRs to determine their reliability as data sources in estimating VC. A standard HBR was defined as one that had recording fields for all recommended 17 vaccine doses of the schedule, and discordance between HBR and FBR as having different vaccination dates recorded, or vaccination information missing in one of the records. We computed proportions and concordance statistics, and used logistic regression to explore predictors of discordance.

RESULTS

We recruited 619 children, including 74% (n = 458) aged 0-11 months. Half (50.6%) of HBRs were non-standard. About two-thirds (64.6%) of children were concerned with discordant information. Compared to HBRs, FBRs were generally associated with low negative predictive values (median: 0.41; IQR: 0.16-0.70). Multivariate logistic regression model showed that standard HBR was protectively associated with discordant information (OR = 0.46, 95% CI: 0.26-0.81, p = 0.010).

CONCLUSION

We documented a lack of standardization of HBRs and frequent information discordance with FBRs. There is a pressing need to update and standardize vaccination recording tools and ensure their continuous availability in HFs to improve data quality in Burkina Faso.

Sliding window reduced FOV reconstruction for real-time cardiac imaging

BACKGROUND

Current functional cardiovascular imaging protocols mostly rely on electrocardiogram (ECG) gating and breathholding. The resulting image quality can substantially suffer from insufficient patient cooperation or severe arrhythmia. Real-time imaging can mitigate these effects but requires highly accelerated techniques, usually relying on non-cartesian trajectories and Compressed Sensing (CS).

METHODS

We investigate a sliding window reduced field of view (FOV) Echo Planar Imaging (EPI) technique for real-time cardiac MRI. Segmented EPI has been combined with a subtraction technique for reducing the FOV in cardiac applications to the region of the beating heart. Residual respiratory motion, potentially impairing the image quality, has been addressed by continuous update of the static image fraction, which is derived from a low-temporal resolution sliding window reconstruction. For further acceleration, the proposed technique was combined with parallel imaging.

RESULTS

The sliding window reduced FOV technique was proven feasible to reconstruct images of diagnostic image quality at a temporal resolution of 36.5ms per image. Semi-quantitative evaluation of image quality showed significant improvement over the existing rFOV method (p=0.039). Derived functional parameters show comparable results as with the BH-CINE reference. However, a trend to a slight underestimation of the largest and smallest in-plane volumes is observed.

CONCLUSION

The proposed technique is feasible of providing real-time cardiac MRI with a temporal resolution better than 40ms without the need of computably complex reconstruction techniques.

EPI immunization coverage, timeliness and dropout rate among children in a West Cameroon health district: a cross sectional study

BACKGROUND

Monitoring of the expanded program on immunization's performance is not only limited to routine periodic reports but equally includes surveys. Based on unpublished national EPI surveillance data from the past 5 years in Cameroon, the Foumban health district has reported a high number of vaccine preventable disease suspected cases. Contradictory information on the immunization coverage in this district exists from both administrative data and published literature. As a result, the objective of this study was to estimate the immunization coverage and dropout rate in age group 12-23 months and timeliness in age group 0-59 months among children in Foumban Health District (Cameroon), in 2018.

METHOD

This was a descriptive cross-sectional study targeting randomly selected children aged 0-59 months from Foumban health district. Data were collected by trained and supervised surveyors using a pretested questionnaire to describe the immunization coverage, timeliness and dropout rate in eighty clusters of about thirty buildings selected by stratified random sampling in July 2018.

RESULTS

In total, 80 clusters covering 2121 buildings were selected and all were reached (100%). A total of 1549 (81.2%) households accepted to participate in the survey and 1430 children aged 0-59 months including 294 (20.6%) aged 12-23 months were enrolled into the study. Of these 1430 children, 427 [29.9 (27.4-32.2)%] aged 0-59 months were vaccinated with evidence. In the age group 12-23 months, the immunization coverage with evidence of BCG, DPT-Hi + Hb 3 and measles/rubella were 28.6(23.4-33.9)%, 22.8 (18.1-27.6)% and 14.3 (10.3-18.1)% respectively. Within age group 0-59 months; the proportion of children who missed their vaccination appointments increased from 23.3 to 31.7% for the vaccine planned at birth (BCG) and last vaccine planned (Measles/Rubella) for the EPI program respectively. In age group 12-23 months; the specific (DPT-Hi + Hb1-3) and general (BCG-Measles/Rubella) dropout rates of vaccination with evidence were 14.1 and 50.0% respectively.

CONCLUSION

Documented immunization coverage, dropout rate and timeliness in Foumban Health district are lower than that targeted by the Cameroon EPI. Competent health authorities have to take necessary actions to ensure the implementation of national guidelines with regards to children access to immunization. Also, studies have to be conducted to identify determinants of low immunization coverage and delays in immunization schedules as well as high dropout rates.

Why Have Immunization Efforts in Pakistan Failed to Achieve Global Standards of Vaccination Uptake and Infectious Disease Control?

Immunization is one of the most successful public health initiatives in recent times. It is, therefore, worrying to learn the level of under-vaccination in Pakistan. Diseases that have been successfully eliminated through the aid of vaccination in other countries have not been eliminated in Pakistan. The reasons for this vary and show the uniqueness of the economic, healthcare and environmental landscape of Pakistan, through which public health programmes need to be implemented. The “Expanded Programme of Immunization” (EPI) is the main programme through which routine immunization is provided to the public. Within Pakistan, it has encountered many problems since its inception. This includes logistical obstacles, inefficient health worker attitudes, parental and female awareness, and education, the influence of religious community leaders and the complications that accompany conflict. When compared to globally standardised targets for immunization, Pakistan is trailing behind. Not achieving these targets is worrying from both a global perspective and within the national healthcare landscape of Pakistan. Research is necessary to bring together findings on the failings of routine immunization and polio campaigns; there are many intersecting factors that global health bodies and the Department of Health in Pakistan must address in order to relieve the burden of vaccine-preventable diseases (VPDs).

Echo-planar imaging of the human head with 100 mT/m gradients and high-order modeling of eddy current fields

PURPOSE

To demonstrate the utility of a high-performance gradient insert for ultrafast MRI of the human head.

METHODS

EPI was used for the first time with a readout gradient amplitude of 100 mT/m, 1200 T/m/s slew rate, and nearly 1 MHz signal bandwidth for human head scanning. To avoid artefacts due to eddy currents, the magnetic field was dynamically monitored with NMR probes at multiple points, modeled by solid harmonics up to fifth order, and included in the image reconstruction. An approximation of a negligible intra-echo effect of the eddy currents was made to accelerate the high-order reconstruction. The field monitoring-based approach was compared with a recently proposed phase error estimation from separate reconstructions of even and odd echoes.

RESULTS

Images obtained with the gradient insert have significantly lower distortions than it is the case with the whole body 30 mT/m, 200 T/m/s gradients of the same system. However, eddy currents of high spatial order must be properly characterized and corrected for in order to avoid a persistent 2D Nyquist ghost. Multi-position monitoring proves to be a robust method to measure the eddy currents and allows higher undersampling rates than the image-based approach. The proposed approximation of the eddy currents effect allows a significant acceleration of the high-order reconstruction by a separate processing of each spatial dimension.

CONCLUSION

Strong gradients with adequate switching rates are highly beneficial for the quality of EPI provided that robust measures are taken to include the contribution of eddy currents to the image encoding.

Vaccination Coverage Under the Expanded Program on Immunization in South West Cameroon

BACKGROUND

Inadequate vaccination coverage with increased risk of vaccine preventable disease outbreaks remain a problem in Africa. The aim of this study was to assess the vaccination coverage levels under the Expanded Program on Immunization (EPI) in a health area and to identify factors that affect vaccination coverage in view of providing valuable data for disease prevention.

METHODS

A cross-sectional household survey was conducted in August 2017 in the Mbonge health area, Southwest Cameroon. Clustered sampling technique was used to select study communities and a purposive sampling design was used to select households. An interviewer-administered questionnaire was used to obtain information from consenting caregivers of children aged 9-23 months. Vaccination coverage was assessed by consulting the vaccination cards and parents' recall. In households with more than one child aged 9-23months, the youngest was chosen.

RESULTS

Overall, 300 caregivers were enrolled into the study. The average vaccination coverage for the past three years (2014-2016) was 34.0%. Two hundred and fifty-five (85%) children had vaccination cards. Amongst the children, 143 (47.7%) had taken all vaccines as recommended while 30 (10%) had not received a single dose. Factors significantly associated with incomplete vaccination status included: occupation (being a farmer) (p-value=0.011), marital status (married) (p-value=0.048), caregiver's utilization of health facility (p-value=0.003), low levels of mothers' utilization of antenatal care (ANC) services (p-value=0.000), and low knowledge on vaccination (p-value=0.000).

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

Adequate vaccination coverage can be attained through good sensitization and health education for primary caregivers. Targeting families living far away from vaccination centers, using appropriate communication and vaccination strategies may improve vaccination coverage in the Mbonge Health Area of South West Region, Cameroon.

Retrospective Review of Documentation Practices of Hepatitis B Immunoglobulin, Birth Dose, and Vaccination at the Hospital of Birth, in Thai Nationals and Migrants in Northern Thailand

Background

Vaccination remains the mainstay of prevention of hepatitis B virus (HBV) including birth dose and hepatitis B immunoglobulins (HBIGs). National estimates of vaccination coverage exclude migrants. The objective of this study is to investigate documentation practices of HBV-related infant vaccinations in Northern Thailand including migrants.

Methods

This is a retrospective review of hospital records of women who birthed infants in 2015 at Maharaj Nakorn Hospital, Chiang Mai (CM) or on the Thailand-Myanmar border, Tak.

Results

Of 2522 women, 987 were from CM (861 Thai nationals, 126 migrants) and 1535 were from Tak (651 Thai residence and 884 Myanmar residence). In CM, documentation for the birth dose vaccine (999 of 999, 100%) and HBIG was complete. In Tak, documentation was 1441 of 1549 (93%) for birth dose and 26 of 34 (76.5%) for HBIG, with missed opportunities including home delivery, delay in obtaining hepatitis B e-antigen status, and limitations of the records. Expanded Program of Immunization (EPI) documentation of 3 follow-up vaccinations dwindled with subsequent doses and distance, and complete documentation of 3 HBV EPI vaccines at the hospital of birth was low, 41.5% (1056 of 2547), but equitable for Thai or migrant status.

Conclusions

This review provides strong support for excellent documentation of HBIG and birth dose vaccination in urban and rural settings, and in migrants, consistent with Thailand's vaccination policy and practice. Documentation of the 3 HBV EPI at the hospital of birth decreases with sequential doses, especially in families further away. Innovative data linkage is required to prove coverage and identify gaps.

Partial Fourier reconstruction for improved resolution in 3D hyperpolarized 13 C EPI

PURPOSE

Asymmetric in-plane k-space sampling of EPI can reduce the minimum achievable TE in hyperpolarized 13 C with spectral-spatial radio frequency pulses, thereby reducing T 2 * weighting and signal-losses. Partial Fourier image reconstruction exploits the approximate Hermitian symmetry of k-space data and can be applied to asymmetric data sets to synthesize unmeasured data. Here we tested whether the application of partial Fourier image reconstruction would improve spatial resolution from hyperpolarized [1- 13 C ]pyruvate scans in the human brain.

METHODS

Fifteen healthy control subjects were imaged using a volumetric dual-echo echo-planar imaging sequence with spectral-spatial radio frequency excitation. Images were reconstructed by zero-filling as well as with the partial Fourier reconstruction algorithm projection-on-convex-sets. Resulting images were quantitatively evaluated with a no-reference image quality assessment.

RESULTS

The no-reference image sharpness metric agreed with perceived improvements in image resolution and contrast. The [1- 13 C ]lactate images benefitted most, followed by the [1- 13 C ]pyruvate images. The 13 C -bicarbonate images were improved by the smallest degree, likely owing to relatively lower SNR.

CONCLUSIONS

Partial Fourier imaging and reconstruction were shown to improve the sharpness and contrast of human HP 13 C brain data and is a viable method for enhancing resolution.

Propeller echo-planar time-resolved imaging with dynamic encoding (PEPTIDE)

PURPOSE

To develop a motion-robust extension to the recently developed echo-planar time-resolved imaging (EPTI) approach, referred to as PROPELLER EPTI with dynamic encoding (PEPTIDE), by incorporating rotations into the rapid, multishot acquisition to enable shot-to-shot motion correction.

METHODS

Echo-planar time-resolved imaging is a multishot EPI-based approach that allows extremely rapid acquisition of distortion-free and blurring-free multicontrast imaging and quantitative mapping. By combining k-space encoding rotations into the EPTI sampling strategy to repeatedly sample the low-resolution k-space center, PEPTIDE enables significant tolerance to shot-to-shot motion and B₀ phase variations. Retrospective PEPTIDE data sets are created through a combination of in vivo EPTI data sets with rotationally acquired protocols, to enable direct comparison of the 2 methods and their robustness to identical motion. The PEPTIDE data sets are also prospectively acquired and again compared with EPTI, in the presence of true subject motion.

RESULTS

The PEPTIDE approach is shown to be motion-robust to even severe subject motion (demonstrated > 30° in-plane rotation, alongside translational and through-plane motion), while maintaining the rapid encoding benefits of the EPTI technique. The technique enables accurate quantitative maps to be calculated from even severe motion data sets. While the performance of the motion correction depends on the type and severity of motion encountered, in all cases PEPTIDE significantly increases image quality in the presence of motion comparative to conventional EPTI.

CONCLUSION

The newly developed PEPTIDE technique combines a high degree of motion tolerance into the EPTI framework, enabling highly rapid acquisition of distortion-free and blurring-free images at multiple TEs in the presence of motion.

k-Space deep learning for reference-free EPI ghost correction

PURPOSE

Nyquist ghost artifacts in echo planar imaging (EPI) are originated from phase mismatch between the even and odd echoes. However, conventional correction methods using reference scans often produce erroneous results especially in high-field MRI due to the nonlinear and time-varying local magnetic field changes. Recently, it was shown that the problem of ghost correction can be reformulated as k-space interpolation problem that can be solved using structured low-rank Hankel matrix approaches. Another recent work showed that data driven Hankel matrix decomposition can be reformulated to exhibit similar structures as deep convolutional neural network. By synergistically combining these findings, we propose a k-space deep learning approach that immediately corrects the phase mismatch without a reference scan in both accelerated and non-accelerated EPI acquisitions.

THEORY AND METHODS

To take advantage of the even and odd-phase directional redundancy, the k-space data are divided into 2 channels configured with even and odd phase encodings. The redundancies between coils are also exploited by stacking the multi-coil k-space data into additional input channels. Then, our k-space ghost correction network is trained to learn the interpolation kernel to estimate the missing virtual k-space data. For the accelerated EPI data, the same neural network is trained to directly estimate the interpolation kernels for missing k-space data from both ghost and subsampling.

RESULTS

Reconstruction results using 3T and 7T in vivo data showed that the proposed method outperformed the image quality compared to the existing methods, and the computing time is much faster.

CONCLUSIONS

The proposed k-space deep learning for EPI ghost correction is highly robust and fast, and can be combined with acceleration, so that it can be used as a promising correction tool for high-field MRI without changing the current acquisition protocol.

Prospective motion correction in functional MRI using simultaneous multislice imaging and multislice-to-volume image registration

The sensitivity to subject motion is one of the major challenges in functional MRI (fMRI) studies in which a precise alignment of images from different time points is required to allow reliable quantification of brain activation throughout the scan. Especially the long measurement times and laborious fMRI tasks add to the amount of subject motion found in typical fMRI measurements, even when head restraints are used. In case of moving subjects, prospective motion correction can maintain the relationship between spatial image information and subject anatomy by constantly adapting the image slice positioning to follow the subject in real time. Image-based prospective motion correction is well-established in fMRI studies and typically computes the motion estimates based on a volume-to-volume image registration, resulting in low temporal resolution. This study combines fMRI using simultaneous multislice imaging with multislice-to-volume-based image registration to allow sub-TR motion detection with subsequent real-time adaption of the imaging system. Simultaneous multislice imaging is widely used in fMRI studies and, together with multislice-to-volume-based image registration algorithms, enables computing suitable motion states after only a single readout by registering the simultaneously excited slices to a reference volume acquired at the start of the measurement. The technique is evaluated in three human BOLD fMRI studies (n = 1, 5, and 1) to explore different aspects of the method. It is compared to conventional, volume-to-volume-based prospective motion correction as well as retrospective motion correction methods. Results show a strong reduction in retrospectively computed residual motion parameters of up to 50% when comparing the two prospective motion correction techniques. An analysis of temporal signal-to-noise ratio as well as brain activation results shows high consistency between the results before and after additional retrospective motion correction when using the proposed technique, indicating successful prospective motion correction. The comparison of absolute tSNR values does not show an improvement compared to using retrospective motion correction alone. However, the improved temporal resolution may provide improved tSNR in the presence of more exaggerated intra-volume motion.

Can ITN distribution policies increase children's ITN use? A DHS analysis

Background

Insecticide-treated nets (ITN) have largely been distributed via mass distribution campaigns. Since 2011, however, the World Health Organization (WHO) has recommended additional ITN distribution via routine antenatal care (ANC) and expanded programme on immunization (EPI) services. Countries have begun to implement these routine facility-based distribution strategies, but inconsistently, and there is little research on outcomes of these new programmes. This paper investigates the impact of ITN distribution policies on children’s net use, comparing countries with different policies in place.

Methods

Demographic Health Surveys from 25 countries in Africa were used to analyse household ITN ownership, and ITN use among children under 5 years of age. Countries were categorized in terms of the ITN facility-based distribution policies in place, based on nationally reported policies and distribution data provided to the WHO. The analysis was conducted for individual countries and then pooled with all countries in each category weighted equally to present the average country experience, by ITN distribution policy.

Results

Household ITN ownership, children’s ITN use, and children’s ITN use in households with at least one ITN increase with each additional routine facility-based distribution policy. An average of 54.0% of children slept under an ITN in countries with ITN distribution via ANC and EPI, compared to 34.3% and 24.7% in countries with ITN distribution via ANC only, or no facility-based distribution, respectively. Linear regression found a 13% increase in net use among children under 5, on average, with each additional ITN distribution policy.

Conclusion

ITN distribution via ANC and EPI can not only assist countries in maintaining ITN ownership and use, but may be extremely effective at increasing ITN ownership and use. There is also an additional benefit associated with combined ANC and EPI-based ITN distribution, compared to ANC distribution alone.

Echo planar time-resolved imaging (EPTI)

PURPOSE

To develop an efficient distortion- and blurring-free multi-shot EPI technique for time-resolved multiple-contrast and/or quantitative imaging.

METHODS

EPI is a commonly used sequence but suffers from geometric distortions and blurring. Here, we introduce a new multi-shot EPI technique termed echo planar time-resolved imaging (EPTI), which has the ability to rapidly acquire distortion- and blurring-free multi-contrast data set. The EPTI approach performs encoding in ky -t space and uses a new highly accelerated spatio-temporal CAIPI sampling trajectory to take advantage of signal correlation along these dimensions. Through this acquisition and a B0 -informed parallel imaging reconstruction, hundreds of "time-resolved" distortion- and blurring-free images at different TEs across the EPI readout window can be created at sub-millisecond temporal increments using a small number of EPTI shots. Moreover, a method for self-estimation and correction of shot-to-shot B0 variations was developed. Simultaneous multi-slice acquisition was also incorporated to further improve the acquisition efficiency.

RESULTS

We evaluated EPTI under varying simulated acceleration factors, B0 -inhomogeneity, and shot-to-shot B0 variations to demonstrate its ability to provide distortion- and blurring-free images at multiple TEs. Two variants of EPTI were demonstrated in vivo at 3T: (1) a combined gradient- and spin-echo EPTI for quantitative mapping of T2 , T2* , proton density, and susceptibility at 1.1 × 1.1 × 3 mm3 whole-brain in 28 s (0.8 s/slice), and (2) a gradient-echo EPTI, for multi-echo and quantitative T2* fMRI at 2 × 2 × 3 mm3 whole-brain at a 3.3 s temporal resolution.

CONCLUSION

EPTI is a new approach for multi-contrast and/or quantitative imaging that can provide fast acquisition of distortion- and blurring-free images at multiple TEs.

Fast bound pool fraction mapping via steady-state magnetization transfer saturation using single-shot EPI

PURPOSE

To enable clinical applications of quantitative magnetization transfer (qMT) imaging by developing a fast method to map one of its fundamental model parameters, the bound pool fraction (BPF), in the human brain.

THEORY AND METHODS

The theory of steady-state MT in the fast-exchange approximation is used to provide measurements of BPF, and bound pool transverse relaxation time ( T 2 B ). A sequence that allows sampling of the signal during steady-state MT saturation is used to perform BPF mapping with a 10-min-long fully echo planar imaging-based MRI protocol, including inversion recovery T₁ mapping and B₁ error mapping. The approach is applied in 6 healthy subjects and 1 multiple sclerosis patient, and validated against a single-slice full qMT reference acquisition.

RESULTS

BPF measurements are in agreement with literature values using off-resonance MT, with average BPF of 0.114(0.100-0.128) in white matter and 0.068(0.054-0.085) in gray matter. Median voxel-wise percentage error compared with standard single slice qMT is 4.6%. Slope and intercept of linear regression between new and reference BPF are 0.83(0.81-0.85) and 0.013(0.11-0.16). Bland-Altman plot mean bias is 0.005. In the multiple sclerosis case, the BPF is sensitive to pathological changes in lesions.

CONCLUSION

The method developed provides accurate BPF estimates and enables shorter scan time compared with currently available approaches, demonstrating the potential of bringing myelin sensitive measurement closer to the clinic.

Evaluating corrections for Eddy-currents and other EPI distortions in diffusion MRI: methodology and a dataset for benchmarking

PURPOSE

To propose a methodology for assessment of algorithms that correct distortions due to motion, eddy-currents, and echo planar imaging in diffusion weighted images (DWIs).

METHODS

The proposed method evaluates correction performance by measuring variability across datasets of the same object acquired with images having distortions in different directions, thereby overcoming the unavailability of ground-truth, undistorted DWIs. A comprehensive diffusion MRI dataset, collected using a suitable experimental design, is made available to the scientific community, consisting of three DWI shells (Bmax = 5000 s/mm2 ), 30 gradient directions, a replicate set of antipodal gradient directions, four phase-encoding directions, and three different head orientations. The proposed methodology was tested using the TORTOISE diffusion MRI processing pipeline.

RESULTS

The median variability of the original distorted data was 123% higher for DWIs, 100-168% higher for tensor-derived metrics and 28-111% higher for MAPMRI metrics, than in the corrected versions. EPI distortions induced substantial variability, nearly comparable to the contribution of eddy-current distortions.

CONCLUSIONS

The dataset and the evaluation strategy proposed herein enable quantitative comparison of different methods for correction of distortions due to motion, eddy-currents, and other EPI distortions, and can be useful in benchmarking newly developed algorithms.

Optimizing maternal fat suppression with constrained image-based shimming in fetal MR

PURPOSE

Echo planar imaging (EPI) is the primary sequence for functional and diffusion MRI. In fetal applications, the large field of view needed to encode the maternal abdomen leads to prolonged EPI readouts, which may be further extended due to safety considerations that limit gradient performance. The resulting images become very sensitive to water-fat shift and susceptibility artefacts. The purpose of this study was to reduce artefacts and increase stability of EPI in fetal brain imaging, balancing local field homogeneity across the fetal brain with longer range variations to ensure compatibility with fat suppression of the maternal abdomen.

METHODS

Spectral Pre-saturation with Inversion-Recovery (SPIR) fat suppression was optimized by investigating SPIR pulse frequency offsets. Subsequently, fetal brain EPI data were acquired using image-based (IB) shimming on 6 pregnant women by (1) minimizing B0 field variations within the fetal brain (localized IB shimming) and (2) with added constraint to limit B0 variation in maternal fat (fat constrained IB shimming).

RESULTS

The optimal offset for the SPIR pulse at 3 Tesla was 550 Hz. Both shimming approaches had similar performances in terms of B0 homogeneity within the brain, but constrained IB shimming enabled higher fat suppression efficiency.

CONCLUSION

Optimized SPIR in combination with constrained IB shimming can improve maternal fat suppression while minimizing EPI distortions in the fetal brain.

Identifying Respiration-Related Aliasing Artifacts in the Rodent Resting-State fMRI

Resting-state functional magnetic resonance imaging (rs-fMRI) combined with optogenetics and electrophysiological/calcium recordings in animal models is becoming a popular platform to investigate brain dynamics under specific neurological states. Physiological noise originating from the cardiac and respiration signal is the dominant interference in human rs-fMRI and extensive efforts have been made to reduce these artifacts from the human data. In animal fMRI studies, physiological noise sources including the respiratory and cardiorespiratory artifacts to the rs-fMRI signal fluctuation have typically been less investigated. In this article, we demonstrate evidence of aliasing effects into the low-frequency rs-fMRI signal fluctuation mainly due to respiration-induced B0 offsets in anesthetized rats. This aliased signal was examined by systematically altering the fMRI sampling rate, i.e., the time of repetition (TR), in free-breathing conditions and by adjusting the rate of ventilation. Anesthetized rats under ventilation showed a significantly narrower frequency bandwidth of the aliasing effect than free-breathing animals. It was found that the aliasing effect could be further reduced in ventilated animals with a muscle relaxant. This work elucidates the respiration-related aliasing effects on the rs-fMRI signal fluctuation from anesthetized rats, indicating non-negligible physiological noise needed to be taken care of in both awake and anesthetized animal rs-fMRI studies.